Photobiomodulation for MS

Photobiomodulation is a promising treatment for several neuro-degenerative diseases. However, few studies have been done regarding Multiple Sclerosis. In this blog I describe my experiments with reducing MS related fatigue.

From 2017 till 2021 I conducted a series of experiments with my friend John, who suffers from MS. During these 5 years I frequently irradiated him with infrared light while tracking his sleep and cognitive performance. The results of these experiments are not unambiguous nor compelling, but nevertheless yielded some interesting observations and ideas. Along the way, I had to let go of my initial plan to turn this project into a formal scientific publication, as this would simply have taken too much time. The Covid-19 pandemic didn’t help either. By writing this blog about the project, both other researchers and patients may benefit from it.

Enjoy the article and feel free to contact me if you have a question.
Last updated: December 1 2022.


1. Introduction
2. Experiments
3. Measuring the effects
4. Device & treatment
5. Lessons learned
6. Capita selecta
7. Appendix: Information for MS patients
8. Conclusion
9. Sources


1. Introduction

Before diving deeper, let’s start with a short introduction of multiple sclerosis, photobiomodulation and an overview of the currently available research.

Multiple Sclerosis

Multiple sclerosis (MS) is a chronic neurodegenerative auto-immune disease that damages the insulating myelin sheath of nerve cells in the brain and spinal cord. It affects approximately 2.5 million people worldwide. Patients experience a wide spectrum of (neurological) symptoms. Often reported are fatigue and cognitive impairment, that interfere with normal daily functioning and quality of life.

Photobiomodulation

Photobiomodulation (PBM) is a treatment that uses red and near infrared light to increase healing and decrease inflammation and pain. PBM – formerly known as Low-Level Laser Therapy (LLLT) – is well researched with many reviews and clinical trials, but still a non-conventional therapy. One of the main biological effects of PBM is on mitochondria, where it increases ATP production. The fundamental difference with a pharmaceutical approach is that photons instead of chemicals are used to induce changes in biochemistry. Promising results with shining near infrared light on the brain – also known as transcranial photobiomodulation (tPBM)  – have been achieved for various neurodegenerative diseases like Alzheimer’s and Parkinson’s. For MS however, not a lot of research has been done yet. In the next paragraph I’ll give a short overview of the few studies I found.

photobiomodulation MS

Research history of photobiomodulation & MS

The first published study was done in Poland in 2003, treating around 100 MS patients with 632 nm laser light, and reported substantial objective and subjective improvements. After this human study, most studies used a mouse model of MS – usually experimental autoimmune encephalomyelitis (EAE). Like those of the University of Wisconsin – Milwaukee in 2012 and 2013 where mice with early MS-like symptoms were treated with 670 nm ‘full body’ LED light. The clinical condition of the mice improved.
In 2016 the group of Gonçalves in Brazil used 660 and 904 nm laser light to treat a mouse model of MS (EAE) and concluded that their results suggest the use of LLLT as a therapeutic application during autoimmune neuroinflammatory responses, such as MS. Also in Brazil in 2018 by a group of Universidade Federal de São Paulo led by Duarte found that among other things laser-treated (808 nm transcranially) animals presented motor performance improvement and attenuation of demyelination.
The University of Nove de Julho in Brazil completed a randomised clinical trial in 2020. They treated 14 people diagnosed with relapsing-remitting MS with a 808 nm laser. The treatment positively modulated the expression of interleukin-10, an anti-inflammatory cytokine which is often low in MS patients.
A 2021 review article from Iran concludes with ”LLLT could be a promising therapeutic approach for the treatment of MS”. The data from the 2022 USA study (Jeri-Anne Lyons) show that PBM therapy has the potential to modulate pro- and anti-inflammatory cytokines in people with MS. The study from Brazil in 2022 found no effect of 808 nm laser systemic treatment (via mouth/wrist) on fatigue in relapsing-remitting MS patients.

