Related Terms

• Acute inflammatory demyelinating polyneuropathy, antibodies, antidepressant, autoimmune disease, B lymphocytes, bacteria, campylobacter, campylobacteriosis, cardiovascular, CIDP, corticosteroid, counseling, diarrhea, electromyogram EMG, flu, gastrointestinal, hypertension, hypokinesia, immune, immunoglobulin, infectious mononucleosis, inflammatory, inflammatory demyelinating polyradicalneuropathy, influenza, Landry's ascending paralysis, lumbar puncture, microbial, motor, movement disorder, myelin, myelin sheath, NCV, nerve conduction velocity, neurological disorder, opiate, paralysis, parethesia, peripheral nerves, physical therapy, plasmapheresis, pulmonary embolism, respiratory failure, spinal tap, T lymphocytes, vaccination, viral, viral hepatitis.

Background

• Guillain-Barre syndrome (GBS), also called acute inflammatory demyelinating polyneuropathy and Landry's ascending paralysis, is an inflammatory disorder in which the body's immune system attacks the peripheral nerves. The immune system is a complex and highly developed organization in the body that seeks out and kills foreign invaders, such as viruses and bacteria. Peripheral nerves are nerves that reside outside of the brain and spinal cord (collectively the central nervous system). Rarely, nerves in the brain or spinal cord are attacked. The peripheral nerves convey sensory information (including pain and temperature) from the body to the brain. Peripheral nerves also convey motor (movement) signals from the brain to the body. In GBS, these functions are affected in varying degrees, from mild to severe.

• Individuals with GBS may develop symptoms rapidly. Symptoms include weakness and numbness in the legs and arms. Often, paralysis of the legs, arms, breathing muscles, and face will occur. Symptoms of GBS can develop over the course of hours or days, or it may take up to three to four weeks. Scientists have not discovered why some individuals develop GBS. Some experts consider GBS to be an autoimmune disease. Autoimmune diseases occur when the body's own immune system attacks itself.

• According to the Centers for Disease Control (CDC), GBS is rare and affects an estimated one to two in every 100,000 persons annually in the United States. Any race is susceptible to GBS, but its incidence increases with age.

• Usually GBS occurs a few days or weeks after the patient has had symptoms of a respiratory (breathing) or gastrointestinal (digestive) viral infection. Occasionally, surgery or vaccinations will trigger the syndrome.

• GBS may be triggered by pregnancy or a medical procedure, such as a vaccination or minor surgery, or have no evident reason for developing. Because the cause of GBS is unknown, there is no way to prevent the disease from occurring. If symptoms develop, a doctor should be contacted immediately.

• In its most severe form, GBS is a medical emergency and may require hospitalization. Severe GBS may result in total paralysis, potentially dangerous changes in heart rate and blood pressure, and inability to breathe without respiratory assistance. The individual is often put on a machine called a respirator to assist with breathing. The muscles used for eye movement, speaking, chewing, and swallowing also may become weak or paralyzed. Individuals with severe GBS often need long-term rehabilitation to regain normal independence and as many as 15% experience lasting physical impairment, such as problems walking, using the arms, or breathing. In some cases, GBS can be fatal.

• Most individuals recover from even the most severe cases of GBS, although some continue to have some degree of weakness. Available treatments, if started soon after signs and symptoms appear, may lessen the severity of GBS and reduce recovery time. About 30% of those with Guillain-Barre still have weakness after three years. About three percent may suffer a relapse of muscle weakness and tingling sensations many years after the initial attack.

• Chronic inflammatory demyelinating polyradicalneuropathy (CIDP): Chronic inflammatory demyelinating polyradicalneuropathy (CIDP) is considered to be a chronic autoimmune condition with similar symptoms to Guillain-Barre syndrome (GBS). However, it is much less common than GBS and evolves much more slowly and is usually longer lasting. Some individuals with CIDP experience periods of worsening and improvement and individual relapses are often confused with GBS. A doctor can determine through proper diagnosis if an individual has CIDP or GBS.

Risk Factors and Causes

• The cause of Guillain-Barre syndrome (GBS) is not known. Many cases occur shortly after a microbial (viral or bacterial) infection such as the flu, the common cold, gastrointestinal viral infection, sore throat, or diarrhea. GBS can also occur due to campylobacteriosis (eating bacteria from undercooked poultry) and porphyria (a rare disease of red blood cells). The Epstein-Barr virus (herpesvirus type 4) or Hodgkin's disease (a type of lymphoma or cancer of the lymph nodes) also may occur before developing GBS.

• GBS is not hereditary (transferred from parent to child) or contagious (transferred from one individual to another). Half of all cases the onset of the syndrome follow a viral or bacterial infection, such as in influenza (flu), common cold, gastrointestinal viral infection, infectious mononucleosis, and viral hepatitis (inflammation of the liver caused by a virus).

• Autoimmune disorder: Some theories suggest that GBS is an autoimmune disease, in which the individual's defense system of antibodies and white blood cells begin to damage the myelin sheath, which is a fat layer that surrounds and covers peripheral nerves. The destruction of this myelin sheath may lead to weakness and abnormal sensations such as tingling and numbness. In diseases in which the peripheral nerves' myelin sheaths are injured or degraded, the nerves cannot transmit signals efficiently. The muscles begin to lose their ability to respond to the brain's commands that must be carried through the nerve network.

• Virus: When a viral or bacterial infection occurs prior to GBS, it is possible that the virus has changed the nature of cells in the nervous system so that the immune system treats the cells as foreign cells. It is also possible that the virus makes the immune system itself less able to be detected, allowing some of the immune cells, such as certain kinds of lymphocytes and macrophages, to attack the myelin sheath surrounding the nerves. Cells of the immune system, called T lymphocytes and B lymphocytes, work together to produce antibodies against the cells in the myelin sheath. The antibodies will attack the cells and may contribute to the destruction of the myelin. This is an autoimmune disease.

