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Multiple Sclerosis, otherwise known as MS, is an autoimmune disorder that causes demyelination of the nerves in the central nervous system which interferes or interrupts communication to the rest of the body. The myelin on the nerve axons is fundamental to assisting with nerve conduction and increases the speed in which the impulses travel from one point to the next. When the myelin deteriorates, the conduction and speed slow down. It is thought that when the core body temperature increases, the conduction of the impulses is further compromised due to the heat dissipation of the electrical impulses.
1 Below are four different articles discussing the effects of heat on patients with Multiple Sclerosis.
Multiple Sclerosis is a difficult disease to diagnose. As of now, there is not one specific test to diagnose MS. Today, the protocol is to eliminate other diseases with similar symptoms until only MS is left. At that point, a combination of blood tests, lumbar punctures and MRIs can be used to confirm the diagnosis.
In the late 1800s, the hot bath test was used to diagnose Multiple Sclerosis. The hot bath test was performed by having a patient that showed symptoms of MS lay in a warm water bath. If their neurological symptoms were exacerbated, such as fatigue, muscle weakness, and visual disturbances, then it was thought that the patient had Multiple Sclerosis.6 Given this information, we are expecting the research below to support the theory that hot water will worsen Multiple Sclerosis symptoms.
Sensitivity to heat in MS patients: a factor strongly influencing symptomology– an explorative survey2
Citation: Flensner G, Ek A, S?derhamn O, Landtblom A. Sensitivity to heat in MS patients: a factor strongly influencing symptomology – an explorative survey. NCBI. Published 2011. Accessed October 11, 2019.
Types of Research: Explorative survey and Questionnaire
Inclusion/ Exclusion requirements for the subjects:
Inclusion: Subjects between 20-60 years old living in Eastern Sweden with an EDSS of 0-6.5
Exclusion: Subjects over the age of 65 or under 20, or not living in the region.
Number of Subjects: 256 subjects, 197 women and 61 men
A survey was sent out to 256 subjects between the ages 20-65. They were given a questionnaire style survey that included their age, gender, marital status, education, occupation, when they were diagnosed, years since the diagnosis, medications, Expanded Disability Status Score (EDSS), type of MS (relapsing-remitting, primary progressive, secondary progressive), MS-related symptoms (fatigue, leg weakness, concentration difficulties, pain, paresthesia, urination urgency and loneliness) all in relation to heat sensitivity in each of those symptomatic categories.
Of the 256 total subjects, 149 subjects report heat sensitivity and of that, 70% of subjects prefer a room temperature of 68o or below. 63% of subjects who reported heat sensitivity reported severe fatigue and 45 % of subjects who reported no heat sensitivity reported mild to no fatigue. This study found that heat sensitivity was correlated with symptoms of fatigue, pain and even concentration problems.
Exercise in 94 degree F water for a patient with multiple sclerosis3
Citation: Peterson C. Exercise in 94 degree F water for a patient with multiple sclerosis. Physical Therapy. 2001;81(4):1049-1058. Accessed October 11, 2019.
Type of Research: The type of research in this article was a case study.
Inclusion/exclusion requirements for the subjects:
The patient was part of the case study because she has Multiple sclerosis for 3 years, and was a willing participant in aquatherapy. She also had no other underlying medical conditions besides MS.
Number of Subjects: 1 subject: woman, 33 years old, diagnosed with MS 3 years prior to case study
The patient with MS received aqua therapy in a pool that was heated to 94 degrees Fahrenheit. She has quadriplegia due to a lesion at level C6, which means for her that she has very limited use of her lower extremities at the time of the study, but still moderate use of her upper extremities. She participated in 2-45 minute sessions of Aquatic therapy per week and was monitored for increased core temperature, increased perceived exertion, and fatigue. The physician and physical therapist both agreed that the treatment would immediately stop if the patient’s core body temperature increased more than two degrees. This decision was made due to research stating that it is possible that a 4-degree increase in body temperature can exacerbate MS symptoms, such as fatigue.
