Multiple sclerosis (MS) is an inflammatory and demyelinating disease
characterized by multiple lesions (or plaques) in the white matter of the
central nervous system (CNS), destruction of the myelin sheaths of nerve fibers
(demyelination), perivascular infiltration of inflammatory cells, and gliosis
(scarring). Approximately 350,000 Americans have MS, making it the most common
cause of neurologic dysfunction of young adults between 20 and 40 years of age.
Women are affected twice as often as men, and whites are affected twice as often
as African Americans. It is almost unknown in black native Africans and rare in
native Japanese, but not uncommon in African-Americans and Japanese-Americans.
The etiology of MS is unknown; it is thought to begin with an infectious
agent (virus) in childhood that primes the immune system for an autoimmune
attack against myelin components in early adulthood. Prevalence data support the
suggested role of environmental exposure, as epidemics of MS have been
described. A genetic predisposition is suggested by family clusters:
first-degree relatives of an index case have a 2% to 5% increased risk of
developing MS, and the concordance rate is 25% to 30% for monozygotic twins and
2% to 5% for diazygotic twins.
- First-degree relatives with MS
- Age between 20 and 40
- Living in the northern latitudes for the first 15 years of
- Northern European, Northern American, or Scandinavian
- Possession of immune response genes (e.g., HLA-DR2)
|Signs and Symptoms|
- Blurred vision from optic neuritis or diplopia (double vision) due to
- Motor weakness presenting as fatigue, gait disturbances, loss of
dexterity, or hyperreflexia
- Sensory disturbances such as paresthesia (tingling) or hypesthesia
- Loss of proprioception and muscle coordination (ataxia)
- Pain due to trigeminal neuralgia, Lhermitte's sign (painful,
lightning-like sensations down the back elicited by flexion of the neck),
dysesthesia (pain from normal stimuli such as touch), or tonic
- Vertigo (dizziness) that appears suddenly and is severe
- Intention tremor and spasticity
- Heat sensitivity (Uhthoff's phenomena), in which symptoms worsen after
exposure to heat
- Urinary bladder dysfunction (e.g., frequency, urgency, incontinence,
- Cognitive impairment (e.g., memory loss, problem-solving
- Depression or inappropriate
- Cerebrovascular disease (e.g., subdural hematoma, embolism, cavernous
- Brain abscess
- CNS vasculitides (e.g., Sjogren's syndrome, Behcet's disease,
- Metastatic tumors
- Primary CNS tumors
- Lyme disease
- Metabolic disturbances (e.g., hypoglycemia)
- Psychogenic disorder
There is no definitive diagnostic test for MS; the diagnosis depends on a
history of intermittent clinical manifestations which leave the patient more
impaired, physical examination findings of neurological deficits, and laboratory
tests which support the suspected diagnosis.
- Cerebrospinal fluid (CSF) examination—for
elevated protein, high immunoglobulin G (IgG) levels, and CSF IgG/CSF albumin
ratio over 1.7, which are characteristic of MS
- Agar gel electrophoresis—to determine
presence of oligoclonal IgG bands, which are found in 90% of MS
- Magnetic resonance imaging (MRI)—to detect
small, bright foci in the periventricular area and on spinal cord
- Computed tomography (CT) scan—to detect areas
of decreased attenuation or contrast
- Gadolinium-enhanced MRI—to detect a breach in
the blood-brain barrier
- Myelogram—to examine lesions with low
resolution on MRI
- Radioimmunoassay—to detect high
concentrations of myelin basic protein (MBP) during relapses
Determination of visual-, auditory-, somatosenory-, and motor-evoked
potential responses—to detect subclinical areas of
Currently only immunosuppressive and anti-inflammatory drugs appear to reduce
the severity of initial attacks and exacerbations; no drugs have any effect on
the progression of the disease.
Rehabilitative measures such as braces, wheelchairs, ramps, lifts, and cars
with manual controls should be pursued to delay the bedridden stage of MS.
Physical and occupational therapy should begin early to ensure optimal physical
functioning for as long as possible. Physical therapy and passive muscle
stretching are necessary for optimum management of spasticity of the lower
- Methylprednisolone (500 mg daily for three to five days) followed by
high dose oral prednisone—to shorten an acute
exacerbation of optic neuritis (Caution: Oral prednisone without
methylprednisolone has been reported to increase the risk of subsequent episodes
of optic neuritis.)
- Immunosuppressive drugs (e.g., methotrexate (7.5 mg once a week for
two years), azathioprine (2 to 3 mg/kg daily), cyclophosphamide, cyclosporin
A)—to improve the clinical course of some patients;
however, severe toxicity is a problem.
- Interferon-beta 1a (6 MIU intramuscularly once a week), and
interferon-beta 1b (8.0 MIU subcutaneously every other
day)—to decrease white matter lesions and the frequency
and severity of attacks
- Copolymer I, a polymer of MBP—to improve the
clinical course of relapsing-remitting MS
- Amantadine (100 mg bid) or pemoline (37.5 mg
bid)—to treat fatigue
- Isoniazid (300 to 1200 mg/day) with pyridoxine (100
mg/day)—to treat postural tremor
- Oxybutynin (5 mg bid) and propantheline (7.5 to 15 mg
qid)—to treat bladder disturbances
- Baclofen (15 to 80 mg/day), clonazepam (0.5 to 1.0 mg bid or tid),
primidone (125 to 250 mg bid or tid), or ondansetron (4 to 8 mg bid or
tid)—to treat spasticity and increased muscle tone of
- Carbamazepine (100 to 1200 mg/day), phenytoin (300 mg/day), or
amitriptyline (50 to 200 mg/day)—to treat trigeminal
neuralgia and painful dysesthesias
- Ventrolateral thalamotomy—to treat severe and
- Rhizotomy or myelotomy—to reduce severe
|Complementary and Alternative
Nutritional therapies are helpful in reducing inflammation and slowing the
progression of MS. Mind/body techniques such as meditation, yoga, and tai chi
may be beneficial in reducing the effects of stress. Some patients with MS have
a high level of Candida in their stool culture and respond well to treatment
- Eliminate refined foods, alcohol, caffeine, saturated fats (e.g.,
animal products), and additives (especially monosodium glutamate and
- Avoid food allergens and sensitivities. The most common allergens are
wheat, dairy, eggs, soy, citrus, tomatoes, corn, chocolate, fish, and peanuts.
