University of Iowa researchers, using an innovative therapy involving intensive nutrition, progressive exercise, and neuromuscular stimulation, have observed evidence of improvement in patients with secondary progressive multiple sclerosis (SPMS).

This treatment approach, described as radical by the researchers, was selected as a "Hot Topic" at the Neuroscience 2011 annual meeting, presented by the Society for Neuroscience and held this week in Washington, D.C. Babita Bisht, a Ph.D. candidate in the Department of Health and Human Physiology in the College of Liberal Arts and Sciences, is the first study author and presented the research Sunday afternoon at the meeting.

Terry Wahls, a clinical professor of internal medicine at the UI Carver College of Medicine and the Iowa City VA Medical Center, is the senior study author and living proof of the effectiveness of this treatment plan. Wahls was diagnosed with SPMS in 2003 and soon became dependent upon a tilt-recline wheelchair. After developing and using this protocol, she is now able to walk through the hospital and commute to work by bicycle.

"My scientific colleagues thought I was completely incorrect creating a protocol that is this complicated, because if you got people better you wouldn't know why," Wahls says. "But we're doing this based on my own personal experience. The first question was whether other people with MS would be willing to adopt such a complex regimen. Then if they did, what happens."

SPMS patients cite disabling levels of fatigue and progressive muscle weakness. Different treatments, including drugs and physical therapy, are available to delay the progression of the disease, however, no cure or treatment to reverse progression is currently available.

The researchers had eight patients complete a three-month intervention that included an intensive nutrition food plan —- nine cups of fruits and vegetables, protein rich foods, and nutritional supplements —- a customized exercise program to strengthen weak muscles of the trunk and legs, and customized neuromuscular stimulation to strengthen weak muscles.

At the end of three months, seven patients showed very good compliance, and one showed fair compliance. Two patients showed a deterioration of symptoms. These patients were severely disabled at baseline and could take only minimal amounts of electrical stimulation current and perform only minimal exercise.

The other six patients showed improvement in their level of fatigue (averaging 5.6 before the intervention and 3.25 afterwards on the seven-point Fatigue Severity Scale; the lower the number the more clinical improvement in fatigue) and gait (29-percent average increase in mean walking speed). One subject who initially walked with a cane is now walking three miles a day unassisted. Another subject who was unable to walk upstairs a single step is now able to walk upstairs seven steps holding onto railings and with minimal assistance from the caregiver.

Reported side effects were weight loss, nausea, and gastric problems associated with the supplements.

"Unless you do something, you can't say if it's effective. Dr. Wahls' example was good enough to tell you that it works in one person," says Bisht, a physical therapist who administers the subjects' motor assessments. "If it can work on one human being, it's worth trying in others."

The researchers are planning to conduct a randomized controlled clinical trial to test the hypothesis that the combination of treatments involving major lifestyle changes results in a more rapid stabilization and reversal of disease symptoms than using a single treatment modality.

"At some point, we would like to try and break things out and see how each part contributes," says Warren Darling, professor of health and human physiology and second study author. "We absolutely think the exercise contributes, and it's not just the diet. And neuromuscular stimulation has contributions as well."

The research was funded by DIRECT-MS of Calgary, Alberta, Canada.