Upper Cervical Care And The Patient With Seizures

(Editor's note: Remember the objective of upper cervical care is to correct head neck misalignment that is interfering with proper brain to body communication. When this is corrected the body functions at a higher level and can often correct other problems more efficiently on its own. Please do not confuse upper cervical care as a treatment for seizures or any other condition, disease or symptom.)

The Patient With Seizures

by Dr. Smith

Another interesting case is that of a 19 year old female, who presented to my office with complaint of sudden onset of seizures. She was admitted to the hospital a few days prior to this office visit, when the sudden onset of a seizure had scared her and her mother quite seriously. While at the hospital, at least three more seizures took place, and the doctors put her through an entire battery of tests, cervical x-rays and a brain scan, but all tests were completed as negative. She was released under supervision, but told there was nothing they could do at that time because the doctors didn’t know why the seizures were occurring. She had never experienced seizures before, so what exactly was the cause?

During the consultation, her case history revealed she had been the passenger on a public transportation bus when it had been in a collision about one month prior. I suggested that although the damage to the bus was considered light, perhaps enough force had been transmitted to her body that the upper cervical region had misaligned, and the increased pressure on the brain-stem was causing nervous system interference to the point of intermittent seizures.

We took upper cervical specific x-rays of the cervical spine, and it was determined that the axis, or C2 had misaligned to a greater extent than the atlas, or C1. The misalignment was considered a "constant", so she therefore had an axis major listing. Analysis of repeated spinal temperature graphs revealed the body was in pattern, and a specific vectored adjustment was given to the axis. Being young has its advantages where healing is concerned, and all other variables being equal, the body is generally able to heal quicker in a younger person.

After the first adjustment was performed and the resting period elapsed, the post scan revealed that her pattern had almost completely resolved. It took only two more adjustments over the next four weeks for the body to remain free of pattern for long periods of time. Although her body’s response was much quicker than typically seen, especially in chronic cases, the most important news is that she has not suffered from another seizure since that first upper cervical adjustment.

Can Mental Function Improve with Upper Cervical Care?

J Manual Medicine (1992) 6:215-216
(c) Springer-Verlag
Clinical Note

Upper Cervical Adjustments May Improve Mental Function
M.D. Thomas and J. Wood

Palmer College of Chiropractic Clinic, 1000 Brady Street, Davenport, Iowa 52803, USA

Summary

This report describes abrupt improvement in mental and motor deficits in a 14-year-old girl after the initiation of specific upper cervical chiropractic care. Cessation of this care for several months was associated with a return to the patient's previous condition. Repeat manipulation was followed by recovery of the patient to the level of her previous improvement. This cycle of regression to pretreatment condition in the absence of care followed by recovery after specific upper cervical care has occurred three times to date.

Periodic evaluations of a 14-year-old girl by her school psychologist were conducted between March 1984 and October 1989. The Leiter Performance Scale indicated severe mental, deficits, and the Vineland Adaptive Behavioral Scale indicated social adaptation within the trainable mentally handicapped range. Evaluations were most recently performed prior to initial chiropractic care in 1989. Informally, her teachers reported occasional moments of increased alertness and performance of tasks she normally did not perform.

Medical history

The birth of this patient followed an uncomplicated pregnancy. Apgar scores were seven after 1 min and nine after 5 min., well within normal ranges. Speech problems were first noted at 30 months of age. In November 1978, the patient was admitted into an Early Childhood Education Program because of her deficiencies in speech and social development. She had developed behavioral problems by November 1979. She was evaluated by a neurologist who told the parents she would outgrow these problems by the age of 6 years. An electroencephalogram (EEG) performed in September 1980 was reported as normal.

The patient was enrolled in kindergarten in September 1981. She was transferred to a behavioral disability class in the next semester because of inattention in class and poor test scores. Initially, it was hoped the smaller class and more intense instruction would correct the inattention and test scores would improve. In September 1982, the patient's teacher reported she was having "staring spells". In January 1983 "slight abnormalities” were noted in a sleeping EEG.

