Complementary and Alternative Medicine Usage by Multiple Sclerosis Patients: Results from a Prospective Clinical Study

Medicinal plants used in multiple sclerosis patients, prevalence and associated factors: a descriptive cross-sectional study

INTRODUCTION

Multiple sclerosis (MS) is a chronic and debilitating disease that not only leads to disability and associated condition but also impacts one's ability to maintain a professional life. People's acceptance and utilization of medicinal plants (MPs) play an important role in managing their treatment process. As a result, this study aims to investigate the use of medicinal herbs among patients with MS.

METHODS

A descriptive cross-sectional study was conducted on 150 MS patients who visited a private clinic and the MS Association in Kerman, Iran in 2021. A questionnaire comprising questions about sociodemographic information, disease variables, and aspects of MPs usage was utilized for data collection. Statistical analysis was performed using SPSS version 20 (SPSS Inc., Chicago, IL). The Chi-square test was employed to identify any association between demographic characteristics and MPs usage. To determine the prevalence of plant use in a specific area and the consensus among informants, the use value (UV) and Informant consensus factor (Fic) were calculated.

RESULTS

The study revealed a high prevalence of MPs usage among MS patients. Chamomile (66.6%) and golegavzaban (62.0%) were the most commonly used plants with the highest UV indices (0.88 and 0.82 respectively), while St. John's wort and licorice were rarely used (0.67% and 4% respectively). Participants cited pursuing a healthier lifestyle as the primary reason for using MPs (24%). St. John's wort, lavender, and chamomile were the most satisfying plants (100%, 100%, and 53.0% respectively). Chamomile had the highest Fic too. Most patients were motivated to get MPs from their relatives.

CONCLUSIONS

Given the widespread use of MPs among MS patients, neurologists should enhance their knowledge in this area to guide patients away from seeking advice from non-professionals. Providing standardized formulations can help prevent potential interactions between MPs and mainstream drugs, thereby improving patients safety and outcomes.

The Use of Traditional and Complementary Medicine Among Patients With Multiple Sclerosis in Morocco

BACKGROUND

Multiple sclerosis (MS) is an acquired chronic, autoimmune, and neurodegenerative disease of the central nervous system. In addition to conventional MS therapy, patients are interested in traditional and complementary medicine (T&CM). Our study aims to describe the use of T&CM in a cohort of Moroccan patients with MS.

METHODS

A quantitative descriptive study was adopted to study this subject. For data collection, we opted for an anonymous questionnaire for 98 patients with MS. We gathered data via an electronic survey, using multivariable analysis to examine the effect of specific factors on T&CM use. Data collection took place from March 2022 to June 2022.

RESULTS

The results show that 52% of patients use T&CM. Of those, 29.6% use cupping, 23.5% recite the Holy Quran, 15.3% use phytotherapy, 13.2% use apitherapy, and 10.2% use acupuncture. In addition, 66.3% of the surveyed respondents stated that alternative medicine positively affects their health. Finally, 49.1% of surveyed patients who use alternative medicine are between 30 and 40 years old. The results also show that the rate of T&CM use is higher in patients with progressive MS (OR = 2.540) and patients without financial access to disease-modifying therapy (OR = 2.100).

CONCLUSIONS

This study invites us to consider societal, cultural, and economic factors when studying the use of T&CM among people with MS. Further research is needed to understand the motivations for using T&CM.

Use of Complementary and Alternative Medicine in Patients With Idiopathic Inflammatory Demyelinating Diseases of the Central Nervous System: A Cross-Sectional Study in Thailand

Background

Complementary and alternative medications (CAM) are common among patients with multiple sclerosis (MS) for physical and psychological support. However, there is insufficient data regarding the application of CAM in the different cultures and beliefs of each community as well as patient's status.

Objective

To evaluate the prevalence and modalities of the use of CAM among patients with central nervous system idiopathic inflammatory demyelinating diseases (CNS-IIDD) in a tertiary care hospital.

Methods

A cross-sectional study was conducted at Siriraj Hospital from June to December 2021 involving patients with MS, neuromyelitis optic spectrum disorders (NMOSD), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), idiopathic transverse myelitis (iTM), and optic neuritis (ON) to examine the prevalence and mode of CAM use and its correlation with patient characteristics.

Results

There were 107 patients. The diagnoses were MS (38), NMOSD (55), MOGAD (5), iTM (7), and ON (2). Most of the patients were female (89.7%), and 61.7% were diagnosed over 5 years. The mean Expanded Disability Status Scale was 2.63 (S.D., 2.38), and the median ambulation index was 0 (range 0-8.5). There were 68 patients (63.6%) with a history of CAM use for at least 3 months, while those with current use decreased to 62 (58.5%). Vitamins and minerals were the most commonly used, particularly vitamin D (97.1%) and calcium (47.7%). Both treatments were primarily prescribed (95.3%) rather than self-administered (24.3%). The main reasons for the use of CAM were to strengthen their health (48.6%) and relieve existing symptoms (28.0%).

