Do drugs cause MS ? This study evaluated the risk of developing MS due to taking drugs. There were 3,223 reports of MS in the US Adverse Event Reporting System (FAERS)- where the disease (MS) was the adverse reaction reported from taking pills. 33% of cases were linked with anticancer and immuno-modulating drugs including etanercept and infliximab. Other drugs associated with increased risk of developing MS included drugs used for managing hormone imbalances, bone density and central nervous system.
The authors concluded: “Our findings add weight to the evidence suggesting that immunomodulatory drugs increase the risk of MS and point out that some other drug classes should be further investigated for this risk” [1].
Do a lot of research before deciding to use a drug, especially a newer one. Immuno-modulating drugs are used for the treatment of MS.
Adding Alternative Therapies To The Standard MS Treatment
Researchers from Macedonia evaluated the best CAM (complementary and alternative medicine) therapies for MS, suggesting to add these therapies to the MS treatment plans to improve quality of life. The following therapies had been showed beneficial for MS: yoga, tai chi, acupuncture, music therapy, meditation, art therapy, hydrotherapy (swimming pool), hyperbaric oxygen therapy, cryotherapy and herbal therapy [2].
Herbs & Supplements
Cannabis: More and more research on cannabis. In this study, treatment with CBD caused attenuation of MS in animal models. Not only clinical symptoms, but also other markers had been improved (Technical: study showed decreased T cell infiltration in the CNS, reduced IL-17 and IFNγ; interestingly, CBD treatment led to a profound increase in myeloid-derived suppressor cells (MDSCs)) [8]. Another study reviews the multiple benefits of this plant- not just for MS, Parkinson’s but also pain, inflammation, glaucoma, cancer and heart diseases [9]. A third study: Sativex (oral spray CBD-THC) shows improvement in spasticity (20% improvement after one month of use, as an add on therapy), according to this new study [10].
Persian herbal combination: in a controlled, double-blind clinical trial a herbal combination was found to improve sleep and fatigue associated with MS. The Persian herbal combination includes herbs that had been previously researched for treating MS: C.sativus (saffron), H.perforatum (St John’s wort), C.verum (cinnamon), and V.vinifera (grape seeds) [3].
Silica can help remove aluminum from the body. Supplementing the diet with a silicon-rich mineral water, for a period of 12 weeks, reduced aluminum body burden in individuals with MS; concomitantly, in this short amount of time, disability scoring showed clinically relevant improvements in 2 out of 15 individuals [14].
Chondroitin sulphate: certain compounds from Chondroitin sulphate shows potential to improve markers of inflammation and reduce clinical symptoms in MS, according to this new study (animal models) [4].
Carnosol: carnosol, a key plant compound found in rosemary and sage, has significant potential as a therapeutic agent for autoimmune diseases like MS, according to this new study (animal models) [5].
Icariin: Icariin, major bioactive compound from Epimedium (aka Horny Goat Weed or Yin Yang Huo) shows benefits for treating autoimmune conditions such as MS and rheumatoid arthritis. While mostly known as a tonic and anti-aging agent, studies reveal many other benefits. It promotes cardiovascular health, prevents neurodegeneration, anti inflammatory, antioxidant and anti-cancer qualities. Technical :For autoimmune diseases mechanism of action : regulation of lymphocytes balance, anti-inflammatory/inflammatory cytokines, signal pathways ie NF-kappaβ and Erk-p38-JNK, lymphocyte transcription factors and other targets such as TLRs, STAT PTEN [6].
Kurarinone: Kurarinone, a plant flavonoid helps improve clinical scores, CNS inflammation, and CNS demyelination in animal models of MS. Technical: it modulates the immune system- inhibiting Th1, Th2, and Th17 cell differentiation and proliferation [7].
Ginger: 6-shogaol, a major constituent of ginger, and its biological metabolite, 6-paradol, previously showed anti-inflammatory and anti-oxidative properties in the brain. This study was conducted in EAE, the animal model of MS. Results: Once-daily administration of 6-shogaol and 6-paradol to symptomatic EAE mice significantly improved clinical signs of the disease along with remyelination and reduced cell accumulation in the white matter of spinal cord [11].
Probiotics: Probiotics influence systemic immune responses and promote healthy microbiota. Technical: The mechanisms proposed include mucus secretion, antimicrobial peptide production, maintenance of the function of the GI-epithelial barrier, reducing oxidative stress, ensuring adequate interactions between the gut microbiota and the mucosal immune cells, and activating of host immune system in response to pathobionts [12].
Teminalia chebula: this herb has been traditionally used in the Iranian traditional medicine and Ayurveda for neurologic disorders and inflammation. This new study (lab study) explores why this herb work. (technical: decreased inflammation responsible to LPS, influences gene expression level of inflammatory and anti-inflammatory mediators; promising effects on healing of neuro-inflammation and neurodegeneration through microglia roles) [13].
Other Therapies
Hydrotherapy shows some potential to improve quality of life in individuals with MS [14].
rTMS: repetitive transcranial magnetic stimulation(rTMS) plus a short period of exercise may induce significant reduction of spasticity in MS (SPMS and PPMS types), according to this new study [15].
