Observation On Clinical Efficacy Of Yishenduluo Decoction In Treating Relapse - Relaxation Type Multiple Sclerosis

Multiple sclerosis (MS) is a chronic autoimmune disease, mainly involving the central nervous system (CNS) of white matter. Inflammatory demyelination and axonal degeneration are the main pathological manifestations of MS. Clinically, it has high morbidity and it is easy to relapse, belonging to the knotty disease of neurology. Relapsing remitting MS(RRMS) is the most common style, accounting for 80-85% of all the MS patients in clinical. With the development of Magnetic Resonance Imaging (MRI) technology and its popularization in developing countries currently, the diagnosed rate of MS is rising, which also leads to the corresponding increased incidence in China. But its pathogenesis is not fully clear, nor the effective drugs. Nowadays western medicine treatment is still widely used in the world, such as the hormone and interferon, which not only have great side effects, but also expensive, and bring great psychological and economic burdens to individuals, families and society in long-term use of some western medicines. Some studies of Chinese medicine treatment on MS are developing constantly, and show a certain advantage. According to the effect of traditional Chinese and western medicine on etiology, pathogenesis and treatment of MS, and the literature review reference, we used Yishen Daluo Decoction as the basic therapeutic prescription, which is based on the function and feature of the famous prescription- Dihuang YinZi to treat RRMS patients who are in remission and explore the clinical curative effect on MS.Objective:With the RRMS which is the most common clinical type in the MS as the research object, choosing Yishen Daluo Decoction as the basic therapeutic prescription, by observing the change of clinical performance, rating scale and DTI to explore the clinical curative effect on RRMS in remission.Method:This study selected RRMS patients in Department of Neurology, Dongzhimen Hospital affiliated to Beijing University of Chinese Medicine from January 2012 to December 2014. All patients take the oral formula for 9 months, which is based on Yishen Daluo Decoction. To collect information(such as relapse, rating scale and so on) of the patients on the first day, the day after 3 months, the day after 6 months and the day after 9 months. We obtained the MRI data of some RRMS patients on the first day and the day after 9 months.SPSS 17.0 software was used in the study to analyze all the clinical data. MRI data for some patients were obtained and statistical analysis were calculated compared with healthy person and themselves after 9 months’ treatment. Through the change of the clinical and MRI index of patients in the different treatment stages to judge the clinical curative effect of Yishen Daluo Decoction on RRMS.Results:There are 18 RRMS patients in our study. We found that Yishen Daluo Decoction can decrease the number and the rate of recurrent (The recurrence rate is 2.33% before treatment, after is 0.10%. statistically significant).MRI data show that there is no new lesions in T2 image of all the patients. The lesions are found in white matter and gray matter widely, and FA value of the lesions express lower than normal control group correspondingly. According to the statistics, the lesions in our patients mainly distributed in white matter around lateral ventricle, frontal pillow parietal lobe, brain stem, basal ganglia, centrum semiovale, the optic nerve, thalami, cerebellum and the corpus callosum. Patients with intracranial lesions mainly show as ovoid, circular, patchy, punctate or long T1 long T2 signals, and around lateral ventricle lesions are characterized by lesions of long axis vertical and lateral ventricle demyelinating plaques. There are three lesions whose FA value shows significant difference (P<0.001, voxel>5) before treatment compared with 9 months treatment. FA value of Extra-Nuclear regions in Right cerebral hemisphere white matter was reduced, on the contrary, the temporal gyrus and parahippocampal gyrus have been increased.We found that Yishen Daluo Decoction can decrease the clinical EDSS score, EDSS score curative effect evaluation in the day after 3 months, the day after 6 months and the day after 9 months are 55.56%,66.67% and 66.67% respectively, and all the EDSS score are lower than the first day. Yishen Daluo Decoction can reduce the HAMD scores of RRMS patients (the day after 6 months P<0.05, and the day after 9 months P<0.01). Results show that PDQ scores have no statistics differences on the day after 3 months and 6 months, while other times show significant difference. Yishen Daluo Decoction can improve MSQOL-54 scale score. The results show that there are significant differences statistically in the comprehensive scores of physical and mental health on the day after 9 months. All patients did not appear adverse events in the entire process.There is a correlation between clinical rating scales and clinical scales with imaging. Positive correlation appears in HAMD scores and PDQ scores of RRMS patients. Physical health comprehensive score were negatively correlated with EDSS score, HAMD scores and PDQ score, which also existed in mental health comprehensive evaluation with HAMD scores and PDQ score. They all have significant differences statistically. The FA value of the lesions which exist significant difference before and after the 9 months’treatment in the brain are also correlated with clinical rating scale. There is a negative correlation between EDSS score and FA value of temporal gyrus and parahippocampal gyrus, MSQOL-54 score and FA value of the parahippocampal gyrus were positively correlated.Conclusion:Yishen Daluo Decoction can reduce the recurrence rate in every year, the rate of recurrence clinically and the neurologic deficits and disability score of RRMS patients. It also can improve the clinical symptoms and depression, alleviate the degree of cognitive dysfunction and increase the satisfaction of their quality of life. there is a certain correlation between EDSS score and PDQ. MSQOL-54. HAMD scores. DTI data show all the patients have lesions compared with healthy people and the lesions exist in white matter and gray matter widely, FA value of all the lesions is lower than normal. After the treatment of Yishen Daluo Decoction, FA value of some lesions was increased and the statistical differences is significant, which suggesting the myelin regeneration. FA value of the lesions which exist significant difference before and after the 9 months’ treatment in the brain are correlated with clinical rating scale (EDSS, HAMD. MSQOL-54).