Conclusions

The use of CAM is common among patients with Thai CNS-IIDD. Further exploration of patient perspectives and preferences regarding CAM usage may contribute to a more comprehensive management approach for patients with CNS-IIDD.

Exploratory 5-year follow-up study of retinol, tocopherols, and carotenoids in multiple sclerosis

BACKGROUND

Retinol, tocopherols, and carotenoids (RTC) have physiological roles as vitamins, pro-vitamins, and antioxidants, and provide biomarkers of dietary vegetable and fruit intake. The goal was to investigate RTC in multiple sclerosis (MS).

METHODS

This exploratory study included 106 people with MS (71 relapsing-remitting MS or RR-MS; and 35 progressive MS or PMS) and 31 healthy controls (HC) at baseline and 5-year follow-up (5YFU). Serum retinol, α-carotene, β-carotene, α-tocopherol, δ-tocopherol, γ-tocopherol, β-cryptoxanthin, lutein/zeaxanthin, and lycopene were measured using high performance liquid chromatography. Serum neurofilament light chain (sNfL) levels were measured using the single molecule array method. Expanded Disability Status Scale (EDSS) and low contrast letter acuity (LCLA) were used as disability measures.

RESULTS

Retinol in MS was positively correlated with α-carotene, β-carotene, β-cryptoxanthin, lutein/zeaxanthin, and α-tocopherol but negatively correlated with δ-tocopherol. EDSS was associated with α-tocopherol, δ-tocopherol, and lycopene. Greater retinol levels were associated with greater LCLA in RR-MS and PMS; high contrast visual acuity was not associated. Greater γ-tocopherol levels were associated with lower LCLA and high contrast visual acuity in PMS.

CONCLUSIONS

RTC exhibit distinctive associations with LCLA and EDSS in MS.

Perceived Benefits of Magdalena Energy Healing Sessions: An Exploratory Study of Clients' Perspectives

BACKGROUND

Energy healing techniques are associated with many physical and mental benefits. A qualitative study was conducted to understand clients' experiences of a new energy healing modality called Magdalena Energy Healing.

METHODS

Semi-structured qualitative interviews were conducted after clients experienced 60 min Magdalena energy healing session(s). Twenty-five adults participated in the study. All participants received Magdalena energy healing from a certified, trained practitioner. Thematic analysis was conducted to determine clients' perceived benefits of the Magdalena energy healing session(s).

RESULTS

Four themes emerged from the data: Physical, Mental, Social, and Spiritual Benefits. Physical health benefits included relief from a variety of medical symptoms, improved sleep quality, and physical body awareness. Mental Health benefits included relaxation and peace, decision-making clarity, relief of mental health symptoms, and an increased ability to cope with life. Social Benefits included improved attitudes in relationships. Spiritual Benefits included optimism, gratitude, self-acceptance, and increased spiritual connection.

CONCLUSIONS

Participants' perceptions are that Magdalena energy healing sessions offer peace, symptom relief, and gratitude. Magdalena energy healing can address priorities of The National Center for Complementary and Integrative Health (NCCIH). Sessions can be seamlessly integrated into traditional medical care as a useful complementary/integrative healing option to improve physical, mental, and/or spiritual wellbeing across a variety of diseases.

Complementary and alternative medicine carts in the inpatient rehabilitation unit: Access and nurses' use

PURPOSE

To determine if increased accessibility to complementary and alternative medicine (CAM) increases the usage of CAM interventions.

METHODS

A prospective pre-post study with a "run-in" design in a hospital with two inpatient rehabilitation floors was used. Data were analyzed with SAS v9.4.

RESULTS

CAM use before implementation was 2.8 (1.0); after implementation, 3.1 (0.56).

CONCLUSION

Greater access to CAM materials did not significantly increase their use (P = .233). Aromatherapy was used more after increased availability, but heat and cold application decreased. Nurses valued CAM even though independent practice was not fully supported.

The preventive effect of Zingiber officinale essential oil on demyelination of corpus callosum in a cuprizone rat model of multiple sclerosis

Objective

Multiple sclerosis (MS) is the most prevalent neurological disability among young adults. Anti-inflammatory drugs have shown to be effective in MS. The anti-inflammatory and antioxidative properties of Zingiber officinale (ginger) have been shown and proven in many phytotherapy studies. This study aimed to evaluate effects of ginger essential oil on preventing myelin degradation in a rat model of MS.

Materials and Methods

In this study, we divided 49 rats into 7 groups; 4 control and 3 experimental groups that received 3 different dose of ginger essential oil (50, 100, and 150 mg/kg/day) for treatment of cuprizone-induced demyelinated rats. Basket test and transmission electron microscopy were performed in this study. Olig2 and Mbp genes and proteins were respectively evaluated by reverse transcription-polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA).