• Others: GBS may be triggered by medical procedures including surgery and, in rare cases, influenza immunizations. However, the connection between the flu vaccine and GBS is weak and the risk the vaccine poses to the individual's health is much less significant than the risk of developing flu-related illness.

• Older adults with other medical problems, such as diabetes or heart conditions, are at the greatest risk of death from GBS.

Signs and Symptoms

• The first symptoms of Guillain-Barre syndrome (GBS) include paresthesia (numbness or tingling) in the toes and fingers with progressive weakness in the arms and legs over the next few days. Some individuals experience paresthesia only in the toes and legs, while others only experience symptoms on one side of the body. GBS generally progresses quickly. Most individuals experience the most significant weakness in the legs, arms, chest, and other areas within three weeks of the start of this disorder. In some cases, the signs and symptoms of GBS may progress very rapidly with complete paralysis of legs, arms, and breathing muscles over the course of a few hours.

• If an individual is at risk for developing GBS and symptoms appear, 911 should be called immediately and a doctor seen as soon as possible.

• The symptoms may be mild, causing only slight difficulty in walking, requiring crutches or a walking stick. If GBS is mild, the signs and symptoms may not extend beyond a feeling of general weakness.

• However, sometimes the illness progresses, leading to complete paralysis of the arms and legs. About one-quarter of the time, the paralysis continues up the chest and freezes the breathing muscles, leaving the patient dependant on a ventilator. If the swallowing muscles are also affected, a feeding tube may be needed.

• The signs and symptoms of GBS may also include difficulty with eye movement, facial movement, and speaking, a slow heart rate, or low blood pressure. Difficulty with bladder control or intestinal functions may also occur.

• GBS may improve without treatment within a few weeks and some individuals initially may think the signs and symptoms are simply due to the flu or a cold. The signs and symptoms of GBS may last days, weeks, or months before muscle sensation begins to return. Regaining strength and functioning is slow, sometimes requiring months or years. However, most individuals with GBS return to normal within months.

• In chronic inflammatory demyelinating polyradicalneuropathy (CIDP), the illness lasts longer and respiratory failure is much less likely.

• If a tingling sensation is experienced in the toes, feet, or legs followed by muscle weakness, prompt medical attention is recommended by healthcare providers. Failure to see a doctor promptly may lead to progression of the disorder and paralysis, which can leave the individual incapacitated and unable to get help.

Diagnosis

• Guillain-Barre syndrome (GBS) can be difficult to diagnose in its earliest stages. The signs and symptoms are similar to those of other movement disorders, such as hypokinesia (absent or reduced ability to perform purposeful movement).

• An individual presenting with signs and symptoms of GBS will generally be placed in a hospital setting for tests and evaluation. The length of stay depends upon the severity of the symptoms and the testing ordered by the doctor.

• The individual's symptoms and a physical exam are usually sufficient to make a diagnosis of GBS. The rapid onset of weakness, frequently accompanied by abnormal sensations (such as tingling or numbness) that affect both sides of the body similarly, is commonly seen. Loss of reflexes, such as the knee jerk, is usually found. To confirm the diagnosis, a medical procedure called a lumbar puncture and an electrical test of nerve and muscle function may be performed.

• Lumbar puncture: Lumbar puncture, or spinal tap, is a procedure that involves inserting a needle into the spinal canal, usually the low back area called the lumbar region. A doctor can determine the pressure of the cerebrospinal fluid and a sample of fluid can be removed for laboratory analysis. Lumbar puncture may include checking for evidence of bleeding, the number and types of white blood cells (indicating infection), the levels of glucose and protein, the types of proteins, and tests for bacteria and fungi. Generally, individuals undergoing a lumbar puncture are given an anesthetic, such as lidocaine (Xylocaine®), in the area where the needle will be inserted. Pain is common with a lumbar puncture.

• Electromyogram: Electromyogram (EMG) is an effective diagnostic tool because it records muscle activity. An EMG can show the loss of reflexes due to the disease's characteristic slowing of nerve responses. In an EMG, a technician inserts electrodes in fine needles into the muscles being tested. Then, they place electrodes on the patient's skin that are over certain nerves.

• Nerve conduction velocity: Nerve conduction velocity (NCV) is performed with EMG. Together, they are often referred to as EMG/NCV studies. NCV records the speed at which signals travel along the nerves.

Complications

• The long-term outlook for most individuals with Guillain-Barre syndrome (GBS) is good. About 75-85% of those affected with GBS recover completely, generally with only minor, continued weakness or abnormal sensations such as numbness or tingling.

• Individuals may experience more serious, permanent problems with sensation and coordination, including some cases of severe disability.

• About one in ten of those affected is at risk of experiencing a relapse.

• GBS may cause severe damage to the muscles and nervous system, weakening the heart and lungs. About one-third of individuals with GBS require assisted breathing using a machine called a ventilator while they are ill. Up to one in 12 individuals with GBS die of related complications such as respiratory (breathing) failure, pulmonary embolism, or a blockage of the pulmonary artery in the lungs by a blood clot and heart attack.

• GBS can be a devastating disorder because of its sudden and unexpected onset. Most individuals reach the stage of greatest weakness within the first two weeks after symptoms appear. By the third week of the illness, 90% of all individuals are at their weakest. The recovery period may be as little as a few weeks or as long as a few years. About 30% of those with GBS still have a residual weakness after three years. About three percent may suffer a relapse of muscle weakness and tingling sensations many years after the initial attack.

Treatment

• There is no cure for Guillain-Barre syndrome (GBS). However, certain treatments can lessen the intensity of the condition and speed up recovery for most people. The general treatment for GBS is supportive care to help with activities of daily living, such as eating, bathing, and using the toilet. For some, recovery can take a long time, from several months to a year or more. GBS is considered a medical emergency and most patients are admitted to intensive care (ICU) soon after diagnosis.

