Multiple Sclerosis (MS)

Last Updated: June 29, 2023

Multiple sclerosis is an autoimmune neurological disease characterized by the destruction of the myelin sheaths (nerve insulators) on neurons in the central nervous system. Its symptoms can vary, but eye pain, difficulty balancing, and numbness, tingling, and weakness in limbs are common. Attacks are “multiple” over time and/or location in the nervous system.

Multiple Sclerosis (MS) falls under theAutoimmune Diseasecategory.

What is multiple sclerosis?

Multiple sclerosis (MS) is a neurodegenerative disease characterized by what is most likely an autoimmune attack on the central nervous system. The most well-known aspect of MS (and the reason for its name) is the destruction of the myelin sheaths that insulate neurons, which results in the formation of lesions throughout the brain and spinal cord. The myelin sheath forms the insulation around axons of neurons, and allows efficient propagation of electrical impulses from one neuron to the next. Their destruction slows down or stops electrical conduction, leading to the neurological deficits associated with the condition.[1]

What are the main signs and symptoms of multiple sclerosis?

The main symptoms of multiple sclerosis are optic neuritis, blurred or double vision, instability and dizziness, numbness or tingling in limbs, weakness in limbs, muscle spasticity, and incontinence. The main signs of multiple sclerosis are lesions in the central nervous system.

How is multiple sclerosis diagnosed?

No single piece of information is sufficient for diagnosing MS. In order for a clinician to make an MS diagnosis, they must observe lesions in at least 2 areas of the central nervous system and find evidence that these lesions formed at different points in time. More details about the diagnosis of MS can be found here.

What are some of the main medical treatments for multiple sclerosis?

Drugs are the primary treatment for MS. Pharmaceuticals are used to either reduce the rate of disease progression or the rate of relapse, manage relapses by speeding recovery, or treat specific symptoms.[2]

Have any supplements been studied for multiple sclerosis?

Vitamin D, vitamin A, biotin, and L-carnitine have all been studied in the context of multiple sclerosis. Although all of them could potentially have effects on the disease (i.e., they have plausible mechanisms through which they could improve MS), no research thus far has been tremendously compelling.[3]

How could diet affect multiple sclerosis?

There hasn’t been much research on diet and MS, but it’s been hypothesized that hypercaloric and proinflammatory diets like the Western diet may be harmful for MS.[4] Additionally, people who had obesity (BMI of at least 30 kg/m2) in childhood to young adulthood have about double the risk of developing MS as people who did not have obesity during this time period.[5]

Are there any other treatments for multiple sclerosis?

Cannabinoids can bind to receptors throughout the brain and body and play a role in motor control, inflammation, and cognition. Based on the current understanding of the research, it seems that cannabis (or synthetic cannabinoids) can slightly reduce pain and bladder dysfunction, and many people with MS report improvements, but these outcomes can’t be measured objectively. It’s not clear if cannabis improves cognitive symptoms beyond any mood-elevating properties.[6]

What causes multiple sclerosis?

The immune system is heavily involved in the development of MS, but it’s not clear what provokes this response in the first place. Genetics, viral infections, and other environmental factors have all been connected to MS in observational research.[7] Psychological stress (e.g., parental divorce and extreme grief) may also predispose people to the disease.[8]

