Review article
COMPLEMENTARY AND ALTERNATIVE MEDICINE IN THE TREATMENT OF MULTIPLE SCLEROSIS
MILJENKA JELENA JURAŠIĆ
; Sestre milosrdnice University Hospital Centre, Department of Neurology, Reference Center for Neuroimmunology and Neurogenetics of the Ministry of Health, Zagreb, Croatia
IRIS ZAVOREO
; Sestre milosrdnice University Hospital Centre, Department of Neurology, Reference Center for Neuroimmunology and Neurogenetics of the Ministry of Health, Zagreb, Croatia
LUCIJA ZADRO MATOVINA
; Sestre milosrdnice University Hospital Centre, Department of Neurology, Reference Center for Neuroimmunology and Neurogenetics of the Ministry of Health, Zagreb, Croatia
VANJA BAŠIĆ KES
; Sestre milosrdnice University Hospital Centre, Department of Neurology, Reference Center for Neuroimmunology and Neurogenetics of the Ministry of Health, University of Zagreb, School of Dental Medicine, Zagreb and Josip Juraj Strossmayer University of Osi
Abstract
Introduction: Multiple sclerosis (MS) is a chronic, yet incurable disease. Currently, there are fi ve different approaches in patient management: disease modifying therapy, relapse treatment, symptomatic treatment, and extension of better functional ability through implication of physical therapy and emotional support. Considering the long-term lifelong duration of the disease and concomitant symptoms, many patients (30%-80%) use at least one of complementary and alternative (CAM) techniques for either primary or additional treatment of this disease. Aim: Our aim was to search through scientifi cally published papers for medically valid data in order to provide the best medical advice for both physicians and patients in search for useful and non-harmful CAM methods. Methods: We performed extensive MEDLINE search and included references dating back from the year 2000, since we believed the most recent data to carry the most relevant and updated information. Results and Discussion: We noticed that patients were prone to using CAM methods, either solely or in addition to prescribed therapy by their conventional medical doctor, usually a neurologist. The rate was higher for women, those with higher educational level, and those whose health was not rated well. CAM therapies can be divided into biologically based practices (cannabinoids, gingko biloba), other biologically based practices such as bee venom, dietary supplementation
(omega-3 fatty acids, Cari Loder regimen), energy medicine and manipulative body-based practices (magnetic therapy and reflexology). Some benefi ts are reported as subjective and others as objective improvement, but patients tend to be either over- or under-critical in therapy assessment. Thus, true scientifi cally supported data are necessary for evaluation, best collected by the primary care giving neurologist, or by the patients themselves. All these data need to be handed to a medical specialist, i.e. MS nurse or neurologist in charge, who will thus be informed on the treatment effects and potential adverse effects. Therefore, in this article, we propose data collection tabulated diaries for easier monitoring. We, also, present scientifi c evidence based data that support the benefi cial effect of CAM therapies for the patient. Additionally, severe adverse effects of these therapies are also mentioned. Most importantly, the level of interaction with disease modifying therapy is still unknown, so it is best to advise your patients about the possible interactions and to monitor for any changes
in physical or mental status. Conclusion: The goal would be to collect as much data as possible and re-evaluate all relevant three points in patient management, i.e. effectiveness of CAM therapy, noted adverse effects, and possible infl uence on disease modifying agents. The best approach to patient management is through MS centers that are comprehensively equipped for both diagnostic and therapeutic approach. This team approach would improve the patient sense of security in the system of care, and increase the functionality of diagnosis and treatment and patient independence. The neurologist should be in charge of this team and coordinate it, since his knowledge of the disease process and pathophysiology allows for identifi cation of important issues that can further determine or alter the course of treatment.
Keywords
multiple sclerosis; complementary and alternative medicine; treatment; EDSS scale; symptoms
Hrčak ID:
208633
URI
Publication date:
16.11.2018.
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