Nutrition, Neuromuscular Electrical Stimulation (NMES) and Secondary Progressive Multiple Sclerosis (SPMS)

• Average walking speed [ Time Frame: Baseline, 12 M ] [ Designated as safety issue: No ]
  Average walking speed calculated from 25 foot walk. Distance (feet)walked divided by time in seconds.
  
  

• Fatigue Severity Scale [ Time Frame: baseline, 3M, 6M, 9M, 12M ] [ Designated as safety issue: No ]
  Self reported fatigue severity scale, (agreement with 9 questions describing impact of fatigue on daily activities)
  
  
• Short Form 36 [ Time Frame: baseline, 3M, 6M, 9M, 12M ] [ Designated as safety issue: No ]
  Self reported function in multiple domains.
  
  
• Mood scales [ Time Frame: Baseline, 3 M, 6M, 9M, 12M ] [ Designated as safety issue: No ]
  Beck depression index, Beck anxiety index
  
  
• Cognitive Scales [ Time Frame: baseline, 3 M, 6M, 9M, end of study ] [ Designated as safety issue: No ]
  Cognitive stability index or cognitive stability test, subscales of Dkef, Wtar, Wais III.
  
  
• Medical Symptoms Questionnaire [ Time Frame: baseline, 1 M, 2M, 3M, 4M, 5M, 6M, 7M, 8M, 9M, 10 M, 11M, 12M ] [ Designated as safety issue: No ]
  Detailed review of systems which is scored 0 to 4 for each item.
  
  
• Side effects log [ Time Frame: Baseline, 1M, 2M, 3M, 4M, 5M, 6M, 7M, 8M, 9M, 10 M, 11M, 12M ] [ Designated as safety issue: Yes ]
  Questions about potential side effects from vitamin, supplements and diet, questions about potential side effects from NMES, and questions about potential side effects from exercise.
  
  
• MS Function [ Time Frame: Baseline, 3 M, 6M, 9M, 12M ] [ Designated as safety issue: No ]
  Self reported disability scales (from North American Research committe on Multiple Sclerosis)
  
  
• MSSS-88 [ Time Frame: Baseline, 3M, 6M,9M and 12M ] [ Designated as safety issue: No ]
  88 Questions about the impact of spasticity on various activities of daily living
  
  
• Daily log [ Time Frame: Baseline, 1M, 2M, 3M, 4M, 5M, 6M, 7M, 8M, 9M, 10 M, 11M, 12M ] [ Designated as safety issue: No ]
  Daily reports of foods consumed, exercises and activities completed.
  
  
• Vitamin log [ Time Frame: Baseline, 1M, 2M, 3M, 4M, 5M, 6M, 7M, 8M, 9M, 10 M, 11M, 12M ] [ Designated as safety issue: No ]
  Log of vitamins supplement bottles date opened, date emptied, pill size, number of pills in bottle.
  
  
• Medical examination [ Time Frame: Baseline, 12 M ] [ Designated as safety issue: Yes ]
  Medical examination
  
  
• Neurological examination [ Time Frame: Baseline and 12 M ] [ Designated as safety issue: No ]
  Neurological examination
  
  
• Exposure history form [ Time Frame: Baseline ] [ Designated as safety issue: No ]
  History of exposures to chemicals.
  
  
• Health questions [ Time Frame: Baseline ] [ Designated as safety issue: No ]
  health questions about chronic disease states
  
  
• Menses and pregnancy risk [ Time Frame: Baseline, 3M, 6M, 9M, 12M ] [ Designated as safety issue: Yes ]
  Questions about menses and potential for pregnancy
  
  
• Medication audit [ Time Frame: Baseline, 12 M ] [ Designated as safety issue: Yes ]
  Medications
  
  
• Functional diagnoses [ Time Frame: Baseline ] [ Designated as safety issue: No ]
  Questions about past medical history
  
  
• Manual motor testing [ Time Frame: Baseline, 3M, 6M, 9M, 12M ] [ Designated as safety issue: No ]
  Manual motor testing of arms, legs and core muscle groups.
  
  
• Berg Balance [ Time Frame: baseline, 3M, 6M, 9M, 12M ] [ Designated as safety issue: No ]
  Tests of balance which are progressively more challenging.
  
  
• Modified Ashworth [ Time Frame: baseline, 3M, 6M, 9M, 12M ] [ Designated as safety issue: No ]
  Test of spasticity by physical examination.
  
  
• Circumference [ Time Frame: baseline, 3M, 6M, 9M, 12M ] [ Designated as safety issue: No ]
  Circ. of waist, hips, R and+ L calf and R. and L. thigh.
  
  
• Peak flow [ Time Frame: basaeline, 3M, 6M, 9M, 12M ] [ Designated as safety issue: No ]
  Peak expiratory flow rate.
  
  
• Number of falls in prior two months [ Time Frame: Baseline, 3M, 6M, 9M and 12M ] [ Designated as safety issue: No ]
  Self reported number of falls and associated factors contributing to fall and severity of fall related injuries.
  
  
• Dietary compliance [ Time Frame: Baseline, 6 month and 12 month ] [ Designated as safety issue: No ]
  Assessments, self report, Harvard Food Frequency (baseline, 12 month), 24 hour dietary recalls (6M)
  
  
• Blood pressure [ Time Frame: baseline, 3M, 6M, 9M, 12M ] [ Designated as safety issue: No ]
  blood pressure
  
  
• Waist/ Hip ratio [ Time Frame: baseline, 3M, 6M, 9M, 12M ] [ Designated as safety issue: No ]
  circumference of waist over the circumference of hip
  
  

Restoration of function is very rare in individuals with MS who have experienced gradual worsening in the absence of acute MS symptoms (relapses) and partial or complete recovery of those acute symptoms (remissions).

A recent case report of a patient with secondary progressive MS documented a transition from scooter dependence to mild gait disability following the initiation of electrotherapy in the form of neuromuscular electrical stimulation and nutritional interventions aimed at reducing oxidative stress and increasing the organic sulfur in the diet. Multiple studies of neuromuscular electrical stimulation in athletes, cerebral palsy and stroke patients have demonstrated gains in strength, coordination and diminished resting muscle tone. Multiple authors have reported that antioxidants, essential amino acids and micronutrient rich diets are neuroprotective. It is likely that the combination of the intensive nutrition and the electrotherapy contributed to the marked gains in improvement. However in the absence of an additional case report the strength of the association remains unknown.

The intent of this study is to replicate the interventions from the case report as closely as possible.

Our primary objective is to measure how many and how completely subjects implement 1) the nutritional interventions, 2) the home exercise program intervention, and 3) the electrotherapy intervention and if the improve improved nutrition and exercise are associated with improved function. To assess improvements in function will measure 1) the change in nutritional status as reported in food frequency surveys, 24 hr dietary recalls, 2) change in neurocognitive testing and behaviors, 3) change in self-reported function and disability scales, 4) change in gait and 5) change in medications doses or classes for MS related symptoms.