1. INTRODUCTION:

Motor neuron disease is the slow degeneration of upper and lower motor neurons (MND). The name "amyotrophic lateral sclerosis" was coined by Jean-Martin Charcot in 1874 to describe the disease (ALS). The most common type of the disease is now known as ALS, and the terms are frequently interchanged with MND.¹Muscle atrophy or weakness in one or more limbs or bulbar areas is a symptom of Amyotrophic lateral sclerosis (ALS).²A combination of upper and lower motor neuron loss leads to widespread muscle weakness. MND start age, location of onset, and rate of progression are all highly variable, with each of these factors having a significant impact on life expectancy.¹

For a long time, it was thought that classic motor neuron disease/amyotrophic lateral sclerosis (cMND/ALS) spared cognitive abilities. However, there are multiple historical allusions to behavioral problems in MND, as well as descriptive language like schizophrenia and dementia. FTD/MND syndrome is significant because it has the potential to provide insight on the evolution of symptoms in FTD due to its slower progression. It refers to the early cognitive and anatomical changes that occur in FTD prior to the illness spreading and secondary degenerative processes. Furthermore, FTD/MND may have an impact on our understanding of the cognitive changes that occur in cMND/ALS.³

1.1 AYURVEDA IN MANAGEMENT OF MOTOR NEURON DISEASE:

Ayurveda defines health as a state in which the physical body, senses, and psyche are in their original or natural state in terms of body and function. Vata is thought to be the most important component in the body's physiological upkeep. The central, autonomic, and peripheral neural systems are all controlled by the vata bio-factor. The respiratory, circulatory, lymphatic, excretory, and reproductive systems, as well as all forms of movements, are all under Vata's influence. It's also in charge of the brain's cognitive and neo-cognitive functions, as well as the secretion of chemical neurotransmitters and hormones. Vata's functions are similar to those of the central, peripheral, and autonomic nervous systems.⁴

Here are a few characters of Vata, According to Sanskrit theory, these explain more about the Vata dosha's connection to motor neuron illness. They are as follows:

· The initiation of every activity depends on the Vata Motor commands fall under this activity of the Vata Dosha

· The initiation of all motor activities and guides to the movements

· Binds the body together and keeps the body intact

· Responsible for Vata Dosha⁶

1.1.1 The approach of Ayurvedic Treatment for MND:

The major goal of MND treatment is to slow the disease's progression and prevent the body from decaying. Life is not like the condition.⁶

1.1.1.1 To stop the further decay of the nerve cells:

For the treatment of this condition, two points approach for motor neuron disease are used.⁶

1.1.1.1.1 Detoxification of body:

The first step is to eliminate the body's deep-seated poisons. Toxins may come from the environment may be present as a result of a "genetic arrangement of the body." This is when Panchakarma comes in. We are unable to perform substantial panchakarma on MND patients. Because there is too much deterioration in the body of a person with motor neuron disease. As a result, he makes excellent use of medicines and panchakarma.⁶

1.1.1.1.2 Rasayana Therapy:

Rasayana is the nourishing medicine. These are extremely nourishing to the body. These can range from simple combinations like Ashwagandha Amala and Mulethi to more sophisticated ones like Brahmarasayans or Chyawanprash. It is up to the doctors to choose the appropriate medicine for the patient's condition.⁶

1.1.1.2 Ensuring the proper nourishment of remaining cells:

Because the body's degeneration is rapid in MND, we must appropriately nourish the body. While addressing the therapy of VataVyadhi, Charak makes an insightful observation on the subject. Ghee, oils, animal fats, and bone marrow are all good sources of nutrition. These can be applied to the skin, as well as taken orally and through Basti. The patient should be placed in a warm environment. Foods that are sweet, salty, and sour that nourish the body are advised. Charaka had a vision and was aware of the treatment plan.⁶

