MOGAD(Myelin Oligodendrocyte Glycoprotein Antibody Disease) is a neurological autoimmune disease characterized by inflammation affecting the central nervous system. It mainly impacts the spinal cord, brain, and optic nerves. Antibodies against myelin oligodendrocyte glycoprotein (MOG), a protein that shields the myelin sheath of nerves, are indicative of it.

In Ayurveda, it can be correlated with disorders arising from an imbalance of vata dosha and pitta dosha, which affect the nervous system and the immune response(Ojas).

• Vata dosha: Governs the nervous system; its vitiation can cause nerve degeneration and loss of function.
• Pitta dosha: When aggravated, it can lead to inflammatory conditions in the body.
• Ojas depletion: Autoimmune disorders, often create a weakened immune system, which Ayurveda attributes to a reduction in Ojas, the essence of vitality.

CLINICAL SYMPTOMS OF MOGAD DISEASE:

The given below are chief clinical symptoms related to MOGAD. These symptoms are based on the affected areas whether it’s brain, spinal cord, brainstem or cerebrum.

1. OPTIC NEURITIS:

• `Lost vision, or blurred vision either in one or both eyes.
• Pain in the eyes, during the movement.
• Dyschromatopsia/Color vision loss. Here Red and green vision loss normally occur.
• It can also cause vision loss in the initial phase which can be reversible with treatment.

2. TRANSVERSE MYELITIS:

• Symmetrical or asymmetrical weakness or paralysis in the limbs.
• Sensory symptoms like burning sensation, numbness, and tingling in the legs.
• Pain either sharp or blunt and tightness can be present all over the body/torso.
• Loss of bowel or bladder control /incontinence.
• Few other symptoms like fever, respiratory problems, loss of appetite, anxiety, and depression can be found.

3. BRAIN STEM AFFECTED SYMPTOMS:

• Vertigo, dizziness or unsteadiness.
• Nystagmus(abnormal eye movements) or diplopia(double vision).
• Nausea and vomiting.
• Headache.
• Behavioral changes like altered consciousness.
• Difficulty in speaking or swallowing.
• Loss of balance and coordination.

4. PEDIATRIC SYMPTOMS:

• If there is a cortical lesion it can lead to epileptic or seizure episodes.
• Developmental issues and behavioral changes in kids.

5. ADEM(Acute Disseminated Encephalomyelitis):

• This is usually seen in children who are positive with MOGAD.
• Multiple neurological deficits due to diffuse inflammation of the brain.
• Confusion, personality changes, irritability, tremors, involuntary twitching of muscles, etc.

RED FLAGS IN MOGAD:

• The MRI shows fluffy, large, poorly defined lesions.
• Presence of MOG antibodies in CSF(Cerebrospinal Fluid) or blood.
• Motor deficits.
• Severe vision loss.

DIFFERENTIAL DIAGNOSIS:

MOGAD usually has similarities in clinical and radiological features with other Central Nervous System demyelinating autoimmune disorders.

A few Differential Diagnosis are:

• Multiple Sclerosis(MS).
• Neuromyelitis Optica Spectrum Disorder(NMOSD).
• Acute Disseminated Encephalomyelitis(ADEM).
• Autoimmune Encephalitis.
• Ischemic myelitis.
• Idiopathic optic neuritis.
• Sarcoidosis.
• Vasculitis or Autoimmune CNS disorders.
• Central Nervous System Lymphoma.

DIAGNOSIS OF MOGAD 

1. CLINICAL ASSESSMENT:

• Analyze symptoms like acute optic neuritis, transverse myelitis, vertigo, diplopia, dyschromatopsia, brainstem and cerebellar syndromes.

2. SEROLOGICAL TESTING:

• MOG-IgG antibody detection using cell-based ASSAY, the antibodies are more reliably detected in the blood.

3. IMAGING TESTS:

MRI shows :

• Brain: Lesions that are fluffy and ill-defined in the cortex, brainstem, or periventricular areas.
• Spinal cord: Lesion noted in the central part of the spinal cord. Severe transverse myelitis in more than three vertebrae.
• Optic nerves: Bilateral involvement is usually seen, and enhancement and swelling of optic nerves are also found.