Overview of published photobiomodulation MS research 
2003 Poland: Laser on humans [link]
2012 USA: LED on mice [link]
2013 USA: LED on mice [link]
2016 Brazil: Laser on mice [link]
2018 Brazil: Laser (transcranial) on mice [link]
2018 Brazil: Laser on humans (study protocol) [link]
2020 Brazil: Laser on humans (clinical trial) [link]
2021 Iran: Literature study (review) [link]
2022 USA: Red & near-infrared on human cell cultures [link]
2022 Brazil: Laser on humans (clinical trial) [link]

The majority of studies has produced positive outcomes. Looking closely at this and other photobiomodulation research, one can notice that there are many treatment parameters. There can be differences in the light source used (laser or LED), the light frequency (600-1200 nm), signal type (continuous or pulsed with frequency and duty cycle), treatment location, target tissue, dose, treatment surface and more. An important part of the way forward is finding the most effective treatment protocols. This overview is probably not complete; more research may be available in Russia or China.


2. Experiments

In this section a description of the experiments.

The beginning

Around 2016 I started hearing about low level laser therapy and photobiomodulation. I began to look at the studies and saw that there was great potential for many chronic neurological diseases (1).

In the spring of 2017 I asked my friend John – who is a MS patient – whether he would be interested to see if infrared light could benefit his condition. He was, and so we got together.

John is a retired physical therapist and therefore accustomed to work with various medical devices. During his career he also operated (wide spectrum) infrared equipment. Understandably, his role was not limited to just being the subject of the experiments.

Where to shine the light?

Our initial question was: where to shine the light? In the first year we tried the spine, the head, the wrists, sublingually and even inside the nose. For each of these there is a rationale why this could be effective.

We used various devices: a pad with a mix of red and infrared LED’s, a COB LED device with lens, a power LED array and an intranasal device. We used low intensities and built exposure up slowly, as not to provoke strong reactions. Read more about our safety precautions in ‘Lessons learned‘ below.

John would simply tell if he noticed any changes – for instance in sleep, well-being or mood. Later on we relied more on measurements.

About John
John is a 67 year old retired physical therapist with secondary progressive MS. He experienced the first signs in 1990 and was officially diagnosed in 2000. Over time he developed many of the typical MS symptoms like loss of balance, loss of muscle strength, cognitive decline, food intolerances, pain and most of all: fatigue. 

Like many MS patients, John is forced to take naps (usually after dinner) to reduce this fatigue. Over the years the duration of these naps has gone up from 15 minutes to around 2 hours. On average his daily total sleep time is currently 10 hrs.

John is a caucasian male born in 1955 and has no other chronic diseases. His weight is 70 kg and his height is 176 cm. He is monitored by the St Antonius hospital in Utrecht, The Netherlands, via an online questionnaire every two weeks and is yearly seen by a neurologist.

Apart from being the subject John also contributed to this project with his many years of experience in therapeutic settings. For over 20 years he worked in hospitals and was involved in measurements for scientific rheumatology research.

Transcranial PBM

After trying out these combinations for a period of time, shining infrared light on the forehead (prefrontal cortex) and the sides of the head seemed to work best. So we began to focus on transcranial photobiomodulation (tPBM) treatments using the power LED array. We also needed to optimise the dose, so we tried different distances and varied the exposure time.

Findings of our experiments

During the period of experimenting we found three effects of tPBM.

The first (in 2017 and 2018) was a reduction in sleep. John reported a reduced need for extra daytime sleep on treatment days. Normally, this would be around two hours after dinner. After treatments, this would frequently be just 90 minutes. So, there was a daytime sleep reduction of around 30 minutes per day. After some time however this reduction in sleep disappeared or at least became elusive.

The second was that we could also reduce John’s MS related lower back pain, with local treatment on the lower back. Because back pain is an ailment that occurs less frequently and not in all MS patients, we chose not to focus on it. Pain reduction is a known application of PBM, that has already been studied extensively.