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Update History
  1. ^MedlinePlusMultiple Sclerosis
  2. ^Benjamin K-T Tsang, Richard MacdonellMultiple sclerosis- diagnosis, management and prognosisAust Fam Physician.(2011 Dec)
  3. ^Bagur MJ, Murcia MA, Jiménez-Monreal AM, Tur JA, Bibiloni MM, Alonso GL, Martínez-Tomé MInfluence of Diet in Multiple Sclerosis: A Systematic Review.Adv Nutr.(2017-May)
  4. ^Riccio P, Rossano RNutrition facts in multiple sclerosis.ASN Neuro.(2015)
  5. ^Alberto Ascherio, Kassandra L MungerEpidemiology of Multiple Sclerosis: From Risk Factors to Prevention-An UpdateSemin Neurol.(2016 Apr)
  6. ^Nielsen S, Germanos R, Weier M, Pollard J, Degenhardt L, Hall W, Buckley N, Farrell MThe Use of Cannabis and Cannabinoids in Treating Symptoms of Multiple Sclerosis: a Systematic Review of Reviews.Curr Neurol Neurosci Rep.(2018-02-13)
  7. ^Rachael E Tarlinton, Ekaterina Martynova, Albert A Rizvanov, Svetlana Khaiboullina, Subhash VermaRole of Viruses in the Pathogenesis of Multiple SclerosisViruses.(2020 Jun 13)
  8. ^Briones-Buixassa L, Milà R, Mª Aragonès J, Bufill E, Olaya B, Arrufat FXStress and multiple sclerosis: A systematic review considering potential moderating and mediating factors and methods of assessing stress.Health Psychol Open.(2015-Jul)
  9. ^B G WeinshenkerNatural history of multiple sclerosisAnn Neurol.(1994)
  10. ^Marcus Koch, Elaine Kingwell, Peter Rieckmann, Helen TremlettThe natural history of primary progressive multiple sclerosisNeurology.(2009 Dec 8)
  11. ^International Multiple Sclerosis Genetics Consortium (IMSGC), Ashley H Beecham, Nikolaos A Patsopoulos, Dionysia K Xifara, Mary F Davis, Anu Kemppinen, Chris Cotsapas, Tejas S Shah, Chris Spencer, David Booth, An Goris, Annette Oturai, Janna Saarela, Bertrand Fontaine, Bernhard Hemmer, Claes Martin, Frauke Zipp, Sandra D'Alfonso, Filippo Martinelli-Boneschi, Bruce Taylor, Hanne F Harbo, Ingrid Kockum, Jan Hillert, Tomas Olsson, Maria Ban, Jorge R Oksenberg, Rogier Hintzen, Lisa F Barcellos, Wellcome Trust Case Control Consortium 2 (WTCCC2), International IBD Genetics Consortium (IIBDGC), Cristina Agliardi, Lars Alfredsson, Mehdi Alizadeh, Carl Anderson, Robert Andrews, Helle Bach Søndergaard, Amie Baker, Gavin Band, Sergio E Baranzini, Nadia Barizzone, Jeffrey Barrett, Céline Bellenguez, Laura Bergamaschi, Luisa Bernardinelli, Achim Berthele, Viola Biberacher, Thomas M C Binder, Hannah Blackburn, Izaura L Bomfim, Paola Brambilla, Simon Broadley, Bruno Brochet, Lou Brundin, Dorothea BAnalysis of immune-related loci identifies 48 new susceptibility variants for multiple sclerosisNat Genet.(2013 Nov)
  12. ^International Multiple Sclerosis Genetics Consortium, Wellcome Trust Case Control Consortium 2, Stephen Sawcer, Garrett Hellenthal, Matti Pirinen, Chris C A Spencer, Nikolaos A Patsopoulos, Loukas Moutsianas, Alexander Dilthey, Zhan Su, Colin Freeman, Sarah E Hunt, Sarah Edkins, Emma Gray, David R Booth, Simon C Potter, An Goris, Gavin Band, Annette Bang Oturai, Amy Strange, Janna Saarela, Céline Bellenguez, Bertrand Fontaine, Matthew Gillman, Bernhard Hemmer, Rhian Gwilliam, Frauke Zipp, Alagurevathi Jayakumar, Roland Martin, Stephen Leslie, Stanley Hawkins, Eleni Giannoulatou, Sandra D'alfonso, Hannah Blackburn, Filippo Martinelli Boneschi, Jennifer Liddle, Hanne F Harbo, Marc L Perez, Anne Spurkland, Matthew J Waller, Marcin P Mycko, Michelle Ricketts, Manuel Comabella, Naomi Hammond, Ingrid Kockum, Owen T McCann, Maria Ban, Pamela Whittaker, Anu Kemppinen, Paul Weston, Clive Hawkins, Sara Widaa, John Zajicek, Serge Dronov, Neil Robertson, Suzannah J Bumpstead, Lisa F Barcellos, RaGenetic risk and a primary role for cell-mediated immune mechanisms in multiple sclerosisNature.(2011 Aug 10)
