E-ISSN:2456-3110

Review Article

Motor Neuron Disease

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 7 JULY
Publisherwww.maharshicharaka.in

Exploring Panchkarma Treatment Modalities for Managing Motor Neuron Disease and ALS - A Review

Narine AA1*, Mangal G2
DOI:10.21760/jaims.10.7.23

1* Avvinish Annant Narine, PhD Scholar, Department of Panchkarma, National Institute of Ayurveda (Deemed University), Jaipur, Rajasthan, India.

2 Gopesh Mangal, Dean PG Studies, Professor and HOD, Department of Panchkarma, National Institute of Ayurveda (Deemed University), Jaipur, Rajasthan, India.

Introduction: Motor Neuron Disease (MND), particularly Amyotrophic Lateral Sclerosis (ALS), represents a complex and progressive neurodegenerative condition characterized by the degeneration of motor neurons in the nervous system. These neurons, crucial for voluntary muscle activity, deteriorate progressively, leading to muscle weakness, atrophy and eventual paralysis. ALS, the most common form of MND, affects both upper and lower motor neurons, resulting in a combination of symptoms such as muscle twitching (fasciculations), spasticity and significant weakness. MND incidence is approximately 2 / 100,000 people annually, with ALS typically presenting in most cases.

Methods: The pathophysiology of ALS involves a cascade of cellular and molecular events including the accumulation of neurofilaments, the formation of protein aggregates and mitochondrial dysfunction, all contributing to the death of motor neurons. Despite extensive research, the aetiology remains largely unclear, though genetic and environmental factors are considered contributors.

Result and Conclusion: In contrast, Ayurveda views MND/ALS through the lens of Vatavyadhi, a disorder primarily involving Vata Dosha. It correlates MND/ALS with Dhatukshayajanya Sarvangavata, implicating the depletion of Dhatu and an imbalance in the Dosha. By addressing imbalances in the Dosha, Dhatu and Srotas, Ayurveda offers a holistic framework that may complement conventional treatments, improve patient outcomes, and enhance quality of life. Future research is needed to validate the efficacy of these approaches and establish integrative care models that merge traditional and modern medical practices.

Keywords: Ayurveda, Amyotrophic Lateral Sclerosis (ALS), Motor Neuron Disease (MND), Neurodegenerative Disorders, Panchkarma, Vatavyadhi

Corresponding Author How to Cite this Article To Browse
Avvinish Annant Narine, PhD Scholar, Department of Panchkarma, National Institute of Ayurveda (Deemed University), Jaipur, Rajasthan, India.
Email: 		Narine AA, Mangal G, Exploring Panchkarma Treatment Modalities for Managing Motor Neuron Disease and ALS - A Review. J Ayu Int Med Sci. 2025;10(7):154-161.
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https://jaims.in/jaims/article/view/4608/

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2025-05-27 2025-05-31 2025-06-07 2025-06-16 2025-06-24
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© 2025 by Narine AA, Mangal G and Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Avvinish AN et al. Managing Motor Neuron Disease and ALS - A Review

Introduction

Motor neuron disease (MND) encompass a group of degenerative disorders that selectively affect upper motor neurons (UMN), lower motor neurons (LMN) or both. These conditions are progressive & ultimately result in fatal outcomes. Symptoms can vary in severity & typically include muscle weakness & atrophy, fasciculations, emotional lability & respiratory muscle weakness.[1] The annual incidence of MNDs is approximately 2 per 100,000 individuals, with a prevalence of about 7 per 100,000.[2] Out of every ten people affected by MND, six are men & four are women.[3] Amyotrophic lateral sclerosis (ALS) is most common type of MND. It mostly affects anterior horn cells, which cause LMN signs & corticospinal tract, which causes UMN signs. Other MND may involve specific subsets of motor neurons. In a healthy system, signals from UMN in brain are transmitted to LMN in brainstem & spinal cord, which then relay commands to specific muscles. UMN direct LMN to produce movements such as walking or chewing, while LMNs control movement in arms, legs, chest, face, throat & tongue. The spinal motor neurons are often referred to as anterior horn cells, whereas UMN are known as corticospinal neurons. Disruptions in signals between LMN & muscles lead to improper muscle function, resulting in gradual weakening, atrophy, & uncontrollable twitching (fasciculations). Conversely, disruptions between UMN & LMN can lead to increased stiffness in limb muscles (spasticity), slow and effortful movements and heightened tendon reflexes, such as knee & ankle jerks. Over time, this can result in a significant loss of voluntary movement control.[4]