MS photobiomodulation: cortical metric Fatigue
Cognitive fatigue improved more after 5 active versus 5 sham transcranial PBM treatments.

The third effect appeared during the last period – from 2019 til 2021 – when we focused mostly on cognitive fatigue. The experimenting became more systematic and I also included sham treatments. The metric ‘fatigue’ of the brain gauge responded (20 min post treatment) more to active treatments. John’s cognitive fatigue was temporarily improved by shining near-infrared light on his head.

Please note that these findings are the result of (single blinded) experimenting on just one subject (n=1), and not of rigorous formal scientific study.


3. Measuring the effects

We explored various ways to measure John’s cognitive performance and other markers of his health.

Initially, I asked John how he felt after each treatment and whether he noticed any improvements. This worked well – as he observed a reduction in the need for extra daytime sleep after treatments – but at some point we needed to find a way to quantify these subjectively reported effects.

Apart from sleep duration and quality, I was interested in measuring John’s cognitive function, physical activity and heart rate variability. This way we could detect other possible unnoticed effects. A next round of experimenting started. We set up and made baseline recordings using three non-invasive, low cost and easy to use ‘quantified self’ measurement tools.

A. CogEval

The first we tried was CogEval – a Processing Speed Test (PST) that runs on iPads (8). It is based on the commonly used Symbol Digit Modalities Test (SDMT) which was developed to evaluate cognitive function in MS patients. It uses elements of attention, psychomotor speed, visual processing and working memory. The SDMT is particularly sensitive to the slowed processing of information that is seen in many MS patients.

CogEval is intended for use in the healthcare setting and is available only to MS healthcare providers. I contacted pharmaceutical company Biogen (that developed the app) and they agreed that we could use it.

To be able to see effects of the photobiomodulation treatments we first wanted to get some baseline data, so John started to do the CogEval test daily. In the beginning his cognitive impairment clearly showed up in the results. However, after some time the test scores went up significantly and he even outperformed healthy people of his age. This was good news for the state of John’s neuroplasticity, but made the test less useful for our project. The CogEval scores can be improved by doing the test regularly, and therefore it doesn’t yield a stable baseline that we could use. This phenomenon is know as the ‘practice effect’ (PE) in the field of cognitive assessment.

Then we heard of a fitness tracker called ‘Oura’ that could be useful.

B. Oura ring

The second tool was the Oura ring – a wearable fitness tracker for activity, heart rate variability and sleep. We used a ring of the second generation. John paired it to his phone and I could monitor the data via an online dashboard.

The Oura ring may be popular in quantified-self and biohacking circles, it is not a scientific instrument, however. It failed to track naps in a reliable fashion (2019) and was therefore unfit to play a central role in our project. Also the tracking of heart rate variability (HRV) was limited.

Nevertheless, John has continued to use the Oura ring since, as it gives him insights into his sleep and health.

We needed yet another way. Luckily there was the Brain Gauge.

Photobiomodulation MS measuring
From left to right: Brain Gauge, CogEval & Oura ring.

C. The Brain Gauge

The Brain Gauge is a tool to measure brain function (cortical metrics) using tactile tests. This cognitive health assessment system takes advantage of the well-documented relationship between the sensory nerves in the fingers and the projection of those nerves to corresponding regions in the brain. The metrics obtained relate to the building blocks of information processing (3).

The Brain Gauge looks like a computer-mouse with two buttons that can vibrate and detect movements with high precision. The device is very sensitive. We used the pro version.

During the tests, vibrations of varying duration and intensity are offered to the index and middle finger of the subject. The accompanying desktop app will ask questions about what was felt, and then analyze the subject’s responses. In less than 20 minutes you can gain valuable insight into your mental fitness.