4. ANALYZATION OF CEREBROSPINAL FLUID:

Usual findings include,

• Increased WBC(White Blood Cell count)-pleocytosis.
• Protein levels elevated.
• Oligoclonal bands are usually absent or transient unlike in multiple sclerosis.

5. ADDITIONAL TESTS:

They are:

• Nerve Conduction Studies.
• Visual Evoked Potential(VEP)-Have delayed conduction in optic neuritis.

MOGAD should be suspected when;

• ADEM  in kids.
• AQP4-IgG-free LETM or atypical ocular neuritis.
• Repeated occurrence of transverse myelitis or optic neuritis.

TREATMENT OF MOGAD DISEASE IN MAURYA  AYURVEDA

Our hospital offers comprehensive treatments by seamlessly integrating Ayurveda, physiotherapy, and acupuncture to promote holistic healing and wellness.

1.PODI KIZHI:

It is an ayurvedic treatment in which the body is massaged with heated herbal powders tied in a cotton pouch called a Kizhi. Our hospital often makes Podi Kizhi with KOLAKULATHADI CHOORNAM. Normally it is done in about 40 to 45 minutes.

 Advantages of PODI KIZHI in MOGAD:

• It relieves muscle spasms and stiffness.
• It lessens the intensity of pain.
• It facilitates movement.
• It facilitates mobility and recovery.
• Additionally, it lessens inflammation.

2.UDWARTHANAM:

A unique ayurvedic treatment called Udwarthanam, uses herbal powders to massage the body dry. For the same purpose, KOLAKULATHADI or KOLAKULATHADI in addition to TRIPHALA are utilized. It lasts for about forty to forty-five minutes.

أودوارثانام‘s advantages in MOGAD

• It enhances circulation.
• It eases tense muscles.
• It aids in the reduction of edema.
• Detoxification is aided.
• It maintains Kapha dosha.
• It enhances the texture of the skin.
• It eases stiffness.

3.NADI SWEDAM:

Nadi Swedam is a type of localized steam therapy that is administered by a hose or tube. Usually, DASHAMOOLA KASHAYAM is used for producing steam. Typically, the steaming procedure takes ten to fifteen minutes.

The advantages of NADI SWEDA in MOGAD

• It aids in the relaxation of tissues and muscles.
• It helps with circulation.
• It makes muscles less rigid.
• It helps to lessen discomfort/pain.
• It helps with detoxification.
• It reduces muscle tension.

4. DHARA:

A constant stream of medicinal liquids, such as herbal oils, buttermilk, milk, or decoctions, is applied to the afflicted area during the therapeutic process known as dhara. Dhara is categorized according to the liquid used and the application area.

In these circumstances, we typically do Kashaya dhara and Dhanyamla dhara

• Herbal concoctions are warmed and applied topically in KASHAYA DHARA. This dhara is performed with Dashamoola Kashayam.
• DHANYAMLA DHARA: This type of specialized therapy involves Dhanyamla, a fermented medicinal liquid, being poured over the body in a steady stream.

Advantages of DHARA

• It helps to lessen inflammation.
• It eases discomfort.
• It aids in the process of detoxification.
• Nerves are stimulated by it.

5.LEPAM:

Applying a medicinal herbal paste to the area of pain and swelling is known as Lepam in Ayurveda. That is left in that area for roughly half an hour to an hour. Usually, the paste can be removed by washing it off after drying. For the application of Lepam, we typically utilize RASNADI and GRAHADHOOMADI, warmed in Jambeera (lemon juice).

Advantages of LEPAM

• It aids in lowering of inflammation and swelling.
• Aids in easing stiffness and discomfort in the muscles.
• Lessens joint pain as well.

6.NASYAM:

Nasyam is one of the five panchakarma purifying techniques. Here, the patient is asked to lie down while receiving a light massage of the face, neck, and head. Then, through either one of the nostrils, therapeutic oil or medicinal herbs are administered. The patient is then told to take a deep breath, which aids in the medication’s delivery to the sinuses and head area. The patient is then requested to spit out any phlegm or mucus that might have come out.

Typically, there are two methods:

Pratimarsha Nasya: Taking 1-2 drops of medicinal oil daily in lesser quantities. For this, Anu Taila is typically utilized.