MND is also widely recognized as Lou Gehrig’s Disease, named after legendary baseball player who was diagnosed in 1939. Disease has also affected other notable individuals, such as Stephen Hawking, renowned physicist & Astro, drummer of British band UB40. These public figures brought increased visibility to condition, though it remains incurable & continues to challenge both patients & healthcare systems.[5] In Ayurvedic medicine, MND are often viewed as Vata-predominant diseases. Vata is considered critical factor for physiological maint-enance of body.[6] Many signs & symptoms of MND, including fasciculations, cramps, wasting, weakness & spasticity, align with classical manifestations of Vata derangement as described in Ayurveda.[7]

The Samprapti (~pathogenesis) of MND involves all three Doshas, emphasizing complex interplay of bodily energies in progression of this condition.

Types of MND

Motor neuron diseases (MND) encompass a diverse array of neurodegenerative disorders characterized by progressive degeneration of motor neurons, which are critical for controlling voluntary muscle movements. Among these,Amyotrophic Lateral Sclerosis (ALS)is most prevalent and recognized form (see Fig. 1: a mind map summarizing MND classification). ALS is marked by degeneration of both upper motor neurons (UMN) in brain and lower motor neurons (LMN) in spinal cord, as previously mentioned. This condition typically manifests with symptoms such as muscle weakness, atrophy, fasciculations (muscle twitches), spasticity, dysarthria (speech difficulties), dysphagia (swallowing difficulties) and ultimately respiratory muscle weakness, which can lead to respiratory failure.[8] ALS can present in various forms, withsporadic ALSbeing most common, whilefamilial ALS, which accounts for 5-10% of cases, has a genetic basis linked to mutations in specific genes such as SOD1, C9orf72, and TARDBP.[9]

Another type of MND isProgressive Muscular Atrophy (PMA), which primarily affects lower motor neurons. PMA leads to symptoms such as progressive weakness & muscle atrophy without spasticity typically seen in ALS. Patients may experience muscle wasting & fasciculations, but cognitive function generally remains intact.[10] Conversely,Primary Lateral Sclerosis (PLS)is characterized by degeneration of upper motor neurons, resulting in spasticity & weakness, particularly in legs. Symptoms may include gradual onset of muscle stiffness, hyperreflexia (increased reflexes), & difficulties with balance, but unlike ALS, PLS does not usually involve lower motor neuron signs.[11] Bulbar Onset ALSis specific variant of ALS in which initial symptoms arise from degeneration of motor neurons in brainstem, affecting speech & swallowing muscles. Patients may experience dysarthria, dysphagia & emotional lability.[12] Pseudobulbar Palsyshares some similarities with bulbar onset ALS, characterized by weakness of muscles involved in speaking & swallowing due to bilateral upper motor neuron lesions in brainstem. It can occur in various neurological conditions, including ALS, multiple sclerosis and stroke.[13]


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jaims_4608_01.JPG
Figure 1: MND Classification

Spinal Muscular Atrophy (SMA)is another significant MND, primarily affecting lower motor neurons. It is categorized into several types based on age of onset and severity.SMA Type I(Werdnig-Hoffmann disease) presents at or shortly after birth, resulting in severe weakness and a limited lifespan.SMA Type IIappears between six months and 18 months of age, with children able to sit but not walk independently.SMA Type IIItypically presents after 18 months, allowing for independent walking, although muscle weakness may develop over time.SMA Type IV, or adult-onset SMA, generally emerges in the late twenties or thirties, leading to mild to moderate muscle weakness.[14] Additionally, Frontotemporal Dementia with Motor Neuron Diseaserepresents a variant that combines cognitive and motor dysfunction. Patients with this condition exhibit symptoms of frontotemporal dementia, including personality changes, language difficulties, and executive dysfunction, along with signs of motor neuron disease, often overlapping with familial ALS.[15]

Lastly, while the aforementioned types are the most recognized, there are other less common forms of MNDs, such asMultifocal Motor Neuropathy (MMN), which presents as asymmetrical muscle weakness and atrophy due to a demyelinating process affecting motor nerves[16] andHereditary Spastic Paraplegia (HSP), a genetic disorder primarily affecting upper motor neurons, leading to progressive weakness and stiffness in the lower limbs. In general, MNDs represent a complex spectrum of disorders, each with distinct clinical features and progression patterns. Accurate diagnosis is crucial, often requiring a multidisciplinary approach that includes clinical evaluation, electromyography, imaging studies, and genetic testing. Understanding the specific type of MND is essential for developing effective management strategies and providing comprehensive support for patients and their families (see Fig. 2).