Results

Histologically, cuprizone created demyelination in the corpus callosum fibers. Remyelination of fibers was seen in the group treated with the medium dose of ginger essence, by toluidine blue staining. transmission electron microscopy (TEM) revealed increased thickness of the myelin of fibers in all 3 treated groups (p<0.05). Feeding by the medium dose of ginger essence significantly increased the levels of Mbp and Olig2 genes (p<0.05). ELISA test showed that 100 mg/kg/day of ginger caused a significant difference between experimental and the cuprizone-induced groups (p<0.05).

Conclusion

Our findings suggested that administration of ginger essential oil prevented demyelination and improved remyelination of rats` corpus callusom and can be used as an effective substance in the prevention of MS.

The role of multiple sclerosis therapies on the dynamic of human gut microbiota

Gut microbiota, the total microorganisms in our gastrointestinal tract, might have an implication in multiple sclerosis (MS), a demyelinating neurological disease. Our study included 50 MS patients and 21 healthy controls (HC). Twenty patients received a disease modifying therapy (DMT), interferon beta1a or teriflunomide, 19 DMT combined with homeopathy and 11 patients accepted only homeopathy. We collected in total 142 gut samples, two for each individual: at the study enrolment and eight weeks after treatment. We compared MS patients' microbiome with HC, we analysed its evolution in time and the effect of interferon beta1a, teriflunomide and homeopathy. There was no difference in alpha diversity, only two beta diversity results related to homeopathy. Compared to HC, untreated MS patients had a decrease of Actinobacteria, Bifidobacterium, Faecalibacterium prauznitzii and increased Prevotella stercorea, while treated patients presented lowered Ruminococcus and Clostridium. Compared to the initial sample, treated MS patients had a decrease of Lachnospiraceae and Ruminococcus and an increased Enterococcus faecalis. Eubacterium oxidoreducens was reduced after homeopathic treatment. The study revealed that MS patients may present dysbiosis. Treatment with interferon beta1a, teriflunomide or homeopathy implied several taxonomic changes. DMTs and homeopathy might influence the gut microbiota.

Alternative medicine therapies in neurological disorders: Prevalence, reasons and associated factors. A systematic review

OBJECTIVE

This systematic review aimed to identify the prevalence of CAM use in patients with neurological disorders, and also to know most frequent types of CAM used.

METHODS

Five databases: PubMed, Science Direct, EBSCO, Latindex and Scielo (in English and Spanish) were searched from January 2010 to May 2021. Only original cross-sectional, retrospective and cohort studies were included, whose primary objective was to describe the frequency of CAM use in neurological disorders and/or the related factors to its use in adults. Based on the data, a descriptive analysis was performed, covering the characteristics of studies, measuring methods, prevalence, types and related factors. To control the risk of bias, a quality assessment of each study was performed using STROBE checklist.

RESULTS

For the final analysis, 40 studies were included. Most common pathologies observed in the studies were multiple sclerosis, headache, stroke, Parkinson and epilepsy. The STROBE score of studies ranged from 13 to 22 points, with an average of 18.2. Prevalence of CAM use was highly variable from one study to another (16% in stroke patients, to 100% in amyotrophic lateral sclerosis or spinal cord injury patients). Biological therapies (dietary supplements and herbal medicine) were the most commonly CAM types used. The associated factors identified were female sex, an age between 40 and 50 years, and higher socioeconomic level. Not all studies investigated about the results of CAMs but these ranged from 35% to more than 80% of reporting positive effects.

CONCLUSIONS

The prevalence of CAM use in neurological diseases is highly variable (16%-100%); the most used type of CAM was biological therapies and the associated factors were female sex, age between 40 and 50 years old and high socioeconomic level.

Demyelinating diseases of the central nervous system registry for patients with traditional Chinese medicine: Rationale and design of a prospective, multicenter, observational study

Background: Traditional Chinese medicine (TCM), a main form of complementary and alternative medicine provides a potential possibility for demyelinating disease of the central nervous system (DDC) management and has been applied in considerable amounts of patients with this disorder. Nevertheless, powerful real-world evidences regarding the epidemiological and clinical characteristics, safety, and outcomes of TCM in DDC are lacking. The primary objective of the Demyelinating Diseases of the Central Nervous System Registry for Patients with Traditional Chinese Medicine (DATE-TCM) is to create an organized multicenter data collection structure to define integrative characteristics of DDC patients treated with TCM in an endeavor to fill these knowledge gaps to better inform clinical care and health policy.

Method: This study provides a prospective and voluntary registry by using a web-based system. Baseline data will be recorded and subsequently regular follow-up visits will be implemented every 3–6 months for a total of 5 years. The primary outcome is Annualized Aggregate Relapse Rate at 5-year follow-up.

Results: DATE-TCM is currently designed to capture the multidimensional (epidemiologic, demographic, clinical, etc.) features of DDC patients receiving TCM treatment, the type and long-term safety and efficacy of TCM intervenes in the DDC populations, as well as the interaction of TCM treatments and disease modifying therapies in the management of DDC, aiming to include 2000 eligible adult DDC patients with TCM intervenes from 35 participating centers, covering 77.4% of provincial administrative regions of mainland China.

