Neuropharmacology & Neurotherapeutics
Oct. 23, 2023
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In this article, the author evaluates the role of "complementary medicine," or "alternative medicine," in the practice of neurology. These should be considered supplementary to conventional medicine rather than as an alternative. Well-known therapies of this category include herbs, homeopathy, chiropractic, acupuncture, Ayurvedic medicine, and Chinese medicine. Scientific basis is shown in only a few of these approaches. Some of these methods may be used for the treatment of disorders for which no satisfactory therapy exists in modern medicine; further research is needed for the evaluation of these methods. Adverse effects of complementary methods should not be ignored.
• The use of alternative therapies in Western countries is increasing.
• Scientific basis of most of the alternative therapies has not been established.
• Some of the alternative therapies for which safety information is available may be used as a supplement to conventional treatments.
• Commonly used alternative systems of medicine are Ayurveda, Chinese medicine, homeopathy, and chiropractic.
The term for alternative therapies that is preferred in Europe is "complementary medicine" because most Europeans perceive these therapies as supplementary to conventional medicine rather than an alternative. The comprehensive term “complementary and alternative medicine (CAM)” covers all forms of unconventional therapies. Another term, "holistic" (or "wholistic") therapy, is applied to several of these practices on the basis that these therapies consider the patient as whole, not just the patient's physical aspects. In this author’s opinion, this term is meaningless and is not commonly used. These therapies are difficult to define because they include a broad spectrum of unconventional and unorthodox practices. Some are well known, whereas others are exotic and mysterious. Some are useful, whereas others are useless and even dangerous. Several of these methods are culturally based; their origins are rooted in antiquity. The use of these methods is widespread, but the popularity of these therapies differs among countries.
In some western European countries, approximately 75% of the patient population has used alternative therapies at one time or another. In a study in Austria and Germany, most of the patients rated the integration of complementary care with academic medicine in the acute hospital very positively (37). Courses in alternative medicine are included in the medical curricula of some universities, both in Europe and in the United States. According to a 2008 survey by the National Center for Complementary and Alternative Medicine, approximately 38% of adults and approximately 12% of children in the United States are using some form of complementary and alternative medicine. The use of alternative therapies in the United States varies considerably among cultures. For example, 50% to 90% of Hispanics use a wide range of complementary and alternative therapies, including several that may be unfamiliar to healthcare practitioners (27). Analysis of the Australian National Health Survey database showed that approximately 24% (1.3 million) of Australian adults with a chronic condition regularly used complementary and alternative methods of treatment (03). In a study from the United Kingdom, 40 of 216 subjects (18.5%) seen in a neurology clinic took alternative therapies (38). Although complementary medicine is usually discussed for adult patients, it is used in children frequently. A Canadian study reported that the use of complementary medicine was common among pediatric neurology patients, with over half of the families reporting benefits with few side effects (45).
The regulation of practitioners of these methods varies widely. Some of these methods are used by licensed physicians, and licensing requirements do exist for health practitioners specializing in alternative methods. Several explanations exist for the resurgence of interest in alternative medicine, but the four most important factors are:
(1) Disenchantment of the public with the impersonal attitude of modern physicians and technology-oriented modern medicine. A rebellion has taken place against technology and impersonal medical care.
(2) Modern medicine is still unable to offer any cure for several disabling and fatal diseases. Patients turn to alternative therapies that offer them some hope.
(3) A common belief that alternative therapies have fewer side effects than modern medicines.
(4) Rising costs of modern medicine and the trend towards reducing these costs by encouraging alternative medical practices.
Most individuals using alternative medicine do so not due to their dissatisfaction with conventional medicine, but because they find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life.
Alternative therapies are used for a wide range of illnesses, which vary in seriousness from minor symptoms to cancer. A neurologist should be familiar with alternative therapies for the following reasons:
• Patients with incurable neurologic ailments seek alternative therapies.
• Surveys in the United States have shown that most of the patients who have used unconventional methods do not inform their physicians. Some of these patients may be using such therapies at the time they present to a neurologist; therefore, history of the use of such a method should be elicited in all neurologic patients.
• Neurologic complications are known to result from several of the alternative therapies.
• Some of these methods may have a place in the management of neurologic patients.
Some of the alternative therapies are outright fraud or quackery and will not be described, although complications of some of these methods will be mentioned as examples. Several herbal preparations are in clinical trials for neurologic disorders, but the focus of this article is on treatments already in clinical use.
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