Editorials

A review of the literature shows that many patients with multiple sclerosis (MS) have turned to the use of complementary and alternative medicines (CAM).^1-3 As a neurologist who specializes in the treatment of patients with MS, I receive frequent questions about alternative therapies from many of the patients I treat. As healthcare providers, we have a responsibility to guide our patients; however, most of us know little or nothing about CAM therapies. This makes sense, since there are few randomized controlled trials (RCTs) of CAM therapies in MS.

Because our patients keep using these therapies and ask about them, it behooves us to respond in the most helpful way possible. How should we guide our patients in this matter?

First, do no harm. Modalities such as yoga or acupuncture (by a trained, certified acupuncturist) may have few RCTs to back them up, but if your patient says they are helpful, there seems to be little harm and at least some psychological benefit in using them. In fact, yoga, and exercise in general have been shown to help symptoms of MS such as fatigue.⁴ However, there are red flags you can help patients watch for. Here are some suggestions that might help guide your patients who pursue CAM therapies:

• Beware of any claim that a particular diet or supplement can “cure” MS.
• Be suspicious of patient testimonials, or anything that seems “too good to be true,” because it definitely is. Just turn on the TV after 1:00 AM for prime examples.
• Explain to your patients that because people with MS already have overactive immune systems, they should avoid any supplements that claim to strengthen the immune system.
• Avoid pills or supplements that claim to "cleanse" the liver. We are not certain if these "cleansers" may potentially induce the hepatic metabolism of disease-modifying therapies and result in lower levels of systemic drug.
• The ingredients in over-the-counter vitamins and supplements are not regulated by the FDA, as are approved medications.

The most important message we can send to our patients with MS is that unconventional or “natural” therapies should be complementary to FDA-approved therapies for MS. These therapies are not alternatives to approved medical therapies for the treatment of MS, and they are not curative. Nothing should take the place of or interfere with approved medical therapies for the treatment of MS, and current FDA-approved therapies represent the best treatment options we have right now.

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