Acupuncture in Neurological Disorders: An Evidence-Based Overview

Over the past 20 years acupuncture has been rapidly gaining in popularity both in clinical practice and in research. New evidence for the benefits of acupuncture in various disorders is emerging seemingly every week, and recent large-scale systematic reviews and meta-analyses have suggested that acupuncture’s benefits in pain conditions can be maintained long term. At present the strongest evidence for acupuncture in the treatment of neurological disorders is in the fields of migraine, tension headaches, diabetic neuropathy, carpal tunnel syndrome, and Bell’s palsy. Recent trials suggest that acupuncture may be used as an adjunct in stroke rehabilitation and in improving the quality of life in patients with Parkinson’s disease and dementia. Despite recent mechanistic research advances, much remains unknown about acupuncture’s mechanism of action and there are common misconceptions about the origins of modern-day acupuncture. As acupuncture is being rapidly integrated into mainstream medical practice and increasingly being sought by patients, healthcare providers and neurologists in particular need to be educated about its applications and benefits for various neurological disorders. Our hope is that this chapter will serve toward this educational goal.

Traumatic Brain Injury and Concussion

Millions of Americans suffer from traumatic brain injuries and concussion each year. It used to be thought that recovery from a noncomplicated concussion was quick and easy. However, recent research has shown that multiple physiological mechanisms may result from a single impact to the head, and worsen with subsequent injuries. Head injuries have been shown to affect different systems of the body, including the endocrine system, the immune system, and maintenance of the gastrointestinal microbiome. This chapter will review these mechanisms, the sequelae of head injury, and the importance of conducting a thorough evaluation. Integrative methods of treatment and management will be discussed.

Stress and Burnout in Neurology

Stress and burnout are epidemic in medicine in general and neurology in particular. This has resulted in a healthcare crisis because burned-out physicians are subject to multiple adverse personal outcomes and are more likely to make mistakes in their work. The seeds of this crisis are found in the earliest stages of medical education and acculturation. Resilience is produced by a set of cognitive skills that can be taught and nurtured, building on a strengths-based rather than a deficit-based approach. Positive health and well-being is built on positive affect, engagement, positive relationships, meaning, and accomplishment (PERMA for short) according to the formulation of Martin Seligman, the father of positive psychology. PERMA and positive psychology form the framework for combating stress and burnout in neurology.

Integrative Approaches to Multiple Sclerosis

Multiple sclerosis (MS) is a chronic progressive autoimmune disorder specific to the central nervous system. The incidence of MS in the United States is roughly 400,000 cases, and worldwide there are approximately 2.5 million cases. It is one of the more common neurodegenerative disease and is thought to be autoimmune, although an antibody has not yet been identified. The current standard of treatment consists of disease-modifying drugs, which have their own toxicity profiles that can inflict further harm to a patient. Indeed, many patients are wary of initiating or continuing this type of treatment. Many patients include alternative treatment approaches. This chapter reviews an integrative approach based on our understanding of the disease and the current state of evidence.

Cognitive Neurology: Integrative Approaches to Prevent and Manage Cognitive Impairment and Dementia

This chapter reviews the increasing prevalence and public health impact of dementia for individuals, families, and societies globally. It discusses the common lifestyle and environmental risk factors of cerebrovascular disease and neurodegeneration and their role in brain health and dementia. It also reviews the spectrum of cognitive impairment and new diagnostic criteria of dementia within the context of a lifespan model of healthy aging. It describes the main findings from observational studies on risk and neuroprotective factors for dementia and Alzheimer’s disease and summarizes the current knowledge of mindset, lifestyle, and mind/body interventions for risk reduction, prevention, and management of dementia, and the promotion of resilience and well-being in aging. This chapter is written for neurologists, psychiatrists, geriatricians, and integrative clinicians.

