Written by Renata Filiaci. MSHW
Introduction
Multiple sclerosis (MS), affecting about 2.5 million people in the world, is a demyelinating autoimmune disease where the immune system attacks the central nervous system producing inflammation in the form of lesions and scarring, permanently destroying the myelin sheaths. Antibodies and T-cell lymphocyte cells are an immune response damaging the myelin sheath furthering inflammation. Although the etiology is unknown, the demyelination can occur in any part of the central nervous system which causes irregularity of lesions, largely affecting the optic nerves, oculomotor nerves, corticospinal, cerebellar, and posterior column systems. MS presents different symptoms in everyone; some patients could have occasional exacerbations, while in others, MS is extremely progressive and debilitating causing disability. When myelin is lost, signals through the nerves are impassable leading to abnormal function (Namjooyan, Ghanavati, Majdinasab, Jokari, & Janbozorgi, 2014; Banasik & Copstead, 2019). It has been suggested that the Epstein-Barr virus (EBV) is linked to the potential development of MS. In chronic and active MS brain lesions as well as in non-MS brains, the presence of EBV was detectable by immunohistochemistry and by in situ hybridization; however, EBV was more prevalent in MS brains (Moreno, Or-Geva, Aftab, Khanna, Croze, Steinman, & Han, 2018).
Depending on the location of damaged myelin, a wide range of symptoms could arise and become exacerbated by heat, infection, or fever, such as blurred vision, weakness, numbness, tingling, fatigue, imbalance, diplopia, and coordination difficulties. Additionally, cognitive impairment and neurobehavioral symptoms can become apparent. Within the stages of the disease, symptoms can worsen, leading to bladder and bowel difficulties, pain, and paresthesia as well as paralysis. These symptoms aggravate when the process of remyelination through oligodendrocytes at lesion site is not sufficient and the axons are eventually destroyed (Namjooyan, Ghanavati, Majdinasab, Jokari, & Janbozorgi, 2014; Banasik & Copstead, 2019).
There is no cure for MS; however, there is the conventional treatment to maintain the symptoms, minimize the autoimmune effect on the myelin, and manage acute attacks. Many times, acute attacks are controlled with prednisone which is an anti-inflammatory corticosteroid (Banasik & Copstead, 2019). However, short-term and long-term corticosteroid use can have many adverse effects on the body including an increase in rates of sepsis, venous thromboembolism, and fractures (Waljee, Rogers, Lin, Singal, Stein, Marks, Ayanian & Nallamothu, 2017). Other medications used to treat MS are antispasmodics, anticholinergics, antidepressants, and antimicrobials (Banasik & Copstead, 2019). Considerable clinical studies show the use of complementary and alternative medicinal treatment as suggestive therapy for people with MS.
Results/Discussion
Complementary and alternative medicinal interventions have shown to modulate the inflammatory state, protect against neurodegeneration, or promote nervous system repair. It is crucial to limit toxic agents, such as excessive alcohol consumption, smoking, and drugs as these associated with patterns of symptoms (Newland, Flick, Xian, & Thomas, 2016). The role of diet is very important in the development and management of MS. Certain diets, such as the Western diet, can promote a pro-inflammatory response, increased risk of relapse in attacks, and increased endotoxin levels in people with MS. The Western diet consists of the overconsumption of fats, salt, sugars, proteins, carbohydrates, and processed foods. Short-chain fatty acids as opposed to long-chain fatty acids, which are found in processed foods, show an anti-inflammatory effect. Short-chain fatty acids are chiefly produced by the gut in reaction to high dietary fiber and plant-based foods. Also, after eating a diet high in fiber, with unrefined grains and legumes, vegetables, fruits, and low in protein showed a decrease in pro-inflammatory cells and reduced levels of patient-reported disease activity and disability (Riccio & Rossano, 2015; Sand, 2018).
A vitamin D deficiency has been linked to a risk in developing MS and disease activity in patients with MS as well as autoimmune disease development through numerous observational studies. Clinical trials have shown that the level of serum vitamin D affects the risk of developing MS due to its effects on skeletal and non-skeletal functions, including immune functions. Taking vitamin D supplementation or eating foods high in vitamin D, such as fatty fish (e.g., salmon, mackerel), cod liver oil, egg yolk, and shiitake mushrooms, can reduce clinical activity in established MS (Sintzel, Rametta, & Reder, 2017). Medicinal plants and their derivatives are being used as a promising therapeutic approach for MS. The use of 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, and the blend MS14 have shown to relieve fatigue, improve cognitive performance and urinary system dysfunction, reduce inflammation, and have neuroprotective and anti-depressant properties Mojaverrostami, Bojnordi, Ghasemi-Kasman, Ebrahimzadeh, & Hamidabadi, 2018).
The mushroom, Phellinus igniarius (PI), of the Hymenochaetaceae fungus family contains bioactive compounds that can modulate the human immune system. Experimental autoimmune encephalomyelitis (EAE) in mice were given PI water-soluble extract and, three weeks after initial treatment, the mushroom had decreased the daily incidence rate and clinical score of EAE by suppressing demyelination and access of immune cells including CD4+ T cells, CD8+ T cells, macrophages, and B cells in the spinal cord. The results present that PI have therapeutic effects on MS progression (Li, Wu, Choi, Jang, Kim, Sung, Cho, Suh, & Park, 2014). The cannabis plant has a biologically active chemical, Cannabidiol (CBD), which has some beneficial pharmacological effects, such as anti-inflammatory, antioxidative, antiemetic, antipsychotic, and neuroprotective. After CBD supplementation, people with MS have reduced symptoms like inflammation, depression, fatigue, pain, spasticity, and ultimately it improves mobility and quality of life (Rudroff & Sosnoff, 2018).
Conclusions
Multiple sclerosis is a demyelinating autoimmune disease where the immune system attacks the central nervous system producing inflammation in the form of lesions and scarring, permanently destroying the myelin sheaths. Acute or chronic attacks may be caused by the destruction of the axons, which produce an array of debilitating symptoms and eventually paralysis. Conventional medicine is effective in managing the symptoms; however, it can present with adverse effects. Though there are limited clinical trials focusing on the use of complementary and alternative medicinal protocols for treatment and management of MS, they have been effective in reducing symptoms and inflammation, improving cognitive behavior, reducing levels of patient-reported disease activity and disability, as well as having neuroprotective properties.
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