MicroVascular
Therapysm for Diabetic
(and some non-diabetic)
Neuropathy:
____Most of the possible mechanisms in the
pathogenesis of neuropathy result in ischemia, and the resultant
hypoxia is, in every case, a major causitive agent in the degredation
of axonal structure. The common response in seeking new therapeutic
solutions is to search for a pharmacological agent to work on
the selected mechanism to achieve an increase in neuronal blood
flow and a reduction or elimination of hypoxia.
____MVT is a physical medicine modality which
addresses the problem from a different perspective: working directly
and mechanically to move blood flow through neuromuscular stimulation
of the venous muscle pump.
____In MVT, a MicroVas Vascular Treatment
System generates ionic impulses which pass through the body,
or its extremities, using strategically placed carbon emitter
pads. The pads are positioned 180° from each other in groups
of up to 8 pairs. The ionic impulses pass completely through
the limb or body, creating neuromuscular stimulation of the venous
muscle pump, and simultaneously upregulating the metabolic process.
____While little information exists concerning
the MVT mechanism of action or efficacy, one study of 25 diabetics1
shows encouraging results:
While the 48% average increase in TcPO2 for patients after one
45 minute treatment is dramatic, the 157% increase in baseline
TcPO2 for patient number 4, suggests that the benefits of treatment
are cumulative and perhaps long-lasting. It is postulated that
this is the result of angiogenesis, or perhaps the reversal of
stenosis brought about through the repeated pulsations with increased
blood flow and increased hydrostatic pressures.
In terms of limb salvage, patient number 2 may be the single
most dramatic example. In week one, with a TcPO2 reading of 0
before treatment and 2 after treatment, he represented an unsalvageable
limb. After four weeks of treatment, he still reads only 3 before
treatment and 8 after treatment: quite an |
improvement, but still not a
salvageable limb. Following treatment in the eighth week, however,
he reached a reading of 35-very likely a salvageable limb!
____While data regarding microvascular therapy
as applied in peripheral neuropathy are scarce, initial findings
show promise (Chart 2). Patients were referred to this clinic
by neurologists, vascular and orthopedic surgeons as well as
family practitioners, all of whom had depleted their pharmacological
armamentarium on these patients without results.2
____Patients were 71% female (40), 29% male
(16) and ranged in age from 58 to 80. Both diabetic (88%) and
non-diabetic neuropathy (12%, unknown etiology) were represented.
(MVT has been used in other studies on chemotherapy-inspired
neuropathy).
____Not shown in the data, but of significant
importance is the patient response to MVT, which included a reduction
or elimination of drug use. Patient HS went from a dose of six
Tramadols, 1200 milligrams of Neurontin and three to four Hydrocodone
daily, to a use of half a Hydrocodone three times daily. Patient
VS was taking 4 Tegretol, 3 Norgesic Forte and 16 ibuprofen daily.
After six weeks of treatment, the patient has ceased all drug
use. Patient JP was taking 3,200 milligrams of Neurontin daily,
then went to Methadone twice daily. Today, he is drug-free and
pain-free.
____There is a need for more studies with
precise measuring methods, such as quantitative nerve conduction
velocities and amplitudes of evoked responses, which are objective
techniques for accurately assessing nerve function, rather than
relying on the patient's subjective response.
____Can a relatively short regimen of physical
medicine actually reverse neuropathy without addressing the underlying
causes? (See chart "The MicroVascular Hypothesis" at
left) Are the apparent improvements shown in these limited trials
transient or long-lasting? There is a need for long-term studies.
In a recent article, Doctors George King and Aristidis Veves
of Harvard Medical School said:
"an
urgent need exists to develop new therapeutic approaches that
will improve nerve function in diabetic patients".
Perhaps MVT is that new therapeutic approach!
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