Conclusion: DATE-TCM is the first, largest, most geographically extensive, and standard registry-based observational study that systematically document the real-world data regarding the TCM application in the DDC populations, which will be extraordinarily important for clarifying the comprehensive characteristics and outcomes of TCM in DDC, further shed light on standardizing and optimizing the TCM measures for DDC management and establishing evidence-based clinical practice guidelines for TCM application in DDC.

Medicinal herbs and multiple sclerosis: Overview on the hard balance between new therapeutic strategy and occupational health risk

Multiple sclerosis (MS) is an autoimmune disease characterized by demyelination and axonal loss of the central nervous system (CNS). Despite its spread throughout the world, the mechanisms that determine its onset are still to be defined. Immunological, genetic, viral, and environmental factors and exposure to chemicals may trigger MS. Many studies have highlighted the anti-inflammatory and anti-oxidant effects of medicinal herbs, which make them a natural and complementary treatment for neurodegenerative diseases. A severe reduction of several MS symptoms occurs with herbal therapy. Thus, the request for medicinal plants with potential beneficial effects, for MS patients, is constantly increasing. Consequently, a production increase needs. Unfortunately, many medicinal herbs were untested and their action mechanism, possible adverse effects, contraindications, or interactions with other drugs, are poorly or not investigated. Keeping in mind the pathological mechanisms of MS and the oxidative damages and mitochondrial dysfunctions induced by pesticides, it is important to understand if pesticides used to increase agricultural productivity and their residues in medicinal plants, may increase the risk of developing MS in both workers and consumers. Studies providing some indication about the relationship between environmental exposure to pesticides and MS disease incidence are few, fragmentary, and discordant. The aim of this article is to provide a glance at the therapeutic potential of medicinal plants and at the risk for MS onset of pesticides used by medicinal plant growers and present in medicinal herbs.

Complementary medicine usage in surgery: a cross-sectional survey in Germany

Background

Complementary medicine (CM) is frequently used by patients, but little is known about the usage of CM in surgical patients. The study aimed to elucidate the relevance of CM in surgery.

Methods

This cross-sectional, multi-center survey utilized a paper-based questionnaire consisting of 21 questions to capture CM usage and interest as well as CM communication in visceral and thoracic surgical patients being hospitalized at the corresponding departments of surgery at the University Medical Centers in Freiburg, Heidelberg und Ulm, Germany.

Results

Overall, 151 patients consented to the survey. On average, current CM usage was stated by 44% of patients. Most frequently used CM approaches were physical exercise (63%), nutritional supplements (59%) and herbal medicine (56%). Strong interest in CM counselling was stated by 51% of patients. Almost 80% of patients wanted to be treated in a holistic manner and desired for reliable information about CM as well as CM informed physicians. Only 12% of patients communicated CM usage and interest with their attending physician. Review of literature revealed similar results showing an overall CM usage of 43%, preferring nutritional supplements and herbal medicine.

Conclusion

The results of our cross-sectional study indicate a high percentage of CM users and a strong interest in CM among surgical patients. Indeed, the current communication about CM between patients and surgeons is poor. With respect to safety and quality reasons, but also to pay attention to patients’ demands, physicians should be aware of patients’ CM usage in surgery.

Trial registration

German Clinical Trial register (DRKS00015445).

Angiogenesis and Multiple Sclerosis Pathogenesis: A Glance at New Pharmaceutical Approaches

Multiple sclerosis is a chronic disease of the central nervous system characterized by demyelination and destruction of axons. The most common form of the disease is the relapsing-remitting multiple sclerosis in which episodic attacks with typical neurological symptoms are followed by episodes of partial or complete recovery. One of the underestimated factors that contribute to the pathogenesis of multiple sclerosis is excessive angiogenesis. Here, we review the role of angiogenesis in the onset and in the development of the disease, the molecular mechanisms underlying angiogenesis, the current therapeutic approaches, and the potential therapeutic strategies with a look at natural compounds as multi-target drugs with both neuroprotective and anti-angiogenic properties.

The effect of Zingiber Officinale Extract on Preventing Demyelination of Corpus Callosum in a Rat Model of Multiple Sclerosis

Background

Multiple sclerosis (MS) is the most prevalent neurological disability of young adults. Anti-inflammatory drugs have relative effects on MS. The anti-inflammatory and antioxidative effects of Zingiber officinale (ginger) have been proven in some experimental and clinical investigations. The aim of this study was to evaluate the effects of ginger extract on preventing myelin degradation in a rat model of MS.

Methods

Forty nine male Wistar rats were used in this study and divided into four control groups: the normal group, cuprizone-induced group, sham group (cuprizone [CPZ] + sodium carboxymethyl cellulose [NaCMC]), standard control group (fingolimod + cuprizone), including three experimental groups of CPZ, each receiving three different doses of ginger extract: 150, 300, and 600mg/kg /kg/day.