• Plasmapheresis: Individuals diagnosed early in the course of GBS and those who are immediately ill often respond well to plasmapheresis, or blood plasma exchange. In this procedure, blood is withdrawn and passed through a series of filters that separate the different types of blood cells. The blood cells are then suspended in donor or synthetic (man-made) plasma and returned to the individual's body. Plasmapheresis is thought to remove the substances that damage myelin. It may shorten the course of GBS, alleviate symptoms, and prevent paralysis.

• Immunoglobulin: Large doses of immunoglobulin into the veins through an IV can help shorten the duration of symptoms. This treatment is recommended when plasmapheresis is not available, when individuals do not respond to it, and when individuals are not good candidates for the plasmapheresis.

• Medications: Muscle and joint pain can be treated with over-the-counter (OTC) pain relievers such as aspirin or ibuprofen (Advil® or Motrin®). If the individual has a bleeding disorder or takes blood thinning medications (such as warfarin or Coumadin®), acetaminophen (such as Tylenol®) may be used. Narcotic pain relievers, such as hydrocodone (Vicodin® or Lortab®) or acetaminophen with codeine (Tylenol #3), may also be taken. However, these medications may cause side effects such as constipation and drug dependence. Muscle spasms can be controlled with muscle relaxants such as diazepam (Valium®), although the risk of dependence is high.

• Muscle relaxants, such as cyclobenzaprine (Flexeril®) or carisoprodol (Soma®), may be used instead of narcotic pain relievers as they do not have the addiction potential that narcotics do, but may still cause drowsiness and fatigue (extreme tiredness).

• In the later stages of rehabilitation, lingering sensation problems can be treated with tricyclic antidepressants, such as amitriptylline (Elavil®), or anticonvulsants, such as gabapentin (Neurontin®). Both these medications may cause drowsiness and fatigue (extreme tiredness).

• Corticosteroids, such as prednisone (Deltasone®), may be used to treat CIDP but are not used to treat GBS, as they may worsen rather than improve the condition.

• Physical therapy: Before recovery begins, caregivers move the patient's arms and legs to prevent stiffness. After symptoms subside, the rehabilitation team will prescribe an active exercise routine to help regain muscle strength and independence. Training with wheelchairs or braces may give the individual greater mobility.

• Hydrotherapy: Hydrotherapy, or whirlpool therapy, may help relieve pain and may be useful in retraining the movement of affected limbs.

• Counseling: It may be helpful to talk to a counselor or therapist in addition to a primary care doctor. Counseling can help relieve the emotional difficulties an individual is feeling because of sudden paralysis and dependence on others. Counseling often is suggested to reassure individuals diagnosed with GBS or CIDP and to help individuals with GBS feel positive about their treatment and recovery.

• Prognosis: Individuals may remain in the hospital for several months and recovery may take a year or more. Most individuals recover completely, but some have residual weakness, numbness, and occasional pain. A small number are unable to resume their normal occupation. Daily activities may be affected during recovery time, such as cooking, eating, or dressing and the individual may need assistance.

• Fewer than five percent of GBS patients die. Fatalities usually result from heart or respiratory complications, such as heart attack or pulmonary embolism. Death resulting from CIDP is rare.

Integrative Therapies

• Note: Although there are limited clinical studies existing using integrative therapies for the treatment of Guillain-Barre syndrome (GBS), there have been studies in other neurological disorders or movement disorders that may present with similar symptoms, such as dementia and Parkinson's disease. Listed below are integrative therapies that have been studied clinically in various movement disorders.

• Good scientific evidence:

• 5-HTP: 5-HTP is the precursor for serotonin. Serotonin is the brain chemical associated with sleep, mood, movement, feeding, and nervousness. Cerebellar ataxia results from the failure of part of the brain to regulate body posture and limb movements. 5-HTP has been observed to have benefits in some people who have difficulty standing or walking due to cerebellar ataxia. However, current evidence is mixed. Further research is needed before a strong conclusion can be drawn.

• Avoid 5-HTP if allergic or hypersensitive to it. Signs of allergy to 5-HTP may include rash, itching, or shortness of breath. Avoid with eosinophilia syndromes, Down syndrome, or mitochondrial encephalomyopathy. Use cautiously if taking antidepressant medications, 5-HTP receptor agonists, carbidopa, phenobarbital, pindolol, reserpine, tramadol, or zolpidem. Use cautiously with kidney insufficiency, HIV/AIDS (particularly HIV-1 infection), epilepsy, or with a history of mental disorders. Avoid if pregnant or breastfeeding.

• Music therapy: Music therapy has been reported to improve symptoms in people with Parkinson's disease. Modest improvements were seen in symptoms including: motor coordination, speech intelligibility and vocal intensity, bradykinesia (slow movement), emotional functions, activities of daily living, and quality of life. Music therapy is generally known to be safe.

• Zinc: Wilson's disease is an inherited disorder of copper metabolism characterized by a failure of the liver to excrete copper, which leads to its accumulation in the liver, brain, cornea, and kidney, with resulting chronic degenerative changes. Early research suggests that zinc treatment may be effective in the management of Wilson's disease. More well-designed trials are needed to confirm these early results.

• Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. While zinc appears safe during pregnancy in amounts lower than the established upper intake level, caution should be used since studies cannot rule out the possibility of harm to the fetus.

• Unclear or conflicting scientific evidence:

• Acupressure, Shiatsu: The practice of applying finger pressure to specific acupoints (energy points) throughout the body has been used in China since 2000 B.C. Shiatsu technique involves finger pressure at acupoints and along body meridians (energy lines). It can incorporate palm pressure, stretching, massaging, and other manual techniques. Shiatsu practitioners commonly treat musculoskeletal and psychological conditions, including neck/shoulder and lower back problems, arthritis, depression, and anxiety. Acupressure may benefit several measures of severity of Parkinson's disease. Preliminary clinical evidence from one small study with individuals with facial spasms reported improvement when using Shiatsu acupressure. Further study is needed before conclusion can be made.

• Acupressure appears to be safe if self-administered or administered by an experienced therapist. Serious, long-term complications have not been reported, according to available scientific data. Hand nerve injury and herpes zoster ("shingles") cases have been reported after shiatsu massage. Forceful acupressure may cause bruising.