Diagnosis of Motor Neuron Disease

Motor neuron diseases (MND) present a diagnostic challenge due to the lack of specific tests for most forms, except for certain genetic tests available for conditions like Spinal Muscular Atrophy (SMA).[17] Symptoms of MND can vary significantly among individuals and may initially resemble those of other neurological disorders, complicating the diagnostic process.[18] The diagnostic approach in modern science typically begins with a comprehensive physical examination, followed by an extensive neurological assessment. This evaluation assesses motor and sensory skills, nerve function, coordination, balance, hearing, speech, vision, mental status and mood changes.[19] A series of tests may be employed to exclude other diseases or assess the extent of muscle involvement. These tests may include: Electromyography (EMG) to evaluate electrical activity of muscles & is crucial for diagnosing lower motor neuron disorders.[20]

Nerve Conduction Velocity (NCV) Studies, this is often performed alongside EMG, NCV studies assess speed and size of electrical impulses in nerves. Blood and urine tests may be conducted to rule out other conditions. Magnetic Resonance Imaging (MRI) scans are utilized to visualize brain and spinal cord structures, helping to rule out tumours, infections and other abnormalities affecting central nervous system.[21] Muscle or Nerve Biopsy may be performed to confirm nerve or muscle disease. Transcranial Magnetic Stimulation (TMS) assesses upper motor neuron function by generating magnetic pulses that evoke motor responses in specific body areas. In Ayurveda, diagnosis of motor neuron diseases (MNDs) centers on comprehensively understanding imbalances within body’s Dosha (~bioenergies), Dhatu (~tissues) and Srotas (~channels). MNDs are primarily associated with vitiation of Vata Dosha, which governs movement and neurological functions. The diagnostic process begins with a thorough clinical assessment of symptoms.


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Ayurvedic practitioners evaluate various manifestations such as Aksha Glani (~muscle weakness), Mamsashosha (~atrophy), Sphurana (~fasciculations), Stabdhata (~stiffness), Annapravesha Kricchrata (~dysphagia) & Vak Sanga (~dysarthria). The predominance of these symptoms throughout progression of disease indicates an imbalance in Vata Dosha. The next step involves assessing overall Dosha balance, focusing on interplay between Vata, Pitta, & Kapha, with particular attention to subtypes of Vata, including Vyanavata, Pranavata & Udanavata. The dominance of Vata points to a potential diagnosis of Vataja Nanatmaja Vikara, underscoring necessity of addressing this imbalance in treatment as per Ayurvedic Samhita.[22]

Understanding pathogenesis, or Samprapti, of MNDs is crucial, as Ayurveda highlights gradual Dhatukshaya (~depletion of body elements) correlating with progression of symptoms in patients. Analyzing evolution of these symptoms from their initial manifestations to full disease expression aids in discerning underlying causes. Additionally, evaluating digestion & metabolism plays a vital role in Ayurvedic diagnosis; assessing Agni (~digestive fire) & identifying presence of Ama (~toxins) are critical. Compromised digestive fire can lead to toxin accumulation, further exacerbating Vata imbalances.[23] Health of Srotas is another significant aspect of diagnosis, particul-arly Rasavaha Srotas (~plasma-related channels), Raktavaha Srotas (~blood-related channels),


and Mamsavaha Srotas (~muscle-related channels). Impairments in these channels may contribute to characteristic symptoms observed in MNDs. Finally, assessing individual’s unique constitution or Prakriti, is essential for identifying susceptibility to MNDs and tailoring treatment strategies aimed at restoring balance and health. This comprehensive diagnostic framework in Ayurveda provides holistic perspective on understanding and managing motor neuron diseases.

