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Thiamin hydrochloride: 300mg to 500mg, 30 minutes before meals and bed hour, and during
the night if
awake. The higher amounts in long-standing cases. This
requirement is high, since much is lost through action of gastric juices and
loss due to perspiration; 400 mg. daily by needle, given intramuscularly. During
summer months this can be given every 12 hours to good advantage. Two to three
times each week, and where office access is convenient, 20 mg. per kg. body weight,
or at least 1000 mg. is administered intravenously. This is given with 100 mg
to 200 mg. Niacin (nicotinic acid) which is available 100 mg. in 10cc ampules.
(The concentrated Niacin, available in 30cc vials, must be diluted if employed
intravenously.) The intravenous dose is given with the patient in a recumbent
position. A 20cc to 30cc syringe, carrying a one-inch 22-gauge needle should
be employed. The injection is given slowly (5 to 7 minutes) holding the syringe
with one hand. The usually-employed three fingers of the other hand must be on
the patient's pulse. An increased pulse rate indicates too fast a flow
of the medicine. This indicates the rate of phosphorylization. Thiamin hydrochloride
is, indeed, a toxic substance, and anaphylactic reactions have been reported,
but I have never seen a case in treating thousands of patients, (not necessarily
Myasthenia Gravis or Multiple Sclerosis), in 30 years of clinical observation.
I have observed one case of extreme sensitivity in which itching was present
within one minute after an intramuscular injection of 100mg. This was immediately
controlled with 5cc Benadryl, IM. It must be remembered that once thiamin hydrochloride
is phosphorylated, it is no longer a critical allergic substance, but is cocarboxylase,
a necessary but absolutely harmless agent. (My problem has been the preservatives
now required by FDA regulations, and they should be removed.) Higher doses of
thiamin can be used, but then the dilution factor must be greater.
2) Niacin (nicotinic acid): We recommend 100mg to 3 grams, thirty minutes before
meals and at bed hour, and also during the night if awake – whichever dose
will produce a strong body flush. Niacin dilates the blood vessels, even those
that have been compressed by scar tissue, allowing a greater amount of nutrient
material to reach the cell laboratory or factor comprising muscles and nerves.
This constant, repeated dilatation of the blood vessels acts in the same manner
as the dilating urethral catheter to correct constriction. One is chemical, the
other is mechanical. Hot fluids taken at the same time as the niacin will enhance
the flush. Pyridoxine has been a suggested stimulant. The lack of constant flushing
in Multiple Sclerosis is disappointing but not hopeless. It will require a longer
time to achieve results. Many times patients will flush with intramuscular niacin
when they fail to flush by the oral route. An occasional patient will experience
the sensation of a chill following nicotinic acid flush. This is transient and
of no consequence. Food, even jelly beans or a glass of milk, will prevent or
minimize the experience. Some patients will flush sometimes and not at other
times, even during a single day. If no flush develops within 45 minutes, the
dose should be repeated. A delayed reaction of several hours can occur, and should
this be superimposed upon a previous medication, the result could be severe.
Do not scratch when itching from niacin. Just press the area with your fingers,
or better still, with a cube of ice. Antihistamines will stop the itching and
limit the flush, should this be necessary. Niacin should be given very slowly
by the intravenous route in the geriatric patient, with or without cardiac pathology,
since it can produce dilatation great enough to effect right-side heart failure.
Myasthenia Gravis patients sometimes attain geriatric status. Vasomotor collapse
of peripheral vessels, although rare, can occur. Eight mg. Decadron given IM
will reverse this condition.
3) Pyridoxine (Vitamin B6): Lack of this vitamin has been shown to induce microcytic
hypochromic anemia and neurologic lesions in dogs and pigs. The term B6 includes
not only pyridoxine, but also pyridoxal and pyridoxamine, all three compounds
being found in nature. These derivatives have biological activity equal to that
of pyridoxine, as demonstrated in rats. Pyridoxine plays a part in the metabolism
of unsaturated fatty acids. It is also important in the metabolism of amino acids.
Pyridoxal phosphate functions as a coenzyme, and in transamination reactions;
100mg to 200mg is given before meals and bed hour. At least 100mg daily is given
4) Cobalamin (Vitamin B12): It is thought that vitamin B12 acts as a catalyst
in the formation of the purine and pyrimidine deoxyribosides which are present
in deoxyribonucleic acid. Technically, B12 is cyanocobalamin. Vitamin B12 with
pterylglutamic reduces the requirement for choline essential in the treatment
of neurological diseases; 1000mcg. is given three times each week by needle (repository
type). The incident of dermatitis from continued use of vitamin B12 by needle
is roughly 15%. I have never seen this develop in a patient with Myasthenia Gravis
or Multiple Sclerosis. B12 is recognized as a factor in the synthesis of myelin.
5) Ascorbic Acid (Vitamin C): The use of high daily doses of vitamin C will prevent
a superimposed illness and will lend itself in metabolism. Ten to twenty grams
should be taken daily by mouth in divided doses.
6) Riboflavin (Vitamin B2): A deficiency of vitamin B2 in young animals results
in inhibition of growth terminated by death. The yellow enzyme can, as demonstrated
by Warburg and Christian, participate in a series of enzyme reactions involved
in the metabolism of carbohydrates. It is capable of transporting hydrogen from
reduced coenzyme II, a niacin coenzyme which attacks hexosemonophosphate, regenerating
the riboflavin phosphate-protein complex. Riboflavin also takes part in enzymic
reactions as a dinucleotide prosthetic group, consisting of riboflavin, two phosphoric
acids, ribose and adenine. Riboflavin is very important in the regulatory function
of the hormones involved in carbohydrate metabolism. It is classified as a low-energy
package; 40mg to 80mg given daily by needle IM; 25 mg. before meals and bedtime.
