Dear Dr. Roach: In 1973, I was hospitalized for three days in a U.S. air force hospital in Thailand with an unknown viral illness. I quickly recovered and went back to my duties.
In 1992, I started having one problem after another for about six months, culminating in losing my ability to walk in about 10 minutes. My bowels and bladder were paralyzed also.
A doctor at the VA hospital connected the dots with my 1973 illness. The viral illness I had, which was never precisely diagnosed, destroyed the myelin sheath on my nerves, causing me to 鈥渟hort out.鈥�
I was given a guess diagnosis of acute disseminated encephalomyelitis. I recovered enough to be able to stand after pushing up with my arms, but that is about all.
What is being done with stem cell research in this or any spinal area? I have heard nothing positive.
A.M.
Acute disseminated encephalomyelitis is an autoimmune disease of the brain and spinal cord. It can be triggered by infections and sometimes by immunizations (the rabies vaccine was the first to be associated, but the smallpox vaccine and other vaccines also have been implicated).
However, symptoms usually begin eight to 21 days after the infection or immunization, with the longest reported time between infection and onset being 45 days.
It is hard for me to believe that the infection nearly 20 years earlier could have been the only trigger for this condition.
The symptoms of the disease are very similar to multiple sclerosis, another demyelinating disease of the brain. (The word 鈥渄emyelinating鈥� refers to the destruction of the myelin sheath, a wrapping around the nerve that insulates the axon, the part of the nerve down which impulses travel. The insulation is essential for proper functioning of the nerve.)
In both MS and ADEM, the body鈥檚 immune cells see the myelin as an invader and destroy it. It can be difficult to distinguish between ADEM and an initial bout of MS.
About 35 per cent of people initially diagnosed with ADEM will be diagnosed with MS, usually within the first year.
Unfortunately, only 10 to 46 per cent of those affected will completely recover from ADEM.
I do not know of any effective treatment for people with long-term symptoms of ADEM, but treatment during the
initial phase of the disease (with steroids, plasma exchange or immune globulin) improves the likelihood of a good
outcome.
I could not find any evidence of benefit from stem cells, although in theory they might help, and I understand studies are ongoing.
Dear Dr. Roach: Many years ago I had difficulty conceiving, so I went to a gynecologist and found out that I was born with one kidney, one ovary, one Fallopian tube and half of a uterus. Could I have been a twin? Could my mom have been ill during the development of these organs? (By the way, I eventually did conceive!)
Anon.
It sounds like you have a unicornuate uterus, which often is associated with other developmental abnormalities, including the loss of a Fallopian tube and a missing (or misplaced) ovary. It also is not surprising for women with this condition to have only one kidney, and difficulties with conception are common.
Although the cause isn鈥檛 known, most experts think a problem with development of the blood vessels to the ovary (perhaps a twist in the developing ovary) causes loss of all structures from the Mullerian ducts, an embryological structure responsible, among other things, for the Fallopian tubes. I don鈥檛 think you had a lost twin or that your mother was ill.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
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