While MND is primarily interpreted in Ayurveda as Vata-predominant neurodegenerative condition, some classical and contemporary Ayurvedic scholars propose an alternative pathophysiological model involving Kapha Avarana of Vata—that is, obstruction of Vata by Kapha. This approach becomes relevant particularly in early-stage presentations or in subtypes of MND where symptoms such as heaviness, slowness of movement, rigidity and mucous accumulation are more dominant than wasting or fasciculations. In such cases, directly pacifying Vata without first addressing Kapha may exacerbate symptoms. Accordingly, Kapha-reducing therapies such as Udvartana (~dry powder massage), Langhana (~lightening therapies), and dietary modifications are initiated to clear obstruction. Once Kapha is reduced, Vata-pacifying Panchkarma therapies like Basti and Abhyanga can be more effectively employed. This dual model reflects individualized nature of Ayurvedic diagnostics, where clinical presentation guides Doshic prioritization.


Panchkarma Therapies for Motor Neuron Diseases

jaims_4608_02.JPG
Figure 2: Panchkarma for MND


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Panchkarma, the cornerstone of Ayurvedic medicine, encompasses a series of therapeutic procedures aimed at detoxification and rejuvenation, primarily focusing on restoring balance to the Doshas (~bioenergies) and eliminating accumulated Ama (~toxins) from the body.

In the context of Motor Neuron Diseases (MNDs), including Amyotrophic Lateral Sclerosis (ALS), Panchkarma therapies can provide symptomatic relief and improve the quality of life by specifically addressing the predominant Vata Dosha, which is often implicated in the pathophysiology of these disorders (see Fig. 2: a mind map summarizing the key Panchkarma therapies for MND). Listed here is a detailed exploration of key Panchkarma therapies relevant to MND management.

Basti (~Medicated Enema)

Basti is regarded as one of the most effective therapies for pacifying Vata Dosha. It involves the administration of herbal decoctions and oils via the rectum, providing a direct method for colon detoxification. Basti promotes the elimination of toxins, hydrates bodily tissues and restores balance to the nervous system. The administration of medicated oils helps in nourishing the nervous system, facilitating better communication between the brain and the body.[24]

This therapy is particularly beneficial for symptoms such as muscle weakness, spasms and atrophy, which are characteristic of MNDs. It also helps alleviate constipation, a common concern in MND patients, thereby enhancing nutrient absorption and overall vitality.

Nasya (~Nasal Administration)

Nasya involves the administration of medicated oils or powders through the nasal passages, directly impacting the head and brain. This therapy is believed to clear the nasal passages, enhance cognitive function and stimulate the nervous system. By improving the olfactory sense and brain function, Nasya can alleviate neurological symptoms associated with MNDs.[25]

Nasya is particularly useful for individuals experiencing cognitive decline, mood disturbances and other neurological symptoms associated with MNDs. It can also help alleviate headaches and enhance mental clarity.

Abhyanga & Swedana (~Therapeutic Oil Massage & ~Sudation)

Abhyanga, involves the application of warm, medicated herbal oils to the entire body using specific massage techniques. This therapy mitigates Vata imbalance by calming the nervous system and enhancing circulation. The warmth and viscosity of the oils allow them to penetrate deeply into the dhatus (tissues), promoting relaxation, muscle nourishment and improved flexibility.[26] Abhyanga is particularly effective for alleviating muscle stiffness, weakness and pain—key symptoms in Motor Neuron Disease (MND). It also supports lymphatic drainage and helps reduce stress and anxiety, which are commonly experienced by MND patients. Often performed in conjunction with Swedana (herbal steam therapy), this combination enhances the therapeutic effects. Swedana involves the application of gentle heat or steam to the body, which opens up Srotas (~channels), facilitates detoxification and softens tissues to absorb the medicinal properties of the oils used during Abhyanga. Together, Abhyanga and Swedana help reduce neuromuscular tension, support circulatory health and ease muscle rigidity, making them a foundational duo in Ayurvedic management of neurodegenerative disorders like MND.

Shirodhara

Shirodhara is a unique therapy that involves the steady flow of warm, herbalized oils poured over the forehead. This therapy calms the mind and balances the nervous system by stimulating the Ajna chakra (the third eye). The soothing nature of Shirodhara can help reduce anxiety, improve sleep quality and enhance overall mental well-being.[27] Shirodhara is particularly beneficial for managing stress, emotional instability and sleep disturbances, commonly experienced by individuals with MNDs.

