Multiple sclerosis, an autoimmune inflammatory disease: prospects for its integrative management

Alternative Medicine Review, Dec, 2001 by Parris M. Kidd

Abstract

Multiple sclerosis (MS) is aptly named for the many scars it produces in the brain and spinal cord. A sometimes fatal, often debilitating disease, MS features autoimmune inflammatory attack against the myelin insulation of neurons. Thymus derived (T) cells sensitized against myelin self-antigens secrete tumor necrosis factor, cytokines, prostaglandins, and other inflammatory mediators that strip away the myelin and sometimes destroy the axons. Familial and twin inheritance studies indicate MS is mildly heritable. No single MS locus has been identified, but an HLA haplotype has been implicated. Unique geographic distribution of the disease is best attributed to some combination of vitamin D abnormality and dietary patterns. No pharmaceutical or other therapies exist that confer prolonged remission on MS, and obvious interrelationships between toxic, infectious, and dietary factors make a persuasive case for integrative management. The time-proven MS diet meticulously keeps saturated fats low, includes three fish meals per week, and eliminates allergenic foods. Dietary supplementation for MS minimally requires potent vitamin supplementation, along with the thiol antioxidants, the anti-inflammatory omega-3 fatty acids, and adaptogenic phytonutrients. Gut malabsorption and dysbiosis can be corrected using digestive enzymes and probiotics. Long-term hyperbaric oxygen therapy can slow or remit the disease. Transdermal histamine offers promise, and adenosine monophosphate may sometimes benefit. Chronic viruses and other infectious load must be aggressively treated and exercise should maintain muscle tone and balance. Early intervention with integrative modalities has the potential to make MS a truly manageable disease. (Altern Med Rev 2001;6(6):540-566)

Introduction

Multiple sclerosis (MS) is an inflammatory, autoimmune, demyelinating disease of the central nervous system. It generally strikes at an early age, most often the early adult years. Its most frequent symptoms include numbness, impaired vision, loss of balance, weakness, bladder dysfunction, and psychological changes. Fatigue is an early symptom in MS, often the earliest. The disease can wax and wane for up to 30 years, but in perhaps half of all cases it steadily progresses to severe disability and premature death. (1)

MS owes its name to the presence of multiple sclerotic (hardened) lesions in the brain and spinal cord -- multiple scars. The optic tract also is often involved. This disease has major autoimmune character, with T-cells and other immune effector populations entering the brain and attacking the nerve cells, stripping away their myelin insulation and sometimes destroying their axons and entire remaining structures. Principal patterns of demyelination and axonal degeneration are schematized in Figure 1.

[FIGURE 1 OMITTED]

MS is the most common cause of neurologic disability in young adults. The lesions of demyelination are histopathologically characteristic of the disease. Brain examination by MRI (magnetic resonance imaging) can accurately detect these "white matter plaques." MRI correlates well with the classic histopathology of the lesions, and is progressively a more sensitive tool for detecting the characteristic lesions of MS in situ, as compared to conventional functional evaluation.

Currently approved drug therapies for MS are highly toxic; the immunosuppressants cortisone, prednisone, methotrexate, and cytoxan are still mainstays of conventional MS management. In 1993, interferon [beta]-1b was approved in the United States as attack prevention therapy, (3) but this drug itself is burdened with frequent and severe adverse effects. (4) The limitations of the conventional drug therapies for MS make imperative the development of a less toxic, integrative strategy for its management.

Diagnosis, Prevalence, and Progression of MS

Multiple sclerosis is a complex disease, perhaps encompassing more than a single etiopathological entity and very likely subject to multifactorial etiology. (5) MS prevalence worldwide is estimated at one million cases; in the United States this number is 250,000-350,000. (6) Although not generally considered life threatening, this disease kills about 3,000 people each year in the United States. (7)

MS overlaps extensively with numerous other syndromes, including acute disseminated encephalomyelitis (ADEM), Marburg's variant of MS, recurrent optic neuritis, neuromyelitis optica (Devic's syndrome), internuclear ophthalmoplegia, acute transverse myelitis, and cerebellar, pyramidal, and dorsal column dysfunctions. Weinshenker (3) proposed grouping all these into a pathophysiological matrix of idiopathic inflammatory demyelinating diseases of the CNS. Optic neuritis or other single demyelinating syndromes can develop over time into MS. Such "conversion" occurs especially in females with relatively early onset. MRI is currently the technique of choice to identify those at risk for conversion to clinical MS. (3) When a clinician detects exacerbation of symptoms, MRI will detect new lesion activity in most cases. However, patients without clinical activity can still manifest new lesion activity on MRI examination. MRI lesion data may strongly predict probability of subsequent attacks and progression to disability.