1.1.1.3 To Help the Nourishment of Muscles:

Complete this stage by completing the previous one. Bruhmanchikitsa aids in muscular deterioration and is damaging. Panchakarma methods like NavarKizhi, in addition to medicines, aid in this.⁶

1.1.2 Panchkarma Therapies quite effective in MND are:

Fig. 1: Panchkarma Therapy⁷

1.1.2.1Abhayandam:

The Ayurvedic oil massage is an important aspect of the Ayurvedic healing system's daily regimen for total health and well-being. Traditional Ayurvedic scriptures are quite eloquent on the advantages. Here's what one person says: Every day, give yourself a full-body oil massage. It nourishes all parts of the body, pacifies the doshas, relieves exhaustion, offers stamina, pleasure, and perfect sleep, improves the complexion and luster of the skin, promotes longevity, and nourishes all doshas.⁵

Fig. 2: Abhyanga⁸

Benefits:

1. Increased circulation, especially to nerve endings.

2. Toning of muscles and the whole physiology

3. Calming for the nerves and lubrication of the joints

4. Softer, smoother skin and better, deeper sleep at night

5. Increased mental alertness

6. Improved elimination of impurities from the body⁵

Abhyanga allows for transdermal absorption of the healing characteristics of the massage material, and it aids the skin, the body's largest organ, in performing its many duties, such as allowing toxins to be removed from the body or allowing nutrients to be absorbed by the tissues. It's similar to oiling your car's engine: if you do it on a regular basis, your engine will be in top shape and provide you with years of trouble-free service. ⁵

Herbal massage oils are made from a blend of herbs that have been carefully selected for their potential to enhance the physiology and calm the mind. Ayurveda uses a range of powerful massage treatments to help correct structural instabilities.⁵

1.1.2.2 Shirodhara:

Shirodhara is an ancient method of Ayurvedic therapy that has been used for over 5000 years. It entails a steady flow of heated herbalized oils across the forehead, focusing on the third eye (the chakra points immediately above and between the brows). It's thought to be the origin of human awareness). The oils are allowed to flow over the scalp and through the hair, giving a relaxing experience as you lie on your back with your body cocooned in warm towels above you.⁵

Fig. 3: Shirodhara⁹

Your head will be placed beneath the oil ‘fountain’, which is a metal bottle with a slow-flowing nozzle from which the oils will gradually drip onto your forehead. All ailments, according to Ayurveda, are caused by an imbalance of energy in the body. Ayurveda uses purification therapy to cleanse the body and restore the balance of life force through rejuvenation to treat ailments. Shirodhara treatment is a rejuvenation technique that is known for calming and repairing an overworked nervous system.⁵

Benefits:

1. Produces a deep state of relaxation in the body and mind, reducing tension.

2. Nervous system stabilizer and it aids in the treatment of insomnia.

3. Rejuvenation and purification of the body and mind.

4. Restores skin's natural shine and youthfulness by replenishing skin oils.

5. Activates the pituitary, pineal glands, and hypothalamus, all of which organize and regulate the body's hormones.

6. Assists in the production of endorphins, the body's neurotransmitters.

7. It stimulates the senses and encourages a cheerful outlook on life and brings spiritual consciousness to the third age.

8. Increases intuition and stimulates cognitive memories.

9. Improves focus, mental clarity, and comprehension.

10. Stimulates the pituitary gland, which is responsible for the activation of sexual and reproductive hormones.

11. Clears the mind, relieves stress, and relaxes the face muscles, softening lines and wrinkles.

12. Nourishes the hair and scalp, as well as the hair follicles, to prevent hair loss and greying.⁵

1.1.2.3 Nasyam:

Nasya, often known as nasal drop, is a popular Ayurvedic remedy. It's one of the treatments utilized in Panchkarma, Ayurveda's detoxification or cleansing procedure. Nasya is the practice of injecting oil or other substances into the nostrils in a controlled manner. In some circumstances, it can also be done with powder. Nasya is a very effective and promising procedure for disorders of the ear, nose, and throat. When done on a regular basis, it has a positive impact.⁵