  13. ^Jessica D Forbes, Gary Van Domselaar, Charles N BernsteinThe Gut Microbiota in Immune-Mediated Inflammatory DiseasesFront Microbiol.(2016 Jul 11)
  14. ^Yan Wang, Lloyd H KasperThe role of microbiome in central nervous system disordersBrain Behav Immun.(2014 May)
  15. ^Soldan SS, Lieberman PMEpstein-Barr virus and multiple sclerosis.Nat Rev Microbiol.(2023-Jan)
  16. ^Bjornevik K, Cortese M, Healy BC, Kuhle J, Mina MJ, Leng Y, Elledge SJ, Niebuhr DW, Scher AI, Munger KL, Ascherio ALongitudinal analysis reveals high prevalence of Epstein-Barr virus associated with multiple sclerosis.Science.(2022-Jan-21)
  17. ^Thacker EL, Mirzaei F, Ascherio AInfectious mononucleosis and risk for multiple sclerosis: a meta-analysis.Ann Neurol.(2006-Mar)
  18. ^Lanz TV, Brewer RC, Ho PP, Moon JS, Jude KM, Fernandez D, Fernandes RA, Gomez AM, Nadj GS, Bartley CM, Schubert RD, Hawes IA, Vazquez SE, Iyer M, Zuchero JB, Teegen B, Dunn JE, Lock CB, Kipp LB, Cotham VC, Ueberheide BM, Aftab BT, Anderson MS, DeRisi JL, Wilson MR, Bashford-Rogers RJM, Platten M, Garcia KC, Steinman L, Robinson WHClonally expanded B cells in multiple sclerosis bind EBV EBNA1 and GlialCAM.Nature.(2022-Mar)
  19. ^Lünemann JD, Jelcić I, Roberts S, Lutterotti A, Tackenberg B, Martin R, Münz CEBNA1-specific T cells from patients with multiple sclerosis cross react with myelin antigens and co-produce IFN-gamma and IL-2.J Exp Med.(2008-Aug-04)
  20. ^Levin LI, Munger KL, Rubertone MV, Peck CA, Lennette ET, Spiegelman D, Ascherio ATemporal relationship between elevation of epstein-barr virus antibody titers and initial onset of neurological symptoms in multiple sclerosis.JAMA.(2005-May-25)
  21. ^Afrasiabi A, Parnell GP, Fewings N, Schibeci SD, Basuki MA, Chandramohan R, Zhou Y, Taylor B, Brown DA, Swaminathan S, McKay FC, Stewart GJ, Booth DREvidence from genome wide association studies implicates reduced control of Epstein-Barr virus infection in multiple sclerosis susceptibility.Genome Med.(2019-Apr-30)
Examine Database References
  1. Balance - H S Greenberg, S A Werness, J E Pugh, R O Andrus, D J Anderson, E F DominoShort-term effects of smoking marijuana on balance in patients with multiple sclerosis and normal volunteersClin Pharmacol Ther.(1994 Mar)
  2. Multiple Sclerosis Symptoms - Mari Carmen Torres-Moreno, Esther Papaseit, Marta Torrens, Magí FarréAssessment of Efficacy and Tolerability of Medicinal Cannabinoids in Patients With Multiple Sclerosis: A Systematic Review and Meta-analysisJAMA Netw Open.(2018 Oct 5)
  3. Multiple Sclerosis Symptoms - C Vaney, M Heinzel-Gutenbrunner, P Jobin, F Tschopp, B Gattlen, U Hagen, M Schnelle, M ReifEfficacy, safety and tolerability of an orally administered cannabis extract in the treatment of spasticity in patients with multiple sclerosis: a randomized, double-blind, placebo-controlled, crossover studyMult Scler.(2004 Aug)
  4. Multiple Sclerosis Symptoms - Zajicek JP, Sanders HP, Wright DE, Vickery PJ, Ingram WM, Reilly SM, Nunn AJ, Teare LJ, Fox PJ, Thompson AJCannabinoids in multiple sclerosis (CAMS) study: safety and efficacy data for 12 months follow upJ Neurol Neurosurg Psychiatry.(2005 Dec)
  5. Multiple Sclerosis Symptoms - W Notcutt, R Langford, P Davies, S Ratcliffe, R PottsA placebo-controlled, parallel-group, randomized withdrawal study of subjects with symptoms of spasticity due to multiple sclerosis who are receiving long-term Sativex® (nabiximols)Mult Scler.(2012 Feb)
