title: Complementary and alternative medical therapies in multiple sclerosis--the American Academy of Neurology guidelines: a commentary.
abstract: BACKGROUND
  Complementary and alternative medicine (CAM) use in individuals with multiple sclerosis (MS) is common, but its use has been limited by a lack of evidence-based guidance.
  
  
  METHODS
  In March 2014, the American Academy of Neurology published the most comprehensive literature review and evidence-based practice guidelines for CAM use in MS. The guideline author panel reviewed and classified articles according to the American Academy of Neurology therapeutic scheme, and recommendations were linked to the evidence strength.
  
  
  RESULTS
  Level A recommendations were found for oral cannabis extract effectiveness in the short term for spasticity-related symptoms and pain and ineffectiveness of ginkgo biloba for cognitive function improvement in MS. Key level B recommendations included: Oral cannabis extract or a synthetic cannabis constituent, tetrahydrocannabinol (THC) is probably ineffective for objective spasticity improvement in the short term; Nabiximols oromucosal cannabinoid spray is probably effective for spasticity symptoms, pain, and urinary frequency, but probably ineffective for objective spasticity outcomes and bladder incontinence; Magnetic therapy is probably effective for fatigue reduction in MS; A low-fat diet with fish oil supplementation is probably ineffective for MS-related relapses, disability, fatigue, magnetic resonance imaging lesions, and quality of life. Several Level C recommendations were made. These included possible effectiveness of gingko biloba for fatigue; possible effectiveness of reflexology for MS-related paresthesias; possible ineffectiveness of the Cari Loder regimen for MS-related disability, symptoms, depression, and fatigue; and bee sting therapy for MS relapses, disability, fatigue, magnetic resonance imaging outcomes, and health-related quality of life.
  
  
  CONCLUSIONS
  Despite the availability of studies evaluating the effects of oral cannabis in MS, the use of these formulations in United States may be limited due to a lack of standardized, commercial US Food and Drug Administration-regulated preparations. Additionally, significant concern about prominent central nervous system-related adverse effects with cannabis was emphasized in the review.
authors.affiliation: MS Center at OHSU, Department of Neurology, Oregon Health & Science University; Department of Neurology, Veterans Affairs Medical Center, Portland, Oregon. Electronic address: yadavv@ohsu.edu.
authors.forename: Vijayshree
authors.initials: V
authors.lastname: Yadav
authors.affiliation: Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Pushpa
authors.initials: P
authors.lastname: Narayanaswami
mesh_terms: D000529:Complementary Therapies; D006801:Humans; D009103:Multiple Sclerosis / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D014481:United States