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Overcoming IBM | Comprehensive Therapy for Inclusion Body Myositis Outline

07 Oct, 2021
Overcoming IBM | Comprehensive Therapy for Inclusion Body Myositis Outline


Patients with IBM all over the world are told that there is no cure. And what is more important the consensus in the medical society is there is no treatment. But what if someone told you that even though he cannot cure your IBM, but can make you feel stronger and treat your body?

Deep understanding of the immune system, years of research and clinical practice in autoimmune diseases treatment made it possible for us to tell you that we CAN treat you.

Approx. time to read: 10 minutes.

There is the treatment.

Five-six hours, a dozen injections, magnetic stimulation and one-on-one PT with a doctor. Daily. Four-six weeks on average. Sounds like training camp? Perhaps, but the result worth it. It is not just an effort to stop the progression of symptoms, it is a likely chance to fight back what was lost from the disease: take a cup with one hand, get up from the chair, walk without fear of falling or even thinking how to make the next step.

The patient and the doctors work together hard. But we also do rest, but more on that later. Let's talk about what we in Lymphatech Clinic, Perm, Russia believe to be the approach to the IBM therapy.

 

Before we start. Is there something else behind the scene?

We believe that both the patient and the doctor understand that every situation is unique. We are committed to proper expectations so that the patient can make an informed decision on whether to travel to Russia for medical treatment or not. Thus before we start planning the trip the preliminary analysis for the patient comes first. We ask for more details, including story, any medical documents and test results, vitals, photos and many more. This is the most critical part of our undertaking as a thorough study gives both sides confidence and hope. So it is not only tests related to IBM. It is truly impressive that everything in a human body is interconnected. So the diagnostics and treatment will be planned according to the anamnesis.

The first week of the medical program is usually busy for the patient. We do not wait and start the treatment on the very first day. At the same time the primary appointments, physical examinations, bloodwork, diagnostic tests take place. One of our patinets called the first day to be an Executive exam. And it is a thorough approach to collecting all the required data to estimate the current condition and use it as the metrics of the treatment results.

The metrics that we use is: bloodwork results, EMG with central motor pathways, motor neurons exitibility and motor unit potential studies, muscle MRI, volume of the muscle, volume of the movement, Oxford scale of muscle strength grading, dynamometry as well as patinets subjective assessment. Before, during and after the course of treatment. So more about the treatment and what happens to a patient in those five hours a day.

 

Step 1. Create the condition for new muscles to appear.

Target: Improve general metabolics and microcirculation.
Procedure: Intravenous infusion.
Duration of the procedure: 1 hour.

You already know that the Inclusion Body Myositis is characterized by progressive muscle damage, i.e. muscle cells die. This process is not uncommon, it actually happens all the time in every human body. Dead cells with all their waste products are contained in pericellular space and then utilised through the lymphatic system. The challenge is that the scale of this process is bigger with the IBM, both metabolism and microcirculation are depressed. To help body with this issue we apply compound drug with riboxin, nicotinamide and others.

Riboxin promotes carbohydrate, protein and fat metabolism, tissue oxygenation. It also limits the area of ​​necrosis, has an anabolic effect, and activates tissue regeneration. Nicotinamide improves cerebral blood flow, metabolic processes in the central nervous system, eliminates reflex disturbances, sensory disorders, and improves intellectual and mnestic functions of the brain.

 

Step 2. Get rid of the wastes.

Target: Increase lymphatic drainage function in the affected muscles.
Procedure: Subcutaneous «Lymphatropic» infusion.
Duration of the procedure: 30 minutes.

Alongside with the depressed metabolics the body is not capable to clean itself. Drainage function is compromised, especially in the affected muscles. So we need to bring in the cleaner that will provide support to the lymphatic system. We use a compound drug with succinic acid and other agents and address it to the lymphatic region of the affected muscles via subcutaneous injections with help of the infusion pump.

Succinic acid shows cerebroprotective, antihypoxic, antioxidant and metabolic effects, prevents amyloid accumulation. Due to its regulatory effect, the energy potential of cells in general is being restored. Succinic acid has a pronounced antitoxic effect, providing the necessary energy support to the systems of detoxification and elimination.

For many years we successfuly use this patented technology for treating multiple diseases, including lymphedema (swelling) and atherosclerosis.

 

Step 3. Drop the CPK fast.

Target: Reduce the inflammation.
Procedure: Subcutaneous «Lymphatropic» injection.
Duration of the procedure: 30 minutes.