7) Vitamin E as d-alpha tocopherol acetate of d-alpha tocopherol
acid succinate. The latter is more practical since it is a pure form.
Complex biochemical changes in the muscle tissue in chronic vitamin E deficiency
are followed by histalogical
lesions characteristic of muscular dystrophy. Deficiency has also been shown
to produce demyelinization and distortion of the axon pattern in the spinal cord,
giving rise to hypalgesia and progressive paresis. Fatal massive liver necrosis
occurs in animals maintained on diets low in vitamin E and sulfur-containing
amino acids; 800 international units before meals and bedtime must be adhered
to in this treatment.
8) Crude liver: This substance contains factors still unknown but essential in
metabolism. Patients with pernicious anemia often show neurological involvement,
and are tremendously benefited by liver injections which, of course, contain
vitamin B12. Degenerative changes brought on by other factors, therefore, can
also be benefited by daily injections of crude liver.
9) Adenosine-5-Monophosphoric acid: One of the purine bases occurring in muscle
is adenine. It, along with other purines, exists in various forms. Adenosine
polyphosphate is of primary interest in this discussion. The basic structure
is adenosine, adenine-9-riboside. This is esterified with phosphoric acid at
the 5-position of the ribofuranose, to form adenosine-5-phosphoric acid, also
known as adenosinemonophosphate (AMP). Inosinic acid is a commonly-occurring
breakdown product of AMP, formed by deamination in muscle extract. Myosin displays
enzymic activity similar to adenylic deaminase. By attaching further phosphoric
acid residues in pyrophosphate linkage, adenosine-diphosphate (ADP) and adenosinetriphosphate
(ATP) are obtained. ATP, as previously noted, is the energy package essential
for life. By adding this to our treatment, we enhance all chemistry dealing with
10) Choline: Choline is a structural component of fat and nerve tissue, thus
has a strong relationship to the phospholipids and to its acetyl ester. Acetylcholine
plays an important role in the humoral transmission of parasympathetic and other
nerve impulses to effector organs. It also plays a part in transmethylation.
Choline serves as a methylating agent in the physiological process – guanidoacetic
acid to creatine. We give 700mg to 1400mg after each meal and at bed hour.
11) Lecithin: Lecithin is the glyceryl ester of a pair of fatty acids and a substituted
phosphoric acid group attached to a choline radical. "Choline" is
one of the products of lecithin, representing about 15% of the molecule. Lecithin
placed in water and observed under the microscope, will diffuse out, forming
long, curving strands (myelin forms). The hydrophilic nature of the lecithin
molecule plays an important part in the structure and properties of cell membranes.
It is the lipid used in nerve tissue. We give 1200 mg. Soybean Lecithin after
12) Magnesium: 100mg. after each meal to supply additional ions for muscle activity.
It is an enzyme activator.
13) Calcium Gluconate (10 grain tablets): We give two tablets after each meal
and at bed hour to supplement dietary intake for muscle activity. At times, this
is given intravenously, one gram twice weekly.
14) Calcium pantothenate: The physiologically active form of pantothenic acid
is coenyzme A. Its acetyl derivative (acetyl CoA) is synonymous with active acetate.
Metabolic transformations are very complex and involve numerous enzymes and coenzymes.
Coenzyme A participates in the acetylation of amines. The pantothenic acid coenzyme
plays a vital role in carbohydrate metabolism and acetyl transfer also occurs
in the metabolism of fatty acids. We give 200 mg. after each meal and at bed
15) Aminoacetic acid (glycine): Glycine enters into a variety of metabolic functions.
It is directly concerned in the synthesis of glutathione, the tripeptide which
plays an important part in intracellular oxidation and reduction. Rapport and
Katz have shown that when glycine is added to perfused muscle, the oxygen absorption
is 40% higher than otherwise, indicating that the presence of this amino acid
stimulates the combustion of other tissue constituents. To the body in general,
glycine is no doubt most important because of its wide adaptability in the detoxicating
process of the body. More than one hundred substances, when fed, are joined in
the body with glycine. In the deamination of glycine, three products will be
formed: ammonia, carbon dioxide and water. The ammonia from this reaction is
then quantitatively converted to urea. One heaping tablespoon of the powder in
a glass of milk four times each day. Much of the oral medication can be taken
with this drink.
16) Make certain that the hemoglobin is at least 13 grams.
17) High protein diet with two to three eggs for breakfast.
18) One Theragram-M cap. daily for trace minerals.
19) Dantrium has value for relieving intentional tremor and Symmetrel
stiffness in Multiple Sclerosis. Dose must be individualized.
20) Zinc gluconate: 10 mg. three times each day has some value in Myasthenia
Gravis. Take several hours after vitamin B2.
This treatment works so dramatically in Myasthenia Gravis, that should a given
patient's physician refuse to administer this schedule, I have this recommendation:
One gram thiamin hydrochloride one hour before meals and at bed hour, and during
the night if awake. Niacin taken at the same time, and in amounts sufficient
to produce a good body flush. Two hundred mg. calcium pantothenate and 100mg
pyridoxine before meals and at bed hour. Ten grams ascorbic acid, taken in divided
doses. Amino acetic acid: one heaping tablespoon in a glass of milk, four times
each day. Naturally, the full schedule will afford more dramatic response.
For a long time, it has seemed to me that virus bodies might have the potential
to alter their protein coat, and therefore their dimension, and become another
virus for another disease. In our long practice, we would see, as I am certain
many of you have, chickenpox just before Thanksgiving, mumps by Christmas, red
measles in the Spring, and polio or a virus mimicking polio in the Summer. German
measles, virus colds, and virus pneumonitis just about any time.
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