Results

Ginger extract of 600 mg/kg prevented corpus callosum from demyelination; however, a significant difference was observed in the fingolimod group (p < 0.05). Difference in the CPZ group was quite significant (p < 0.05).

Conclusion

Treatment with ginger inhibited demyelination and alleviated remyelination of corpus callosum in rats. Therefore, it could serve as a therapeutic agent in the MS.

Lifestyle and complementary therapies in multiple sclerosis guidelines: Systematic review

Management of multiple sclerosis (MS) may comprise clinical interventions and self-management strategies, including complementary therapies and modifiable lifestyle factors such as exercise and smoking cessation. Lifestyle modifications and complementary therapies with proven safety and efficacy are essential as part of best-practice MS management, especially when faced with limited access to healthcare services. However, it is unclear to what extent MS clinical practice guidelines and consensus statements address these strategies. A systematic review was conducted, wherein MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, Web of Science, guideline databases and developer sites were searched for guidelines and consensus statements that addressed lifestyle modifications and complementary therapies of interest. Two researchers independently screened articles, extracted data and assessed guideline quality using the Appraisal of Guidelines for Research and Evaluation version II. Thirty-one guidelines and consensus statements were included. Quality was high for 'clarity of presentation' (77%) and 'scope and purpose' (73%), moderate for 'stakeholder development' (56%), 'rigour of development' (48%) and 'editorial independence' (47%), and low for 'applicability' (29%). Two guidelines, related to physical activity and exercise, mindfulness, smoking cessation, and vitamin D and polyunsaturated fatty acid supplementation, scored high in all domains. These guidelines were two of only four guidelines intended for use by people with MS. High-quality guidelines and consensus statements to guide lifestyle modifications and complementary therapies in MS management are limited. Our findings indicate the need for more guidelines intended for use by people with MS, and a further focus on implementation resources.

Paeonol Ameliorates Cuprizone-Induced Hippocampal Demyelination and Cognitive Deficits through Inhibition of Oxidative and Inflammatory Events

Multiple sclerosis (MS) is a chronic and inflammatory disorder of the central nervous system with autoimmune nature that is typified by varying degrees of demyelination and axonal damage. Paeonol is an active ingredient in some medicinal plants with anti-inflammatory and neuroprotective property. This study was conducted to reveal whether paeonol can alleviate hippocampal demyelination and cognitive deficits in cuprizone-induced murine model of demyelination as a model of MS. C57BL/6 mice received oral cuprizone (400 mg/kg) for 6 weeks, and paeonol was administered p.o. at two doses of 25 or 100 mg/kg, starting from the second week post-cuprizone for 5 weeks. After assessment of learning and memory in different tasks, oxidative stress and inflammation were evaluated besides immunohistochemical assessment of hippocampal myelin basic protein (MBP). Paeonol (100 mg/kg) properly ameliorated cognitive deficits in Y maze, novel object discrimination (NOD) test, and Barnes maze with no significant improvement of performance in passive avoidance task. In addition, paeonol treatment at the higher dose was also associated with partial restoration of hippocampal level of oxidative stress and inflammatory markers including MDA, ROS, GSH, SOD, catalase, NF-kB, and TNF. Besides, paeonol improved MMP as an index of mitochondrial integrity and health and reduced MPO as a factor of neutrophil infiltration. Furthermore, paeonol treatment prevented hippocampal MBP immunoreactivity, indicating its prevention of demyelination. In conclusion, the current study showed the preventive effect of paeonol against cuprizone-induced demyelination and cognitive deficits through reversing most oxidative stress- and inflammation-related parameters in addition to its improvement of mitochondrial health.

The effect of aromatherapy with lavender essential oil on the working memory of women with multiple sclerosis

Working memory, one of the cognitive components, may be impaired in patients with multiple sclerosis. Accordingly, this study aims to determine the effects of aromatherapy with lavender essential oil on the working memory of women with multiple sclerosis (MS). In this clinical trial, 60 women with multiple sclerosis were selected using the sampling method from patients referred to the MS Clinic of Rafsanjan. Based on the inclusion and exclusion criteria, the participants were randomly divided into intervention and placebo groups. In addition, the working memory test developed by Daneman and Carpenter was used to evaluate the participants’ working memory before the intervention and the day after the last intervention. The collected data were analyzed using SPSS Statistics version 18.0. According to intragroup comparison results and based on the paired t-test, the mean score of the working memory before the intervention in the intervention group was 82.77±6.87, which increased to 87.64±5.57 after the intervention (P<0.001). The average working memory score of the placebo group was 80.30±11.09 and 82.09±11.31 before and after the intervention, respectively, which did not have a statistically significant difference (P=0.154). Based on findings from the independent t-test, the mean scores of working memory had a statistically significant difference between the intervention and placebo groups after the intervention (P=0.02). According to the results from this study, aromatherapy with lavender essential oil improved working memory in women with multiple sclerosis.