  6. Multiple Sclerosis Symptoms - Letizia Leocani, Arturo Nuara, Elise Houdayer, Irene Schiavetti, Ubaldo Del Carro, Stefano Amadio, Laura Straffi, Paolo Rossi, Vittorio Martinelli, Carlos Vila, Maria Pia Sormani, Giancarlo ComiSativex(®) and clinical-neurophysiological measures of spasticity in progressive multiple sclerosisJ Neurol.(2015 Nov)
  7. Multiple Sclerosis Symptoms - Jody Corey-Bloom, Tanya Wolfson, Anthony Gamst, Shelia Jin, Thomas D Marcotte, Heather Bentley, Ben GouauxSmoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trialCMAJ.(2012 Jul 10)
  8. Multiple Sclerosis Symptoms - David J Rog, Turo J Nurmikko, Tim Friede, Carolyn A YoungRandomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosisNeurology.(2005 Sep 27)
  9. Multiple Sclerosis Symptoms - J Killestein, E L J Hoogervorst, M Reif, N F Kalkers, A C Van Loenen, P G M Staats, R W Gorter, B M J Uitdehaag, C H PolmanSafety, tolerability, and efficacy of orally administered cannabinoids in MSNeurology.(2002 May 14)
  10. Multiple Sclerosis Symptoms - Michael G Serpell, William Notcutt, Christine CollinSativex long-term use: an open-label trial in patients with spasticity due to multiple sclerosisJ Neurol.(2013 Jan)
  11. Multiple Sclerosis Symptoms - Zajicek JP, Hobart JC, Slade A, Barnes D, Mattison PG, MUSEC Research GroupMultiple sclerosis and extract of cannabis: results of the MUSEC trialJ Neurol Neurosurg Psychiatry.(2012 Nov)
  12. Multiple Sclerosis Symptoms - Sven G Meuth, Thomas Henze, Ute Essner, Christiane Trompke, Carlos Vila SilvánTetrahydrocannabinol and cannabidiol oromucosal spray in resistant multiple sclerosis spasticity: consistency of response across subgroups from the SAVANT randomized clinical trialInt J Neurosci.(2020 Dec)
  13. Multiple Sclerosis Symptoms - Zajicek J, Fox P, Sanders H, Wright D, Vickery J, Nunn A, Thompson A, UK MS Research GroupCannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trialLancet.(2003 Nov 8)
  14. Multiple Sclerosis Symptoms - C Collin, E Ehler, G Waberzinek, Z Alsindi, P Davies, K Powell, W Notcutt, C O'Leary, S Ratcliffe, I Nováková, O Zapletalova, J Piková, Z AmblerA double-blind, randomized, placebo-controlled, parallel-group study of Sativex, in subjects with symptoms of spasticity due to multiple sclerosisNeurol Res.(2010 Jun)
  15. Multiple Sclerosis Symptoms - Aragona M, Onesti E, Tomassini V, Conte A, Gupta S, Gilio F, Pantano P, Pozzilli C, Inghilleri MPsychopathological and cognitive effects of therapeutic cannabinoids in multiple sclerosis: a double-blind, placebo controlled, crossover studyClin Neuropharmacol.(2009 Jan-Feb)
  16. Multiple Sclerosis Symptoms - A Novotna, J Mares, S Ratcliffe, I Novakova, M Vachova, O Zapletalova, C Gasperini, C Pozzilli, L Cefaro, G Comi, P Rossi, Z Ambler, Z Stelmasiak, A Erdmann, X Montalban, A Klimek, P Davies, Sativex Spasticity Study GroupA randomized, double-blind, placebo-controlled, parallel-group, enriched-design study of nabiximols* (Sativex(®) ), as add-on therapy, in subjects with refractory spasticity caused by multiple sclerosisEur J Neurol.(2011 Sep)
  17. Multiple Sclerosis Symptoms - R M Langford, J Mares, A Novotna, M Vachova, I Novakova, W Notcutt, S RatcliffeA double-blind, randomized, placebo-controlled, parallel-group study of THC/CBD oromucosal spray in combination with the existing treatment regimen, in the relief of central neuropathic pain in patients with multiple sclerosisJ Neurol.(2013 Apr)
  18. Multiple Sclerosis Symptoms - Derick T Wade, Petra Makela, Philip Robson, Heather House, Cynthia BatemanDo cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patientsMult Scler.(2004 Aug)