In February 1983 the diagnosis of psychomotor seizures was presented to the family. Tegretol and Dilantin were prescribed without positive results. By August 1983, the patient had been weaned off both medications. At this time the patient's neurologist felt that there was a “degenerative neurological disorder," and she was subsequently referred to the Mayo Clinic in Rochester, Minnesota. By January 1984, she had twice been examined at the Mayo Clinic without further definition except for acknowledgment that the sleeping EEG continued to be slightly abnormal. In May 1984, the patient was transferred from a behavioral disability class to a trainable mentally handicapped class.

In August 1985, she underwent a week-long evaluation at the National Institute of Health in Bethesda, Md. Again, all was normal (including MRI and various serum studies) except for slightly abnormal EEG. By July 1987, her EEG had improved and a degenerative neurological process was ruled out. In October 1988 and August 1989, this patient was examined at the Children's Hospital in Milwaukee. All findings were negative.

Chiropractic care

At the Palmer Public Clinic, interviews conducted in October 1989 with the parents and examination of available written records revealed a 13 -year-old female with a tested verbal ability at approximately 3 years of age. The patient reportedly spent most of every day sitting and staring into space while listening to the radio. She never made contact with others. The patient tended to stay near her family and followed behind them when they went walking. She spoke very rarely, using single words, always nouns, which were occasionally appropriate and often echolalic. She often mumbled incoherently to herself. Given several choices, she always took the last choice offered.

The patient did not use her left arm or hand in situations where normal children would. In retrieving objects or grasping a swing while swinging she used only her right arm. The left arm did not swing appropriately as she walked, hanging flaccidly at her side while her right arm swung appropriately. We found adequate grip strength in both hands, with the right hand stronger than the left.

Orthopedic and neurologic evaluation was difficult due to patient noncompliance. The supine leg check showed leg length inequality, with the right leg 2 cm shorter. X-rays revealed osseous misalignment at the craniovertebral junction, with left atlas laterality and posterior rotation. This was accompanied by coupled motion of the inferior cervical vertebrae into the left frontal plane. Skull rotation was into the right frontal plane. Postural distortion was consistent with unilateral right extensor muscle hypertonicity. Specific upper cervical adjustments using National Upper Cervical Chiropractic Association (NUCCA) procedures were given on 16, 17, and 19 October 1989. Leg length inequality and postural distortion were corrected after the third adjustment. Post manipulation X-rays on 19 October 1989 revealed a proportional 90% correction of the previous cranio-vertebral misalignment.

The patient began to make eye contact. On 19 October 1989 she returned with her parents to her home in Wisconsin. Within 2 weeks, the patient was forming sentences with personal pronouns, verbs, adjectives and nouns. The patient began standing straighter. She used her left arm in activities and swung her left arm normally during walking. These changes persisted for about 6 weeks, when her condition again began to deteriorate.

The patient was adjusted by a succession of three chiropractors near her home utilizing three techniques, different from the technique we employed. None of their interventions was effective. By June 1990, the patient's condition was back to its
previous baseline. On 6 August 1990, the patient was again brought to our clinic. Upper cervical radiographs were again taken and specific upper cervical adjustment delivered. Radiographs obtained immediately after the adjustment revealed a proportional 95% correction. Immediately, the patient responded with eye contact, full sentences, and appropriate speech which she initiated. Left arm use was again regained. She stood straighter and walked more symmetrically. For the first time, she engaged in family conversation and activities. When offered a choice, her decision was truly a decision and not agreement or a repeat of the last choice given.

The family returned home and these changes persisted for about 6 weeks before the patient began to return to her former condition. By the time the patient was next adjusted by a chiropractor using NUCCA procedures, in late June of 1991, she had lost much of the use of her left arm and was no longer speaking in sentences. Specific upper cervical adjustment again restored use of the left arm and ability to speak in complete sentences. As of 28 August 1991, the patient had not been again
adjusted and no longer spoke in complete sentences, although active left arm use persisted.

