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Arachnoiditis: by L.O. Simpson & M.G. Anderson Two part study:- Part I -Comparative Symptom Survey – NZ, Global, USA Part II - Red Blood Cell Shape Analysis – Results & Implications for Treatment L.O. Simpson M.Sc (Hons), Ph
D. M.G. Anderson MB BCH, FCP (S.A.), BA INTRODUCTION Physicians are frequently faced with the challenge of diagnosing patients who present with a range of symptoms common to several disease entities of differing aetiologies. This situation applies to conditions such as Myalgic Encephalomyelopathy (ME), Fibromyalgia (FM), Gulf War Syndrome (GWS), Lupus, Multiple Sclerosis (MS). A similar presentation occurs in adhesive arachnoiditis, a chronic form of meningitis associated with spinal cord impairment and chronic intractable pain. In all of these conditions there is apparent multi-system pathology and chronic tiredness. Exacerbation of symptoms and rapid depletion of energy levels by physical, mental or emotional stress is characteristic. While the causes of these chronic disease states are diverse, or may be unknown, it is reasonable to assume that common pathophysiological factors could account for the similarity of symptoms. By extension, if a commonality could be elucidated, further research could conceivably lead to treatment regimes that might be effective in relieving symptoms. Simpson et al proposed that the tiredness, lethargy and rapid exhaustion following exertion which occur in disorders such as MS, ME and Lupus could be due to inadequate delivery of oxygen and metabolic nutrients to the tissues. (1). This proposal was based on previous studies showing differences in the proportions of red blood cell shapes in health and disease. (2). In healthy subjects red blood cells can be classified into 6 shapes. (3). Flat cells are the most common with smaller percentages of different shapes making up the balance. These are biconcave discocytes, cells with surface changes, early and late cup forms, and cells with altered margins. Any change in the cell environment may lead to increased numbers of cells in one or other of these classes. In this situation cell deformability is reduced. As they pass through narrow capillaries the rate of blood flow slows and the result is an inadequate oxygen delivery to tissues throughout the body. (4). Evening Primrose Oil contains the essential fatty acids cis-linoleic and gammalinolenic acids, and the end products of their metabolism are Prostaglandin E-1 (PGE-1), the major metabolite, and arachidonic acid. In 1974 Kury et al (5) used the sophisticated technique of spin labelling to show that PGE-1 increased the fluidity of the lipid bilayer of the red cell membrane. It was considered that this would increase red blood cell deformability, and this was confirmed by a filtration technique in the following year (6). The consequences of improved red cell deformability are an improved rate of flow in small capillaries with an enhanced rate of delivery of oxygen and nutrient substrates. The implication of such changes relative to peripheral neuropathies has been discussed. (7). In an analysis of red cell shapes in several thousands of blood samples from subjects with ME in 4 countries (8) or FM (unpublished), it was found that the most frequent change was an increased percentage of flat cells in both disorders, the FM samples on average containing higher percentages. Among one overseas batch of samples undergoing analysis was one with a diagnosis of arachnoiditis; the others had been diagnosed with FM. All had similar symptoms and increased percentages of flat cells. Against this background it was felt that further investigations on people with arachnoiditis was warranted. A preliminary study on ten volunteers showed that nine had significantly increased levels of flat cells. An expanded study was then designed with the following objectives:-
METHODS Members of the Arachnoiditis Support Group, the majority of whom are New Zealanders, were invited to participate in the proposed study after being advised of the relevant background information. Part I. Participants were allocated numbers by the secretary to ensure anonymity. The research laboratory provided vials containing fixative for collection of the blood samples, with instructions for the health provider who would draw blood for the test. A Health Assessment questionnaire was included for demographic purposes and to identify the range of symptoms, factors which triggered or aggravated the symptoms, and treatments used to alleviate the symptoms. The blood samples were sent directly to the research laboratory by the participants for analysis using electron microscopy, photography, and counting of the various classes of cells. The researcher, Dr Simpson, sent each participant a copy of the photograph with a report on the findings. Where it was ascertained that there was an increase in the percentage of abnormally shaped red cells a comment was made regarding the reported positive effects of Evening Primrose Oil on blood flow and oxygen delivery to the body tissues. Copies of the photographs and completed questionnaires were made available for evaluation to a member of the support group who was unaware of the identities of the respondents. Information supplied in the questionnaire was compared with that obtained in an international survey conducted by Dr Sarah Smith in 1999, (9), and with some of the figures given by Dr D.M. Long in his 1992 review. (10)
Part II. Three months later a second questionnaire was sent to those who had taken part in the study. Questions related to the use of Evening Primrose Oil (EPO) – whether or not it had been trialled and if it had, what changes in specified symptoms had been observed The subjects who were using EPO were asked to discontinue doing so for a 2 week period to observe any deterioration while off the supplement, and any improvement after resuming intake thereafter. |