  19. Multiple Sclerosis Symptoms - Jolana Markovà, Ute Essner, Bülent Akmaz, Marcella Marinelli, Christiane Trompke, Arnd Lentschat, Carlos VilaSativex ® as add-on therapy vs. further optimized first-line ANTispastics (SAVANT) in resistant multiple sclerosis spasticity: a double-blind, placebo-controlled randomised clinical trialInt J Neurosci.(2019 Feb)
  20. Multiple Sclerosis Symptoms - D T Wade, P M Makela, H House, C Bateman, P RobsonLong-term use of a cannabis-based medicine in the treatment of spasticity and other symptoms in multiple sclerosisMult Scler.(2006 Oct)
  21. Multiple Sclerosis Symptoms - P Fox, P G Bain, S Glickman, C Carroll, J ZajicekThe effect of cannabis on tremor in patients with multiple sclerosisNeurology.(2004 Apr 13)
  22. Neuropathic Pain Symptoms - Michael Iskedjian, Basil Bereza, Allan Gordon, Charles Piwko, Thomas R EinarsonMeta-analysis of cannabis based treatments for neuropathic and multiple sclerosis-related painCurr Med Res Opin.(2007 Jan)
  23. Urinary Incontinence Signs - R B C Kavia, D De Ridder, C S Constantinescu, C G Stott, C J FowlerRandomized controlled trial of Sativex to treat detrusor overactivity in multiple sclerosisMult Scler.(2010 Nov)
  24. Urinary Incontinence Signs - R M Freeman, O Adekanmi, M R Waterfield, A E Waterfield, D Wright, J ZajicekThe effect of cannabis on urge incontinence in patients with multiple sclerosis: a multicentre, randomised placebo-controlled trial (CAMS-LUTS)Int Urogynecol J Pelvic Floor Dysfunct.(2006 Nov)
  25. Multiple Sclerosis Symptoms - Ghasem Mosayebi, Ali Ghazavi, Keyvan Ghasami, Yahya Jand, Parviz KokhaeiTherapeutic effect of vitamin D3 in multiple sclerosis patientsImmunol Invest.(2011)
  26. Multiple Sclerosis Symptoms - William Camu, Philippe Lehert, Charles Pierrot-Deseilligny, Patrick Hautecoeur, Anne Besserve, Anne-Sophie Jean Deleglise, Marianne Payet, Eric Thouvenot, Jean Claude SouberbielleCholecalciferol in relapsing-remitting MS: A randomized clinical trial (CHOLINE)Neurol Neuroimmunol Neuroinflamm.(2019 Aug 6)
  27. Multiple Sclerosis Symptoms - Raymond Hupperts, Joost Smolders, Reinhold Vieth, Trygve Holmøy, Kurt Marhardt, Myriam Schluep, Joep Killestein, Frederik Barkhof, Manolo Beelke, Luigi M E Grimaldi, SOLAR Study GroupRandomized trial of daily high-dose vitamin D 3 in patients with RRMS receiving subcutaneous interferon β-1aNeurology.(2019 Nov 12)
  28. Multiple Sclerosis Symptoms - Vahid Shaygannejad, Mohsen Janghorbani, Fereshteh Ashtari, Hamed DehghanEffects of adjunct low-dose vitamin d on relapsing-remitting multiple sclerosis progression: preliminary findings of a randomized placebo-controlled trialMult Scler Int.(2012)
  29. Multiple Sclerosis Symptoms - Margitta T Kampman, Linn H Steffensen, Svein I Mellgren, Lone JørgensenEffect of vitamin D3 supplementation on relapses, disease progression, and measures of function in persons with multiple sclerosis: exploratory outcomes from a double-blind randomised controlled trialMult Scler.(2012 Aug)
  30. Multiple Sclerosis Symptoms - Pierrot-Deseilligny C, Rivaud-Péchoux S, Clerson P, de Paz R, Souberbielle JCRelationship between 25-OH-D serum level and relapse rate in multiple sclerosis patients before and after vitamin D supplementationTher Adv Neurol Disord.(2012 Jul)
  31. Multiple Sclerosis Symptoms - Lovera JF, Kim E, Heriza E, Fitzpatrick M, Hunziker J, Turner AP, Adams J, Stover T, Sangeorzan A, Sloan A, Howieson D, Wild K, Haselkorn J, Bourdette DGinkgo biloba does not improve cognitive function in MS: a randomized placebo-controlled trialNeurology.(2012 Sep 18)