• Acupuncture: Aucupuncture has been reported to help relieve symptoms of some neurological disorders, including cerebral palsy, nerve damage, Parkinson's disease (characterized by fine muscle coordination and tremors), Tourette's syndrome (characterized by "tics"), and trigeminal neuralgia. More trials need to be performed.

• Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders, medical conditions of unknown origin, neurological disorders or if taking anticoagulants. Avoid on areas that have received radiation therapy and during pregnancy. Avoid electroacupuncture with irregular heartbeat or in patients with pacemakers. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics or with a history of seizures.

• Alexander technique: The Alexander technique is an educational program that teaches movement patterns and postures with an aim to improve coordination and balance, reduce tension, relieve pain, alleviate fatigue, improve various medical conditions, and promote well-being. Preliminary research suggests that Alexander technique instruction may improve fine and gross movements and reduce depression in patients with Parkinson's disease. Well-designed human trials are necessary.

• Serious side effects have not been reported in the available literature. It has been suggested that the technique may be less effective with learning disabilities or mental illnesses. The Alexander technique has been used safely in pregnant women.

• Arginine: Arginine, or L-arginine, is considered a semi-essential amino acid because although it is normally synthesized in sufficient amounts by the body, supplementation is sometimes required. Injections of arginine have been proposed to help manage adrenoleukodystrophy (ALD), although most study results are inconclusive. Further research is needed to evaluate the use of arginine in ALD and other neurological conditions.

• Avoid if allergic to arginine. Avoid with a history of stroke or liver or kidney disease. Avoid if pregnant or breastfeeding. Use cautiously if taking blood-thinners, blood pressure drugs, antidiabetic drugs, or herbs or supplements with similar effects. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease.

• Ashwagandha:Ashwagandha (Withania somnifera) is widely cultivated in India and the Middle East for its medicinal properties, and it is also found in parts of Africa. There is insufficient scientific evidence to determine if ashwagandha is a safe and effective treatment for Parkinson's disease.

• Avoid if allergic or hypersensitive to ashwagandha products or any of their ingredients. Dermatitis (allergic skin rash) was reported in three of 42 patients in one ashwagandha trial.There are few reports of adverse effects associated with ashwagandha, but there are few human trials using ashwagandha and most do not report the doses or standardization/preparation used.Avoid with peptic ulcer disease. Ashwagandha may cause abortions based on anecdotal reports. Avoid if pregnant or breastfeeding.

• Ayurveda: Ayurveda is a form of natural medicine that originated in ancient India more than 5,000 years ago. Ayurveda is an integrated system of techniques that uses diet, herbs, exercise, meditation, yoga, and massage or bodywork to achieve optimal health. There is evidence that the traditional herbal remedy Mucuna pruriens may improve symptoms in Parkinson's disease and that it may offer advantages over conventional L-dopa preparations in the long-term management of the disorder. More studies are needed in this area.

• Ayurvedic herbs should be used cautiously because they are potent, and some constituents may be potentially toxic if taken in large amounts or for a long time. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs may interact with other herbs, foods, and drugs. A qualified healthcare professional should be consulted before taking.

• Belladonna: Belladonna has been used for centuries to treat many medical conditions. To date, human studies have shown a lack of benefit from belladonna in treating autonomic nervous system disorders.

• Avoid if allergic to belladonna or plants of the Solanaceae(nightshade) family (bell peppers, potatoes, eggplants). Avoid with a history of heart disease, high blood pressure, heart attack, abnormal heartbeat, congestive heart failure, stomach ulcers, constipation, stomach acid reflux (serious heartburn), hiatal hernia, gastrointestinal disease, ileostomy, colostomy, fever, bowel obstruction, benign prostatic hypertrophy, urinary retention, narrow angle glaucoma, psychotic illness, Sjögren's syndrome, dry mouth, neuromuscular disorders, (such as myasthenia gravis), or Down syndrome. Avoid if pregnant or breastfeeding.

• Chiropractic: Chiropractic is a healthcare discipline that focuses on the relationship between musculoskeletal structure (primarily the spine) and body function (as coordinated by the nervous system) and how this relationship affects the preservation and restoration of health. Although there is not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of Parkinson's disease, anecdotal reports suggest a positive impact on fine muscle coordination in some individuals. More clinical research is necessary.

• Avoid with symptoms of vertebrobasilar vascular insufficiency, aneurysms, unstable spondylolisthesis, or arthritis. Avoid with agents that increase the risk of bleeding. Avoid in areas of para-spinal tissue after surgery. Avoid if pregnant or breastfeeding due to a lack of scientific data. Use extra caution during cervical adjustments. Use cautiously with acute arthritis, conditions that cause decreased bone mineralization, brittle bone disease, bone softening conditions, bleeding disorders, or migraines. Use cautiously with a risk of tumors or cancers.

• Choline: Data regarding the effectivenses of choline in the treatment of Parkinson's disease is conflicting and inconclusive at this time.

• Avoid if allergic/hypersensitive to choline, lecithin, or phosphatidylcholine. Use cautiously with kidney or liver disorders or trimethylaminuria. Use cautiously with a history of depression. If pregnant or breastfeeding it seems generally safe to consume choline within the recommended adequate intake (AI) parameters; supplementation outside of dietary intake is usually not necessary if a healthy diet is consumed.

• Chromium: Chromium is an essential trace element that exists naturally in trivalent and hexavalent states. Chromium has been studied for its protective benefits in Parkinson's disease and is included in antioxidant multivitamins. However, there is lack of scientific evidence in humans in this area. Additional research is needed.

• Trivalent chromium appears to be safe because side effects are rare or uncommon. However, hexavalent chromium may be poisonous. Avoid if allergic to chromium, chromate, or leather. Use cautiously with diabetes, liver problems, weakened immune systems (such as HIV/AIDS patients or organ transplant recipients), depression, Parkinson's disease, heart disease, and stroke and in patients who are taking medications for these conditions. Use cautiously if driving or operating machinery. Use cautiously if pregnant or breastfeeding.

