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Multiple sclerosis

• 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 in which communication between the brain and other parts of the body is disrupted. 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 20 - 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

MS is accompanied by the following signs and symptoms:

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

What Causes It?

The cause of MS is unknown. 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 20 and 40
• Living in the northern latitudes for the first 15 years of life
• North European, North American, or Scandinavian ancestry
• Immune response genes

What to Expect at Your Provider's Office

If you or someone you care for are experiencing 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 through the use of 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:

• 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.

Nutrition and Supplements

Following 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 cooking oils, such as olive oil or vegetable 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 one to two times a day, to help decrease inflammation and improve immunity. Cold-water fish, such as salmon or halibut, are good sources.
• Evening primrose oil (EPO), 500 mg to 8 grams daily, for symptoms of MS. Consult with your health care provider for the best dosage for your body.
• 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 and vitamin D supplement, 1 - 2 tablets daily, for support of muscle and skeletal weakness.
• Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant, immune, and muscular support.
• N-acetyl cysteine, 200 mg daily, for antioxidant effects.
• Acetyl-L-carnitine, 500 mg daily, for antioxidant and muscle protective activity.
• Probiotic supplement (containing Lactobacillus acidophilus) , 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. You should refrigerate your acidophilus products.
• Grapefruit seed extract ( Citrus paradisi ), 100 mg capsule or 5 - 10 drops (in favorite beverage) three times daily, for antibacterial or antifungal activity and immunity.
• L-theanine, 200 mg one to three times daily, for nervous system support.
• Melatonin, 2 - 5 mg 1 hour before bedtime, for sleep and immune protection.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should 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 three times daily, for antioxidant and immune support.
• 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 two to three times daily, for detoxification support.
• Bromelain ( Ananus comosus ) standardized, 40 mg three times daily, for pain and inflammation.

Homeopathy

Combination remedies may be used for fatigue, spasm, and to help rid the body of impurities.

• Carboneum sulphuratum
• Causticum
• Lathyrus sativus
• Phosphorus

Acupuncture

Acupuncture may alleviate symptoms. Acupuncture may help enhance immune function, normalize digestion, and address disease conditions.

Massage

Massage is important for maintaining flexibility and reducing spasticity, as well as improving the overall sense of well-being.

Prognosis/Possible Complications

About 70 percent of patients experience attacks and remissions, and about half of these undergo a chronic, progressive worsening after about 10 years. Ten to 15%% of patients experience a chronic, progressive worsening of the disease from the initial onset. Fifteen to 20% of patients have a relatively mild course of disease. Most MS patients live for 30 years or more, many still working and mobile.

Following Up

Patients need lifelong monitoring, especially during flare-ups.

Supporting Research

Adams RD, Victor M. Principles of Neurology . 6th ed. New York, NY: McGraw-Hill; 1997: 902–921.

Bartram T. Encyclopedia of Herbal Medicine . Dorset, England: Grace Publishers;1995:299-300.

Branch WT. Office Practice of Medicine . 3rd ed. Philadelphia, PA: Saunders;1994: 721, 766–767.

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

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

Conn RB. Current Diagn osis . Philadelphia, PA: Saunders; 1991: 988–991.

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.

Fauci AS, et al. Harrison's Principles of Internal Medicine . 14 ^th ed. New York, NY: McGraw-Hill; 1997: 2409–2419.

Gaby AR. The role of coenzyme Q10 in clinical medicine: Part 1. Alt Med Rev . 1996; 1(1):11-17.

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

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.

JAMA Patient Page. How much vitamin C do you need? JAMA. 1999;281(15):1460.

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.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

Kelley WN, et al. Textbook of Internal Medicine . 3 ^rd ed. Vol 2. Philadelphia, PA: Lippincott-Raven; 1997: 2385–2387.

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.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

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.

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

Taylor RB, et al. Family Medicine: Principles and Practice . 5th ed. Berlin, Germany: Springer; 1998: 589–591.

Rosen P, Barkin R, et al . Emergency Medicine: Concepts and Clinical Practice . Vol 3. St. Louis, MO: Mosby; 1998: 2219–2221.

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

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: 8/6/2006
• Reviewed By: Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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