Multiple sclerosis
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Multiple sclerosis

Table of Contents > Conditions > Multiple sclerosis     Print

Signs and Symptoms
What Causes It?
Who's Most At Risk?
What to Expect at Your Provider's Office
Treatment Options
Prognosis/Possible Complications
Following Up
Supporting Research

Multiple sclerosis (MS) is an unpredictable disease of the nervous system that disrupts communication between the brain and other parts of the body. Its effects can range from relatively mild in most cases to somewhat disabling to devastating. The symptoms may mysteriously occur and then disappear. In the worst cases, a person with MS may be unable to write, speak, or walk. About 350,000 Americans have MS, with most cases occurring between 18 - 45 years of age.

During an MS attack, inflammation occurs in areas of the white matter (pale colored nerve tissue) of the central nervous system in random patches called plaques. This is followed by destruction of myelin, the fatty covering that protects nerve cell fibers in the brain and spinal cord. Myelin allows for the smooth, high speed transmission of electrochemical messages between the brain, the spinal cord, and the rest of the body. When myelin is damaged, neurological transmission of messages may be slowed or blocked completely, resulting in diminished or lost function.

Signs and Symptoms

  • Weakness in motor skills and loss of muscle coordination
  • Fatigue
  • Tingling, numbness, dizziness
  • Blurred vision
  • Pain
  • Heat sensitivity
  • Loss of bladder control
  • Memory loss, problem solving difficulties
  • Mood disturbances
  • Spasticity or tremor
  • Sexual dysfunction

What Causes It?

The cause of MS is unknown. The disease is thought to be a T-cell autoimmune disease influenced by genetic and environmental factors. Other theories include a childhood virus that primes the immune system for an attack against myelin in early adulthood.

Who's Most At Risk?

People with the following conditions or characteristics are at risk for developing MS:

  • First degree relatives with MS
  • Age between 18 - 45
  • Living in the northern latitudes for the first 15 years of life
  • North European, North American, or Scandinavian ancestry
  • Immune response genes
  • Women -- MS affects 2 - 2.5 more women than men
  • Cigarette smoking
  • People with chronically low levels of vitamin D

What to Expect at Your Provider's Office

If you are having symptoms associated with MS, you should see your health care provider. Your health care provider will take a history of clinical symptoms, check for neurological problems, and refer you for lab tests, such as a cerebrospinal fluid exam and agar gel electrophoresis, and imaging procedures, such as a computed tomography scan (CT scan) and magnetic resonance imaging (MRI).

Treatment Options

Treatment Plan

The primary goal of a treatment plan is to reduce the severity of attacks using certain medications and to extend the individual's physical functioning for as long as possible.

Drug Therapies

Your health care provider may prescribe the following medications -- or a combination of the following medications:

  • Steroids with anti-inflammatory properties to reduce severity of attacks
  • Beta interferon to decrease myelin destruction, reduce frequency and severity of attacks, and slow progression of disease
  • Immunotherapy, antigen targeting, cytokines, and remyelination are experimental therapies that may alter the course of the disease

Surgical and Other Procedures

Surgery may be used to treat severe and disabling tremors or to reduce severe spasms.

Complementary and Alternative Therapies

A comprehensive treatment plan for MS may include a range of complementary and alternative therapies (CAM). Always work with a knowledgeable provider when seeking CAM therapies for the treatment of MS. Some CAM therapies may interfere with conventional treatments. Inform all of your health care providers about any CAM therapies you are considering.

Nutrition and Supplements

These nutritional tips may help reduce symptoms:

  • Eliminate all suspected food allergens, including dairy, wheat (gluten), soy, chocolate, corn, preservatives, and food additives. Your health care provider may want to test you for food allergies.
  • Eat more antioxidant rich foods (such as green, leafy vegetables and peppers) and fruits (such as blueberries, tomatoes, and cherries).
  • Avoid refined foods, such as white breads, pastas, and sugar.
  • Eat fewer red meats and more lean meats, cold water fish, tofu (soy, if no allergy) or beans for protein.
  • Use healthy oils in foods, such as olive oil or coconut oil.
  • Reduce or eliminate trans fatty acids, found in such commercially baked goods as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
  • Avoid coffee and other stimulants, alcohol, and tobacco.
  • Drink 6 - 8 glasses of filtered water daily.
  • Exercise moderately, if tolerated, at least 30 minutes daily, 5 days a week.

