Santiago, R.; Kahn, F.; Kim, S.; Oszarfati, J.

This patient had been diagnosed with Rasmussen’s Encephalitis and decided to independently pursue a course of Laser Therapy, making the decision to select this therapeutic approach prior to surgical intervention which had been advised.

The patient is a 23-year-old female who lives in France and has been diagnosed with Rasmussen’s Encephalitis, characterized by frequent grand mal seizures which she had been experiencing since November 2015. These seizures were poorly controlled by individual or a combination of medications in high dosages. Her condition became more severe in April 2017 when paralysis of the right side of the body developed accompanied by an increase in the severity of her seizures. This was accompanied by pain on the right side of the face and tongue, gradually extending to the right side of the body including both extremities.

A CT scan performed in January 2018 noted a hypodense area in the left parietal region consistent with Chronic Encephalitis. During this period, she began to experience focal seizures of the right lower extremity which was poorly responsive to medication. This prompted treatment with intravenous immunoglobulin therapy over a 3-month period, which improved her condition minimally. Over time she developed decreased muscle tone and lack of coordination of the right side of her body which confined her to a wheelchair, and resulted in increased difficulty writing, eating and functioning on virtually every level. She also began to experience difficulty processing information and developed expressive aphasia. Prior to presenting at our clinic, she had been under the extended care of a Neurologist in France.

Treatment with Laser Therapy was initiated in May 2018 at the Meditech Clinic in Toronto. Therapy began with the application of both large surface arrays utilizing radiation at Red 660 nm and Infrared 840 nm, followed by the Red and Infrared Laser Probes at 660 nm and 830 nm, respectively. Therapy was applied to the cervicothoracic spine region targeting the brainstem, cerebellum and the cervical spine including the cord. Cranial coverage was included following a week of therapy to the cervico-spinal area.

The initial positive response from the patient included an increased range of motion of the right lower extremity, gradually permitting short walks independently. Of significance was the improved quality of her sleep which increased in duration and depth along with emotional stability. This improved her overall status significantly. Her seizures became less severe in frequency and duration and the protocols were adjusted as the various symptomatic improvements continued to improve. The tremors she had experienced in her right leg decreased in severity.

Following two weeks of therapy at the Meditech Clinic in Toronto, the patient noted continuing improvement in her overall well-being, particularly sleep duration and quality and improved range of motion of all affected areas, accompanied by an almost total lack of seizure activity. On that basis, she was provided with a portable unit to continue treatment in France. This followed careful training of the patient and her family who were provided with a variety of protocols to use at home in accordance with symptom changes.

The patient was advised to continue treatment on alternate days including the cervicothoracic spine and the cranium with instructions for change concomitant with her symptomatology. She was advised to communicate with the clinic in Toronto by email for ongoing guidance. She was also advised to continue treatment with IV immunoglobulin therapy and anticonvulsants as indicated by her Neurologist. The patient currently continues to respond to this multifaceted approach and at this time, the proposed cerebral hemispherectomy, which had been previously advised has been cancelled.

Rasmussen’s Encephalitis is a rare and chronic neurological disorder characterized by unilateral hemispheric inflammation of the cerebral cortex, seizures and progressive neurological and cognitive deterioration. At this time, cerebral hemispherectomy is generally offered to patients in this category, particularly those who respond poorly to conventional medication1. Decisions regarding surgical intervention and the appropriate time to institute such measures are challenging to healthcare providers, caregivers and, needless to say, patients, particularly in the absence of a severe neurological deficit and is questionable at best. Immunomodulatory therapy appears to slow rather than halt progression of the disease and does not change the eventual outcome.

Over the past two decades, Laser Therapy has been introduced as an innovative treatment for the modulation of neural activity in order to improve brain function. Treatment requires exposure of the cervical spine and the central nervous system to a low fluence of light using appropriate delivery methods. The safety and ability to customized protocols using Laser Therapy including variations in wavelength, fluence, power density, number and duration of treatments and the mode of application (continuous or pulsed) to the central nervous system have been investigated in many clinical studies. Several reports with regard to the effects of Laser Therapy demonstrate a significant effect on a wide range of CNS disorders2 including epilepsy, traumatic brain injury, neurodegenerative disorders, headaches, vertigo, mobility problems, multiple sclerosis, neuromuscular disorders along with impaired sleep patterns, CVA and transient ischemic episodes.

Although the response of this patient to Laser Therapy may primarily be attributed to its neuromodulatory and neuroprotective effects, the potent anti-inflammatory effect on tissue may have contributed significantly. A number of researchers have demonstrated an increase in adenosine-3’, 5’-cyclic monophosphate (cAMP) following the administration of Laser Therapy. Although it is tempting to suppose that this increase in cAMP is a direct consequence of a rise in ATP following light therapy, clear-cut evidence for this supposition is still beyond the realm of proof. It has been reported that cAMP-elevating agents, i.e. prostaglandin E2, inhibit the synthesis of TNF and therefore downregulated the inflammatory process. Lima et al. investigated the signaling pathways responsible for the anti-inflammatory action of Laser Therapy (administered at 660 nm, 4.5 J cm−2) when applied to the lungs and airways. They found reduced TNF levels in the tissue treated, probably secondary to an increase in cAMP levels3. This would indicate that Laser Therapy may be a useful adjunct in the treatment of certain central nervous system disorders that are accompanied by a significant inflammatory component.

CONCLUSION:
This case of Rasmussen’s Chronic Encephalitis serves as an example of how Laser Therapy can be utilized in the neuromodulation of a serious brain disorder and demonstrates how Laser Therapy can potentially be a significant factor in the neuromodulation of both the central and peripheral nervous system where conventional therapies do not offer solutions. This is based on a significant improvement in this patient’s overall status and clearly illustrates the potentials of Laser Therapy in the treatment of these conditions. This is largely due to its neuromodulatory, neuroprotective and anti-inflammatory effects and supports ongoing research and application of this treatment for this and other neurological conditions. During a relatively brief course of treatment which is continuing, the majority of the patient’s symptoms were markedly reduced and functions at most levels have improved substantially. Currently as her treatment is effective, surgery need not be considered. Moreover, the patient and her family are pleased with the positive changes noted.

1. Varadkar S, Bien C, Kruse C, Jensen F, Bauer F, Pardo C, Vincent A, Mathern G, Cross JH. Rasmussen’s encephalitis: clinical features, pathobiology, and treatment advances. Lancet Neurol. 2014 Feb; 13(2): 195–205.
2. Salehpour F, Mahmoudi J, Kamari F, Sadigh-Eteghad S, Rasta SH, Hamblin M. Brain Photobiomodulation Therapy: a Narrative Review. Molecular Neurobiology https://doi.org/10.1007/s12035-017-0852-4.
3. Freitas LF, Hamblin M. Proposed Mechanisms of Photobiomodulation or Low-Level Light Therapy. IEEE J Sel Top Quantum Electron. 2016 May-Jun; 22(3): 7000417.