Effectiveness of equine-assisted therapies for improving health outcomes in people with multiple sclerosis: A systematic review and meta-analysis

BACKGROUND

Scientific evidence has shown that equine-assisted therapies (EAT) lead to improvements in the physical function and the quality of life (QoL) of people with disabilities through the practice of hippotherapy or therapeutic riding (TR). There is a need to confirm whether people with multiple sclerosis (PwMS) can also benefit from its practice. This review aimed to systematically evaluate and meta-analyze the available data on the potential health benefits of EAT in PwMS.

METHODS

Four electronic databases (MEDLINE/PubMed, Web of Science, SPORTDiscus, and Scopus) were searched systematically from their inception until June 2021 for randomized controlled trials (RCTs) and comparative studies that provided information regarding the effects of EAT on PwMS. The studies' methodological quality assessment was performed using the PEDro and the MINORS scales. For the meta-analysis, heterogeneity across studies was quantified using the I² statistic. Fixed-effect or random-effects models were applied to obtain the pooled results in the case of low (I² < 30%) or high (I² > 30%) heterogeneity values, respectively. Standardized mean differences (SMD) and 95% confidence intervals (CIs) were calculated to assess the change in each outcome.

RESULTS

After removing duplicated studies, 234 results were retrieved by the literature search and 11 were eligible for full text search. Finally, 9 studies with a methodological quality ranging from good to low quality met the inclusion criteria. Six of them focused on hippotherapy and 4 of them were included in the quantitative analysis. Totally, 225 PwMS patients were evaluated. Findings from the meta-analysis indicated that this therapy improved static (SMD = 0.42; 95% CI: 0.05, 0.78) but not dynamic balance (SMD = 0.51; 95% CI: -0.04, 1.06), while significant benefits were observed on the patients' QoL (SMD = 0.37; 95% CI: 0.00, 0.73). Hippotherapy showed effectiveness for reducing self-perceived fatigue (SMD = 0.70; 95% CI: 0.33, 1.07), while TR showed mixed effects on balance and QoL.

CONCLUSION

The actual evidence on the effectiveness of EAT in PwMS is mainly limited to hippotherapy. This rehabilitation approach seems to have beneficial effects on static balance, QoL and fatigue, but not directly on gait and dynamic balance. Altogether, the findings suggest that hippotherapy could be incorporated as a complementary therapy when developing comprehensive care plans for PwMS.

Utilization of Complementary and Integrative Health Care by People With Spinal Cord Injury in the Spinal Cord Injury Model Systems: A Descriptive Study

OBJECTIVE

To characterize the use of complementary and integrative health care (CIH) by people with spinal cord injury.

DESIGN

Cross-sectional self-report study.

SETTING

Participants were recruited from 5 Spinal Cord Injury Model Systems (SCIMS) centers across the United States.

INTERVENTIONS

Not applicable.

PARTICIPANTS

A total of 411 persons enrolled in the SCIMS completing their SCIMS follow-up interview between January 2017 and July 2019 (N = 411).

MAIN OUTCOME MEASURES

Participants completed a survey developed for this study that included questions about types of CIH currently and previously used, reasons for current and previous use, reasons for discontinuing use of CIH, and reasons for never using CIH since injury.

RESULTS

Of the 411 respondents, 80.3% were current or previous users of CIH; 19.7% had not used CIH since injury. The most commonly used current types of CIH were multivitamins (40.0%) and massage (32.6%), whereas the most common previously used type of CIH was acupuncture (33.9%). General health and wellness (61.4%) and pain (31.2%) were the most common reasons for using CIH. The primary reason for discontinuing CIH was that it was not helpful (42.1%). The primary reason for not using CIH since injury was not knowing what options are available (40.7%).

CONCLUSIONS

These results point to the importance for rehabilitation clinicians to be aware that their patients may be using 1 or more CIH approaches. Providers should be open to starting a dialogue to ensure the health and safety of their patients because there is limited information on safety and efficacy of CIH approaches in this population. These results also set the stage for further analysis of this data set to increase our knowledge in this area.

Ellagic acid ameliorates neuroinflammation and demyelination in experimental autoimmune encephalomyelitis: Involvement of NLRP3 and pyroptosis