Discussion

Interpretation of these results is difficult, because there is a correlation between upper cervical adjustments and apparent improvement in mental function. High correlation does not necessarily indicate a causative relationship. Perhaps the mechanism that might most assist in explaining neural dysfunction accompanying upper cervical misalignments is altered input to the central nervous system from neck joint capsule receptors [1]. Some chiropractors who treat the upper cervical spine believe that upper cervical misalignments may alter neural function by causing longitudinal and transverse traction on the upper cervical spine and brain stem or on the upper cervical spine alone. Even in cases where stretching is not pathological, stretching of axons decreases their diameter. Conduction velocity decreases as fiber diameter is decreased [2]. Sufficient reduction of axon diameter completely blocks the transmission of nerve impulses.

References

1. Schwartz IL, Siegel GJ (1985) Excitation, conduction, and transmission of the nerve impulse. In: West JB (ed) Best and Taylor's physiological basis of medical practice, 11 th edn, chapter 3. Williams & Wilkins, Baltimore, pp 28-57

2. Wyke B (1979) Neurology of the cervical spinal joints. Physiotherapy 65:72-76

Trigeminal Neuralgia and Upper Cervical

Yet another example of Upper Cervical Care and the results possible.

Chiropractic management of trigeminal neuralgia: A preliminary study

Roger Hinson, DC and Susan Brown, PhD, DC.

Trigeminal Neuralgia (TN), the most common pain disorder of the face and one of the most painful afflictions known,1 affects one or more branches of the fifth cranial nerve and has a reported annual incidence of 4.3 per 100,000.2 Once known as the suicide disease, TN effects women more often than men and the annual incidence rate increases significantly with age. The pain, abrupt in onset and typically lasting no more than a few seconds, can be triggered by both mechanical and thermal stimuli from inside or outside the area of pain. TN may undergo spontaneous remissions and recurrences, but the frequency of pain commonly increases with chronicity. 3

Medical management starts with a course of anticonvulsants (carbamazepine, gabapentin, phenytoin) gradually increasing in dosage as symptoms warrant. Surgery is performed if symptoms are initially, or become, refractory to medication. Percutaneous ablation of the Gasserian ganglion is the most commonly practiced approach but carries a relatively high risk of numbness and dysesthesia. Microvascular decompression (MVD) of the trigeminal root, involving open surgery through the posterior fossa, has the best results with long term pain relief and the lowest chance of numbness and dysesthesia but greater incidence of serious complications. All currently practiced neurosurgical procedures are associated with significant morbidity and recurrence rates.

There is no reference in the indexed literature to the efficacy of chiropractic procedures for TN. We report outcomes of an 8 week trial of chiropractic care on 8 subjects suffering from TN.

Patient Background

Eight subjects were recruited for this study through a support organization for facial pain sufferers. All reported with a previous diagnosis made by a neurologist of trigeminal neuralgia. Seven subjects met diagnostic criteria for trigeminal neuralgia set forth by the International Headache Society (IHS), while one subject (5) described pain more characteristic of atypical trigeminal neuralgia (ATN) as there were no pain free periods and Aslow@ pain, i.e. aching, burning sensations, was more bothersome than brief, lancinating pain. One subject (7) suffered from trigeminal neuralgia and contralateral anesthesia dolorosa (AD), an iatrogenic disorder caused by surgical deafferentation and characterized by a constant sensation of numbness and burning pain. She had suffered from bilateral TN prior to unilateral radio frequency ablation two years previous.

All subjects were under medical therapy at the time of enrollment and five had undergone unsuccessful surgical treatment, four subjects had undergone two procedures and one had undergone a single procedure. All were female and the ages ranged from 47 to 79 (mean, 62; SD 11.6) years. Chronicity of TN symptoms ranged from 1 15 (mean, 7.4; SD 5.3) years.

