Thursday, March 13, 2008

I Have One Word For you. Plastics.

When I was diagnosed with MS in 1998 I asked about appropriate physical activity related to physiotherapy wondering if that would help me recover use of my right side. I was told that exercise in general would be good for me but since the damage in MS involves the white matter of the brain and spinal column, any messages I was trying to send my affected muscles wouldn't get through. It's a communications problem in my brain, not a muscular one.

Fast forward 10 years and suddenly we have an onslaught of information everywhere about neuroplasticity. It's a concept that means the brain is very capable of change, that new connections can be, and in fact are, made constantly. Where exactly are these connections happening? In the white matter of the brain, which is responsible for the different parts of the brain to communicate with each other.

The next question you might have is "How do we make more connections? And more importantly, can we make connections to bypass damaged parts of the brain?"

First of all, an optimum environment with basic building blocks is required. An optimum environment would be one free of physical impediments like alcohol and drugs, polluted air, improper amounts of sleep, and stress; and since that is almost impossible, reduce the impediments you are able to. Basic building blocks would be a low fat, high fibre diet with the "good" fats in suitable amounts (a great cheeseburger or hunk of chocolate cake is good for mental health once in a while-at least mine anyway).

Once you've started improving the environment, the fun begins. Research has shown that proper diet, sleep patterns, stress levels, and regular exercise increase the connections your brain makes. Regular exercise? Well, first of all, the exercise increases blood flow to the brain, improving the environment with oxygen and nutrients. Secondly, movement of your body involves a complex set of actions in the brain, neurons firing all over the place, reorganizing and reinforcing the neural networks you have in response to new stimuli.

So that's what we know so far. It's what people have been telling us for years. Use it or lose it. And now that we have a better understanding of how the brain makes these connections, we can put it into practical use. Move the parts of your body that you can, get someone to help with the parts you can't. There are adaptive programs of yoga, stretching, and other exercises available on the web and from your local MS Society office. (And physiotherapists can help with appropriate movements to help relieve symptoms of MS as well)

It appears that movement is the key to making more neural connections. And that's what we want to do as MSers, make more connections to (hopefully) bypass the damaged parts of the brain. That's what rehab for stroke victims entails, why wouldn't it work for us? What have we got to lose by trying? Besides a few unwanted pounds.

At this point you may be wondering about "mental" exercises for your brain. After all, every time you turn around you're reading or hearing about books, puzzles, and games to "strengthen" your brain or improve brain fitness. It's a little more complicated than just doing a crossword puzzle once a day. It's about actually using many cognitive processes that provide novelty, variety, and challenge. So mix it up. Learn something new. Pick a topic you always wanted to know about, research it, and learn about it. Then pick another.

The same can be said of physical exercise. Change it up a little bit, use different routes if you're walking or biking, do your exercises in a different order. Change is novelty and variety and that's a good thing for your brain.

I went to a lecture Tuesday night about neuroplasticity and neurogenesis. I woke yesterday morning feeling very excited about this topic as it explains a couple of things I noticed about myself since I started cycling. First I noticed an improvement of my mood, though you may be thinking that I'm such a ray of sunshine I could never be in a bad mood. But it was there. I also noticed that fatigue didn't hit me as often as it had. My concentration improved. These were subtle differences I noticed for myself, nothing obvious to anyone else, but I also looked great and I felt great. Yeah, I still needed to get rid of a few extra pounds, but I had more compliments last summer than I had in a long time.

I wrote to the lecturer yesterday with a question of sorts:I'm curious about how the brain rewires where lesions are present and neurons may not be damaged, compared to stroke damage where neurons are killed.

Dr. Eskes kindly replied with good news:I checked pubmed and found many references on this as well as a review on this very topic.
Sports Med. 2008;38(2):91-100.
Exercise and brain health--implications for multiple sclerosis: Part 1--neuronal
growth factors.
White LJ, Castellano V.
Department of Kinesiology, University of Georgia, Athens, Georgia 30602, USA.
Recent studies suggest that exercise may enhance neurobiological processes that
promote brain health in aging and disease. A current frontier in the
neurodegenerative disorder multiple sclerosis (MS) concerns the role of physical
activity for promoting brain health through protective, regenerative and adaptive
neural processes. Research on neuromodulation, raises the possibility that
regular physical activity may mediate favourable changes in disease factors and
symptoms associated with MS, in part through changes in neuroactive proteins.
Insulin-like growth factor-I appears to act as a neuroprotective agent and
studies indicate that exercise could promote this factor in MS. Neurotrophins,
brain-derived neurotrophic factor (BDNF) and nerve growth factor likely play
roles in neuronal survival and activity-dependent plasticity. Physical activity
has also been shown to up-regulate hippocampal BDNF, which may play a role in
mood states, learning and memory to lessen the decline in cognitive function
associated with MS. In addition, exercise may promote anti-oxidant defences and
neurotrophic support that could attenuate CNS vulnerability to neuronal
degeneration. Exercise exposure (preconditioning) may serve as a mechanism to
enhance stress resistance and thereby may support neuronal survival under
heightened stress conditions. Considering that axonal loss and cerebral atrophy
occur early in the disease, exercise prescription in the acute stage could
promote neuroprotection, neuroregeneration and neuroplasticity and reduce
long-term disability. This review concludes with a proposed conceptual model to
connect these promising links between exercise and brain health.