It is not about creatine phosphokinase but about inflammatory process in general. You probably heard that high-dose prednisone does not work «while decreasing inflammation but increases amyloid accumulation and worsens strength». We use dexamethasone instead that has a more pronounced immunosuppressive effect. A desired pharmacological effect is achieved with doses up to 7 times less than with prednisone if used intravenously. Though the IBM is a system process, it usually affects very specific muscle groups. We address the medication locally to the region of inflamation via the subcutaneous injections creating a remedy depot and reducing the dose even further.

 

Step 4. Calm the cytokine storm.

Target: Balance the immune system and reduce the autoimmune component.
Procedure: Subcutaneous «Lymphatropic» injection.
Duration of the procedure: 15 minutes.

A common immunopathogenic mechanism of idiopathic inflammatory myopathies is the cytokine-driven infiltration of immune cells into the muscle tissue. Cytokines are produced by a specific population of T Cells. We use an immunogram to find out the ratio of aggressive and inhibitory cells. Separately, we test drugs that may affect the immune system and choose a combination of the two. The purpose of this therapy is to give an instruction to the immune system to "educate" other populations of cells that will not be as aggressive.

One of these drugs is Polyoxidonium. Recent research showed the potential benefit of azoximer bromide (Polyoxidonium) in normalization of the immune status parameters. The results of treatment showed the predominant effect of the drug on the cellular effector mechanisms of the immune system, as well as on the normalization of the content of pro-inflammatory cytokines. At the same time, a unique feature of Polyoxidonium is that when interacting with human peripheral blood monocytes, it activates TNF (tumour necrosis factor) synthesis only in people with initially low or medium levels of its production. In individuals with initially high levels, the drug has no effect or slightly reduces the production of this cytokine. Such properties exclude the minimal possibility of hyperactivation of the immune system under its influence, which is an important condition for the use of any immunotropic drug.

This is a long-term therapy, so the patient takes some of the drugs with him to continue the treatment while not in the clinic.

 

Step 5. Restore the innervation.

Target: Enhance the functions of the peripheral and central nervous system.
Procedure: Subcutaneous «Lymphatropic» injection.
Duration of the procedure: 15 minutes.

When muscle atrophy occurs, the nervous system is also affected: the conductivity of the nerve fiber deteriorates, reflexes suffer, and neuropathy appears. We use cholinesterase inhibitors in the treatment of this part of the IBM picture.

The use of cholinesterase inhibitors have a direct stimulating effect on the conduction of impulses along nerve fibers, interneuronal and neuromuscular synapses of the peripheral and central nervous systems. Pharmacological action is based on a combination of two mechanisms of action: blockage of potassium channels in the membrane of neurons and muscle cells and reversible inhibition of cholinesterase at synapses.

 

Step 6. Improve the plasticity of the brain and work on new synapses.

Target: Increase cortical excitability, motor response.
Procedure: Repetitive Transcranial Magnetic Stimulation (rTMS).
Duration of the procedure: 30 minutes — 1 hour.

It is known that repetitive transcranial magnetic stimulation (rTMS) has an effect on the development of new synapses in the brain. Research in the field of long-term potentiation of the cortex is still underway, but today we see in our patients that the excitability of motor neurons responds to transcranial magnetic stimulation and, in combination with physiotherapy, persists for 4-6 months and more.

Why is it important? By increasing the excitability of the motor representation in the cortex, while ensuring the normalization of impulse conductivity along the peripheral nervous system due to lymphotropic therapy using cholinesterase inhibitors, we increase the motor response, thereby increasing the strength of muscle contractions during physiotherapy.

 

Step 7. Preheat the muscles.

Target: Increase the muscle strength, sensory response, cortical excitability.
Procedure: Repetitive Peripheral Magnetic Stimulation (rPMS).
Duration of the procedure: 1 — 2 hours.

Repetative peripheral magnetic stimulation lets us concentrate on the muscles. High-frequency protocols work out the desired group of muscles while low-frequency protocols reduce spasticity and hypertonicity. At the same time the rPMS improves sensory response and cortical excitability.

Using the rPMS for the stimulation of the lower motor neuron works on the motor response in the innervated group of muscles and the conductivity of the peripheral nervous system.

 

Step 8. Start training with no fear of doing too much.

Target: Increase the muscle strength, mobility in the joints.
Procedure: Physical therapy.
Duration of the procedure: 1 hour.

So we come to physiotherapy. What have we achieved so far? Comprehensive treatment allows us to:

  1. Improve overall metabolism and microcirculation, transfer metabolism to the anabolic phase.
  2. Improve the drainage function of the lymphatic system in areas of inflammation.
  3. Relieve tissue inflammation.
  4. Normalize the immune response.
  5. Improve conductivity in the central and peripheral nervous systems.
  6. "Preheat" motor neurons and increase the amplitude of muscle contractions.
  7. Locally train muscle groups, enhance the sensory component of the peripheral nervous system and indirectly enhance cortical excitability even more.