• Coenzyme Q10: Coenzyme Q10, or CoQ10, is produced by the human body and is necessary for the basic functioning of cells. There is promising evidence to support the use of CoQ10 in the treatment of symptoms associated with Friedrich's ataxia and Parkinson's disease. Better-designed trials are needed to confirm early study results.

• Allergic reactions have not been associated with Coenzyme Q10 supplements, although rash and itching have been reported rarely. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Use cautiously with a history of blood clots, diabetes, high blood pressure, heart attack, or stroke, or if taking anticoagulants (blood thinners) or antiplatelet drugs, blood pressure drugs, blood sugar drgus, cholesterol drugs, or thyroid drugs. Avoid if pregnant or breastfeeding.

• Cowhage: Cowhage (Mucuna pruriens) seeds have been used in traditional Ayurvedic medicine to treat Parkinson's disease. Traditional Ayurvedic medicine and preliminary evidence suggests that cowhage contains 3.6-4.2% levodopa, the same chemical used in several Parkinson's disease drugs. Cowhage treatments have yielded positive results in early studies. However, more research should be conducted to determine the treatment that is most effective.

• Avoid if allergic or hypersensitive to cowhage (Mucuna pruriens), its constituents, or members of the Fabaceae family. Avoid with psychosis or schizophrenia. Use cautiously with diabetes or Parkinson's disease or if taking levodopa, dopamine, dopamine agonists, dopamine antagonists, or dopamine reuptake inhibitors. Use cautiously if taking monoamine oxidase inhibitors (MAOIs) or other antidepressants or anticoagulants (blood thinners). Avoid if pregnant or breastfeeding, as cowhage may inhibit prolactin secretion.

• Creatine: There is currently not enough scientific information to make a firm conclusion about the use of creatine in Huntington's disease. High-quality studies are needed to clarify this relationship.

• Numerous studies suggest that creatine may help treat various neuromuscular diseases and may delay the onset of symptoms when used with standard treatment. However, creatine ingestion does not appear to have a significant effect on muscle creatine stores or high-intensity exercise capacity in individuals with multiple sclerosis, and supplementation does not seem to help people with tetraplegia. Although early studies were encouraging, recent research reports no beneficial effects on survival or disease progression. Additional studies are needed to provide clearer answers.

• It is unclear if creatine is helpful in patients with spinal cord injuries. Results from early studies have been mixed. Further studies are required before a firm conclusion can be made.

• Avoid if allergic to creatine or if taking diuretics. Use cautiously with asthma, diabetes, gout, kidney disorders, liver or muscle problems, stroke, or with a history of these conditions. Avoid dehydration. Avoid if pregnant or breastfeeding.

• DHEA: There is conflicting scientific evidence regarding the use of DHEA (dehydroepiandrosterone) supplements for myotonic dystrophy. Better research is necessary before a clear conclusion can be drawn.

• Avoid if allergic to DHEA. Avoid with a history of seizures. Use cautiously with adrenal or thyroid disorders or if taking anticoagulants or drugs, herbs, or supplements for diabetes, heart disease, seizure, or stroke. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Avoid if pregnant or breastfeeding.

• Dong quai: Dong quai (Angelica sinensis), also known as Chinese Angelica, has been used for thousands of years in traditional Chinese, Korean, and Japanese medicine. There is insufficient evidence to support the use of Dong quai as a treatment for nerve pain. High-quality human research is lacking.

• Although Dong quai is accepted as being safe as a food additive in the United States and Europe, its safety in medicinal doses is unknown. Long-term studies of side effects are lacking. Avoid if allergic/hypersensitive to Dong quai or members of the Apiaceae/Umbelliferae family (like anise, caraway, carrot, celery, dill, parsley). Avoid prolonged exposure to sunlight or ultraviolet light. Use cautiously with bleeding disorders or if taking drugs that may increase the risk of bleeding. Use cautiously with diabetes, glucose intolerance, or hormone-sensitive conditions (like breast cancer, uterine cancer, or ovarian cancer). Do not use before dental or surgical procedures. Avoid if pregnant or breastfeeding.

• Feldenkrais Method®: The Feldenkrais Method® involves stretching, reaching, and changing posture in specific patterns. In some cases, it includes a form of massage. Patients who practice complementary alternative medicine methods have reported that the Feldenkrais Method®, as well as breathing therapy, massage, and relaxation techniques, helped improve symptoms of dystonia. Further data are needed before a firm conclusion can be made. There is currently not enough clinical evidence to determine if the Feldenkrais Method® is an effective treatment for cerebral palsy.

• There is currently a lack of available scientific studies or reports of safety of the Feldenkrais Method®.

• Ginseng: A clinical study found that patients with neurological disorders may improve when taking Asian ginseng (Panax ginseng). This supports research findings that report Panax ginseng improving cognitive function. More research is needed in this area.

• Avoid with known allergy to plants in the Araliaceae family. There has been a report of a serious life-threatening skin reaction, possibly caused by contaminants in ginseng formulations.

• Kava: Kava beverages, made from dried roots of the shrub Piper methysticum, have been used ceremonially and socially in the South Pacific for hundreds of years and in Europe since the 1700s. There is currently unclear evidence on the use of kava for Parkinson's disease. Kava has been shown to increase 'off' periods in Parkinson's patients taking levodopa and can cause a semicomatose state when given with alprazolam. Consult with a qualified healthcare professional before taking kava due to the risk of harmful side effects.

• Avoid if allergic to kava or kavapyrones. Avoid with liver disease, a history of medication-induced extrapyramidal (the motor system related to the basal ganglia) effects, and chronic lung disease. Avoid if taking medications for liver disease or CNS depressants such as alcohol or tranquilizers. Avoid while driving or operating heavy machinery (may cause drowsiness). Use cautiously with depression or if taking antidpressants. Avoid if pregnant or breastfeeding.

