Due to the limited treatments available to ALS patients through the traditional medical community, many PALS turn to alternative medicine for non-traditional approaches.  This article reviews some of the more common routes that PALS explore, though there are many, many more that are beyond the scope of this article.

Acupuncture

Acupuncture is one of the interventional treatments available to practitioners of Traditional Chinese Medicine. It has been used for millennia to treat a variety of ailments in Asia— though it has only been practiced on a broad scale in the United States since the 1970s. Most people think of acupuncture as the application of needles into the skin. While this is accurate, the actual process of acupuncture is more complex. Practitioners usually place solid needles in various, carefully selected places in the body. Additionally, they may stimulate acupuncture points with their hands (acupressure) or use heated plants (moxibustion). Newer approaches even incorporate the use of electricity or lasers for acupuncture point targeting.

According to Traditional Chinese Medicine, illness follows from improper flow of natural energy called qi (pronounced “chee”) through various channels or “meridians” in the body. Acupuncture practitioners target acupuncture points to improve the flow of qi through these meridians to restore health and balance. By restoring balance, the body is able to rid itself of illness or disease.

Acupuncture is one of the most commonly used alternative treatments by people with amyotrophic lateral sclerosis (PALS).¹ There have been several anecdotal reports that it is beneficial to patients,² however no formal clinical trials have been done thus far. Acupuncture has been helpful in animal models of ALS.^3,4 Acupuncture may improve oxygenation and breathing in PALS, particularly during early stages of the disease;⁵ however, acupuncture should not be considered a cure for ALS.

When performed by a licensed practitioner, acupuncture is quite safe. Relatively few complications from acupuncture needling have been reported to the FDA, despite millions of acupuncture treatments and tens of millions of needles used.⁶ Nevertheless, one must consider the risk of bleeding and infection when considering this treatment.

Chiropractic

Chiropractic is a system of medicine in which providers, called chiropractors, use various forms of manual manipulation to treat patients. Most manual manipulation targets the spinal column, though any joint can be treated with chiropractic therapy. Practitioners perform manipulations in order to correct problems of alignment, which is intended to alleviate pain, improve function, and restore balance. Chiropractors also incorporate the use of hot or cold substances, formal relaxation techniques, massage, and various types of stimulation (e.g., electrical stimulation, sonography, etc.) into complex treatment regimens.

There are very few published reports of chiropractic interventions being useful in the treatment of ALS. However, given that chiropractic’s focus is on the interaction between the nervous system and the musculoskeletal system, it seems reasonable that chiropractic may be able to relieve or reduce certain symptoms of the disease.

Is difficult to know the true number of adverse events resulting from manual manipulation and chiropractic care. Side effects of chiropractic treatment may include headache, fatigue, soreness, and increased pain in the treated area. Manipulations of the cervical or lumbar/sacral spine increase the risk of serious adverse events.

Herbal remedies

Plants have been used to treat various medical conditions for thousands of years. For example, Hippocrates used St. John’s Wort to treat mood disorders in the fifth century BC. Saw palmetto was used to treat urinary flow problems in men 3500 years ago. Indeed, over 100 prescribed pharmaceuticals are directly derived from plants. Thus, it seems a bit inaccurate to call herbal remedies “alternative therapy.”

There are a number of natural products that have shown promise as treatments for of ALS; however, most have only been tested in vitro (in laboratory equipment) and in vivo (in animals).⁷ Clinical studies for many natural products are lacking because they require the participation of sufficient numbers of PALS, they take a significant amount of time, and the dosage of the active ingredient must be standardized. It is very difficult for physicians to recommend a particular herbal remedy or remedies without the evidence from a clinical trial. Likewise, it is difficult to know which remedies will be useful, not useful, or even harmful in the treatment of ALS without formal tests in patients. In the meantime, researchers (and PALS) must do their best to know what works from research done in the laboratory.

The safety of herbal remedies can vary significantly. It is important to note that natural products are not intrinsically safer than prescribed medications. In fact, some of the most deadly compounds known to man are natural and derived from plants. On the other hand, most have been used safely for thousands of years. Herbal remedies should be treated like any other prescription medication. Specifically, one should consider whether the herbal medicine interacts with other medications or if the dose is appropriate.