This is a fairly new topic requiring further research, however, there are positive signs that exercise is beneficial to those of us with MS and a possible source of rehabilitation, my idea being that you must exercise the affected areas. We don't want to just come up with compensatory actions for what we may have lost, but make new neural connections or pathways for the affected areas. As humans we have a tendency to take the easy way, path of least resistance and all that. We should probably be exercising those parts of us that offer the greatest resistance in order to promote nerve growth, regeneration, and rewiring. I once talked to a paraplegic who said he wanted to keep up an exercise routine to keep his non-working muscles in shape so he'd be ready for the day when scientists came up with an effective treatment for his spinal cord injury and he'd be able to walk again. Even if exercise doesn't work to completely restore what we may have lost, at least we'll be keeping in shape and we'll be ready for the day when a cure is found.

In case you weren't aware of it, this is Brain Awareness Week. Are you aware?


I will address neurogenesis in a later post. There's another lecture concerning it and transplantation of neural stem cells I want to take in on Friday.

In case you weren't aware, the title of the post is from The Graduate.



It is amazing what the brain and nerves can do. When I lost use of some of my fingers due to MS, I insisted on hand therapy with a specialist. It took ALOT of hard work, but new pathways were developed as strength and coordination began to return to the muscles. I still do the exercises to keep the pathways working, otherwise I'd eventually have to give up on being a musician and that's something I'm not ready for just yet.


Shauna said...

One of the ways to rehabilitate is by learning new things and practising them. Musical practise is one of those things that is especially good as it is such a complex undertaking.
I was surprised to find my abilities returning so quickly, too. I think my thought process was "if this is how it's going to be I better just try to do it"


WOW...very informative. I think I made one or two new pathways just trying to comprehend this! Yep, I'm sure of more IQ point added to my dwindling numbers.

Linda D. in Seattle

Shauna said...

You're right, actually. Especially if it's a new concept for you, you probably sprouted a couple of new connections....not sure if it'll raise your IQ.....

Anonymous said...

Hi Shauna:
When I was dx'd in 1976, little or no info about treatments for MS was available. Everything was theory and nothing was supported yet through studies. Not enough guinea pigs at that time, I guess.

Through trial and error, the help of some top notched specialists and my own research, I have a diet, supplements and exercise plan in place that can be modified as needed.

While I have strongly supported diet and exercise, I've been denounced by many, given the fish eye by others, and straight out been told "you'll need modern medicine someday and then you'll be crawling to a doc."

Well, I do need modern medicine for other symptoms/disorders, but I refuse interferons and other drugs specifically for MS. It is a personal choice for me, not everyone.

I agree with everything in your post, especially that physical activity is key as well as diet.

If more neurologists supported this school of thought, many MSers would stave off disability for a longer period of time. While none of us knows how long we can go without incurring crippling disability, it doesn't hurt to keep our body parts as flexible as possible while on the journey.

Thank you for an insightful post.

Shauna said...

Thanks for your comments. And I'm glad you agree with me. I also agree with you about meds and a course of treatment being a person's choice.
Because everyone is different as is everyone's MS, what works for one won't always work for another. Until we discover what it is that connects us all, it will be a matter of trial and error for a lot of people.

Bubbie said...

ahhh, The Graduate! I have the original soundtrack on not lumbar pucture! LOL May have to get the vinyl out now.
As for reprogramming...I'm all for it. I have trouble with excercise (damned muscles just don't know when to quit jerking and dancing when I do) But the mental excercises, I try to do daily. word puzzles, numbers, eye hand's all good for anyone, not just those with neurodegenerative disease.
BTW-great post.

Shauna said...

Thanks for dropping by. I agree, movement can be difficult for some of us because of MS. That's where a good physiotherapist or partner comes in handy.