Phototherapy Sheds Light on Sleep and Mood Disorders, Inspires MS Research
What is phototherapy?
Phototherapy (or light therapy) refers to a kind of treatment involving exposure to certain kinds of light.
Light therapy has been used in a variety of medical applications. Perhaps the most familiar one is light therapy used to treat acne.
Special lamps, light boxes, wands, goggles, or visors are used to apply beams of light, often at certain times of the day, in order to achieve a healing result (which depends upon the condition and the application of light being used).
How might phototherapy help someone with MS?
A variety of symptoms can benefit from light therapy treatment, but even better, exposure to ultraviolet light (both natural and artificial) is beginning to answer some of research's age-old questions about the role of vitamin D in developing MS.
Common sleep disorders and problems include insomnia (and "painsomnia," in which pain prevents sleep onset), movement disorders of sleep such as restless leg syndrome and periodic leg movements of sleep, sleep phase disorders (advanced or delayed), excessive daytime sleepiness, and jet lag disorder for those who travel.
While phototherapy can't cure many sleep disorders, its bright white light application upon awakening can help to reset disrupted rhythms as well as improve alertness during the day. Maintaining wakefulness during the day can improve nighttime sleep over time as one's sleep-wake rhythms eventually reconsolidate.
People who live in northern climates, in particular, suffer from fatigue during the fall and winter partly because of seasonally low levels of natural light.
Not coincidentally, these latitudes also mark the highest prevalence of people with MS, as less sunlight relates to lower vitamin D levels, a potential risk factor for developing MS.
The body and brain need quality exposure to sunlight (natural or artificial) in order to remain functional and energized. Those of us with MS have additional challenges with fatigue related to our condition.
While sitting in front of bright white light in the morning might not cure us, it could give us a boost of energy or improve our stamina. Research into phototherapy as a non-pharmaceutical treatment for MS-related fatigue is current (as recent as September 2017) and ongoing.
Depression and anxiety are also part of the MS quandary: between the affective symptoms caused directly by MS and the emotional challenges that result from trying to cope with this disease, it's no surprise we can suffer extreme mood changes.
The use of morning phototherapy in the form of a "happy light" has been shown to help improve mood and increase energy in anyone suffering from disordered mood. At this time of year, light therapy is widely used to treat one of the most common problems, Seasonal Affective Disorder.
Some people experience intense periods of deep tissue itching which are caused by MS-related nervous system overstimulation. This is known as systemic neurological pruritus. Phototherapy can be used for some cases of general pruritus and shows promise as a nonpharmaceutical option for those with neurological forms.
Phototherapy in MS research
What you might not be aware of is the current research being done in Australia to identify more specific connections between vitamin D levels and MS progression.
We have patients with CIS to thank for participating in ongoing research there that seems to point to an added value in getting exposure to sunlight as a means of slowing disease progression. While it's easy, safe, and cheap to simply supplement with vitamin D, this new research further establishes the value of actual ultraviolet exposure.
How is Clinically Isolated Syndrome related to MS?
Clinically Isolated Syndrome (CIS) defines a single episode of what appears to be MS from a clinical standpoint.
A person with CIS experiences characteristic inflammation in the brain and demyelination of the central nervous system as seen in MS. However, because these symptoms have happened only once, these patients cannot be diagnosed because their symptoms don't fulfill the McDonald protocol.
The McDonald protocol is a diagnostic tool for MS that requires two or more episodes of inflammatory demyelination, measured over time and space, for a neurologist to confidently diagnose MS.
Those with CIS are considered highly likely, from a clinical standpoint, to "convert" their diagnosis from CIS to MS if they don't receive treatment, making them a unique population to study regarding vitamin D.
The PhoCIS trial
Recent research on those with CIS focuses on applications of phototherapy to better understand a common symptom among those with MS: low vitamin D levels (see Sources, below). To date, no studies have differentiated between supplements and phototherapy as sources for boosting vitamin D levels, yet some research shows they have different impacts on the body.
The PhoCIS trial seeks to improve on current understanding about the relationship between vitamin D and MS by focusing on phototherapy. In this case, phototherapy is defined as applications of artificial light known as narrowband UVB, or ultraviolet type B, phototherapy.
The trial is currently underway, and its subjects are individuals with CIS. It's worth noting that, in Australia, CIS patients are not eligible for disease-modifying therapy (DMT). This makes them perfect candidates for the trial, as subjects with full-blown MS using DMTs might otherwise confound results.
Neurologists already know that increasing vitamin D by way of a supplement would be easy and safe, but results are mixed. However, other research suggests that UV exposure could be equally effective, maybe even preferable. The PhoCIS trial is the first to question whether exposure to ultraviolet light for people with MS would be preferable to supplements.
Sunlight and vitamin D: PhoCIS early results
Sunlight exposure stimulates more than just vitamin D. It also stimulates other immune-modifying molecules in the skin that, when exposed to the sun, could be even more effective and reducing the incidence, prevalence, and mortality of MS.
Interim results from the trial have already shown some promising results, though the sample sizes are still somewhat small.
- Eighteen subjects have been recruited for this trial.
- Forty-four percent were exposed to narrowband UVB (ultraviolet type B) phototherapy dozens of time over two months, while 56 percent were not.
- All participants were also given vitamin D supplements.
- MRI was performed on these subjects at separate intervals (three months, six months, then 12 months) to assess immune system and neurology outcomes.
- Also, blood cells DNA was sequenced throughout the study to identify any changes.
Results thus far:
- After six months, 78 percent of those who did not receive phototherapy ended up experiencing a second demyelinating attack, which converted their CIS diagnosis to an MS diagnosis.
- Meanwhile, a little more than a third of those who did receive phototherapy ended up converting their diagnosis.
- It was also shown that the phototherapy showed additional benefits in trial participants, including a significant increase in IgG4, a substance that provides protection against the attacking immune system.
- Overall, the study currently shows phototherapy to have a slowing effect on disease progression independent of vitamin D supplementation and may be useful for those with CIS who wish to prevent their disease from advancing to full-blown MS.
While more studies are needed, it's encouraging that a similar study using phototherapy on subjects with relapsing remitting MS (RRMS) in Egypt last June has shown similar results.
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