Only after completing these seven steps we are ready to start physiotherapy under the full supervision of an experienced physician. During training, we focus on muscle strength, joint mobility, fine motor skills.

We repeat these steps six days a week providing a team of 3 doctors and a nurse for each patient.

 

The results both the Patient and the Doctor see.

 

 

The place where we care for you.

Coming to Perm, Russia for a medical treatment is a leap of faith on its own, we understand that. But also the idea to travel and stay in another country for 4-6 weeks may be even bigger concern: how to travel during the pandemic? where to stay? how to get to the clinic and back? how to stay in touch with your dearest? how to communicate with people in and outside the clinic? where to eat? what to see? how to do shoping? is there a church? etc. etc. etc.

You will more likely need to get a visa to travel to Russia. During the pandemic Russia remains closed for many countries for a tourist purpose but patients allowed to enter for the medical treatment. We issue the invitation that will allow you to get a visa. Starting from this point we are ready to plan the trip.

So how do we dispell the anxiety about the travel to Russia? We do our best to take care of everything and provide you with an english-speaking personal assistant.

Your personal assistant meets you on arrival and takes you home. Though there is a variety of hotels in Perm we always recommend picking the apartment as a place to stay. In fact the clinic provides the apartment where both you and people that will accompany you can feel comfortable and safe. There are three separate apartments: 2 beds, small studio, large studio with a private corridor linking them and separating from other building. Every apartment is completely furnished to your needs and has an equiped kitchen, bed, working place, TV, bathroom, washing machine, iron, ironing board, drying rack and a 100 mb internet and a beatiful view on the city and the banks of the river Kama.

Perm city was founded in 1723, located on banks of the river Kama, the fourth biggest city in Russia with more than 1 million population, business and cultural center and is only 2-hours-flight-away from Moscow.

Every morning assistant takes you to the clinic and accompanies you throughout your medical agenda. During the day we take you to the cafes and restaurants or ready to place an order for the delivery, of course, following the recommendations for an anti-autoimmune diet from your doctor in charge. At the end of the treatment day we take you back home or if you feel adventurous and ready to explore the city we show you more of Perm. And there are places to see and visit: riverside, opera house, famous pastry-shop «Violet», ice cave and many many more. Whenever needed we take you shoping. On every sunday your asistant can take you to a church.

 

Is Every Situation Unique?

Of course, every situation is unique. No matter what we are not calling this treatment to be a cure. But will you choose the possible and what is more important likely-to-improve your general well-being and strenght alternative to no treatment at all? If you feel like giving it a try and making a first step, contact us in any way you like or follow this link and learn how to get started.

 
 
  1. Greenberg SA. Inclusion body myositis: clinical features and pathogenesis. Nat Rev Rheumatol. 2019;15(5):257-272. [PubMed]
  2. Moran EM, Mastaglia FL. Cytokines in immune-mediated inflammatory myopathies: cellular sources, multiple actions and therapeutic implications. Clin Exp Immunol. 2014;178(3):405-415. [NCBI]
  3. Griggs RC. The current status of treatment for inclusion-body myositis. Neurology. 2006. [Neurology]
  4. Bliss TVP, Cooke SF. Long-term potentiation and long-term depression: a clinical perspective. Clinics (Sao Paulo). 2011;66(Suppl 1):3-17. [NCBI]
  5. Cohen DA et al. Enhancing plasticity through repeated rTMS sessions: the benefits of a night of sleep. Clin Neurophysiol. 2010;121(12):2159-2164. [NCBI]
  6. Ogawa M et al. Repetitive Peripheral Magnetic Stimulation for Strengthening of the Suprahyoid Muscles: A Randomized Controlled Trial. Neuromodulation. 2020;23(6):778-783. [PubMed]
  7. Zschorlich VR et al. Repetitive Peripheral Magnetic Nerve Stimulation (rPMS) as Adjuvant Therapy Reduces Skeletal Muscle Reflex Activity. Front. Neurol. 2019. [Front. Neurol.]
  8. Roy FD, Gorassini MA. Peripheral sensory activation of cortical circuits in the leg motor cortex of man. J Physiol. 2008;586(Pt 17):4091-4105. [NCBI]
  9. Cytoflavin. Pharmachologic effect. [Link]
  10. Karaulov AV. Polyoxidonium. [Link]
  11. Neuromidin. Pharmachologic effect. [Link]

 

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3 Alexandra Matrosova st.
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