Mindfulness meditation.The benefits of mindfulness meditation for MS are reviewed in this study and include: improvement in quality of life, mental health and physical symptoms such as fatigue in adult patients with MS. In adolescents, this practice had been associated with improvements in cognitive performance, attention, social skills, academic skills, emotional regulation, self-esteem, anxiety, stress and fatigue [16].
Exercise. Exercise is an effective therapeutic intervention for improving fatigue, depression and functional parameters, in MS, whether an individual is overweight or has healthy weight. According to this new study [17]. Another study: 12 weeks of aquatic exercise increases BDNF and improved balance, functional exercise capacity, and fatigue associated with MS, based on this new randomized controlled study [18].
Using Artificial Intelligence (AI) for rehab.We’ll see more of this in the future. A prototype system using AI will be used into a rehabilitation center in Turkey for in-depth analysis and experiments. This is a virtual reality based rehabilitation system for Parkinson and Multiple Sclerosis (MS) patients aiming to improve balance, tremor and movement coordination [19].
Everyday Matters, a novel positive psychology program designed to boost psychological resilience is beneficial for improving symptoms of depression and promote well-being, according to this pilot randomized controlled trial conducted in individuals with MS [20].
Stem Cell Therapy. New Therapies for MS ?
Stem cells treatment (mesenchymal stem cell transplantation). Based on the results of two randomized controlled trials and one case studies, stem cell therapy showed a decrease in the number of MS relapses experienced after being treated with stem cell therapy compared to steroids, placebo, and before therapy [22]. Stem cell treatments have a lot of potential and will likely be very popular in the future. Efficacy is not a problem, safety is the problem right now. I see more risks than benefits at this point.
Targeting gut microbiome: This study explores the benefits of targeting the gut microbiome (fecal transplantation) as a therapy for brain conditions like MS, Parkinson’s disease, autism, chronic fatigue syndrome, depression and anxiety [21].
Targeting sex hormones: Progesterone and estrogen — very important hormones for modulating immune system, and therefore managing MS.Technical: the immunological effects of progesterone and estrogen include: shift the immune response towards Th2, stimulateTreg production, inhibit pro-inflammatory cytokine production, prohibit cell migration into CNS, suppress proinflammatory immune cells, stabilize the neuronal environment, and promote neuronal survival. Studies that evaluated the benefits of oral contraceptives showed mixed results- some showing them beneficial to manage MS, while some didn’t find positive correlations [23]. Note: sex hormones can be balanced naturally, without the need of oral contraceptive or hormone replacement therapies (which had been linked with side effects including cancer, increased cardiovascular diseases and more).
Targeting Klotho protein: Klotho protein and its role in neurodegenerative conditions — again in the news. Related to MS, authors describe many benefits of this protein in the brain, including its role in remyelination. Thus, targeting Klotho protein could become a new therapeutic target for MS [24]. My note:Sounds great, in theory. But we need a lot more research on this topic before designing a drug to target Klotho. In those with MS, Klotho seems to be lower (in the CSF, in RRMS) and low levels correlate with more disability. Other studies also reveal higher levels of Klotho, especially in advanced cases of MS (when compared with those recently diagnosed or control group). It is possible that Klotho protein increases as a compensatory mechanism (naturally Klotho levels decrease with age). There is also a genetic predisposition related to Klotho. Until we have more details, it’s worth exploring natural, safe options that balance Klotho levels: exercise, sun exposure, avoiding stress and reducing inflammation.
More Studies
Zinc deficiency linked with MS, according to this study [25]. This is not a surprise considering that MS is associated with multiple nutrient imbalances. In addition, zinc plays a key role in the immune system health. This study also noted that disease modifying MS therapies did not improve zinc levels.
Vitamin D (25(OH)D)levels may be involved in the regulation of Epstein Barr Virus replication/reactivation in patients with MS, according to this new study. Scientists found that the viral load was significantly higher when 25(OH)D levels were low [26].
Diet is important: consumption of non-fermentable fiber (from fruits and veggies)in early adult life prevents autoimmune disease, according to this study. These fibers alter the composition of the gut microbiota and metabolic profile, increasing the healthy long-chain fatty acids [27].
Organic solvents, smoking, and genes tied to higher MS risk: Specifically, people exposed to occupational organic solvents have a 50% higher risk of developing multiple sclerosis (MS). Even greater risk r among carriers of the MS risk HLA gene. Those exposed to smoking and organic solvents who carried MS genetic risk factors had a 30-fold increased MS risk compared with non-exposed participants without the genetic risk factors, according to this study.The strongest genetic factors in MS include HLA-DRB1*15 allele (linked a higher MS risk); the HLA-A*02 allele may have a protective effect [27].
PPMS (primary progressive MS) seems to decline, based on studies conducted in Germany and Sweden. Scientists suggest age of birth as a strong variable. Prevalence of PPMS was 19% for those born in the late 1940s vs 3% in the group born in early 1970s [28].
Side Effects From MS Drugs
heart attack following the use of natalizumab (MS case study) [29]
the risk of PML (multifocal leukoencephalopathy)- new study shows the following: The relative risk of PML with natalizumab was much higher than with any of the other DMDs (fingolimod dimethyl fumarate, rituximab). glatiramer acetate, interferon, and dalfampridine were not associated with PML risk based on this study based on FAERS database(2015-2017)[30]
psychotic depression from steroid drugs (a case study) [31]
