Editing Multiple sclerosis (section)

=== Alternative treatments ===
Over 50% of people with MS may use [[complementary and alternative medicine]], although percentages vary depending on how alternative medicine is defined.<ref name="pmid16420779">{{cite journal |vauthors=Huntley A |date=January 2006 |title=A review of the evidence for efficacy of complementary and alternative medicines in MS |journal=International MS Journal |volume=13 |issue=1 |pages=5–12, 4 |pmid=16420779}}</ref> Regarding the characteristics of users, they are more frequently women, have had MS for a longer time, tend to be more disabled and have lower levels of satisfaction with conventional healthcare.<ref name="pmid16420779" /> The evidence for the effectiveness for such treatments in most cases is weak or absent.<ref name="pmid16420779" /><ref name="pmid19222053">{{cite journal|vauthors=Olsen SA|year=2009|title=A review of complementary and alternative medicine (CAM) by people with multiple sclerosis|journal=Occupational Therapy International|volume=16|issue=1|pages=57–70|doi=10.1002/oti.266|pmid=19222053}}</ref> Treatments of unproven benefit used by people with MS include dietary supplementation and regimens,<ref name="pmid16420779" /><ref>{{cite journal | vauthors = Parks NE, Jackson-Tarlton CS, Vacchi L, Merdad R, Johnston BC | title = Dietary interventions for multiple sclerosis-related outcomes | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | pages = CD004192 | date = May 2020 | issue = 5 | pmid = 32428983 | doi = 10.1002/14651858.CD004192.pub4 | pmc = 7388136 }}</ref><ref name="pmid21965673">{{cite journal | vauthors = Grigorian A, Araujo L, Naidu NN, Place DJ, Choudhury B, Demetriou M | title = N-acetylglucosamine inhibits T-helper 1 (Th1)/T-helper 17 (Th17) cell responses and treats experimental autoimmune encephalomyelitis | journal = The Journal of Biological Chemistry | volume = 286 | issue = 46 | pages = 40133–41 | date = November 2011 | pmid = 21965673 | pmc = 3220534 | doi = 10.1074/jbc.M111.277814 | doi-access = free }}</ref> [[vitamin D]],<ref>{{cite journal | vauthors = Pozuelo-Moyano B, Benito-León J, Mitchell AJ, Hernández-Gallego J | title = A systematic review of randomized, double-blind, placebo-controlled trials examining the clinical efficacy of vitamin D in multiple sclerosis | journal = Neuroepidemiology | volume = 40 | issue = 3 | pages = 147–53 | year = 2013 | pmid = 23257784 | pmc = 3649517 | doi = 10.1159/000345122 | type = Systematic review | quote = the available evidence substantiates neither clinically significant benefit nor harm from vitamin D in the treatment of patients with MS }}</ref> [[relaxation technique]]s such as [[yoga as exercise|yoga]],<ref name="pmid16420779" /> [[herbal medicine]] (including [[medical cannabis]]),<ref name="pmid16420779" /><ref>{{cite journal | vauthors = Chong MS, Wolff K, Wise K, Tanton C, Winstock A, Silber E | title = Cannabis use in patients with multiple sclerosis | journal = Multiple Sclerosis | volume = 12 | issue = 5 | pages = 646–51 | date = October 2006 | pmid = 17086912 | doi = 10.1177/1352458506070947 | s2cid = 34692470 }}</ref><ref>{{cite journal | vauthors = Torres-Moreno MC, Papaseit E, Torrens M, Farré M | title = Assessment of Efficacy and Tolerability of Medicinal Cannabinoids in Patients With Multiple Sclerosis: A Systematic Review and Meta-analysis | journal = JAMA Network Open | volume = 1 | issue = 6 | pages = e183485 | date = October 2018 | pmid = 30646241 | pmc = 6324456 | doi = 10.1001/jamanetworkopen.2018.3485 }}</ref> [[hyperbaric oxygen therapy]],<ref name="pmid14974004">{{cite journal | vauthors = Bennett M, Heard R | title = Hyperbaric oxygen therapy for multiple sclerosis | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD003057 | year = 2004 | volume = 