Complementary and Alternative Medicines for NMOSD

Complementary and alternative medicine (CAM) includes a large group of treatment approaches that lie outside mainstream medicine.¹

There has been very little research done on the benefits and risks of complementary therapies in neuromyelitis optica spectrum disorder (NMOSD). Research that has been conducted is not as thorough as some traditional studies, making it hard for doctors to all agree that a complementary therapy might help or ease symptoms of NMOSD.²

What are complementary and alternative approaches?

CAM therapies may be described in various ways:³

• Biologically based therapies – Diets, dietary supplements
• Mind-body medicine – Meditation, mindfulness, hypnosis
• Body-based systems – Massage, chiropractic medicine
• Alternative medical systems – Traditional Chinese medicine, Ayurveda
• Energy therapies – Magnets, therapeutic touch

If an approach is used with traditional medicine, it is often called complementary. If an approach is used instead of traditional medicine, it is called alternative. Given the severity of NMOSD, it is not recommended to use only alternative approaches though complementary approaches added to traditional medicine may have additional benefits.¹

Acupuncture

Acupuncture is a part of traditional Chinese medicine. This therapy involves the use of thin needles placed in specific areas on the body to balance the energy in the body, known as chi or qi. Acupuncture can have positive effects on many aspects of well-being, such as:^4,5

• Mood
• Anxiety
• Pain
• Sleep problems

Not everyone experiences a benefit with acupuncture. However, it has been shown to be safe and well-tolerated, and might be effective for depression and some types of pain.^4,5

Some studies have been mixed about how effective acupuncture can be for certain diseases and symptoms. If you would like to explore acupuncture, talk to your doctor first, and make sure you go to an experienced acupuncturist.⁵

Massage

Massage may be helpful to relieve pain and muscle stiffness that can occur with NMOSD. Seek out experienced massage therapists and ask your doctor about this therapy before having a massage.³

Mindfulness and meditation

Meditation is a mind-body approach of mindfulness. Anyone can practice meditation, and it does not require special equipment. Practicing meditation and mindfulness can help you become relaxed. Along with the emotional benefits, meditation may be helpful in relieving some symptoms of chronic disease. This might include depression, sleep problems, or pain. Talk to your doctor about the pros and cons of this practice.⁶

Vitamin D

Vitamin D supplements are potentially beneficial for people with NMOSD. Vitamin D is recognized as an important factor in maintaining bone density. People with AQP4-IgG positive NMOSD are at increased risk for decreased bone mineral density. There are different reasons for this, including:^7-9

• Steroid use
• Loss of mobility

Other factors, such as increased age or decreased body weight, can also lead to decreased bone density. Having a decreased bone density can lead to an increased risk for fractures. For those with NMOSD, increased fractures are also linked to an increased risk of falls.⁹

Results from several studies suggest that low vitamin D levels may play a role in the development of some brain and spine conditions. More studies are needed to determine a clear relationship between vitamin D and NMOSD.

Also, more studies are needed to test whether vitamin D has disease-modifying effects. If you would like to use vitamin D supplements, talk to your doctor first. Your doctor can give you a blood test to find out your blood level of vitamin D. If your levels is low, your doctor may suggest a daily supplement to bring your levels up to normal.⁷

Fatty oils and acids

There are 2 basic groups of fats in foods:¹⁰

• Saturated fats
• Unsaturated fats

Saturated fatty acids mostly come from animal products, such as red meat, bacon, and cheese. They are considered “bad fats."¹⁰

Other “bad fats'' include trans fats. This is a type of saturated fat that naturally occurs in some foods and is added to many processed foods.¹⁰

Unsaturated fats are considered “good fats.” Omega-3 fatty acids are 1 type of polyunsaturated fat found in fatty fish and nuts, seeds, and vegetable oils. In some studies, fatty acids have been shown to decrease inflammation, which may be helpful in those with NMOSD. However, this link has not been tested, and fatty acids are not an approved treatment for NMOSD.^11,12

Diet

While some studies have shown that what you eat can impact your brain health, no diet has ever been systematically studied in NMOSD. This does not mean that diet and nutrition are not important. Many healthy diet approaches may not benefit those with NMOSD.¹¹

Herbs

Herbal supplements come from plants, and like drugs, they may produce changes in the body. However, there is a lack of evidence from research to support the use of herbal supplements in NMOSD. There are safety concerns since there are no quality control measures to monitor supplements in place. As with any complementary therapy, people who are considering taking herbal supplements should talk to their doctor. Some supplements may interfere with medicines or interact with your immune system.^11,13

Exercise

There is strong evidence that exercise and physical activity can help you get and stay healthy. Those who exercise on a regular basis have a lower risk of long-term diseases such as heart disease, type 2 diabetes, stroke, and some cancers.¹⁴

Being and staying active with NMOSD has its challenges. You may have barriers that keep you from doing the exercises you used to do. The key is to find activities that:¹⁴

• You are able to do
• Challenge you a bit
• Keep you interested

Think of exercise as a daily activity – how can you add more activity and movement to your day? Based on your symptoms, some exercises to consider might include:¹⁴

• Walking
• Swimming
• Gardening

If you can, make exercise a social event. Include your family or friends to give you extra motivation. Some days may be harder than others. If you are extremely tired or in pain, consider modifying your movement. You may need to wear splints or braces in order to overcome muscle weakness or tightness. Always talk to your doctor about the best choices for you.¹⁵

Many CAM therapies can be safely and effectively integrated with traditional medical approaches. However, all therapies should be discussed with your doctor.