• L-carnitine: Although used traditionally for support of neurological conditions, one poorly designed preliminary clinical study reported that L-acetyl-carnitine (carnitine or L-carnitine) possesses neither efficacy nor toxicity towards the patients with Huntington disease. Further trials are required to determine is L-carnitine is beneficial in individuals with neurological disorders.

• Early research on the use of carnitine for Rett's syndrome has produced promising results. However, additional research is needed before a firm conclusion can be made.

• Avoid with known allergy or hypersensitivity to carnitine. Use cautiously with peripheral vascular disease, high blood pressure, alcohol-induced liver cirrhosis, or diabetes. Use cautiously in low birth weight infants and individuals on hemodialysis. Use cautiously if taking anticoagulants (blood thinners), beta-blockers, or calcium channel blockers. Avoid if pregnant or breastfeeding.

• Massage: Early evidence suggests a possible benefit of massage for cerebral palsy, Parkinson's disease, and spinal cord injuries. However, evidence is insufficient on which to base recommendations.

• Avoid with bleeding disorders, low platelet counts, or if taking blood-thinning medications (such as heparin or warfarin/Coumadin®). Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Use cautiously with a history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client.

• Melatonin: Melatonin is a naturally occurring hormone that helps regulate sleep/wake cycles (circadian rhythm). Melatonin has been reported useful in neurological conditions including Parkinson's disease, periodic limb movement disorder, Rett's syndrome, and tardive dyskinesia (abnormal movements that can occur after long-term use of some older antipsychotic drugs). The use of melatonin in these conditions, however, is not supported by rigorous scientific testing. Better-designed research is needed to determine if melatonin is beneficial in individuals with neurological disorders.

• Avoid melatonin supplementation in women who are pregnant or attempting to become pregnant. Use cautiously with bleeding disorders, seizure disorders, or if taking anticoagulants.

• Moxibustion: Moxibustion uses the principle of heat to stimulate circulation and break up congestion or stagnation of blood and chi (energy). One small study reported treatment of trigeminal neuralgia with cupping to have a significant therapeutic effect. However, there is insufficient available evidence and more clinical studies are needed in this area.

• Avoid with aneurysms, any kind of "heat syndrome," heart disease, convulsions or cramps, diabetic neuropathy, extreme fatigue and/or anemia, fever, or inflammatory conditions. Avoid areas with an inflamed organ, contraindicated acupuncture points, allergic skin conditions, ulcerated sores, or skin adhesions. Avoid over the face, genitals, head, or nipples. Avoid in patients who have just finished exercising or taking a hot bath or shower. Avoid if pregnant or breastfeeding. Use cautiously over large blood vessels and thin or weak skin. Use cautiously with elderly people with large vessels. It is considered not advisable to bathe or shower for up to 24 hours after a moxibustion treatment.

• Physical therapy: There is evidence for the use of physical therapy for nerve or neurological disorders such as cerebral palsy, Guillain-Barre Syndrome (GBS), and Parkinson's disease. Additional high-quality studies are needed.

• Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with their qualified healthcare professionals before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the literature, although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy, and although reports of major adverse effects are lacking in the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.

• Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental health professional. The patient explores thoughts, feelings, and behaviors to help with problem solving. Supportive psychotherapy may or may not reduce the motor and vocal tics associated with Tourette's syndrome. More research needs to be done before conclusions can be made. Some forms of psychotherapy may evoke strong emotional feelings and expression.

• Qi gong: Qi gong is a type of traditional Chinese medicine (TCM) that is thought to be at least 4,000 years old. It is traditionally used for spiritual enlightenment, medical care, and self-defense. There is promising early evidence suggesting that internal Qi gong may help in the treatment of Parkinson's disease. However, the evidence is somewhat unclear, and further research is needed.

• Qi gong is generally considered to be safe in most people when learned from a qualified instructor. Use cautiously with psychiatric disorders.

• Reiki: Reiki is a system of laying on of the hands that originated in as a Buddhist practice approximately 2,500 years ago. Human study suggests that reiki may have an effect on autonomic nervous system functions such as heart rate, blood pressure, or breathing activity, important in neurological disorders that may damage autonomic function, including neurological conditions. Large, well-designed studies are needed before conclusions can be drawn.

• Reiki is not recommended as the sole treatment approach for potentially serious medical conditions and should not delay the time it takes to consult with a healthcare professional or receive established therapies. Use cautiously with psychiatric illnesses.

• Rolfing® Structural Integration:Rolfing® Structural Integration involves deep tissue massage aimed at relieving stress and improving mobility, posture, balance, muscle function and efficiency, energy, and overall well being. Rolfing® Structural Integration may slightly improve movement in cerebral palsy patients. More studies are needed to confirm these possible benefits.

• Rolfing® Structural Integration should not be used as the sole therapeutic approach to disease, and it should not delay the time it takes to speak with a healthcare provider about a potentially severe condition. Rolfing® Structural Integration is generally believed to be safe in most people. Avoid in patients taking blood thinners and in patients with broken bones, severe osteoporosis, disease of the spine or vertebral disks, skin damage or wounds, bleeding disorders, blood clots, tooth abscesses, acute disc problems, aneurysm, fever, recent scar tissue, connective tissue disease, cancer, and in patients who have just received cortisone shots or who are on chronic cortisone therapy. Use cautiously in patients with varicose veins or phlebitis, joint diseases, psychosis or bipolar disorder, severe kidney, liver, or intestinal disease, diabetes, menstruation, infectious conditions, colostomies, high blood pressure, and stenoses or strictures.

• Safflower: In clinical research, safflower (Carthamus tinctoria) decreased deterioration caused by Friedreich's ataxia. More high-quality studies with larger sample sizes are needed to establish safflower's effect on neurological conditions.

