LDN Research Trust

A survey to monitor LDN as treatment for MS

This information will be used to collate anecdotal evidence in a statistic format; no names will be used. These anonymous results will be presented to the medical profession, research and other funding bodies, posted on the internet and printed where ever possible.
Your help and support is appreciated to initiate trials. Please complete the survey and return it to:

The LDN Research Trust. PO box 1083. Buxton. Norwich NR 10 SWY. UK or email to contact@ldnresearchtrust.org or use the internet form .

The LDN Research Trust will not pass your personal details on to a third party for any purpose whatsoever.

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Title:

First names::

Surname:

Address:

Phone (incl. area)

eMail Address:

Signature:

Date:

What form of MS do you have?
 
 

When did you start taking LDN approximately?
 
 

Are you still taking LDN?
 
 

In which dosage (s) did you take LDN?
 
 

At what time do you administer LDN?
 
 

If you stopped .. Why?

 

 

Have you had any side effects from taking LDN ?
 
 

If YES, please describe in brief:

Are these Side effects still present ?
 
 

Have you had any further progression while taking LDN?
 
 

Did LDNhelp with symtom relief?
 
 

If YES, how long did it take approximately?

 
 

Does your GP/neurologist recognise an improvement in you since taking LDN?
 
 

 

 

How many relapses did you have in the 12 month BEFORE going on LDN?
 
 

Where they confirmed by your GP/neurologist ?
 
 

How many relapses have you had since starting LDN?
 
 

Where they confirmed by your GP/neurologist ?
 
 

Were you on an interferon drug before starting on LDN?
 
 

Are you still?
 
 

 

 

Who supplies your LDN ie. Dr.Lawrence/your GP/ neurologist/the USA/other?

We would like you to rate your symptoms since starting LDN using the scoring below:

1_Symptom has gone 2_Improved greatly 3_Improved slightly 4_ no improvement 5_Increased greatly 6_increased slightly 7_Never had this symtom

Bladder Urgency
 

Fatigue
 

Bladder Retention
 

Restless legs
 

Sexual Dysfunction
 

Sleep Disturbance
 

Bowel control
 

Hearing
 

Diarrhoea
 

Speech
 

 

 

Swallowing
 

Constipation
 

Migraine type headache
 

Memory
 

Optic Neuritis
 

Concentration
 

Blurred Vision
 

Depression
 

Double Vision
 

Balance
 

 

 

Dizziness/Vertigo
 

 

 

Mobility
 

Muscle Spasm
 

Muscle Strength
 

Muscle Pain
 

Tremor