Multiple sclerosis (MS) is presented as the most common autoimmune and demyelinating neurological disorder with incapacitating complications and with no definite therapy. Most treatments for MS mainly focus on attenuation of its severity and recurrence. To model MS reliably to study pathogenesis and efficacy of possible chemicals, experimental autoimmune encephalomyelitis (EAE) condition is induced in rodents. Ellagic acid is a neuroprotective polyphenol that can protect against demyelination. This study was planned and conducted to assess its possible beneficial effect in MOG-induced EAE model of MS with emphasis on uncovering its modes of action. Ellagic acid was given p.o. (at doses of 10 or 50 mg/kg/day) after development of clinical signs of MS to C57BL/6 mice immunized with MOG_35-55. Results showed that ellagic acid can ameliorate severity of the disease and partially restore tissue level of TNFα, IL-6, IL-17A and IL-10. Besides, ellagic acid lowered tissue levels of NLRP3 and caspase 1 in addition to its mitigation of neuroinflammation, demyelination and axonal damage in spinal cord specimens of EAE group. As well, ellagic acid treatment prevented reduction of MBP and decreased GFAP and Iba1 immunoreactivity. Taken together, ellagic acid can decrease severity of EAE via amelioration of astrogliosis, astrocyte activation, demyelination, neuroinflammation and axonal damage that is partly related to its effects on NLRP3 inflammasome and pyroptotic pathway.

Multiple sclerosis clinical practice guidelines provide few complementary and alternative medicine recommendations: A systematic review

OBJECTIVE

Complementary and alternative medicine (CAM) use is prevalent among individuals with multiple sclerosis (MS), yet the quantity and quality of CAM recommendations in MS clinical practice guidelines (CPGs) has not been assessed. The objective of this study was to determine the mention of CAM in MS CPGs and assess the quality of CAM recommendations.

DESIGN/SETTING

A systematic review was conducted to identify MS CPGs. MEDLINE, EMBASE and CINAHL were searched from 2008 to 2018. The Guidelines International Network and the National Center for Complementary and Integrative Health (NCCIH) websites were also searched. Eligible CPGs containing CAM recommendations published by non-profit agencies on the treatment of MS for adults were assessed for quality and reporting using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument.

OUTCOME/RESULTS

From 204 unique search results, six CPGs mentioned CAM and four made CAM recommendations. Scaled domain percentages from highest to lowest were clarity of presentation (90.3 % Overall, 83.3 % CAM), scope and purpose (87.5 % Overall, 86.8 % CAM), rigour of development (80.0 % Overall, 61.7 % CAM), applicability (55.2 % Overall, 44.3 % CAM), editorial independence (49.0 % Overall, 47.9 % CAM), and stakeholder involvement (55.6 % Overall, 39.6 % CAM). Quality varied within and across CPGs. Three of the four CPGs were recommended by both appraisers; one was recommended as "No" or "Yes with modifications".

CONCLUSION

CAM recommendations were only present in one third of all eligible CPGs. CPGs that scored highly can be used by patients and healthcare professionals as the basis for discussion about the use of CAM therapies for MS treatment/management. Although many people living with MS (PwMS) seek CAM therapies, few CPGs are available to provide guidance for clinicians and patients.

Patterns and Outcomes of Complementary and Alternative Medicine Use Among Adult Patients With Multiple Sclerosis

Multiple sclerosis (MS) is a chronic autoimmune disease that causes demyelination of the central nervous system. No treatment has been shown to be curative; thus, we assume that the tendency for patients with MS to use unconventional therapies, such as complementary and alternative medicine (CAM), might increase. The aim of this study was to explore the pattern of CAM use among patients with MS at a tertiary health care center in Saudi Arabia (SA). This was a questionnaire-based observational cross-sectional study that targeted adult patients diagnosed with MS at King Abdulaziz Medical City in Riyadh, SA, from 2018 to 2019. The sample size included 176 patients, and a consecutive non-probability sampling technique was used to engage them during their appointments. An Arabic questionnaire was used to evaluate patients' use of CAM. The mean age of participants was 34.6 ± 10.9 years, females represented the majority 125 (71%) of participants, and 89% of the participants reported using CAM at least once, with one or more modalities being used. Prayer, Salat, was the most frequent modality (60%) followed by supplication, Dua'a (59%), Ruqia, reciting Holy Quran (52%), and vitamins (44%). Symptomatic improvement was reported by 49 (27.8%) of dietary supplement users and 81 (46%) of non-dietary supplement medicine users. The study found a high prevalence of CAM utilization among Saudi adult patients with MS, which exceeded internationally reported rates. Although some patients described some improvement in their symptoms, further research is needed to evaluate the effectiveness of CAM.

Assessment of the complementary and integrative medicine utilization among patients with multiple sclerosis using a translated and adapted version of the international questionnaire (I-CAM-QP): A cross-sectional study in Southern Iran

AIMS

To assess the prevalence of and factors related to complementary and integrative medicine (CIM) use among multiple sclerosis (MS) patients, using a translated and adapted version of a standard international questionnaire.

METHODS

International complementary and alternative medicine questionnaire (I-CAM-Q) was used. A cross-sectional study was done to assess the prevalence of and factors associated with CIM use among MS patients in Southern Iran. Patients who were randomly selected from MS registry center, were interviewed via phone calls.