You may address nutritional deficiencies with the following supplements:

  • Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tbsp. of oil 1 - 2 times a day, to help reduce inflammation and improve immunity. Fish oils may increase bleeding in sensitive individuals, such as those taking blood-thinning mediations (including aspirin).
  • Evening primrose oil (EPO), 500 mg - 8 grams daily, for symptoms of MS. Speak to your doctor about the appropriate dosage for your bodey. EPO may increase the blood-thinning effects of certain medications, including warfarin (Coumadin) and aspirin. EPO may also interfere with certain antiseizure medications.
  • A multivitamin daily, containing the antioxidant vitamins A, C, D, E, the B-vitamins and trace minerals, such as magnesium, calcium, zinc, and selenium.
  • Calcium (1,500 - 2,000 mg daily) and vitamin D supplement (1,000 IU daily), for support of muscle and skeletal weakness. Recently, low levels of vitamin D have been linked to MS.
  • Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant, immune, and muscular support. Coenzyme Q10 may interact with certain blood thinning medications such as wafarin (Coumadin) and others. 
  • N-acetyl cysteine, 200 mg daily, for antioxidant effects. N-acetyl cysteine can interact with nitroglycerine.
  • Acetyl-L-carnitine, 500 mg daily, for antioxidant and muscle protective activity. Acetyl-L-carnitine has been suspected by some researchers to be unsafe for people with a history of seizure disorders. Speak with your doctor.
  • Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Some probiotic supplements may need refrigeration. Check the label carefully. While probiotics may be helpful for most people with MS, they may not be appropriate for individuals who are severely immunosuppressed or who are on immunosuppressive drugs.
  • Grapefruit seed extract (Citrus paradisi), 100 mg capsule or 5 - 10 drops (in favorite beverage) 3 times daily, for antibacterial or antifungal activity and immunity. Grapefruit can interfere with a variety of medications; speak with your doctor. 
  • L-theanine, 200 mg 1 - 3 times daily, for nervous system support. Theanine may lower blood pressure.
  • Melatonin, 2 - 5 mg 1 hour before bedtime, for sleep and immune protection. Melatonin may interact with many medications, including sedatives, antidepressants, hormone medications, including birth control, and others.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should speak with your health care provider before starting treatment. You may use herbs as dried extracts (capsules, powders, and teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

  • Ginkgo (Ginkgo biloba) standardized extract, 40 - 80 mg 3 times daily, for antioxidant and immune support. Ginkgo supplements may increase bleeding in sensitive individuals, such as those taking blood-thinning mediations (including aspirin).
  • Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
  • Rhodiola (Rhodiola rosea) standardized extract, 100 - 600 mg daily, for antioxidant, antistress, and immune activity.
  • Milk thistle (Silybum marianum) seed standardized extract, 80 - 160 mg 2 - 3 times daily, for detoxification support. Milk thistle may cause an allergic reaction in people who are sensitive to ragweed. Since milk thistle works on the liver, it can potentially interfere with a variety of medications. Speak with your physician.
  • Bromelain (Ananus comosus) standardized, 40 mg 3 times daily, for pain and inflammation. Bromelain may increase the blood-thinning effects of certain medications, such as Coumadin and aspirin and can interefere with certain medications, including some antibiotics.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of gastritis symptoms (such as nausea and vomiting) based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account your constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for you individually. Combination remedies may be used for fatigue, spasm, and to help rid the body of impurities.

  • Carboneum sulphuratum
  • Causticum
  • Lathyrus sativus
  • Phosphorus

Physical Medicine

  • Acupuncture - Acupuncture may alleviate symptoms. Acupuncture may help enhance immune function, normalize digestion, and address disease conditions. Scalp acupuncture may be particularly helpful and is used often with neurological complaints.
  • Massage - Massage is important for maintaining flexibility and reducing spasticity, as well as improving overall sense of well being.
  • Yoga - Yoga may help improve spasticity, cognitive impairment, mood changes, and fatigue in patients who have MS.
  • Aquatic exercise - Studies show that aquatic exercise programs may help improve pain and other symptoms, such as fatigue, spasm, and disability among people who have MS.

Prognosis/Possible Complications

About 70% of patients experience attacks and remissions, and about half of these undergo a chronic, progressive worsening after about 10 years. Between 10 - 15% of patients experience a chronic, progressive worsening of the disease from the initial onset, and 15 - 20% of patients have a relatively mild course of disease. Most MS patients live for 30 years or more with the disease, many still working and mobile, though bladder, bowel and sexual dysfunction are common among this population. Patients who have MS are at higher risk than the general population of developing bone loss from inactivity, steroid use, and vitamin D deficiency. MS is also associated with increased risk of some cancers, including urinary organs and brain tumors.