2011 | pmid = 14974004 | doi = 10.1002/14651858.CD003057.pub2 | veditors = Bennett MH | pmc = 8407327 }}</ref> [[helminthic therapy|self-infection with hookworms]], [[reflexology]], [[acupuncture]],<ref name="pmid16420779" /><ref>{{cite news | vauthors = Adams T | title=Gut instinct: the miracle of the parasitic hookworm | url=https://www.theguardian.com/lifeandstyle/2010/may/23/parasitic-hookworm-jasper-lawrence-tim-adams | newspaper=The Observer | date=23 May 2010 | url-status=live | archive-url= https://web.archive.org/web/20141024051021/http://www.theguardian.com/lifeandstyle/2010/may/23/parasitic-hookworm-jasper-lawrence-tim-adams | archive-date=24 October 2014 | df=dmy-all }}</ref> and [[mindfulness]].<ref>{{cite journal | vauthors = Simpson R, Booth J, Lawrence M, Byrne S, Mair F, Mercer S | title = Mindfulness based interventions in multiple sclerosis—a systematic review | journal = BMC Neurology | volume = 14 | pages = 15 | date = January 2014 | pmid = 24438384 | pmc = 3900731 | doi = 10.1186/1471-2377-14-15 | doi-access = free }}</ref> Evidence suggests vitamin D supplementation, irrespective of the form and dose, provides no benefit for people with MS; this includes for measures such as relapse recurrence, disability, and MRI lesions while effects on health‐related quality of life and fatigue are unclear.<ref>{{cite journal | vauthors = Jagannath VA, Filippini G, Di Pietrantonj C, Asokan GV, Robak EW, Whamond L, Robinson SA | title = Vitamin D for the management of multiple sclerosis | journal = The Cochrane Database of Systematic Reviews | volume = 9 | issue = 9 | pages = CD008422 | date = September 2018 | pmid = 30246874 | pmc = 6513642 | doi = 10.1002/14651858.CD008422.pub3 }}</ref> There is insufficient evidence supporting high-dose [[biotin]]<ref name=Motte2020>{{cite journal |vauthors=Motte J, Gold R |title=High-dose biotin in multiple sclerosis: the end of the road |journal=Lancet Neurol |volume=19 |issue=12 |pages=965–966 |date=December 2020 |pmid=33222766 |doi=10.1016/S1474-4422(20)30353-7 |s2cid=225049079 }}</ref><ref>{{cite journal |vauthors=Tryfonos C, Mantzorou M, Fotiou D, Vrizas M, Vadikolias K, Pavlidou E, Giaginis C |title=Dietary Supplements on Controlling Multiple Sclerosis Symptoms and Relapses: Current Clinical Evidence and Future Perspectives |journal=Medicines  |volume=6 |issue=3 |date=September 2019 |page=95 |pmid=31547410 |pmc=6789617 |doi=10.3390/medicines6030095 |doi-access=free }}</ref><ref>{{cite journal |vauthors=Sedel F, Bernard D, Mock DM, Tourbah A |title=Targeting demyelination and virtual hypoxia with high-dose biotin as a treatment for progressive multiple sclerosis |journal=Neuropharmacology |volume=110 |issue=Pt B |pages=644–653 |date=November 2016 |pmid=26327679 |doi=10.1016/j.neuropharm.2015.08.028 |doi-access=free }}</ref> and some evidence for increased disease activity and higher risk of relapse with its use.<ref name=Goldschmidt2020>{{cite journal |vauthors=Goldschmidt CH, Cohen JA |title=The Rise and Fall of High-Dose Biotin to Treat Progressive Multiple Sclerosis |journal=Neurotherapeutics |volume=17 |issue=3 |pages=968–970 |date=July 2020 |pmid=32761325 |doi=10.1007/s13311-020-00907-5 |pmc=7609671 |doi-access=free }}</ref> A 2022 review found that [[nabiximols]] ([[tetrahydrocannabinol]] and [[cannabidiol]]) can reduce the severity of spasticity in the short term, but may have unwanted neurological effects.<ref>{{cite journal | vauthors = Filippini G, Minozzi S, Borrelli F, Cinquini M, Dwan K | title = Cannabis and cannabinoids for symptomatic treatment for people with multiple sclerosis | journal = The Cochrane Database of Systematic Reviews | volume = 5 | issue = 5 | pages = CD013444 | date = May 2022 | pmid = 35510826 | pmc = 9069991 | doi = 10.1002/14651858.CD013444.pub2 }}</ref>