title: Summary of evidence-based guideline: complementary and alternative medicine in multiple sclerosis: report of the guideline development subcommittee of the American Academy of Neurology.
abstract: OBJECTIVE
  To develop evidence-based recommendations for complementary and alternative medicine (CAM) in multiple sclerosis (MS).
  
  
  METHODS
  We searched the literature (1970-March 2011; March 2011-September 2013 MEDLINE search), classified articles, and linked recommendations to evidence.
  
  
  CONCLUSIONS
  Clinicians might offer oral cannabis extract for spasticity symptoms and pain (excluding central neuropathic pain) (Level A). Clinicians might offer tetrahydrocannabinol for spasticity symptoms and pain (excluding central neuropathic pain) (Level B). Clinicians should counsel patients that these agents are probably ineffective for objective spasticity (short-term)/tremor (Level B) and possibly effective for spasticity and pain (long-term) (Level C). Clinicians might offer Sativex oromucosal cannabinoid spray (nabiximols) for spasticity symptoms, pain, and urinary frequency (Level B). Clinicians should counsel patients that these agents are probably ineffective for objective spasticity/urinary incontinence (Level B). Clinicians might choose not to offer these agents for tremor (Level C). Clinicians might counsel patients that magnetic therapy is probably effective for fatigue and probably ineffective for depression (Level B); fish oil is probably ineffective for relapses, disability, fatigue, MRI lesions, and quality of life (QOL) (Level B); ginkgo biloba is ineffective for cognition (Level A) and possibly effective for fatigue (Level C); reflexology is possibly effective for paresthesia (Level C); Cari Loder regimen is possibly ineffective for disability, symptoms, depression, and fatigue (Level C); and bee sting therapy is possibly ineffective for relapses, disability, fatigue, lesion burden/volume, and health-related QOL (Level C). Cannabinoids may cause adverse effects. Clinicians should exercise caution regarding standardized vs nonstandardized cannabis extracts and overall CAM quality control/nonregulation. Safety/efficacy of other CAM/CAM interaction with MS disease-modifying therapies is unknown.
authors.affiliation: From the Department of Neurology (V.Y., M.C., D.B.), Oregon Health & Science University and Department of Neurology (V.Y., M.C., D.B.), Veterans Affairs Medical Center, Portland; MS Center of Excellence-East (C.B.), VA Maryland Health Care System and Department of Neurology (C.B.), University of Maryland School of Medicine, Baltimore; Multiple Sclerosis Center (J.B.), Swedish Neuroscience Institute, Seattle, WA; Multiple Sclerosis Service and Complementary and Alternative Medicine Service (A.B.), Colorado Neurological Institute, Englewood; The Jacobs Neurological Institute (B.W.-G.), Buffalo, NY; Department of Neurology (G.S.G.), University of Kansas Medical Center, Kansas City, KS; and Department of Neurology (P.N.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA.
authors.forename: Vijayshree
authors.initials: V
authors.lastname: Yadav
authors.forename: Christopher
authors.initials: C
authors.lastname: Bever
authors.forename: James
authors.initials: J
authors.lastname: Bowen
authors.forename: Allen
authors.initials: A
authors.lastname: Bowling
authors.forename: Bianca
authors.initials: B
authors.lastname: Weinstock-Guttman
authors.forename: Michelle
authors.initials: M
authors.lastname: Cameron
authors.forename: Dennis
authors.initials: D
authors.lastname: Bourdette
authors.forename: Gary S
authors.initials: GS
authors.lastname: Gronseth
authors.forename: Pushpa
authors.initials: P
authors.lastname: Narayanaswami
mesh_terms: D002186:Cannabinoids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000529:Complementary Therapies / Q000592:standards*; D019317:Evidence-Based Medicine / Q000592:standards; D017408:Guidelines as Topic; D006801:Humans; D009103:Multiple Sclerosis / Q000188:drug therapy / Q000628:therapy*; D009462:Neurology / Q000592:standards*; D012955:Societies, Medical / Q000592:standards
chemical_list: D002186:Cannabinoids