Fig, 9: Nasya¹⁰

Nasya's Benefits:

Nasya, as a therapeutic therapy, offers astonishing results in the treatment of head problems. The nostrils, according to Ayurveda, are the entryway to the brain. Nasya is used in the treatment of problems with the head, neck, brain, eyes, ears, nose, and throat. ⁵

Nasya aids in the removal of toxins and doshas from the area above the collarbone, resulting in enhanced blood circulation, which nourishes the cells and alleviates connected diseases. Nasya is used to treat facial paralysis, stroke, cervical spondylitis, various headaches, lock jaw, sinusitis, epilepsy, and illnesses of the sensory organs in this way. According to recent research, nasya stimulates the pituitary gland, which can help with hormonal imbalances.⁵

1.1.2.4 Pizhichil:

This Ayurvedic massage combines two traditional Ayurvedic treatments. Swedana (oleation) and Snehana (sudation). The entire body is drenched in warm herbal oil streams while being massaged at the same time. Warm oil and massage open pores, allowing the herbal oil to go deeper into the tissues.⁵

The treatment is applying medicated lukewarm oil to the affected areas and rubbing them for 45-60 minutes. By squeezing a cloth soaked in oil from a vase, the oils are spilled on the body. The essential oils used in this therapy are chosen precisely for your dominant energy body constitution type. For optimal effects, the therapy should be done for 7-14 days. ⁵

Fig. 10: Pizhichil¹¹

Benefits:

1. Pizhichil relieves muscle and joint pain and it is anti-aging in nature.

2. Blood circulation is improved and it increases muscle development.

3. This improves the appearance of the skin.

4. It aids in the treatment of diabetes, hypertension, asthma, and even tuberculosis in its early stages.

5. It is a peaceful and relaxing therapy and this therapy is quite energizing.

6. It relieves the body's burning sensation.⁵

1.1.2.5 Shashtikashalipindaswedan:

One of the most important swedana (sweat-inducing) treatments is Navarakhizhi. It can be used to treat chronic vata disease, sleeplessness, multiple sclerosis, paralysis, muscle weakness or stiffness, joint illness such as osteoarthritis, and other degenerative disorders, or as a rejuvenation and anti-aging treatment for healthy people. It slows down the ageing process by preventing premature greying of the hair, hair loss, and wrinkles. ⁵

Fig. 11: ShashtikaShali Pinda Swedan¹²

The heated medicinal rice puddings made with Ayurvedic herbs are applied in the shape of boluses knotted in a cotton cloth after the administration of medicinal oil over the entire body. The bundles are warmed in a decoction of herbs and cow's milk on a regular basis. Heat and pressure are administered to the body at the same time during the therapy massage, providing sustenance to the muscles and nerve endings. It relieves joint stiffness and cleans the bodily channels, allowing for greater blood circulation and the removal of waste items from the body. It improves the appearance of the skin, promotes a healthy digestive system, and restores vitality.⁵

1.2 HERBS AND HERBAL COMPOUNDS USED IN MND:

1.2.1 Ashwagandha:

Fig. 12: Ashwagandha¹⁴

As a Rasayana, Withaniasomnifera (Ashwagandha) is a highly valued herb in the Indian Ayurvedic system of medicine (tonic). It's used for a variety of ailments, but most notably as a nervine tonic. Many scientific investigations were conducted in light of these findings, and itsanti-stress effects were thoroughly investigated. It has also been discovered to be beneficial in the treatment of neurological illnesses. It has a GABA-mimetic action and has been proven to increase dendritic development. Ashwagandha also increases nerve cell communication and boosts the body's ability to recover nervous system damage.⁵

1.2.1.1 Ashwagandha Capsules

Fig. 13: Ashwagandha Capsules¹⁵

These are pure natural capsules that are obtained from Withaniasomnifera (Ashwagandha). It is the most commonly herb used in Ayurveda which works on the nervous system as it possesses natural rejuvenating properties. It is helpful in relieving all types of nervous related disorders like MND. This herb works on the non-specific basis to normalize the physiological functions by working on neuroendocrine system.

