Written by Greg Arnold, DC, CSCS. A two year supplementation with 1200 mg of lipoic acid significantly reduced (68%) brain atrophy in the 27 study participants with multiple sclerosis compared to the control group.
Multiple Sclerosis (MS) can be defined as a disorder of the central nervous system characterized by numbness, weakness, a loss of muscle coordination, and problems with vision, speech and bladder control. It is thought to be an auto immune disease, where the immune system attacks its own tissue causing a progressive breakdown of the nervous system and muscular coordination. MS affects 400,000 Americans and costs our healthcare system nearly $7 billion per year 1.
Multiple sclerosis can last for decades, but symptoms can stabilize. However, by two decades, the majority with relapsing-remitting MS (RRMS) have secondary progressive MS (SPMS) where a further degeneration occurs. SPMS likely affects the mitochondria of cells, leading to neurodegeneration and accelerated brain atrophy which correlates with the functional disability seen in MS; thus whole-brain atrophy is the current gold-standard MRI surrogate outcome measure for SPMS trials. 2
Researchers conducted a 2017 prospective single-site, phase study II, double-blind, randomized, placebo-controlled trial 3 involving 61 patients, aged 51 to 64, with multiple sclerosis for an average of 29.6 years (and SPMS). They received either 1,200 milligrams of lipoic acid (LA) per day (n=27) or a placebo (n=24) for two years.
The primary objective was to determine if LA could reduce the rate of whole-brain atrophy in SPMS (annualized percent change brain volume (PCBV). Secondary objectives were to determine if LA could reduce rates of atrophy of segmented brain, spinal cord, and retinal substructures, and reduce deterioration of disability and quality of life, and improve safety for those with SPMS.
Whole-brain atrophy is the current gold standard MRI surrogate outcome measure for SPMS trials To determine the degree of whole-brain atrophy clinical measures were collected at baseline and every 6 months They included a “Timed 25-Foot Walk” which documented the number of falls participants experienced over the two years 4 as well as the time needed to walk 25 feet 5. Questionnaires to assess balance, cognition and quality of life were also completed by participants. To monitor safety, complete blood count and liver and kidney panels were done at each visit.
- After 2 years, participants taking LA had significantly less annualized PCBV (20.21%]) than controls (P= 0.002) which corresponds to a 68% reduction in rate of brain atrophy in the LA versus the placebo group.
- Statistical significance was narrowly missed between the two groups for the 25-foot walking test (P = 0.06).
- A significant benefit was noted, however, regarding falls, with the LA group experiencing 54% fewer falls compared to the control group (12 versus 26, P = 0.03).
Study limitations included a small size of participants which precluded detection of clinical benefits; however, although there was just a suggestion of improved walking times, there was a significant reduction in the amount of falls. In addition, quercetin (8.6 mg daily) was present in the placebo (which the researchers were not aware of when they planned the study). Quercetin is biologically active and could potentially have worsened the controls and exaggerated the effects of LA.
The researchers note that the study results “suggested a clinical benefit in secondary progressive multiple sclerosis while maintaining favorable safety, tolerability, and compliance over 2 years” but that “future studies need to establish clinical benefits and explore mechanisms of action of lipoid acid in progressive multiple sclerosis.”
Source: Spain, Rebecca, Katherine Powers, Charles Murchison, Elizabeth Heriza, Kimberly Winges, Vijayshree Yadav, Michelle Cameron et al. “Lipoic acid in secondary progressive MS A randomized controlled pilot trial.” Neurology-Neuroimmunology Neuroinflammation 4, no. 5 (2017): e374.
Copyright © 2017 The Author(s). Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CCBY-NC-ND),
Posted September 18, 2017.
Greg Arnold is a Chiropractic Physician practicing in Hauppauge, NY. You can contact Dr. Arnold directly by emailing him at PitchingDoc@msn.com or visiting his web site at www.PitchingDoc.com.
References:
- Whetten-Goldstein K, Sloan FA, Goldstein LB, Kulas ED. A comprehensive assessment of the cost of multiple sclerosis in the United States. Multiple Sclerosis Journal. 1998;4(5):419-425.
- Mahad DH, Trapp BD, Lassmann H. Pathological mechanisms in progressive multiple sclerosis. The Lancet Neurology. 2015;14(2):183-193.
- Spain R, Powers K, Murchison C, et al. Lipoic acid in secondary progressive MS A randomized controlled pilot trial. Neurology-Neuroimmunology Neuroinflammation. 2017;4(5):e374.
- Furby J, Hayton T, Anderson V, et al. Magnetic resonance imaging measures of brain and spinal cord atrophy correlate with clinical impairment in secondary progressive multiple sclerosis. Multiple Sclerosis Journal. 2008;14(8):1068-1075.
- Hobart J, Riazi A, Lamping D, Fitzpatrick R, Thompson A. Measuring the impact of MS on walking ability The 12-Item MS Walking Scale (MSWS-12). Neurology. 2003;60(1):31-36.