The Endocannabinoid System in the Aging Brain and Neurodegenerative Diseases

Aging is the major risk factor for development of cognitive decline and neurodegenerative disease. The aging brain undergoes gradual neuroanatomical and neurochemical changes, including alterations in components of the endocannabinoid system. These changes impact brain functions controlling motoric, emotive, and cognitive activities. Some degree of age-related cognitive decline occurs independent of the presence of neurodegenerative disorders such as Alzheimer’s disease, Parkinson’s disease, and Huntington’s disease. However, neurodegenerative diseases can also develop in younger individuals who exhibit what appears to be accelerated “aging” of selective populations of neurons. The discovery of the endogenous cannabinoid system is relatively recent and began with identification of receptors in brain that interacted and bound with the main psychoactive component of the phytocannabinoid delta-9-tetrahydrocannabinol (THC). At present, the various components of the endocannabinoid system (endogenous ligands, receptors, biosynthetic and degradative enzymes) have been characterized, and research in this field is rapidly growing. In this brief review, the changes in the endocannabinoid system that occur with aging and in several classical neurodegenerative diseases are discussed with a focus on the therapeutic potential of agents that interact with various components of the endocannabinoid system.

Sleep Health and Sleep Disorders

This chapter reviews the architecture and functions of sleep, how to interview patients on their sleep histories, how to evaluate for sleep disorders, commonly encountered sleep disorders and their pathophysiology, and the conventional and integrative therapies for each. The evaluation process includes a conventional sleep study as well as addressing vitamin D, B, and magnesium status. Sleep disorders discussed in this chapter are obstructive sleep apnea, insomnia, restless legs syndrome, periodic limb movement disorder, rapid-eye-movement behavior disorder, circadian rhythm disorders, and narcolepsy and other central hypersomnias. The role of conventional tools and times when alternative and complementary therapies may be considered are discussed in detail. Treatment covered include continuous positive airway pressure, oral appliance, myofunctional therapy, cognitive-behavioral therapy for insomnia, physical modalities, acupuncture, light therapy, melatonin, nutraceuticals, and other supplements that aid with sleep and daytime symptoms.

Endocrine-Disrupting Chemicals: Brain–Behavior Effects on Thyroid and Sexual Differentiation

The human population is exposed to literally hundreds of industrial chemicals. Studies show that, on average, there are well over 100 industrial chemicals in cord blood samples taken from babies born in the United States. This observation may be disregarded if it were not for solid—and growing—evidence that many of these chemicals interfere with hormone systems that play important roles in human brain development. For example, thyroid hormone is known to be essential for normal brain development and the human brain is much more sensitive to thyroid hormone insufficiency than believed 50 years ago. Chemicals such as perchlorate, polychlorinated biphenyls, and polybrominated flame retardants are associated with cognitive deficits in humans, and the experimental literature reveals a complex interaction with the thyroid system that can account for these effects. Likewise, estrogenic chemicals like bisphenol A (BPA) can affect the development of many organ systems, including sexually dimorphic regions of the brain. There is now convincing evidence that even slight perturbations in hormonal systems caused by endocrine-disrupting chemicals can impact brain development, reducing cognitive function and gender-specific behaviors throughout the remainder of life. The consequences of such chronic exposures at low doses typical of human exposures had, until relatively recently, not been appreciated due to safety testing strategies that are designed to identify overt toxicities, not endocrine disruption and its consequences.

Autism Spectrum Disorder: A Framework for Integrative Pediatric Medicine

Autism spectrum disorders are complex, diverse neurodevelopmental and behavioral disorders that are characterized by the presence of impaired social communication with restricted stereotypical patterns of behavior and interests. The cause remains elusive and multifactorial, including a sophisticated interplay of genetics and environmental factors. Standard treatment options are limited to behavioral therapies, including applied behavioral analysis, and pharmacological treatment for significant behaviors such as aggression. Families are increasingly turning to alternative medical practices for support in managing their children’s care. By using an integrative medical model with a focus on investigating for and treating underlying inflammation and oxidative stress, integrative practitioners can help families navigate the complex world of autism management and treatment.

Neuropathy and Neuropathic Pain

Complementary and alternative treatment modalities are commonly used by patients for neuropathy and neuropathic pain due to perceived lack of benefit from conventional medical treatment. As the association between metabolic syndrome and neuropathy is increasingly recognized, diet and lifestyle interventions are becoming important components in the management of neuropathy. Progress in the understanding of the gut–immune interaction highlights the roles that the gut microbiome and inflammation play in the modulation of neuropathy and neuropathic pain. Evidence for nutritional interventions, exercise, supplements, acupuncture, and mindfulness-based practices in the treatment of neuropathic pain is also encouraging. This chapter reviews the available evidence supporting the safe use of complementary and alternative treatments as adjunctive or preferred options to symptomatic treatment with pharmaceuticals in commonly encountered conditions associated with neuropathy and neuropathic pain.