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Multiple sclerosis

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
  • Walk

During an MS "flare", 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, it may block or slow neurological transmission of messages, resulting in diminished or lost function.


Signs and Symptoms

Symptoms of MS include:

  • 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. Scientists think the disease is an autoimmune condition 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 is Most At Risk?

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

  • First degree relatives with MS
  • Age between 20 to 40
  • 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 to 2.5 more women than men
  • Cigarette smoking
  • Vitamin D deficiency

What to Expect at Your Provider's Office

If you have symptoms associated with MS, you should see your health care provider. Your provider will:

  • Take a history of clinical symptoms
  • Check for neurological problems
  • Order lab tests, such as a cerebrospinal fluid exam and agar gel electrophoresis
  • Order imaging procedures, such as a computed tomography scan (CT scan) and magnetic resonance imaging (MRI)

Treatment Options

Treatment Plan

The primary goal of treatment 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 help treat severe and disabling tremors and reduce severe spasms.

Complementary and Alternative Therapies

A comprehensive treatment plan for MS may include a range of complementary and alternative medical 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 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 provider may want to test you for food allergies.
  • Eat more antioxidant-rich foods (green, leafy vegetables and peppers) and fruits (blueberries, tomatoes, and cherries).
  • Avoid refined foods, such as white breads, pastas, and sugar.
  • 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 to 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 to 2 capsules or 1 tbsp. of oil, 1 to 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 medications (including aspirin).
  • Evening primrose oil (EPO): 500 mg to 8 grams daily, for symptoms of MS. Speak to your doctor about the appropriate dosage for your body. 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 to 2,000 mg daily) and vitamin D supplement (1,000 IU daily): for support of muscle and skeletal weakness.
  • Vitamin D (1,000 IU daily): for immune protection. Since the 1970s scientists have identified vitamin D deficiency as a possible contributing factor in the development of MS. Sun exposure and dietary sources of vitam D during childhood and adolescence have been associated with a lower risk of developing MS.
  • Coenzyme Q10: 100 to 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 to 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 people with MS, they may not be appropriate for individuals who are severely immunosuppressed or who are on immunosuppressive drugs.
  • Melatonin: 2 to 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 are one way to strengthen and tone the body's systems. As with any therapy, you should speak with your 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 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.

  • Green tea ( Camellia sinensis ) standardized extract: 250 to 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 to 600 mg daily, for antioxidant, antistress, and immune activity.
  • Milk thistle ( Silybum marianum ) seed standardized extract: 80 to 160 mg, 2 to 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 warfarin (Coumadin) and aspirin, and can interfere with certain medications, including some antibiotics.

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of gastritis symptoms (nausea and vomiting) based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account your constitutional type, includes 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. Remedies include:

  • 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 for people with MS.
  • 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 people experience attacks and remissions, and about half of these undergo a chronic, progressive worsening after about 10 years. 10 to 15% of people experience a chronic, progressive, worsening of the disease from the initial onset, and 15 to 20% of people have a relatively mild course of the disease. Most people with MS 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. People who have MS are at a higher risk than the general population of:

  • Developing bone loss from inactivity
  • Steroid use
  • Vitamin D deficiency

MS is also associated with increased risk of some cancers, including urinary organs and brain tumors.

Following Up

People with MS will 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.

Ferri: Ferri's Clinical Advisor 2015 , 1st ed. Philadelphia, PA: Elsevier Mosby. 2014.

Gava G, Bartolomei I, Constantino A, et al. Long-term influence of combined oral contraceptive use on the clinical course of relapsing-remitting multiple sclerosis. Fertil Steril. 2014; 102(1):116-22.

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

Kargarfard M, Etemadifar M, Baker P, Mehrabi M, Hayatbakhsh R. Effect of aquatic exercise training on fatigue and health-related quality of life in patients with multiple sclerosis. Arch Phys Med Rehabil. 2012; 93(10:1701-8.

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.

McCoyd M. Update on Therapeutic Options for Multiple Sclerosis . Neurology Clinics. Philadelphia, PA: W.B. Saunders Company; 2013; 31(3).

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.

Rice CM, Kemp K, Wilkins A, Scolding NJ. Cell therapy for multiple sclerosis: an evolving concept with implications for other neurodegenative diseases. Lancet. 2013; 382(9899):1204-13.

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.

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          Review Date: 12/9/2014  

          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. Also reviewed by the A.D.A.M. Editorial team.

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