Echinacea is one of the most popular and well-studied herbs. A long history of echinacea use exists for the treatment of medical conditions, especially infections. North American Indians used echinacea medicinally, and it was the primary herbal therapy for infections in the early 1900s. Echinacea poses a theoretical risk for people with MS, yet, surprisingly, it is sometimes recommended for MS and appears to be used by a relatively large number of people with the disease.
Echinacea is of interest to people with MS because it may prevent or reduce the severity of viral infections. Because viral infections may, in some instances, provoke an MS attack, their reduction has obvious potential benefit. Also, popular books on alternative medicine sometimes specifically recommend echinacea as a treatment for MS, possibly because of echinacea's effects on the immune system.
Many scientific and clinical studies have evaluated echinacea. Some, but not all, studies indicate that echinacea limits the duration and severity of infections, especially the common cold.
The important point for people with MS is that echinacea may act by stimulating two components of the immune system, macrophages and T cells. Macrophages and T cells are already excessively active in MS, and MS medications, such as glatiramer acetate (Copaxone) and interferons (Avonex, Betaseron, and Rebif), decrease their activity. Thus, consuming echinacea may conceivably worsen MS by further stimulating these immune cells, and this may decrease the effectiveness of MS medications. One report documents a person who developed an MS-like condition known as acute disseminated encephalomyelitis (ADEM) after being treated with an herbal muscle injection that included echinacea. Theoretical concerns exist that echinacea may produce liver injury. This effect could be increased if echinacea is taken with those MS medications having possible toxic effects on the liver, including interferons (Avonex, Betaseron, and Rebif) and methotrexate, a chemotherapy drug sometimes used to treat MS. In summary, it is safest for people with MS to avoid echinacea.
What about other measures to prevent or treat the common cold or other minor infections? Goldenseal and garlic (see subsequent sections) have not been shown to have definite effects on infections, and the scientific basis for their use is unclear. Also, vitamin C and zinc, which are discussed in detail elsewhere in this book, sometimes are used for infections. However, both of these compounds also have unclear effects on infections and may activate the immune system.
People with MS may take several safe measures to prevent and treat viral infections such as the flu and common cold. First, the flu vaccine is readily available, appears to be safe for people with MS, and helps prevent the flu. Recently developed prescription medications (oseltamivir [Tamiflu], zanamivir [Relenza]) also decrease the severity of the flu. Finally, viral infections may be prevented by simple measures such as avoiding contact with people with viral infections and frequent hand-washing.
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