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Ovid eBooks Click on Books in top navigation bar. PubMed Books A growing collection of biomedical books that can be searched directly. R2 Digital Library More than health science e-books. SpringerLink - Neurology. MS may have a significant impact on personal and social well-being. In fact, the most common comorbid conditions in patients with MS are disorders of mental, not physical, health. High levels of stress may increase risk for relapses and worsen symptoms. For anxiety and depression, lifestyle and unconventional medicine greatly expand the treatment options beyond those of conventional medicine ie, typically medications and psychotherapy.

Probably the most effective nonpharmacologic treatment for anxiety and depression is physical activity. Depression or anxiety in some people with MS may even be caused or worsened by lack of physical activity because of the disability caused by MS. In these people, careful escalation of physical activity, often done with physical therapist consultation, may produce significant mental health benefits. There are many other lifestyle and unconventional strategies that in studies of variable quality in MS and other conditions have shown beneficial effects for anxiety and depression Table 3.

Tobacco smoking and excessive alcohol use in those with MS may have multiple adverse effects on general health and on MS itself, but may not be addressed in clinical practice. Smoking may adversely affect MS directly and indirectly and has been associated with increased risk for developing MS. Smoking increases risk for development of neutralizing antibodies to natalizumab and interferons, which may decrease effectiveness of those medications.

Alcohol use, like tobacco smoking, may have direct and indirect effects on MS. Mild-to-moderate alcohol use that is not done with care may have effects that interfere with function in those with MS, including decreased alertness and cognitive function, incoordination, gait dysfunction, fatigue, and increased reaction times. Excessive alcohol use increases the risk for multiple comorbidities that may indirectly affect MS, including hypertension, multiple cancers, liver disease, and malnutrition.

Neurologists are not typically directly involved in treatment for alcohol and tobacco misuse. However, if these issues are identified in practice, neurologists may play a valuable role by providing input to patients about the adverse health effects of tobacco and alcohol, including those on MS, and referring patients to their primary care providers for treatment.

As noted earlier, comorbidities may have adverse effects on those with MS. Many of these comorbidities may be caused, or worsened by, lifestyle.

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As a result, steps of this paradigm Box 2 become important both for prevention and treatment of many comorbidities. Ideally, comorbidities are prevented by a healthy lifestyle.

Limitations of the Evidence Based Approach

There may be great opportunities for comorbidity prevention in those with MS because MS is typically diagnosed between the ages of 20 and 40, an age group that has relatively few comorbid conditions. In those with comorbidities, treatment of the comorbidities should be optimized. Specific attention may be paid to comorbidities that may be improved or even reversed with lifestyle modification, such as diabetes, obesity, hypertension, and hyperlipidemia.

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A critical component of effective integrative care for patients with MS is healthy lifestyle change, which neurologists may facilitate. Early in my career, several patients told me that the diagnosis of MS was one of the best things that had ever happened to them. In the moment, I thought these patients, with whom I had never discussed lifestyle, suffered from some variant of la belle indifference. In fact, they were actually wiser and more insightful than I was.

Online Complementary Therapies In Neurology: An Evidence Based Approach

On their own, they had worked to leverage the bad news diagnosis of MS into a motivator for living a meaningful, rich, and healthy life that included making lifestyle changes at a young age that they would not have made if they had not been diagnosed with MS. A study sought to understand what factors led more than people to make successful or failed lifestyle change. Rather, they were associated with crystallizations of discontent, often characterized by unexpected focal life events from external threats eg, health problems that produced intense negative emotional experiences. A diagnosis of MS and events in the disease course eg, relapses, new MRI lesions, or the onset of secondary progressive disease are such focal events and may be potent motivators for lifestyle change.

Neurologists who help patients identify and leverage these in a positive way may produce lifelong health benefits for their patients.

Likewise, neurologists who do not address this may be missing opportunities to improve their patients' health. Integrative care of patients with MS is underappreciated and underutilized by neurologists. This is unfortunate because this paradigm is ideally suited to MS and provides treatment approaches and health opportunities that are not provided by exclusive conventional medical practice. The concepts and approaches in this article should allow neurologists to begin using this treatment model in day-to-day clinical practice.

Bowling AC. New York: Demos Medical Publishing; Complementary and alternative medicine in multiple sclerosis. In: Giesser B. Primer on Mutliple Sclerosis. New York: Oxford University Press; Complementary and alternative medicine and multiple sclerosis. Neurol Clin North Amer. Summary of evidence-based guideline: complementary and alternative medicine in multiple sclerosis: report of the guideline development subcommittee of the American Academy of Neurology. Rakel D, and Weil A.

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Philosophy of integrative medicine. In: Rakel, D. Buy Softcover. Rent the eBook. FAQ Policy. Show all. Stroke Pages Aguilar, Maria I. Epilepsy Pages Burneo, Jorge G. Show next xx. Read this book on SpringerLink. Recommended for you.