Dosage: 1-2 capsules twice daily. ⁵

1.2.2 Brahmi

Fig. 14: Brahmi¹⁶

The herbal nutraceutical Bacopa monnieri (Brahmi) is known in Ayurveda for its role as a MedhyaRasayana or nootropic agent. Bacopa monniera's medicinal benefits are thought to be mediated by triterpenoid saponins found in the plant extract. Bacosides are the most important triterpenoid saponins. It's been proven that they improve nerve impulse transmission. By upregulating neuronal synthesis and kinase activity, the bacosides aid in the healing of injured neurons. The bacosides also aid in the restoration of synaptic activity, which leads to the transmission of nerve impulses. Nerve impulse transmission is essential for healthy cognitive functions such as attention span, focus, concentration, learning, and memory.⁵

1.2.2.1 Brahmi Capsules

Fig. 15: Brahmi Capsules¹⁷

Brahmi Capsules are made from the herb Brahmi's pure extract. The herb Brahmi is used to balance the Pitta and Kapha doshas in the body. It relieves symptoms such as stress, headaches, anxiety, and brain difficulties, as well as keeping the mind peaceful and relaxed. Bacosides, an active molecule found in it, aids in the regeneration of brain cells. Taking Brahmi pills for longer periods of time is not harmful. It is beneficial to the neurological system as a whole. This herb is also beneficial to the lymphatic, nervous, blood, urinary, circulatory, and digestive systems. It's utilized to help the body's general strength and energy levels.

Dosage: 1-2 capsules twice daily ¹³

1.2.3Kapakacchu

Fig. 16: Kapakacchu¹⁸

Mucuna pruriens (Kapakacchu) is a powerful nervine tonic. It's a natural L-Dopa supplement that boosts the body's Dopamine levels. Dopamine levels must be kept at a healthy level for smooth sensory function and mental agility. It soothes the senses and helps to alleviate anxiety and stress. Nerve conduction is thought to be improved by increased dopamine levels. It controls mobility abnormalities that are common in neurodegenerative illnesses in a natural way. The medication has a strong vata-pitta hara effect. Rigidity, dryness, roughness, loss of function, and a tingling sensation in the body are all signs of an overactive vata. The unsteady vata is grounded and stabilized by Kapikacchu. It calms the nervous system and gives you more energy.⁵

1.2.4Gotu kola:

Gotu kola (Centella asiatica), also known as Indian or Asiatic pennywort and endemic to Asian wetlands, is regarded the most rejuvenative herb in Ayurvedic medicine and is used as both a medication and a vegetable.

Fig. 17: Gotu kola¹⁹

It gets its name from Sri Lanka, where it grows well in the hot, humid climate and is popular as a green salad vegetable. Essential oils, tannins, plant sterois, amino acids, flavonoids, oligosaccharides, and triterpenoid saponins, such as asiaticoside, madecassoside, and madasiatic acid, can all be found in Gotu kola. It's filled of vitamins and minerals. Gotu kola promotes cognition and memory while supporting proper neurotransmitter activity. It also improves mental performance and protects the brain from degenerative diseases. It enhances brain circulation, protecting it from oxidative damage and lowering the likelihood of developing degenerative brain diseases. Gotu kola boosts GABA levels in the central nervous system, which has a soothing effect by lowering anxiety. It also helps the body's ability to adapt to temporary stress by lowering cortisol levels and assisting with stress management. Gotu kola increases collagen formation and synthesis by stimulating circulation. It has a beneficial effect on the walls of blood vessels.⁵

1.2.4.1 Gotukola Capsules

Fig. 18: Gotu kola Capsules²⁰

Gotukola Capsules are made from a pure extract of the Centella asiatica herb. This herb promotes healthy blood circulation, a healthy brain, and the equilibrium of the body's three doshas: Vata, Pitta, and Kapha. The herb gotukola aids in the relaxation of the central nervous system and the slowing of the ageing process.