An elimination/challenge trial may be helpful. Remove suspected allergens from
the diet for two weeks. Reintroduce foods at the rate of one food every three
days. Watch for reactions which may include gastrointestinal upset, mood
changes, headaches, and exacerbation of symptoms. Do not perform a challenge
with peanuts if there is a history of anaphylaxis. High percentage of MS
patients are sensitive to all gluten-containing foods.
- Eat a diet high in protein and anti-inflammatory oils (nuts, seeds,
and cold-water fish). Include orange, yellow, and dark green vegetables. Eat
whole grains in small amounts.
- Omega-6 oils (borage, evening primrose, black currant oils) 1,500 mg
bid to tid to reduce inflammation. Include zinc (30 mg/day) and selenium (200
mcg/day) to enhance fatty acid metabolism.
- B-complex vitamins, especially B12 (1,000 mcg/day) and
B6 (100 mg/day), and minerals, such as calcium (1,000 mg/day) and
magnesium (500 mg/day), optimize nerve function.
- Vitamin C (1,000 mg tid), vitamin E (400 IU/day), and coenzyme Q10
(100 mg bid) provide antioxidant protection.
Herbs may be used as dried extracts (pills, capsules, or tablets), teas, or
tinctures (alcohol extraction, unless otherwise noted). Dose is 1 heaping tsp.
herb/cup water steeped for 10 minutes (roots need 20 minutes).
Herbs rich in bioflavonoids provide antioxidant protection and stabilize
collagen tissues. Use one to two of the following: hawthorn (Crataegus
monogyna) 200 mg bid to tid, ginkgo (Ginkgo biloba) 120 mg bid
standardized extract, especially with cognitive impairment, quercetin (100 to
250 mg tid), especially with food sensitivities.
Combine the following herbs in equal parts to nourish the nervous system and
help prevent constipation: oatstraw (Avena sativa), skullcap
(Scutellaria laterifolia), lavender (Lavendula angustifolia),
lemon balm (Melissa officinalis), passionflower (Passiflora
incarnata), and horsetail (Equisetum arvense). Drink two to three
cups tea daily or take 30 to 60 drops tincture bid.
An experienced homeopath would consider the individual's constitution.
Combination remedies may be useful for adrenal fatigue, spasticity, and
May be beneficial in alleviating symptomatic complaints.
Essential for maintaining flexibility and reducing spasticity, as well as
improving the overall sense of well-being.
Patients need lifelong monitoring, especially during exacerbations. Drug
toxicities must be monitored with frequent blood and liver studies. Health care
practitioners must be sympathetic and supportive of patients with such a
progressively incapacitating disease and its resultant psychological, social,
and physical issues.
To qualify as an acute exacerbation, new symptoms or worsening of existing
symptoms must last longer than 24 hours. These exacerbations may last days or
weeks; some resolve completely, while others leave impairments. The interval
between attacks is extremely variable, lasting several months to years.
Most patients (70%) follow a relapsing-remitting course after the initial
attack; others (10% to 15%) follow a chronic progressive course from the
beginning (usually patients with late onset MS). Many patients (50%) who begin
with a relapsing-remitting course develop a secondarily chronic progressive
course after about 10 years. Approximately 15% to 20% of MS patients follow a
benign course and never develop permanent deficits. Poor outcome is associated
with incomplete recovery from attacks, frequent attacks, and male gender. A
small number of MS patients die within a few months or years of the diagnosis,
but most patients live for 30 years or more, many still working and
There is a decreased incidence of relapse during pregnancy. Pregnancy is
typically associated with clinical stability or improvement in symptoms.
However, in the three months following parturition, there is an increased
incidence of exacerbations. Pregnant women should be encouraged to minimize
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
Fauci AS, et al. Harrison's Principles of Internal Medicine.
14th ed. New York, NY: McGraw-Hill; 1997:
Kelley WN, et al. Textbook of Internal Medicine. 3rd ed.
Vol 2. Philadelphia, PA: Lippincott-Raven; 1997:
Scalzo R. Naturopathic Handbook of Herbal Formulas. 2nd ed.
Durango, Colo: Kivaki Press; 1994: 63.
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:
Conn RB. Current Diagnosis. Philadelphia, PA: Saunders; 1991:
Branch WT. Office Practice of Medicine. 3rd ed. Philadelphia, PA:
Copyright © 2000 Integrative Medicine
CommunicationsThis publication contains
information relating to general principles
of medical care that should not in any event be construed as specific
instructions for individual patients. The publisher does not accept any
responsibility for the accuracy of the information or the consequences arising
from the application, use, or misuse of any of the information contained herein,
including any injury and/or damage to any person or property as a matter of
product liability, negligence, or otherwise. No warranty, expressed or implied,
is made in regard to the contents of this material. No claims or endorsements
are made for any drugs or compounds currently marketed or in investigative use.
The reader is advised to check product information (including package inserts)
for changes and new information regarding dosage, precautions, warnings,
interactions, and contraindications before administering any drug, herb, or
supplement discussed herein.