RESULTS

Three hundred patients were enrolled in the study; 69% of them were female. Their mean age was 36.6±8.53 years and the mean duration of the disease was 5.6 ± 4.22 years. In all, 99.3% (95% CI) of the patients had used at least one type of CIM. Herbal medicines and dietary supplements were the most commonly used CIM type (97.3%; 95% CI). Praying was the most common modality among all CIM subgroups (81.3%; 95% CI). Long term illness (MS) was selected as the main reason for the last use of all CIM types. Having non-tertiary education and having sequel due to MS were related to visiting a CIM provider (adjusted odds ratio (AOR) = 2.32, 95% confidence interval (CI) = 1.22-4.43), (AOR = 2.67, 95% CI = 1.47-4.83) respectively. Being female was related to the use of self-help practices (AOR = 3.41, 95% CI = 1.5-7.72).

CONCLUSION

There is a high prevalence of CIM use among MS patients. Therefore, patient- physician communication about CIM use should be emphasized.

The Bu Shen Yi Sui Formula Promotes Axonal Regeneration via Regulating the Neurotrophic Factor BDNF/TrkB and the Downstream PI3K/Akt Signaling Pathway

Axonal damage is recognized as an important pathological feature in the chronic progressive neurological disorder multiple sclerosis (MS). Promoting axonal regeneration is a critical strategy for the treatment of MS. Our clinical and experimental studies have shown that the Bu Shen Yi Sui formula (BSYS) promotes axonal regeneration in MS and experimental autoimmune encephalomyelitis (EAE), an animal model of MS, but the exact mechanism has not been thoroughly elucidated to date. In this study, we investigated the effects of BSYS and its two decomposed formulas-the Bu Shen formula (BS) and the Hua Tan Huo Xue formula (HTHX)-on brain-derived neurotrophic factor (BDNF)/TrkB and related signaling pathways to explore the mechanism by which axonal regeneration is promoted in vitro and in vivo. Damaged SH-SY5Y cells incubated with low serum were treated with BSYS-, BS-, and HTHX-containing serum, and EAE mice induced by the myelin oligodendrocyte glycoprotein (MOG)_35-55 peptide were treated with BSYS. The results showed that the BSYS-containing serum markedly increased cell viability and increased the levels of growth associated protein (GAP)-43, phosphorylated (p)-cAMP-response element binding protein (CREB), BDNF, TrkB, and p-PI3K. The BS and HTHX treatments also induced the protein expression of GAP-43 and p-extracellular signal-regulated kinase (ERK) in the cells. Furthermore, the effects of BSYS on cell viability, GAP-43, p-CREB, and neurite outgrowth were clearly inhibited by LY294002, a specific antagonist of the PI3K signaling pathways. The addition of U0126 and U73122, antagonists of the ERK and PLCγ pathway, respectively, significantly inhibited cell viability and GAP-43 protein expression. Moreover, BSYS treatment significantly increased the expression of the 68-, 160-, and 200-kDa neurofilaments (NFs) of proteins and the BDNF, TrkB, PI3K, and Akt mRNA and proteins in the brain or spinal cord of mice at different stages. These results indicated that BSYS promotes nerve regeneration, and its mechanism is mainly related to the upregulation of the BDNF/TrkB and PI3K/Akt signaling pathways. BS and HTHX also promoted nerve regeneration, and this effect involved the ERK pathway.

Lifestyle-based modifiable risk factors in multiple sclerosis: review of experimental and clinical findings

Multiple sclerosis (MS) is a lifelong inflammatory and neurodegenerative disease influenced by multiple lifestyle-based factors. We provide a narrative review of the effects of modifiable risk factors that are identified as being associated with risk to develop MS and/or influencing the future clinical disease outcomes. The emerging data regarding the beneficial effects of diet modifications and exercise are further reviewed. In contrast, obesity and comorbid cardiovascular diseases are associated with increased MS susceptibility and worse disease progression. In addition, the potential influence of smoking, coffee and alcohol consumption on MS onset and disability development are discussed. Successful management of the modifiable risk factors may lead to better long-term outcomes and improve patients' quality of life. MS specialists should participate in educating and facilitating lifestyle-based modifications as part of their neurological consults.

A Review of Herbal Therapy in Multiple Sclerosis

Multiple sclerosis is a complex autoimmune disorder which characterized by demyelination and axonal loss in the central nervous system (CNS). Several evidences indicate that some new drugs and stem cell therapy have opened a new horizon for multiple sclerosis treatment, but current therapies are partially effective or not safe in the long term. Recently, herbal therapies represent a promising therapeutic approach for multiple sclerosis disease. Here, we consider the potential benefits of some herbal compounds on different aspects of multiple sclerosis disease. The medicinal plants and their derivatives; Ginkgo biloba, Zingiber officinale, Curcuma longa, Hypericum perforatum, Valeriana officinalis, Vaccinium macrocarpon, Nigella sativa,Piper methysticum, Crocus sativus, Panax ginseng, Boswellia papyrifera, Vitis vinifera, Gastrodia elata, Camellia sinensis, Oenothera biennis, MS14 and Cannabis sativa have been informed to have several therapeutic effects in MS patients.