Examining the evidence: complementary adjunctive therapies for multiple sclerosis.
OBJECTIVE
The purpose of this article is to provide a comprehensive overview of the most frequently encountered non-conventional approaches trialed for use in multiple sclerosis (MS). The efficacy and safety of non-conventional approaches ranging from bee venom therapy (BVT) to an array of vitamins and herbal products were discussed and evaluated.


METHODS
Relevant English-language articles were identified through searches of MEDLINE (1990-2006), PubMed (1999-2006), Cochrane (1995-2006) and Toxnet (2000-2006). Classification of available literature was conducted according to the evidence based guidelines established by the American Academy of Neurology (AAN). However, due to the non-conventional nature of these treatment approaches, most available literature was derived from anecdotal reports and suboptimal clinical studies, lacking the rigor of evidence-based practice.


RESULTS
There is presently only marginal supportive evidence for BVT in MS treatment. The inability to identify and quantify the active component of BVT combined with the associated risk of anaphylaxis has deterred its widespread use. The most promising evidence comes from prophylactic daily supplementation with vitamin D. Despite beneficial reports regarding non-herbal supplements such as alpha-lipoic acid (ALA), luteolin, evening primrose oil and vitamins such as B12, the lack of evidence does not support their prophylactic use.


CONCLUSIONS
Based on available evidence, the prophylactic use of vitamin D is a viable option as an adjunct to conventional medicine. Although there is a lack of conclusive evidence to support the use of other non-conventional treatments, patients are still opting to trial and bare the risks of these products which are accessible without the intervention of a healthcare professional. Controlled, evidence-based trials are essential for healthcare professionals to competently intervene and recommend these products.
Namaka
Mike
M
Faculty of Pharmacy, University of Manitoba, Department of Neurology, Health Sciences Centre, Winnipeg, Manitoba, Canada. namakamp@ms.umanitoba.ca
Crook
Arla
A
Doupe
Andrea
A
Kler
Kulwinder
K
Vasconcelos
Marcus
M
Klowak
Meghann
M
Gong
Yuewen
Y
Wojewnik-Smith
Alicja
A
Melanson
Maria
M
D000975:Antioxidants / Q000627:therapeutic use; D001514:Bee Venoms / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data*; D000529:Complementary Therapies / Q000379:methods* / Q000706:statistics & numerical data*; D004035:Diet Therapy; D006801:Humans; D009103:Multiple Sclerosis / Q000517:prevention & control / Q000628:therapy*; D010936:Plant Extracts / Q000627:therapeutic use; D040242:Risk Reduction Behavior; D014807:Vitamin D / Q000627:therapeutic use*
D000975:Antioxidants; D001514:Bee Venoms; D010936:Plant Extracts; D014807:Vitamin D