Pizhichil

Pizhichil combines elements of both massage and oil therapy, involving drenching the body in warm streams of herbal oil. This therapy enhances blood circulation, relieves muscle and joint pain and promotes deep relaxation.[28] The warmth of the oil penetrates the tissues, alleviating stiffness and discomfort. Pizhichil is suitable for those experiencing chronic pain and muscle stiffness associated with MNDs, aiding in overall muscle relaxation and rejuvenation.


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Shashtika Shali Pinda Swedana

Shashtika Shali Pinda Swedana employs heated medicinal rice puddings applied to the body. The heat from the rice poultices alleviates muscle stiffness and promotes relaxation. The medicinal properties of the rice nourish the tissues and enhance circulation.[29] This therapy is particularly effective for relieving muscle tension and discomfort, enhancing mobility and improving overall well-being in patients with MNDs.

Discussion

Motor neuron diseases (MNDs) represent a complex and debilitating group of neurological disorders characterized by the progressive degeneration of motor neurons, leading to significant functional impairment and reduced quality of life.

The multifaceted nature of MNDs, particularly amyotrophic lateral sclerosis (ALS), presents significant challenges in both diagnosis and management. Traditional approaches, primarily within the realm of Western medicine, often focus on symptomatic management and supportive care due to the lack of definitive diagnostic tests and effective treatments. Consequently, the need for holistic and integrative treatment modalities becomes evident, particularly from the Ayurvedic perspective.

Ayurveda offers a comprehensive framework for understanding the pathogenesis of MNDs through its unique concepts of Dosha, Dhatu, and Srotas. By identifying the predominant vitiation of Vata Dosha and analysing the progression of symptoms, Ayurvedic practitioners can tailor treatment strategies to address the underlying imbalances.

The emphasis on detoxification through Panchkarma therapies aligns with the need for a holistic approach that targets not just the symptoms but also the root causes of the disease. The incorporation of Ayurvedic principles in diagnosing and treating MNDs underscores the importance of individual Prakriti (~constitution), Agni (~digestive health) and the balance of bodily Srotas (~channels). This perspective encourages a personalized treatment plan that encompasses dietary modifications, herbal formulations and lifestyle changes, aiming to restore balance and improve overall health outcomes.

Additionally, the emphasis on understanding the pathogenesis of MNDs through the lens of Dhatukshaya highlights the importance of early intervention in preventing the progression of the disease.

Despite the promising insights provided by Ayurveda, it is essential to acknowledge the limitations and challenges inherent in integrating traditional practices with contemporary medical approaches. More rigorous clinical studies are needed to validate the efficacy of Ayurvedic treatments in managing MNDs and to establish standardized protocols that can be implemented alongside conventional therapies. Furthermore, interdisciplinary collaboration between Ayurvedic practitioners and neurologists could facilitate a more comprehensive understanding of MNDs and enhance patient care.

Conclusion

The integration of Ayurvedic principles into the diagnosis and management of motor neuron diseases (MNDs) presents a promising approach for enhancing patient outcomes and improving quality of life. By focusing on the underlying imbalances in the Dosha, Dhatu, and Srotas, Ayurveda offers a holistic framework that complements conventional medical strategies. The application of Panchkarma therapies, along with lifestyle modifications and dietary adjustments, has the potential to alleviate symptoms and slow the progression of MNDs, particularly in cases of Amyotrophic Lateral Sclerosis (ALS).

Moreover, incorporating Panchkarma therapies into the management of MNDs offers a holistic strategy that addresses both the physical and emotional dimensions of the condition. By effectively balancing Vata Dosha and eliminating toxins, these therapies can significantly improve the quality of life for individuals affected by MNDs. It is essential for patients to consult qualified Ayurvedic practitioners who can tailor these therapies to meet their specific health conditions and needs.

Future research should aim to elucidate the mechanisms that underpin the efficacy of Ayurvedic treatments, conduct controlled clinical trials, and explore the potential of integrative care models that synergize the strengths of both Ayurvedic and conventional medicine.


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This collaborative approach could lead to more effective management strategies for patients with MNDs, fostering a deeper understanding of these complex disorders and paving the way for innovative treatment paradigms.

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