Methods

Informed consent was obtained from all subjects prior to enrollment. (Upper Cervical)Chiropractic management was per Grostic technique protocol, which utilizes three mutually orthogonal x ray views for measuring upper cervical displacement from a theoretical norm. Adjustments were administered by one clinician as indicated by supine leg length estimation and dual probe thermocouple analysis. The adjustments consisted of a low force, precisely vectored impulse delivered to the transverse process of C1 with an instrument. Patients were seen three times per week for the first 2 weeks of care, then twice a week for weeks 3 and 4. Visits were scheduled for weeks 5 through 8 as needed, typically once a week.

Pain was assessed via short form McGill Pain Questionnaire (SF MPQ), VAS and pain drawing. Depression was evaluated with the Modified Zung Depression Index. The Rand SF 36 was used to evaluate quality of life. Questionnaires were administered at two weeks prior to (Upper Cervical) chiropractic care, on the first day of care, and after 4 and 8 weeks of care. Subjects maintained a diary in which number, intensity and duration of paroxysms and analgesic usage were recorded.

Results

Reduction in pain was reported by all subjects during the experimental phase. Mean values after eight weeks of intervention were reduced by 69% for MPQ and 78% for VAS. Depression as measured by Zung was reduced by 43%. Pain drawings demonstrated reductions in distribution of pain for all patients. Antiseizure medication usage was discontinued by two, decreased by 33% by one and by 66% by one, and unchanged by four subjects during the eight week period of intervention. Two subjects reported complete absence of paroxysmal pain within four days of first adjustment and no return of paroxysms during eight weeks of intervention. One subject suffering from otalgia had no recurrence of such pain subsequent to first adjustment.

Discussion

The spinal tract and nucleus of the trigeminus descend from the caudal brainstem down to the level of the second cervical vertebra. That area of the nucleus located in the cervical spine, the subnucleus caudalis (Vc), contains second order neurons receiving pain and temperature stimuli not only of trigeminal origin, but also from the facial (n intermedius), glossopharyngeal and vagus nerves, and converges with neurons in the upper cervical dorsal horn which convey equivalent stimuli from upper cervical dorsal rami.

Trigeminal, geniculate, glossopharyngeal, vagal and occipital neuralgias have been described as hyperactive dysfunction syndromes. The efficacy of antiseizure compounds in the treatment of these primary neuralgias results from the depression of exitatory mechanisms of Vc neurons.4 The venules which drain the lateral columns proximal to the dorsal horn where Vc is located operate at low pressure and have little redundancy 5. If adverse mechanical tension were transmitted to the cord via upper cervical dentate ligaments, this area would be among those earliest effected. Such tension could lead to direct mechanical compression of the descending tract of the trigeminus, which lies on the periphery of the cord adjacent to the dorsal spinocerebellar tract, or of Vc. Compression might also lead to venous stasis with resulting hypoxia and hyperexcitability of Vc. We speculate that such tension may result from displacement of the atlanto occipital and atlanto axial joints, and that correction of such displacements may result in attenuation of Vc hyperactivity.

Conclusions

Results from this study suggest that upper cervical chiropractic procedures may be of benefit to TN sufferers. Further study is needed to better qualify the efficacy of chiropractic procedures for TN and other primary neuralgias. A controlled trial is planed to improve the evidence base on which clinicians and patients can make decisions.

References

1. Goodman J. chap 14. In: Biller J, Ed. Practical Neurology. Lippencott Raven, 1997: 142 3

2. Katusic S, Williams DB, Beard CM, Bergstralh EJ, Kurland LT. Epidemiology and clinical features of idiopathic trigeminal neuralgia and glossopharyngeal neuralgia: similarities and differences, Rochester, Minnesota, 1945 1984. Neuroepidemiology 1991;10(5 6):276 81

3. Adams R, Victor M, Ropper A. Principles of Neurology, Sixth Ed. McGraw Hill 1997

4. Kondo T, Fromm GH, Sxhmidt B. Comparison of gabapentin with other antiepileptic and GABAergic drugs. Epilepsy Res 1991 Apr;8(3):226 31

5.Gillilan LA. Veins of the spinal cord. Anatomic details; suggested clinical applications. Neurology 1970 Sep;20(9):860 8