I made a custom test batch, consisting of these four:

1. Hardware/Simple Reaction Time
2. Timing Challenge
3. TOJC Challenge
4. Hardware/Simple Reaction Time

This sequence of 4 tests was completed by John just before and 20 minutes after each active and sham treatment. These tests yield 5 metrics – Speed, TOJ, Connectivity, Focus and Fatigue – of which the latter seemed to be impacted most by the intervention. Very relevant, as cognitive fatigue is one of the most reported and disabling symptoms in multiple sclerosis.

brain gauge cortical metrics scores
Example of Brain Gauge cortical metrics scores.

Conclusion

After experimenting for many months and collecting lots of health data, the Brain Gauge appeared to be the best instrument for measuring the effects of the photobiomodulation treatments. Also we saw some positive effects on cognitive fatigue.


4. Device & treatment

When we started in 2017, there were little or no calibrated LED devices for photobiomodulation with accurate specifications commercially available. This meant that I had to make my own. Below I describe the device that I developed for our experiments and the details of the treatment protocol.

Light source

We used a continuous wave 850 nm DIY infrared light device, consisting of two LED arrays of 15 Epistar powerLEDs. As these LEDs emit a faint red glow, visible to the human eye, I conclude that the actual spectrum must be wider (between 700-1000 nm) with most of the power output at around 850 nm. Originally these lamps were intended to be used – non-medically – as security camera illuminator flood lights. I removed all the onboard electronics and powered each LED array with a Mean Well GSC25E-1400 LED driver for stability and to eliminate flickering.

Biohackz DIY tPBM device
Our tPBM device from three angles.

Setup

As seen in the photos above, the LED arrays are held in place by a repurposed desktop microphone stand. This setup was designed for treatment of subjects that are lying down. The value of having the subject in supine position is that the distance between the lamp and the head remains constant – barely altered by the subjects movements. Currently I would use a tPBM helmet device, so that the subject can be seated. This is better, as lying down (resting) is an intervention in and of itself.

Power output

Based on measurements and specifications, I calculated that at the surface of each LED array, the optical power density is approximately 12 mW/cm2. Total surface of the device is 2x 9×14 = 252 cm2. Note that the power is not evenly spread over the surface, as the LEDs have reflectors that focus the light. Their beam angle seems to be around 30 degrees. At 5 cm distance the power density is approximately 9,5 mW/cm2.

Treatment

The subject was treated with the device for a total of eight minutes. The intervention consisted of two parts:

A. Four minutes of irradiation of the left side of the head (including the left side of the forehead and the left side of the back of the head), while the subject was lying in side position (right lateral recumbent).
B. Four minutes of irradiation of the right side of the head (including the right side of the forehead and the right side of the back of the head), while the subject was lying in side position (left lateral recumbent).

The subject was laid down with a pillow under the head to keep the distance between the device and the treatment area constant at 5 cm.

transcranial photobiomodulation
A transcranial photobiomodulation treatment.

Sham treatment

All treatments included some extra light from an infrared heat lamp (Philips Infraphil; 150 watt) at approximately one meter distance. During sham treatments this would still be on, but not the LED arrays. Read more about blinding for PBM in ‘Lessons learned‘ below.

Dose calculation

The head surface area that was irradiated is approximately 255 cm2. The power density at 5 cm from the device is 9.5 mW/cm2. Total power is 9.5 x 255 = 2.422 Watt per side. For both sides together the dose is: 2x 2.422 (Watt) x 240 (Secondes) = 1162 Joules. This is delivered on said 255 cm2, so the radiant fluence (H) is 1162 (J) / 255(cm2) = 4.6 J/cm2. This is not an exact number, but should be seen as a rough indication (order of magnitude) of the treatment dose.


5. Lessons learned

If you are researching photobiomodulation – and particularly its application for multiple sclerosis – you might be able to use some of the things we learned. Please find these below.