Marsha Nasya: In this case, higher doses of medicinal powders or oil are given. Its dosage typically ranges from two to ten drops. Ksheerabala is normally used for the same purpose.

NASYA‘s advantages in MOGAD

• Aids in VATA dosha balance.
• Nerves are stimulated by it.
• It aids in the removal of toxins.
• It aids in relieving symptoms like headaches, vision abnormalities, and brain fog.
• It promotes mental calmness.

7. ROOKSHA VASTHI: 

Rooksha Vasthi is a kind of medicinal enema that is primarily dry and non-unctuous. It is a subtype of purificatory enema, or Shodhana Vasthi, and is mostly used to balance the body’s exacerbated kapha and medas (fat tissue).

The patient is positioned with the right leg bowed and the left leg extended in the vama parshva, or left lateral position. With a dry or less oily preparation, the anal region is only lightly lubricated. In a Vasthi device, the dry powder suspension or medicinal decoction is filled. It enters the rectum gradually through the annal canal. For a predetermined period of time, the patient is told to keep the medicine. Because the formulation is dry, its retention is shorter than that of Sneha Vasthi( an oil-based enema).

It typically lasts three to seven days as part of a therapy strategy.

Benefits of ROOKSHA VASTHI IN MOGAD:

• It reduces kapha and Ama.
• It improves nerve function.
• It can also provide anti-inflammatory effects.
• It improves digestion and absorption.

8.THALAM:

The Ayurvedic term for applying a medicinal paste to the middle of the head is Thalam. The medicinal paste stimulates and acts upon nerve endings to reduce and treat disease.

Its advantages consist of:

• It helps with problems related to sleep.
• It stimulates the sensory channels and improves the senses.
• Controls high blood pressure.
• Making headaches, including migraine, and other ENT-related disorders less common.
• Rasnadi along with Ksheerabala are normally utilized for thlalam.

ROLE OF PHYSIOTHERAPY IN MOGAD:

Physiotherapy techniques used in managing MOGAD mainly focus on alleviating symptoms, enhancing mobility, restoring function, and improving the quality of life.

The key physiotherapy  techniques used are:

1. FOR MOTOR FUNCTION REHABILITATION:

A)Range of Motion exercises(ROM): Active, passive, and active assisted ROM are done.

• Flexion and extension of shoulders, elbow, wrist, knee.
• Dorsiflexion and Plantar flexion of the ankle.

B)Strengthening exercises:

• Using weights, body weight, and resistance bands, that helps to strengthen the weak muscles.
• The principle of progressive overload is also applied here.

C)Functional Task training:

• Practicing activities like sit-to-stand, climbing stairs, or training the patient to do daily activities.

D)NMES(Neuromuscular Electrical Stimulation):

• It stimulates weak muscles and improves neuromuscular function.

 2. FOR MANAGEMENT OF SPASTICITY:

• Stretching is done actively and passively.
• Proper positioning to prevent contractures using braces or pillows.
• Manual therapy techniques like soft tissue mobilization.

 3. FOR REDUCTION OF PAIN:

• Usage of cryotherapy and thermotherapy alternatively.
• TENS(Transcutaneous Electrical Nerve Stimulation): to reduce muscle discomfort and neuropathic pain.
• ULTRASOUND: It helps to reduce pain and inflammation, and enhances tissue healing.
• Manual Therapy: Like myofascial release, trigger point release aids in the reduction of musculoskeletal pain.
• Posture training: Reduce pain due to abnormal loading.

4. SENSORY REHABILITATION:

• Sensory re-education
• Proprioceptive training

5. BALANCE AND COORDINATION TRAINING:

• Core strengthening exercises.

6. GAIT TRAINING:

• Usage of assistive devices like walkers, canes, or orthosis.
• Usage of parallel bars.
• Treadmill training.

 7. FOR RESPIRATORY SUPPORT:

It’s important for patients who experience respiratory dysfunction due to spinal cord involvement, reduced mobility, or general deconditioning. The main goals is to improve lung function and oxygenation and prevent respiratory complications.