• Avoid if allergic/hypersensitive to safflower, Carthamus tinctorius, safflower oil, daisies, ragweed, chrysanthemums, marigolds, or any related constituents. Use parenteral safflower oil emulsions cautiously in newborns. Use cautiously if taking anticoagulants (blood thinners) or anti-platelet drugs, immunodepressants or pentobarbital. Use cautiously with diabetes, low blood pressure, liver problems, bleeding disorders, or skin pigmentation conditions. Use cautiously if pregnant or breastfeeding.

• Selenium: Studies have consistently shown that antioxidants may not have clinical benefits in motor neuron diseases, such as amyotrophic lateral sclerosis (ALS). Although the research thus far does not discourage selenium supplementation in patients, more research is needed to determine if selenium is an effective treatment for central nervous system disorders.

• Avoid if allergic or sensitive to products containing selenium. Avoid with a history of non-melanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.

• Tai chi: Tai chi is a system of movements and positions believed to have developed in 12th Century China. Tai chi techniques aim to address the body and mind as an interconnected system and are traditionally believed to have mental and physical health benefits to improve posture, balance, flexibility, and strength. Community-based fitness programs, which include tai chi classes, may improve balance in patients with Parkinson's disease and may motivate individuals to participate in routine exercise. Additional research is warranted in this area.

• Avoid with severe osteoporosis or joint problems, acute back pain, sprains, or fractures. Avoid during active infections, right after a meal, or when very tired. Some believe that visualization of energy flow below the waist during menstruation may increase menstrual bleeding. Straining downwards or holding low postures should be avoided during pregnancy, and by people with inguinal hernias. Some tai chi practitioners believe that practicing for too long or using too much intention may direct the flow of chi (qi) inappropriately, possibly resulting in physical or emotional illness. Tai chi should not be used as a substitute for more proven therapies for potentially serious conditions. Advancing too quickly while studying tai chi may increase the risk of injury.

• Taurine: Taurine may affect cellular hyperexcitability by increasing membrane conductance to potassium and chloride ions, possibly by altering intracellular (within the cell) availability of calcium. Study results suggest that taurine supplementation may result in improvements in myotonic dystrophy. Well designed clinical trials are needed.

• Taurine is an amino acid, and it is unlikely that there are allergies related to this constituent. However, allergies may occur from multi-ingredient products that contain taurine. Use cautiously in patients with high cholesterol, low blood pressure, bleeding disorders, potential for mania, or epilepsy. Avoid consuming energy drinks containing taurine, caffeine, glucuronolactone, B vitamins, and other ingredients before drinking alcohol or exercising. Use cautiously if pregnant or breastfeeding because taurine is a natural component of breast milk.

• TENS: Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Electrodes are temporarily attached with paste in various patterns, depending on the specific condition and treatment goals. Several studies have reported benefits of TENS therapy in patients with trigyminal neuralgia (facial pain), hemiplegia/hemiparesis, and spinal cord injury. Additional research is needed before a firm conclusion can be drawn.

• Avoid with implantable devices, such as defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation (such as neuropathy) or with seizure disorders. Avoid if pregnant or breastfeeding.

• Therapeutic touch: Therapeutic touch (TT) practitioners hold their hands a short distance from the patient without actually making physical contact. The purpose of this technique is to detect the patient's energy field, allowing the TT practitioner to correct any perceived imbalances. There is some evidence that therapeutic touch may affect some properties of the central nervous system. However, further research is needed to examine whether therapeutic touch could have any effects on central nervous system disorders.

• Therapeutic touch is believed to be safe for most people. Therapeutic touch should not be used for potentially serious conditions in place of more proven therapies. Avoid with fever or inflammation and on body areas with cancer.

• Vitamin B6: Vitamin B6 (pyridoxine) is required for the synthesis of the neurotransmitters serotonin and norepinephrine and for myelin formation. Pyridoxine deficiency in adults principally affects the peripheral nerves, skin, mucous membranes, and the blood cell system. In children, the central nervous system (CNS) is also affected. Major sources of vitamin B6 include cereal grains, legumes, vegetables (carrots, spinach, and peas), potatoes, milk, cheese, eggs, fish, liver, meat, and flour. Some prescription drugs called neuroleptics, which are used in psychiatric conditions, may cause movement disorders as an unwanted side effect. Vitamin B6 has been studied for the treatment of acute neuroleptic-induced akathisia (NIA, a neuromuscular disorder characterized by a feeling of "inner restlessness" or a constant urge to be moving) in schizophrenic and schizoaffective disorder patients. Preliminary results indicate that high doses of vitamin B6 may be useful additions to the available treatments for NIA, perhaps due to its combined effects on various neurotransmitter systems. Further research is needed to confirm these results.

• There is also early evidence that pyridoxine supplementation may be of benefit in hyperkinetic cerebral dysfunction syndrome and tardive dyskinesia. Further research is needed before a recommendation can be made.

• Vitamin B6 is likely safe when used orally in doses not exceeding the recommended dietary allowance (RDA). Avoid vitamin B6 products if sensitive or allergic to any of their ingredients. Some individuals seem to be particularly sensitive to vitamin B6 and may have problems at lower doses. Avoid excessive dosing. Use cautiously if pregnant or breastfeeding.

• Vitamin E: Vitamin E has been studied in the management of tardive dyskinesia (abnormal movements that can occur after long-term use of some older antipsychotic drugs) and Parkinson's disease, although the results of existing studies are not conclusive enough to form a clear recommendation. More research is needed.

• Avoid if allergic or hypersensitive to vitamin E. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders or if taking blood thinners. Avoid doses greater than the recommended daily level in pregnant women and breastfeeding women.

• Yohimbe bark extract: The terms yohimbine, yohimbine hydrochloride, and yohimbe bark extract are related but not interchangeable. Yohimbine is an active chemical (indole alkaloid) found in the bark of the Pausinystalia yohimbe tree. Yohimbine hydrochloride is a standardized form of yohimbine that is available as a prescription drug in the United States. It is theorized that yohimbine may improve orthostatic hypotension (lowering of blood pressure with standing) or other symptoms of autonomic nervous system dysfunction. However, yohimbe bark extract may not contain significant amounts of yohimbine, and therefore may not have these proposed effects. More research is needed before a recommendation can be made.