Safety

There are at least two things to consider when treating MS patients with infrared light. First of all, heat intolerance may cause a temporary worsening of MS-related symptoms in some patients. This is known as Uhthoff’s phenomenon (5). Heating can be prevented by using a narrow spectrum light source without mid and far infrared light– and even without the upper part of the near infrared band. This is to avoid wavelengths that fall into the absorption spectrum of liquid water and so could cause heating. Keeping the lamp at a big enough distance and starting with a low dose also contribute to a safe treatment. I found that our tPBM treatment was no trigger for heat intolerance.

A second risk may occur when using pulsed tPBM. Pulsing light, sound, electricity or magnetic fields at frequencies of around 40 Hz (gamma waves), has been shown to have beneficial effects on reducing the progression of neurodegeneration. However, Dr. Lew Lim has brought forward that in MS patients this may possibly trigger an autoimmune attack, as this frequency is known to stimulate microglia activity. Therefore we used a continuous wave light source to avoid this risk.

Update: Dr. Lew Lim let me know that if microglia are activated by PBM at 40 Hz, it is likely to be the non-inflammatory M2 type, which may in fact add to its safety. Also he is not aware of any adverse events with MS patients using his Vielight 40 Hz tPBM devices.

Randomized controlled human studies are needed to validate the safety and usefulness of (t)PBM for multiple sclerosis.

Blinding

When it comes to blinding in human photobiomodulation research, the difficulty is that subjects could recognize the active treatment in several ways. The most obvious way is by seeing the light. Even in the case of near infrared there is often some leakage (from LED’s) into the visible spectrum. This can easily be solved by visually blinding the subject with a mask.

But there are two other ways. Simply feeling the warmth of the LED’s on the skin. Also sensing the effect of the treatment on the skin, caused by the release of nitric oxide. These two factors are more at play when treating areas of the body that have a high sensory nerve density – like the hands or face. Also, when a subject is visually blinded, the awareness of the other senses usually becomes more prominent. Creating some extra sensations in the skin during both active and sham treatment is an efficacious way to make it impossible to recognise the active treatment.

tPBM treatment for MS
One of the treatment setups – with two heat lamps for blinding at the top.

To that end, we used an infrared heat lamp (Philips Infraphil; 150 watt) at approximately one meter distance, to induce just a little heat on the skin. I asked my subject in a questionnaire after each treatment whether he thought if it was active or sham. He was unable to do so correctly.

Based on my experiences and what I’ve read in the literature so far, there is no indication that the low dose wide spectrum red and infrared light of such a lamp could interfere with the intervention. My conclusion is that using a heat lamp for blinding works well.

Describing infrared irradiation

I underestimated the process of describing the intervention. Shining light on my subject turned out to be much more complex than I initially thought. I also found out, that this is a common problem in the field of PBM research.

Many scientific papers regarding photobiomodulation using laser and LED devices, fail to describe the irradiation with red and infrared light correctly. To be able to compare or replicate studies, or use the results in a clinical setting, the treatment parameters need to be accurately specified.

In 2016 the group of Mohammed Hadis of the University of Birmingham (School of Dentistry) published a systematic review (11) in the Lasers in Medical Science journal. This article provides an overview of ‘best practice’ in infrared light measurement.

They recommend to include light treatment properties such as wavelength, power, pulse parameters, beam area, beam profile information, irradiance, exposure time, radiant exposure and evidence of calibrated measurement tools, interval between treatments and anatomical location.

Unpredictability of MS symptoms

Many MS patients notice that their cognitive functioning is unstable and becomes less reliable as the disease progresses. One moment they can solve a problem or task easily; in the next they fail to do so. This unpredictability of their cognitive ability and energy levels, can make it difficult to plan their day and week.

I heard about this irregularity of MS symptoms early on, but in the cortical metrics data generated by the Brain Gauge it showed up in front of my eyes. For no apparent reason John’s cognitive impairment would come and go. John himself was unable to asses how he performed during the tests.