The patient did not experience an increase in fatigue or perceived exertion with an increase in water temperature of 94 degrees, compared to the normal temperature of 85 degrees which is recommended for patients with MS. This may be due to the frequent rest breaks and the low difficulty level of the exercises. She did experience an increase of core body temperature, but not greater than 1.5 degrees which falls into the guidelines from the medical team.
Fatigue and Heat Sensitivity in Patients with Multiple Sclerosis4
Citation: Bol Y, Smolders J, Duits A, Lang IMJ, Romberg-Camps M, Hupperts R. Fatigue and heat sensitivity in patients with multiple sclerosis. Acta Neurologica Scandinavica. February 2012;126:384-389. Accessed October 13, 2019. doi: 10.1111/j.1600-0404.2012..01660.x
Type of Research: The type of research used for this study was an in-person questionnaire.
Inclusion/exclusion requirements for the subjects:
Inclusion: Patients who presented at the outpatient clinic of the Maastricht University Centre, Netherlands aged 18-60 years and diagnosed with clinically definite MS were asked to participate in the study. Patients with UC were selected from the IBD South Limburg database of the Department of Gastroenterology at the MUMC to participate.
Exclusion: Potential participants were excluded from the study if they had experienced an exacerbation in the past four weeks and were in an active phase of their disease, were using corticosteroids, had dementia or other severe cognitive dysfunction, and had visual, verbal, or motor limitations that would interfere with filling out the questionnaires.
Number of Subjects: 164 participants total; 88 patients with MS, 76 patients with UC.
In order to study the relationship between heat sensitivity, fatigue, and environmental temperature in MS patients, participants with MS and UC were asked to complete a series of questionnaires that assessed their heat sensitivity, physical, and mental fatigue levels in relation to their environment. Participants of the study included patients with different stages of MS, and the results of the two groups were analyzed using SPSS 16.0.1 for Windows, Pearson’s correlation coefficients, Chi-square analysis, and logistic regression analysis. Heat sensitivity was measured using two items from the Fatigue Assessment Inventory with a response format that ranged from 1 (completely disagree) to 7 (completely agree). Patients were classified as heat-sensitive if they had a score >5 on both items and heat-insensitive if they had a score 160 mm Hg, diastolic>95 mm Hg) or signs of any other medical or mental condition precluding participation, and were diagnosed with a central nervous system disease other than MS.
42 subjects in total; 23 subjects with MS experiencing heat sensitivity, 19 healthy volunteers for the control group matching to the participants with MS by sex, age, and education.
The study was to assess the effects of sauna-induced short-term heat stress on physical functioning in persons with MS. Assessments were conducted at baseline and immediately, at one hour, as well as at the twenty-four hours following heat exposure. The procedure followed a three study visit on separate days. The use of the Timed Walk Test (TWT), Nine-Hole Peg Test(9HPT), Grip Strength, Five-Times-Sit-to-Stand-Test (FTSST), Sharpened Romberg Test (bilaterally tested), and The Functional Reach Test (FRT) were used to assess physical functions before and after heat exposure.
Results of the controlled study showed that 35-40 minutes of moderate heat stress-induced acute worsening of physical functioning in subjects with MS. These results imply that mainly functions demanding activity of the lower limbs, like walking, rising from a chair, standing balance, are prone to the deteriorating effects of heat in MS. Measures relating to upper extremities were almost similar in performance between the control group and group with MS. The findings complement studies in which worsened walking and accidental falls have been perceived by persons with MS as the main drawbacks caused by high temperatures. Also the heat-induced deterioration patterns are also in line with the overall frequency of MS-related impairments and limitations. Walking and balance problems are amongst the most common participation restrictions in ambulatory MS subjects, whereas manual dexterity and activities requiring upper extremity function are not.
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