Key breathing techniques:

• Diaphragmatic breathing.
• Pursed lip breathing.
• Segmental breathing.
• Usage of spirometer.

ROLE OF ACUPUNCTURE IN MOGAD

Acupuncture is increasingly being used in managing autoimmune neurological disorders. It’s effective in managing immune dysfunction, reduction of inflammation  and support symptom relief.

1. BODY ACUPUNCTURE:

Here needles are inserted gently and where flow of energy is manipulated to promote immunity and stimulate the nervous system.

The key acupoints here are:

• ST36(Zusanil): It promotes immunity and diminishes fatigue.
• SP6(Sanyinjiao):It aids in hormonal and immune regulation.
• L14(Hegu)+LV3(Taichung): It enhances energy flow and reduces systemic inflammation.
• GB20(Fengchi): It helps in relieving neurological symptoms like headaches or dizziness.
• DU20(Baihui): It enhances brain function and reduces dizziness.
• DU14(Dazhui): It boosts up immunity.

2. ELECTRO ACUPUNCTURE:

• Here mild electrical current is passed between acupuncture needles to enhance circulation.
• Points like DU14, ST36, LI11, and local points near  the affected nerves.

Benefits of Acupuncture in MOGAD:

• It improves blood flow and regulates the vascular system.
• It modulates the central nervous system, helping to desensitize overactive pain and reduces pain.
• It helps to balance between sympathetic and parasympathetic nervous systems, hence reducing stress and anxiety.
• It aids in the diminution of systemic inflammation.
• It also stimulates the endocrine system, and regulates hormones.

ACUPRESSURE AND IT’S BENEFITS:

Acupressure is considered a supportive therapy that is beneficial in neuromuscular autoimmune disease by addressing pain, stress, and energy imbalances while supporting healing and recovery.

Techniques of Acupressure in MOGAD:

1. Direct Pressure Techniques:

• Applying steady, firm pressure using thumb, fingers, or a blunt tool on specific acupoints. Apply it for 1-2 minutes.
• It aids in reduction of pain.

2. Circular Motion technique:

• Applying pressure in acupoints like small slow circular movements.
• It enhances relaxation and reduction of stress.

3. Tapping techniques:

• Tapping around the acupoints gently.
• It enhances circulation  and stimulates the nervous system.

4. Kneading Techniques:

• Using thumb or fingers kneading done rhythmically.
• Beneficial for muscle weakness.

5. Rolling techniques:

• Using roller or knuckle gentle rolling pressure is applied to acupoints.
• It helps to reduce  stiffness and systemic inflammation.

All  these are done in either one or two sessions daily for 5-10 minutes.

Techniques for certain symptoms:

• For muscle weakness: Apply pressure on ST36 and KD3,it improves energy and strength.
• For fatigue: Ren6 and BL23  are the points that boost energy and vitality.
• For pain and spasticity: GB20, LI4, and SP6 which aid in relieving inflammation and tension.
• For nerve dysfunction: At GB20 and SP6 kneading or tapping should be done to stimulate the nerve.

DIETARY GUIDELINES FOLLOWED IN OUR HOSPITAL:

GENERAL INSTRUCTION SUGGESTED IN OUR HOSPITAL:

• Avoid vigorous activities.
• Drink 2.5–3 liters of water.

FOOD ITEMS RECOMMENDED ARE:	FOOD ITEMS DISCOURAGED ARE:
Steamed food items like idiyappam, put, chapati, Appam(not fermented).	Fermented foods like dosa, idli, fermented appam.
Vegetable in boiled form.	Tuber items like potato, tapioca and sweet potato.
Hot kanji.	Non vegetarian items like, Fish, egg and meat(Can be taken in curry form, if necessary).
	Milk, milk products, cold food, pickles, fruits, dry fruits, nuts, fast food, fried and oily foods.

 

DISCLAIMER: The information provided in this article is intended solely for educational  purposes. Treatment decisions should be made exclusively by a well-qualified Ayurvedic physician. Self-medication is strongly discouraged.

Maurya Ayurveda Hospital,opposite to Sabine Hospital,Pezhakkapilly P.O,Muvattupuzha,Ernakulam;PIN:686673,Contact no:9947183000

Email: [email protected]

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