Following Up

Patients need lifelong monitoring, especially during flare-ups.

Supporting Research

Bahmanyar S, Montgomery SM, Hillert J, Ekbom A, Olsson T. Cancer risk among patients with multiple sclerosis. Neurology. 2009;72(13):1170-7.

Bates D. Treatment effects of immunomodulatory therapies at different stages of multiple scleroris in short-term trials. Neurology. 2011;76(1 Suppl 1):S14-25.

Bowling AC. Complementary and alternative medicine and multiple sclerosis. Neurol Clin. 2011;29(2):465-80.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.

Castro-Sanchez AM, et al. Hydrotherapy for the treatment of pain in people with multiple sclerosis: a randomized controlled trial. Evid Based Complement Alternat Med. 2012;2012:473963.

Conway D, Cohen J. Combination therapy in multiple sclerosis. The Lancet Neurology. 2010;9(3).

Courtney A, Treadaway K, Remington G, Elliot F. Multiple Sclerosis. Medical Clinics of North America. 2009;93(2).

Cvetnic Z, Vladimir-Knezevic S. Antimicrobial activity of grapefruit seed and pulp ethanolic extract. Acta Pharm. 2004;54(3):243-50.

Das M, Sur P, Gomes A, Vedasiromoni JR, Ganguly DK. Inhibition of tumor growth and inflammation by consumption of tea. Phytother Res. 2002;16 Suppl 1:S40-4.

Dorchies OM, Wagner S, Vuadens O, et al. Green tea extract and its major polyphenol (-)-epigallocatechin gallate improve muscle function in a mouse model for Duchenne muscular dystrophy. Am J Physiol Cell Physiol. 2006;290(2):C616-25.

Farinotti M, Simi S, Di Pietrantonj C, et al. Dietary interventions for multiple sclerosis. Cochrane Database Syst Rev. 2007;(1):CD004192.

Goldman: Goldman's Cecil Medicine. 24th ed. St. Louis, MO: Saunders Elsevier; 2011.

Hale LP, Greer PK, Trinh CT, James CL. Proteinase activity and stability of natural bromelain preparations. Int Immunopharmacol. 2005;5(4):783-93.

Handunnetthi L, Ramagopalan SV, Ebers GC. Multiple sclerosis, vitamin D, and HLA-DRB1*15. Neurology. 2010;74(23):1905-10.

Huntley A. A review of the evidence for efficacy of complementary and alternative medicines in MS. Int MS J. 2006 Jan;13(1):5-12, 4.

Johnson SK, Diamond BJ, Rausch S, et al. The effect of Ginkgo biloba on functional measures in multiple sclerosis: a pilot randomized controlled trial. Explore (NY). 2006;2(1):19-24.

Kim SE. Daclizumab treatment for multiple sclerosis. Pharmacotherapy. 2009;29(2):227-35.

Kimball SM, Ursell MR, O'Connor P, Vieth R. Safety of vitamin D3 in adults with multiple sclerosis. J Clin Nutr. 2007;86(3):645-51.

Kormosh N, Laktionov K, Antoshechkina M. Effect of a combination of extract from several plants on cell-mediated and humoral immunity of patients with advanced ovarian cancer. Phytother Res. 2006;20(5):424-5.

Mark BL, Carson JA. Vitamin D and autoimmune disease -- implications for practice from the multiple sclerosis literature. J Am Diet Assoc. 2006;106(3):418-24.

Mews S, Zettl UK. Use of alternative and complementary therapies in clinical practice using multiple sclerosis as an example. Dtsch Med Wochenschr. 2012;137(11):547-51.

Pierrot-Deseilligny C, Souberbielle JC. Is hypovitaminosis D one of the environmental risk factors for multiple sclerosis? Brain. 2010;133(Pt 7):1869-88. 

[No authors listed]. L-theanine. Monograph. Altern Med Rev. 2005;10(2):136-8.

Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505.

Snook EM, Motl RW. Effect of exercise training on walking mobility in multiple sclerosis: a meta-analysis. Neurorehabil Neural Repair. 2009;23(2):108-116.

Velikonja O, Curic K, Ozura A, Jazbec SS. Influence of sports climbing and yoga on spasticity, cognitive function, mood and fatigue in patients with multiple sclerosis. Clin Neurol Neurosurg. 2010;112(7):597-601.

Whitmarsh TE. Homeopathy in multiple sclerosis. Complement Ther Nurs Midwifery. 2003;9(1):5-9.

Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-96.

Review Date: 7/3/2012
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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