Dosage: Two capsules twice daily after meals ¹³

1.2.5Shilajit

Fig. 19: Shilajit²¹

Shilajit (Asphaltum) is a powerful brain detoxifier that has been demonstrated to aid in the assimilation of nutrients, minerals, and oxygen into the brain, enhancing the brain's ability to remove harmful toxins. Shilajit has also been discovered to suppress the enzyme that breaks down acetylcholine, a neurotransmitter. Stress and ageing can cause acetylcholine levels to drop, which is bad for memory, concentration, and overall brain function. Shilajit serves to maintain healthy acetylcholine levels in the brain, protecting it from degeneration. Shilajit improves connective tissue adaptations and maintains muscle strength.⁵

1.2.5.1 Shilajit Capsules

Fig. 20: Shilajit Capsules²²

The standardized herbal extract of the Shilajit herb is used to make these capsules (Asphaltum). For its excellent restorative, adaptogen, and rejuvenating effects, this herb is known as 'Rasayana.' It aids in the regeneration of brain cells, the reduction of physical and mental stress, and the enhancement of metabolism and stamina. It also aids in the improvement of immune system function and the removal of pollutants. ²⁴

1.2.6 VrihatVatchintamani Ras:

Aloe Vera juice extract, Swarna Bhasma, LohaBhasma, RajataBhasma, PravalaBhasma, AbhrakaBhasma, Mukta Bhasma, and SutaBhasma are among the natural ingredients used to make VrihatVatchintamani Ras.²⁴

Fig. 21: VrihatVatchintamani Ras²³

Benefits:

It maintains the regular functioning of the brain and neurological system and promotes mental wellness. It also aids in the treatment of pain, tumour control, and the balancing of the Pitta and Vata doshas in the body.²⁴

2. CONCLUSION:

Despite tremendous advances in our understanding of MND pathophysiology in recent years, the clinical benefits to patients have been negligible. The problem of figuring out what causes this lethal sickness is yet unresolved. The available data on PA as a risk factor for MND is insufficient to draw clear conclusions because it is scarce, inconsistent, and of poor quality. Because of the kind and low prevalence of MND, many concerns have developed. The previously found positive association between MND and PA, on the other hand, has yet to be proven beyond a reasonable doubt, and it could reflect an abnormal physiological response to an external stimulus in genetically susceptible individuals. By this review article, we conclude that the Ayurveda has precious role in the treatment and managements of MND. Panchakarma treatment is also used in the MND treatments. Herbs like Ashwagandha, Brahmi, Gotu kola, etc. and their formulations like capsules, churna are used in the treatment of MND.

3. REFERENCES:

1. Swash M. Amyotrophic lateral sclerosis: current understanding. Jouranl of Neuroscience Nursing. 2001; 33(5):245–53.doi: 10.1097/01376517-200110000-00005.

2. Talbot K. Motor neuron disease. Postgrad Med J 2002; 78:513-519.doi: 10.1136/pmj.78.923.513.

3. D. Neary, J.S. Snowden, D.M.A. Mann. Cognitive change in motor neuron disease/amyotrophic lateral sclerosis (MND/ALS). Journal of the Neurological Sciences. 2000; 180(1-2):15-20. doi: 10.1016/s0022-510x(00)00425-1.