It is harder to study the effects of a photobiomodulation treatment in the context of this phenomenon. Despite these difficulties I saw a net positive effect of tPBM on cognitive fatigue.

The main insight here is that the Brain Gauge may well be an excellent instrument to study the fluctuation in cognitive function of multiple sclerosis patients in great detail.


6. Capita selecta

During the period of our experimentation from 2017 till 2022, regularly new ideas, hypotheses and questions regarding multiple sclerosis and photobiomodulation came by. Hereunder I discuss the ones that I consider worth mentioning.

Vitamin D – a proxy perhaps?

There is a latitudinal gradient in the prevalence of MS. The further away from the equator, the higher the number of cases (12). The leading hypothesis suggests that this is caused by lower levels of vitamin D with increasing latitude. Vitamin D is a hormone synthesized in skin through exposure to sunlight. Although humans can get vitamin D from tanning beds, supplements and food, ultraviolet-b (UVB) from sunlight is the main source. Due to the longer distance sunlight has to travel through the atmosphere, less UVB light reaches the surface of the planet at higher latitudes. Hence less serum vitamin D in humans. This seems to be a good theory. However, supplementation with vitamin D does not seem to have the expected benefits for MS patients (13).

That leads to the idea that there could well be another beneficial effect of sunlight. There are many wavelengths to look at: ultraviolet-b (UVB), ultraviolet-a (UVA), visible light (including red), near infrared (NIR), mid infrared (MIR) and far infrared (FIR). Which of these spectra has the most health promoting and/or therapeutic effects?

It looks like red and NIR light is the prime candidate. More than half of the energy radiated by the sun is in the infrared spectrum and nearly all of that is NIR (14). Another clue is that NIR has the deepest penetration into the human body. And then there is a growing body of scientific evidence indicating that NIR light has many beneficial health properties. This perspective and the subsequent importance of photobiomodulation is also the conclusion of a recent Finnish study (15).

To conclude: vitamin D may play a smaller role in multiple sclerosis than was thought up to now. Vitamin D serum levels are a proxy for UVB exposure and therefore also for NIR exposure. Near infrared light could well be a significant factor in the prevention and treatment of MS.

Transcranial versus systemic photobiomodulation

One topic of discussion in multiple sclerosis PBM research is the way (infra)red light should be delivered to the body. This can be done in a variety of ways. The two main routes are transcranial and systemic PBM.

Transcranial PBM is targeted at just one organ – the brain. Applying a treatment locally on the head means that many different tissues inside the skull will be irradiated – not just blood. In tPBM – aka brain photobiomodulation – the target and the location of treatment are close together. Also there is no loss of energy into other areas of the body than the brain.

Systemic PBM uses the circulating blood and the free mitochondria therein to transport the energy downstream to the rest of the body. Often the light is shone on the wrist (radial artery), under the tongue or inside the nose. Here the target and the location of treatment are further apart. The preferred systemic treatment is probably intranasal photobiomodulation; good light-blood interface, not too far from the brain, relatively convenient to the patient and the availability of cheap portable devices.

I personally think that transcranial PBM is the best way to move forward. The proximity of the target tissue means more control over dosing. Also other (non-mitochondrial) effects like stem cell stimulation are more likely to occur close to the site of treatment.
Systemic irradiation like intranasal PBM may also be beneficial for MS patients, but may not reach the central nervous system enough for major effects on disease progression. Of course, a combination of both is also possible.