  32. Multiple Sclerosis Symptoms - Sama Bitarafan, Aliakbar Saboor-Yaraghi, Mohammad-Ali Sahraian, Danesh Soltani, Shahriar Nafissi, Mansoureh Togha, Nahid Beladi Moghadam, Tina Roostaei, Niyaz Mohammadzadeh Honarvar, Mohammad-Hossein HarirchianEffect of Vitamin A Supplementation on fatigue and depression in Multiple Sclerosis patients: A Double-Blind Placebo-Controlled Clinical TrialIran J Allergy Asthma Immunol.(2016 Feb)
  33. Multiple Sclerosis Symptoms - Sanoobar M, Eghtesadi S, Azimi A, Khalili M, Khodadadi B, Jazayeri S, Gohari MR, Aryaeian NCoenzyme Q10 supplementation ameliorates inflammatory markers in patients with multiple sclerosis: a double blind, placebo, controlled randomized clinical trialNutr Neurosci.(2015 May)
  34. Fatigue Symptoms - Sanoobar M, Dehghan P, Khalili M, Azimi A, Seifar FCoenzyme Q10 as a treatment for fatigue and depression in multiple sclerosis patients: A double blind randomized clinical trialNutr Neurosci.(2016)
  35. Multiple Sclerosis Symptoms - Naghashpour M, Majdinasab N, Shakerinejad G, Kouchak M, Haghighizadeh MH, Jarvandi F, Hajinajaf SRiboflavin supplementation to patients with multiple sclerosis does not improve disability status nor is riboflavin supplementation correlated to homocysteineInt J Vitam Nutr Res.(2013)
  36. Multiple Sclerosis Symptoms - Bruce A C Cree, Gary Cutter, Jerry S Wolinsky, Mark S Freedman, Giancarlo Comi, Gavin Giovannoni, Hans-Peter Hartung, Douglas Arnold, Jens Kuhle, Valerie Block, Frederick E Munschauer, Frédéric Sedel, Fred D Lublin, SPI2 investigative teamsSafety and efficacy of MD1003 (high-dose biotin) in patients with progressive multiple sclerosis (SPI2): a randomised, double-blind, placebo-controlled, phase 3 trialLancet Neurol.(2020 Dec)
  37. Multiple Sclerosis Symptoms - Tourbah A, Lebrun-Frenay C, Edan G, Clanet M, Papeix C, Vukusic S, De Sèze J, Debouverie M, Gout O, Clavelou P, Defer G, Laplaud DA, Moreau T, Labauge P, Brochet B, Sedel F, Pelletier J, MD1003 (high-dose biotin) for the treatment of progressive multiple sclerosis: A randomised, double-blind, placebo-controlled study.Mult Scler.(2016-11)
  38. Multiple Sclerosis Symptoms - Sedel F, Papeix C, Bellanger A, Touitou V, Lebrun-Frenay C, Galanaud D, Gout O, Lyon-Caen O, Tourbah AHigh doses of biotin in chronic progressive multiple sclerosis: a pilot study.Mult Scler Relat Disord.(2015-Mar)
  39. Multiple Sclerosis Symptoms - Tourbah A, Gout O, Vighetto A, Deburghgraeve V, Pelletier J, Papeix C, Lebrun-Frenay C, Labauge P, Brassat D, Toosy A, Laplaud DA, Outteryck O, Moreau T, Debouverie M, Clavelou P, Heinzlef O, De Sèze J, Defer G, Sedel F, Arndt CMD1003 (High-Dose Pharmaceutical-Grade Biotin) for the Treatment of Chronic Visual Loss Related to Optic Neuritis in Multiple Sclerosis: A Randomized, Double-Blind, Placebo-Controlled Study.CNS Drugs.(2018-07)
  40. Multiple Sclerosis Symptoms - Tomassini V, Pozzilli C, Onesti E, Pasqualetti P, Marinelli F, Pisani A, Fieschi CComparison of the effects of acetyl L-carnitine and amantadine for the treatment of fatigue in multiple sclerosis: results of a pilot, randomised, double-blind, crossover trialJ Neurol Sci.(2004 Mar 15)
  41. Fatigue Symptoms - Masoud Etemadifar, Farnaz Sayahi, Seyed-Hossein Abtahi, Hamidreza Shemshaki, Gholam-Ali Dorooshi, Mohammad Goodarzi, Mojtaba Akbari, Mahboobeh Fereidan-EsfahaniGinseng in the treatment of fatigue in multiple sclerosis: a randomized, placebo-controlled, double-blind pilot studyInt J Neurosci.(2013 Jul)
  42. Interleukin 6 - Asbaghi O, Sadeghian M, Sadeghi O, Rigi S, Tan SC, Shokri A, Mousavi SMEffects of saffron (Crocus sativus L.) supplementation on inflammatory biomarkers: A systematic review and meta-analysis.Phytother Res.(2021-Jan)
  43. Pain - Wade DT, Robson P, House H, Makela P, Aram JA preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptomsClin Rehabil.(2003 Feb)