4. Motor Neurone Disease (MND / ALS), Charaka the Speciality Ayurveda Institute of Panchakarma & Research. https://charaka.org/motor-neurone-disease-mnd-als/

5. Motor Neuron Disease MND Ayurvedic Herbal Remedies Lifeline Ayurvedic Herbal Clinic. https://www.lifelineherbal.com.au/treatments/motor-neuron-disease-mnd-ayurvedic-herbal-remedies.html

6. Motor Neuron Disease, Vaidya Pradeep’s SukhayuAvurveda 2022. https://www.sukhayuayurved.com/neurology/ayurveda-treatment-for-neurological-diseases/motor-neurone-disease/#Ayurveda_about_Motor_Neuron_Disease

7. Deep AvurvedaFor Healthy Living, 2018-2021. https://deepayurveda.com.au/shop/advance-panchkarma-training-course/

8. Ayurveda Resort Mandira oil Massages: Stress-Relief with ayurvedic Abhyanga https://www.mandira-ayurveda.at/en/oil-massages/

9. AyurVAIDMultispeciality Hospitals, 2022. https://ayurvaid.com/shirodhara

10. Mangisteen Ayurveda and Wellness Resort, 2002-2022. https://mangosteen-ayurveda.com/product/nasyam/

11. Pizhichil Treatment, IndiaMART, 1996-2022. https://www.indiamart.com/proddetail/pizhichil-treatment-19009333062.html

12. Shastika Pinda Sveda Therapy, Dr. Monga Medi Clinic, 2019. https://panchkarmatherapies.com/shastika-pinda-sveda-therapy.html

13. Dr. Vikram Chauhan, Ayurvedic and Herbal Remedies, Ayurvedic Treatment for Motor Neuron Disease (MND) with Herbal Remedies, 6 January, 2020. https://www.alwaysayurveda.net/2020/01/motor-neuron-disease-herbal-remedies.html

14. Tanya Malik, Ashwagandha For Skin: Benefits And Ways To Use It, 19 Aug 2021. https://www.herzindagi.com/beauty/ashwagandha-benefits-for-skin-how-to-use-it-article-182335

15. Dabur Ashwagandha Capsules Immunity Booster-20 Capsules, 1996-2022. https://www.amazon.in/DABUR-Ashwagandha-Capsules-Immunity-Booster/dp/B087X9XS1K

16. Written by Ryan Raman, Medically reviewed by Atli Arnarson, 7 Emerging Benefits of Bacopa monnieri (Brahmi), October 31, 2019. https://www.healthline.com/nutrition/bacopa-monnieri-benefits

17. Ayurvedic Life Brahmi Capsules 300mg Capsules, Natural, 120 count, 1996-2022. https://www.amazon.in/Ayurvedic-Life-Brahmi-Capsules-300mg/dp/B0753PSVZD

18. Kapikacchu- Mucuna Pruriens Benefits, Dose, Side effects- Ayurveda, 2022. https://www.easyayurveda.com/2012/12/26/kapikacchu-mucuna-pruriens-benefits-dose-side-effects-ayurveda/

19. Ogunka-Nnoka Charity Uchechi, Igwe Felix Uchenna, OvuworieFegor Precious, Eme Lilian Olu, NiabariBariburame. Potential of Centella asiatica leaf extract in the management of paracetamol-induced jaundice in albino rats. World Journal of Advanced Research and Reviews. 2020; 06(01): 244–254.doi: 10.30574/wjarr.2020.6.1.0122.

20. Gotu kola, Himalaya Wellness Latvia SIA, 2021. https://himalayawellness.eu/products/gotu-kola

21. Vijeta Rana, Shilajit Benefits for Men, Auric, 2022. https://www.theauric.com/blogs/news/shilajit-benefits-for-men

22. Dabur Shilajit Gold Capsule 20's, Netmeds.com, 2022. https://www.netmeds.com/non-prescriptions/shilajit-gold-20-s

23. Dabur VrihatVatchintamani Ras With Gold & Pearl, 30 Tablets, big basket, 2021. https://www.bigbasket.com/pd/40190633/dabur-vrihat-vatchintamani-ras-with-gold-pearl-30-tablets/

Received on 04.07.2022 Modified on 19.11.2022

Asian J. Res. Pharm. Sci. 2023; 13(2):94-100.

DOI: 10.52711/2231-5659.2023.00018