Mechanism of photobiomodulation for MS

How does near infrared light cause a reduction in the need to sleep, reduce pain or improve cognitive fatigue in an MS patient? Fully understanding this may not be so easy, since there are many ways how photobiomodulation could accomplish this. Let’s start by looking at some of the known effects of photobiomodulation:

  • Increase ATP production in the brain via mitochondria
  • Reducing inflammation
  • Increasing cerebral blood flow
  • Stimulating lymphatic drainage in the brain
  • Altering the electrical activity of the brain (alpha & beta activity goes up)
  • Turning on growth factors
  • Improving brain function via the microbiome, that responds to PBM
  • Increased stem cell production
  • Genetic up/down regulation

Note that there can be different effects in different tissues. Looking at a transcranial PBM treatment we find within the first 5 cm of penetration: skin, blood, bone (including marrow), dura, cerebrospinal fluid and brain. NIR light will stimulate free mitochondria in blood, but stimulate stem cell production in bone marrow. Any PBM treatment will affect more than one type of tissue.

Yet another hurdle: some photobiomodulation effects occur within minutes after exposure, others after hours and yet others after days and even weeks.

Taking all these parameters into consideration, it becomes clear that understanding this is quite complex and therefore it is not easy to draw firm conclusions. Most if not all researchers in the field of photobiomodulation agree at least on one thing: we don’t know much about how it works. Nevertheless, enhanced mitochondrial function is a good candidate, as mitochondrial dysfunction and oxidative stress contribute to MS.

Multiple mechanisms for photobiomodulation
Mechanisms of transcranial photobiomodulation | Michael Hamblin (2019)

Remaining questions

Curiosity is the motor of science. While I am rounding up this project there are still many questions that remain. I would like to formulate some of these to inspire new lines of research.

1. Could unilateral transcranial PBM – where just one side of the head is treated – be of use to increase well-being in MS patients? See the work of Fredric Schiffer for context.

2. Is transcranial PBM treatment for MS more effective in the morning than at other times of the day? The rationale being that the human body is better able to harvest infrared light depending on circadian rhythm (10). Our treatments always took place in the afternoon.

3. Can remyelination be increased by tPBM in conjunction with a supplement or drug (16)?

4. What are the effects of photobiomodulation on the cerebrospinal fluid (CSF)? Can it contribute to remote or systemic impact of local treatment?

5. Multiple sclerosis is essentially the result of a imbalance of demyelination (DM) and remyelination (RM) – both modulated by growth factors produced by microglia. Is it possible to stimulate the regenerative phase with tPBM?


7. Appendix: Information for MS patients

If you have been diagnosed with multiple sclerosis, you may be looking for a cure or ways to improve quality of life. Photobiomodulation (PBM) is an emerging therapy that can treat many conditions. Below I will address some of the questions you could have regarding photobiomodulation and multiple sclerosis. Please note that I am not a doctor and this is not medical advise. Proceed at your own risk.

Can photobiomodulation therapy cure MS?

So far there is no indication that this is possible.

Is photobiomodulation therapy safe for people with MS?

PBM is generally safe and it looks like this also applies to MS patients. Nevertheless it is wise to go low and slow. High doses of red or infrared light can be detrimental. Do not use a device or lamp that produces heat, and avoid saunas of any kind.

Can PBM reduce symptoms or slow down the progression of MS?

It is my impression that this is indeed possible. There is also a mechanism for this: PBM can reduce inflammation, which is responsible for the degeneration of the myelin sheat around the nerves. There are still a lot of questions around the practical application, however.

Does photobiomodulation help against pain?

Yes, it can help with many types of pain, including the musculoskeletal and neuropathic pain that are common in MS. Another non-drug treatment for pain is pulsed electromagnetic field therapy (PEMF). This may sometimes be the better choice as red and infrared light can only reach into the body so far. Using either PBM or PEMF avoids the side effects of pain medication.

Where can I find a doctor or clinic that can treat me?

I don’t know. Search online using the terms ‘photobiomodulation’ or ‘low level laser therapy’. Or see if there is a functional medicine practice or biohacking clinic in your area. If no provider is available and you are capable to taking your health into your own hands, buying a PBM device could be an option.

Which device do you recommend?

