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[2008 updates are highlighted in red]
| Description: |
Ginkgo biloba usually refers to the extract that is derived from the leaf of the ginkgo biloba tree. Among herbs, ginkgo is one of the most extensively studied and one of the most popular. |
| Rationale: |
There are several effects of ginkgo that are relevant to MS. First, it is possible that it could treat the disease itself. Ginkgo has anti-inflammatory and anti-oxidant effects, both of which could be therapeutic for MS. In addition, since ginkgo may improve cognitive function in people with Alzheimer’s disease, it has been proposed that it may have similar effects on MS-related cognitive dysfunction. |
| Evaluation: |
Ginkgo has undergone limited investigation in MS. Ginkgo and related compounds decreased disease severity in some but not all studies in the animal model of MS. One small study of people with MS found that it may be helpful for MS attacks, however this was not supported by a subsequent study that was larger and was more rigorously conducted. Thus, it does not appear to be effective for MS attacks. Whether ginkgo prevents attacks - in a way similar to interferons, glatiramer acetate, mitoxantrone, and natalizumab - has never been investigated. Two small studies found that ginkgo may improve MS-related cognitive difficulties. Another small study reported that ginkgo improved MS-related fatigue. Further studies are needed to determine if ginkgo slows the course of MS or improves MS symptoms, including cognitive difficulties. Studies are currently underway to evaluate the effects of ginkgo on cognitive function in MS. |
| Risks: |
Ginkgo is usually well tolerated. It may have a blood-thinning effect and thus should be avoided in people who have bleeding disorders, take antiplatelet or anticoagulant medication, or are undergoing surgery. In addition, ginkgo may provoke seizures and should be used with caution by those with seizure disorders. It may also cause dizziness, rashes, headache, and gastrointestinal complaints, including nausea, vomiting, diarrhoea, and flatulence. The safety of ginkgo in women who are pregnant or breastfeeding is not known. |
| Costs: |
Ginkgo is inexpensive. |
| Committee opinion: |
Ginkgo is a low-cost therapy that is usually well tolerated. Rarely, it may cause bleeding and provoke seizures. There is a rationale for its use as a disease-modifying therapy in MS and for MS-related cognitive dysfunction. However, there is very limited clinical evidence. It does not appear to be effective for treating MS attacks. Two small studies found that it may be helpful for MS-associated cognitive difficulties and another small study reported that it decreased MS-associated fatigue; further studies in this area are needed. |
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