• Yohimbine is generally well tolerated in recommended doses. However, many side effects have been reported with yohimbine hydrochloride and may apply to yohimbe bark. Avoid if allergic to yohimbe, any of its components, or yohimbine-containing products. Use cautiously with peptic ulcer disease, kidney disease, high blood pressure, heart disease, or if taking drugs that affect blood sugar levels. Avoid with benign prostate hypertrophy (enlarged prostate), anxiety, mania, depression, stress disorders, post-traumatic stress disorders, bipolar disorders, or schizophrenia. Avoid use in children or in pregnant or breastfeeding women.

• Fair negative scientific evidence:

• Choline: Choline is possibly ineffective when taken by mouth for treating cerebellar ataxia. More research is needed in this area.

• Avoid if allergic/hypersensitive to choline, lecithin, or phosphatidylcholine. Use cautiously with kidney or liver disorders or trimethylaminuria. Use cautiously with a history of depression. If pregnant or breastfeeding it seems generally safe to consume choline within the recommended adequate intake (AI) parameters; supplementation outside of dietary intake is usually not necessary if a healthy diet is consumed.

• Coenzyme Q10: There is negative evidence from studies that used coenzyme Q10 in the treatment of Huntington's disease. More studies are needed to confirm these results.

• Allergy associated with coenzyme Q10 supplements has not been reported in the available literature, although rash and itching have been reported rarely. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures. Use caution if history of blood clots, diabetes, high blood pressure, heart attack, or stroke, or with anticoagulants (blood thinners) or antiplatelet drugs (like aspirin, warfarin, clopidogrel (like Plavix®), blood pressure, blood sugar, cholesterol or thyroid drugs. Avoid if pregnant or breastfeeding.

• Creatine: Overall, the evidence suggests that creatine supplementation may not offer benefit to individuals with amyotrophic lateral sclerosis (ALS).

• Avoid if allergic to creatine or if taking diuretics. Use cautiously with asthma, diabetes, gout, kidney disorders, liver or muscle problems, stroke, or with a history of these conditions. Avoid dehydration. Avoid if pregnant or breastfeeding.

• Octacosanol: Policosanol is a mixture of very long chain alcohols that is purified from sugar cane wax. About 67% of policosanol is octacosanol. Although some research has been conducted using policosanol, little research is currently available that focuses on octacosanol alone. Early study does not show any evidence of benefit in brain or lung symptoms of amyotropic lateral sclerosis (ALS) patients. Additional study is needed in this area.

• Avoid if allergic or hypersensitive to octacosanol or policosanol. Use cautiously if taking nitrates, lipid-lowering agents, cholesterol absorption inhibitors, nutraceuticals, aspirin, or agents that lower blood pressure. Avoid if pregnant or breastfeeding.

Prevention

• If an individual is at risk for developing Guillain-Barre syndrome (GBS) or symptoms such as tingling in the arms, hands, feet, or legs occur that do not rapidly go away, a doctor should be called immediately.

• Diet: Nutritional changes, such as eating more fresh fruits and vegetables and less red meats, may be effective in reducing symptoms associated with neurological disorders such as Guillain-Barre syndrome (GBS).

• It is best to avoid caffeine and other stimulants, alcohol, and smoking.

• It may be best to eliminate potential food allergens, including dairy (e.g. milk, cheese, and sour cream), eggs, nuts, shellfish, wheat (gluten), corn, preservatives, and food additives (such as dyes and fillers). Food allergies can be a contributing factor in neurological imbalances.

• It may be best to avoid refined foods such as white breads, pastas, and sugar. Doughnuts, pastries, bread, candy, soft drinks, and foods with high sugar content may all contribute to worsening symptoms of neurological disorders.

• Food can be cut into small pieces, softened, or pureed to ease swallowing and prevent choking. While some foods may require the addition of thickeners, other foods may need to be thinned. Dairy products, in particular, tend to increase the secretion of mucus, which in turn increases the risk of choking.

• Exercise: Maintaining physical fitness is important to those suffering from movement disorders. Those with movement disorders who exercise and keep active tend to do better, with fewer symptoms and a slower disease progression, than those who do not. A daily regimen of exercise can help the person feel better physically and mentally. Individuals should walk as much as possible, even if assistance is necessary. Talking with a healthcare provider about an exercise program is important.

• Coping skills:

• Daily tasks: Decide the tasks that are needed to be performed on a given day and the tasks that can wait until another time. Staying active mentally, physically, and socially are important. Working crossword puzzles, reading books, and visiting friends and relatives may help support the individual with GBS.

• Support of friends and family: Asking for help is not a sign of weakness. Support from family, friends, or a support group can be a great help to those dealing with GBS. Although support groups are not for everyone, they can be good places to hear about coping techniques or treatments that have worked for others.

Author Information

• This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

1. American Autoimmune Related Diseases Association. www.aarda.org.

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4. Guillain-Barre Syndrome Foundation International. www.gbsfi.com.

5. Guillain-Barre Support Group. www.gbs.org.uk.

6. Koeppen S, Kraywinkel K, Wessendorf TE, et al. Long-term outcome of Guillain-Barre syndrome. Neurocrit Care. 2006;5(3):235-42. View Abstract.

7. The Movement Disorder Society. www.movementdisorders.org.

8. National Association of Neurological Disorders and Stroke. www.ninds.nih.gov.

9. Natural Standard: The Authority on Integrative Medicine. www.naturalstandard.com.

10. Ortiz-Corredor F, Pena-Preciado M. Use of immunoglobulin in severe childhood Guillain-Barre syndrome. Acta Neurol Scand. 2007;115(4):289-93. View Abstract.

11. Tam CC, O'brien SJ, Petersen I, et al. Guillain-barre syndrome and preceding infection with campylobacter, influenza and epstein-barr virus in the general practice research database. PLOS ONE. 2007;2:e344. View Abstract.