Ebrahim Khoshraftar
Assistant Professor, MD.
Department of Anesthesiology,
Medical College.
Hamedan Medical Science University.
Iran

Mahnaz Khatiban BSN, MSN, (Corresponding author)
Nursing Department,
School of Nursing and Midwifery,
Hamadan University of Medical Sciences,
Hamadan, Iran.
Office Tel:+98-811-8276051, Office Fax:+98-811-8276052, Cell phone:+98-9188115956.
Email address: m-khatiban@sbmu.ac.ir

Zahra Amini BSN,
Hamedan Nursing & Midwifery Faculty
Iran.

This case concerns a 36 year-old female who first presented in 1993 with a severe common cold followed by diplopia, vertigo and nausea. Then, she also complained of right leg lameness, difficult in right hand grasp such as writing or holding things, and right arm launch. A progressive and chronic MS diagnosis was confirmed by Magnetic Resonance Imaging (MRI). Her medications before acupuncture were: Avonex, IVIG-g, Backlofen, Gabapentin, Clonazepam, Lorazepam, Q-10 Coenzyme, Metocarbamol in lumbar muscle spasm and chlordiazepoxide, botox treatment. The electric stimulations were used during her acute attacks.

At the same time different alternative treatments were pursued by the patient such as energy-therapy and Chinese electro-acupuncture. But she found them ineffectual. She and her family wished to avoid increasing her symptoms. All medications were maintained at the same level in the primary course of acupuncture treatment.

She experienced a variety of severe symptoms despite her medications. Her symptoms included paraplegia with strict muscle weakness in legs, vertigo, visual problems, numbness and weakness with spasm in left hand, resistant spasm and clonus, Lhermitte's sign, frequency and polyuria and instability in the sitting position and some medication side effects. She remained severely fatigued with all persistent symptoms.

The option of acupuncture was discussed with this patient and her family. They all consented. She reported being nervous about needles but was keen to try anything that might reduce her symptoms. The Korean acupuncture method (SU JOK) was selected for its simplicity, safety and efficiency.
The first treatment (in November 2005) consisted of needling at the brain and spinal cord meridians and the lumbar corresponding parts on hands. This treatment was repeated for all the subsequent treatments. The patient received a course of 12- 15 treatments with a 3 day interval over a period of 2.5 years with initial treatments being more closely spaced. All points were needled for 30 minutes using Chinese stainless steel sterile needles, 0.20mm diameter and 3 cm length. The needle appropriate length insertions depended on the place and purpose with no manual or electrical stimulation.

There was an excellent response after the eighth treatment: her symptoms improved and the spasm of her left hand was gone. Her medicine was decreased after the eighth treatment. The improvement was sustained until the fourteenth treatment (January 2006), when she experienced leg muscle tonicity and felt well enough to restart work with her hands. She had extended her mobility because her instability in the sitting position decreased. She has been able to stand up with help of a hand and remain standing for 45 minutes with a walker stick without the knee brace. Then, she stopped taking medications. Her symptoms and medical side effects decreased. Despite her history of paraplegia for 7 years, she also found movement in her little left toe.

MS is a chronic, inflammatory, demyelinating disease that affects the central nervous system. Disease onset usually occurs in young adults, is more common in women, and has a prevalence that ranges between 2 and 150 per 100,000[1]. MS likely occurs as a result of some combination of both environmental and genetic factors [2]. MS affects the areas of the brain and spinal cord known as the white matter then it results in a thinning or complete loss of myelin. These lesions cause some of the neurological symptoms. Between attacks, symptoms may go away completely, but permanent neurological problems often persist [3]. The course of MS is difficult to predict and the disease may at times either lie dormant or progress steadily. In 1996 the United States National Multiple Sclerosis Society standardized the following four subtypes or patterns of progression definitions: relapsing-remitting, secondary progressive, primary progressive and progressive relapsing [4]. The prognosis of an individual patient is unpredictable [2].

The disease does not have a cure, but several therapies have proven helpful. Treatments attempt to return function after an attack, prevent new attacks, and prevent disability. During symptomatic attacks administration of high doses of intravenous corticosteroids is effective [5]. The treatment with interferons during an initial attack can decrease MS development [6]. As with any treatment, medications have several adverse effects.

Different alternative treatments are pursued by many patients. Examples are dietary regimens [7], herbal medicine [8] and general exercise [9]. Although, there are few publications on alternative treatment in MS, the acupuncture approach used here has not been reported previously.
Korean Su Jok acupuncture therapy is a new system of acupuncture using only the hands and feet to effect the same results as body acupuncture. Su Jok means "hand and foot". They represent a small mirror image of the anatomy of the human body (Fig 1). Su Jok Acupuncture is a general term describing this new system.

Su Jok Acupuncture is a two-dimensional system. The first dimension is physical treatment to give simple stimuli to the points in the hands or feet corresponding to the affected body parts. The second dimension draws on classical acupuncture. The classical 12 Main Meridians, the eight Extra Meridians, and their attendant points are represented on the hands and feet. It is very difficult to predict an exact expected length of treatment. It depends on the duration of the disease. In Su Jok Acupuncture, response to treatment is usually immediate [10].



Figure 1: Su Jok

The experiences from the field, by their nature are anecdotal and improvement after treatment may be due to coincidental spontaneous improvement or expectation rather than the treatment. There are, however, several factors in this case that favor causality rather than coincidence. Firstly, in experience of this condition, spontaneous improvement or resolution is rare. The second is that this patient had definite symptoms with CNS affecting her movements and muscles tone particularly in her hands, legs and lumbar areas. So, it was attempted to needle in the brain, spinal cord and lumbar meridians. Most importantly, the patient remains well after putting by her medications.

Korean Su Jok acupuncture therapy may offer benefits to chronic MS sufferers without other conventional and complementary therapies. It may provide an additional treatment option for patients unable to follow or maintain a common medical program. Nurses or paramedics can easily learn and apply the correspondence system of hand and foot without any side effects. In developing countries where people are unable to afford treatment with costly medicines, sophisticated equipment and highly trained medical practitioners, Su Jok Acupuncture offers one of the best, most affordable and effective solutions.