Use a narrowband LED device, that emits either red light (around 660 nm) or near infrared light (810-850 nm) or a combination. I advise against wide spectrum incandescent (sauna) lamps that produce heat, like the ones that are being promoted by Terry Wahls. For pain management the FlexBeam is a well designed device with good specifications. For transcranial photobiomodulation there are the Neuradiant, Mono/Duo Coronet and Vielight.

Are there other treatments for multiple sclerosis that you know about?

Yes. While I was going through the photobiomodulation and MS literature, I regularly stumbled upon other interventions that are worth looking at. Mesenchymal Stem Cell therapy and treatments with peptides (NVG-291) are promising. Focusing on remyelination (16) with lifestyle and supplements (CDP-choline, N-acetylglucosamine) seems a good strategy. To combat MS related cognitive fatigue electric stimulation (tDCS) may work. And I would look at melatonin, molecular hydrogen and also methylene blue. Always do your own research.

The future of photobiomodulation and MS?

There is a lot unknown about PBM and MS. More scientific research has to be done before we know what the exact role of PBM in treating MS can be. Most likely the applications will be fatigue, pain & cognitive function and slowing down disease progression by reducing inflammation. I expect that in the coming years there will be more high quality studies, devices and protocols for neurodegenerative autoimmune diseases like MS.


8. Conclusion

After 5 years of experimenting and studying the literature, I conclude that photobiomodulation can play a role in the management of MS symptoms. Treating MS patients with red and near-infrared light can reduce pain and seems to be able to improve (cognitive) fatigue. More scientific research needs to be done.


9. Sources

1. Michael Hamblin tPBM review study (2016): Shining light on the head: Photobiomodulation for brain disorders
2. Low-Level Laser Therapy: A treatment modality for Multiple Sclerosis targeting autoimmunity and oxidative stress. (Chapter 27 of the Handbook of Low-Level Laser Therapy, 2017)
3. Article on the Brain Gauge by Nattha Wannissorn (SelfHacked)
4. Photobiomodulation research database by Vladimir Heiskanen (Valtsu)
5. Uhthoff’s phenomenon on Wikipedia
6. Joseph Cohen interview with Michael Hamblin
7. Research article (2015) by Jeri-Anne Lyons: Light therapy to treat autoimmune disease
8. Processing speed test: Validation of a iPad ®-based tool for screening cognitive dysfunction in a clinic setting
9. Surface of the human head (for dose calculation) on Wikipedia.
10. Cameron Borg interviews Professor of Neuroscience Glen Jeffrey (timing of PBM treatment)
11. Hadis et al. (2016): ‘The dark art of light measurement: accurate radiometry for low-level light therapy
12. Meta-analysis (2011): ‘Latitude is significantly associated with the prevalence of multiple sclerosis
13. CNS Drugs (2019): ‘An Update on Vitamin D and Disease Activity in Multiple Sclerosis
14. Wikipedia: Infrared
15. Heiskanen, Pfiffner and Partonen (2020): ‘Sunlight and health: shifting the focus from vitamin D3 to photobiomodulation by red and near-infrared light
16. Neurological Research and Practice (2019): ‘An unmet clinical need: roads to remyelination in MS



Author

‘Photobiomodulation for MS’ was written by Dutch biohacker Tjeerd Verbeek (Biohackz) between 2017 and November 2022. It is being updated irregularly.
Permanent URL: https://www.biohackz.nl/photobiomodulation-multiple-sclerosis

Thanks

Many thanks to: John Boogaert, Salomon Tetelepta, Thomas Verbeek, Robert Paimans, Arjen Helder, Vladimir Heiskanen, Joost van der Rijt, Mark Tommerdahl, Chris Tommerdahl, Job Merkies, Merijn de Haen, Els van der Kooij, Mohammed Hadis, Genane Loheswaran and Lew Lim.

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Keywords & hashtags

photobiomodulation, transcranial, multiple sclerosis, low-level laser therapy, #ms, #photobiomodulation, #biohacking, #pbm, #lllt, #tpbm,

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