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Scientists Turn to Alternative Medicine for MS

by C.

Article Date: 08-19-05

A small, preliminary study released this past spring suggests that the alternative supplement known as ginkgo biloba may help some people with multiple sclerosis manage their symptoms.1

Keeping Symptoms in CheckResearchers at Oregon Health and Science University (OHSU) enrolled nearly 40 MS patients for their pilot study to test the efficacy of ginkgo versus a non-therapeutic placebo in helping the patients boost their cognitive function. "Cognitive dysfunction is a major cause of disability in MS, and presently there is no effective treatment," wrote the study's chief investigator, Dennis Bourdette, MD, a neurologist at OHSU, and his team of investigators. "One agent that may have some benefit is ginkgo biloba, which many MS patients use despite a [lack] of existing evidence to support such use."

The patients were divided into two groups. Twenty received 120 mg doses of gingko biloba twice per day, and the remaining 19 patients received a placebo. There were no differences in any of the patients in terms of gender, education, type of MS, years since onset, or initial performance on a series of neurological tests given as part of the study. The tests were given before treatment with ginkgo biloba began, and then again afterwards to compare the results.

Improvement on Tests SeenWhen the exams were given at the end of the study, the group that had been taking ginkgo was four seconds, or about 13%, faster than the group given a placebo on a timed color and word test that measures attention and such functions as planning, decision-making, and controlling goal-directed behavior and execution of certain actions.

In one test, patients are shown colored boxes and are asked to name the colors. They are then shown a list of named colors, but which display different colored inks. For instance, the word "yellow" might be written in "green" ink. The patents are asked to name the word, and then describe the type of ink used for each word.

While the benefits of ginkgo for people taking this test were not clear cut, the results pointed to that possibility,. Bourdette's group maintained. To confirm the possible benefit of the supplement "we would like to do another study in which we choose patients that are impaired in this particular test," explained Jesus Lovera, MD, a research fellow and instructor in Neurology at OHSU who participated in this study. "We would like to test it at higher doses."

Ginkgo BackgroundGinkgo biloba is a compound that comes from the ginkgo tree. Its leaves contain several substances known as ginkgolides. According to experts, ginkgo reduces the clotting tendency of blood, and opens blood vessels, while reducing inflammation. It is used to improve blood flow to the brain and in the lower legs.2 Still, the research on its effectiveness for cognitive function has been controversial. One US study claimed that ginkgo may be able to stabilize or improve mental or social function in people with mild to moderate dementia, including Alzheimer's disease.3 Other research has suggested that ginkgo can boost mental function in healthy older people,4 though additional studies say it has no benefit for elderly people.5 Similarly, one clinical trial concluded older people with dementia or age-associated mental dysfunction do not find benefit from using the supplement.6

The only side effect that's been reported is mild digestive upset, though experts urge that its use be supervised by a physician. Ginkgo may interact with certain anticoagulants, aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), and it may reduce the effectiveness of anti-convulsants.2

According to the investigators in this study, a survey of nearly 2,000 patients in Oregon found that ginkgo was beneficial for 40 percent of the patients who took part. "It has been shown to be of benefit in Alzheimer's," Lovera said. "But we did not know if it would work for MS."

He says the study results demonstrate that the supplement shouldn't be written off as an MS therapy, but that its safety and effectiveness should be tested further in a larger clinical trial. "The study suggests that for cognitive problems, it may only help a certain group of patients," Lovera said. "We need to study this further."

1. Bagert B, Lovera J, Oken B et al. Ginkgo biloba improves cognitive performance in multiple sclerosis patients with cognitive dysfunction: a pilot study. 57th Annual Meeting of the American Academy of Neurology. 2005 Apr 9-16. Miami Beach, Florida.2. The Merck Manual. Ginkgo. Available at: http://www.merck.com/mmhe/sec02/ch019/ch019k.html?qt=ginkgo%20biloba & alt=sh. Accessed August 15, 2005.3. Le Bars PL, Velasco FM, Ferguson JM, Dessain EC, Kieser M, Hoerr R. Influence of the severity of cognitive impairment on the effect of the Gingko biloba extract EGb 761 in Alzheimer's disease. Neuropsychobiology 2002;45(1):19-26.4. Mix JA, Crews WD Jr. A double-blind, placebo-controlled, randomized trial of Ginkgo biloba extract EGb 761 in a sample of cognitively intact older adults: neuropsychological findings. Hum Psychopharmacol 2002 Aug;17(6):267-77.5. PJ, Ricketts E, Wesnes K, Mrazek L, Greville W, Stough C. The acute nootropic effects of Ginkgo biloba in healthy older human subjects; a preliminary investigation. Hum Psychopharmacol 2002 Jan;17(1):45-9.6. van Dongen M, van Rossum E, Kessels A, Sielhorst H, Knipschild P. Ginkgo for elderly people with dementia and age-associated memory impairment: a randomized clinical trial. J Clin Epidemiol 2003 Apr;56(4):367-76. is a long-time health journalist and an editor for Priority Healthcare. His credits include overseeing health news coverage for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.