Aromatherapy

Aromatherapy is the practice of using essential oils from plants to create aroma environments in an effort to help heal patients. The vapors from these essential oils may be inhaled, or the oils may be placed directly on the skin. The stimulation of the sense of smell may help evoke feelings of well-being, calmness, and ease. Essential oils used in aromatherapy may also promote sleep and improve sleep disorders.

Aromatherapy should be thought of as a complementary therapy in that it is not used to treat a particular illness. As a complementary therapy, aromatherapy may help reduce symptoms, particularly psychological symptoms. For example, aromatherapy is commonly used to relieve cancer-related symptoms, such as anxiety and depression—but it is not used to target the cancer itself. There are essentially no adverse effects to aromatherapy other than hypersensitivity reactions in people who are allergic to oils placed on the skin. It is important to note that aromatherapy is highly subjective and may not provide benefits to all PALS.

Meditation

While the general definition of meditation is rather simple—a period of quiet, solitary reflection and focused attention—there is actually a tremendous number of different forms of meditation. These forms vary on whether or not they include a religious or spiritual component, particular postures (e.g., sitting, prone), and the type of breathing used. Examples include mantra meditation, mindfulness meditation, Buddhist meditation, and applied relaxation, just to name a few.

According to the National Center for Complementary and Alternative Medicine (NCCAM),⁸ meditation generally includes four features:

• A quiet location
• A specific, comfortable posture
• A focus of attention
• An open attitude

Because of the plethora of meditation forms, it is particularly difficult to study meditation in a clinical environment. Nevertheless, studies on meditation have shown that it is effective in particular conditions.^9,10,11 None of these studies specifically tested the effect of meditation on PALS, however. On the other hand, meditation is very safe and may be used as a complement to other ALS treatments.

1. Wasner M, Klier H, Borasio GD. The use of alternative medicine by patients with amyotrophic lateral sclerosis. J Neurol Sci. Oct 15 2001;191(1-2):151-154.
2. Liang S, Christner D, Du Laux S, Laurent D. Significant neurological improvement in two patients with amyotrophic lateral sclerosis after 4 weeks of treatment with acupuncture injection point therapy using enercel. J Acupunct Meridian Stud. Dec 2011;4(4):257-261.
3. Jiang JH, Yang EJ, Baek MG, Kim SH, Lee SM, Choi SM. Anti-inflammatory effects of electroacupuncture in the respiratory system of a symptomatic amyotrophic lateral sclerosis animal model. Neurodegener Dis. 2011;8(6):504-514.
4. Yang EJ, Jiang JH, Lee SM, Hwang HS, Lee MS, Choi SM. Electroacupuncture reduces neuroinflammatory responses in symptomatic amyotrophic lateral sclerosis model. J Neuroimmunol. Jun 2010;223(1-2):84-91.
5. Lee S, Kim S. The effects of sa-am acupuncture treatment on respiratory physiology parameters in amyotrophic lateral sclerosis patients: a pilot study. Evid Based Complement Alternat Med. 2013;2013:506317.
6. http://nccam.nih.gov/health/acupuncture/introduction.htm#acupuncture.
7. Zhang X, Hong YL, Xu DS, et al. A review of experimental research on herbal compounds in amyotrophic lateral sclerosis. Phytother Res. Jan 2014;28(1):9-21.
8. http://nccam.nih.gov/health/meditation/overview.htm.
9. Marchand WR. Mindfulness meditation practices as adjunctive treatments for psychiatric disorders. Psychiatr Clin North Am. Mar 2013;36(1):141-152.
10. Marciniak R, Sheardova K, Cermakova P, Hudecek D, Sumec R, Hort J. Effect of meditation on cognitive functions in context of aging and neurodegenerative diseases. Front Behav Neurosci. 2014;8:17.
11. Zeidan F, Grant JA, Brown CA, McHaffie JG, Coghill RC. Mindfulness meditation-related pain relief: evidence for unique brain mechanisms in the regulation of pain. Neurosci Lett. Jun 29 2012;520(2):165-173.