Assesment Of Bulbar Pulsy In Amyotrophic Lateral Sclerosis Patients And Evaluation Of The Effect Of Jianpiyifei Decoction

ObjectiveComplete the assessment of ALS patients’swallowing and speeching function, to analyze the characteristics of ALS patients with pseudobulbar palsy. Discuss the curative effect of Jianpiyifei decoction, which is instructed in the theory of lung and spleen differentiation from Chinese traditional medicine, on ALS patient’s bulbar paralysis.MethodsUsing an open randomized controlled trial, patients meeting the strict diagnosis criteria inclusion criteria, were put in the trial. A participant will usually be assigned to the test group(Jianpiyifei decoction) or the control group(riluzole) at random. To understand the features of ALS patients with pseudobulbar palsy,the assessment of ALS patients’swallowing and speeching function was conducted, and related evaluation index was collected.According to the divided group, patients will get 3-month treatment of Jianpiyifei decoction or riluzole. Once a month during the treatment, they will get the evaluation of bulbar paralysis symptom. These evaluation index will be collected to form clinical efficacy evaluation system to explore whether there is the curative profit of Jianpiyifei decoction on ALS’s bulbar paralysis. Use SPSS19.0 statistical software package for data entry and verification and take methods of statistics such as descriptive analysis, single factor analysis of variance and rank and inspection, to analysze the feature of the ALS patients with bulbar paralysis, and discusses on the curative effect on ALS bulbar paralysis of Jianpiyifei decoction.Results1. Between ALS patients with dysarthria and without dysarthria, differences of Frenchay total score, reflection, breathing, lips, jaws, the soft palate and throat, tongue parts score are statistically significant.Between the bulbar-symton onset and non-bulbar-symton onset team, Frenchay scores, includiing all parts, the differences are not statistically significant.2. Difference ALS patients with swallowing disorder and without swallowing disorder group VGF score, oral cavity and pharynx score are statistically significant, there was no statistically significant difference of aspiration level. In the 15 cases without swallowing disorder, VFSS found that there are 4 cases (26.7%) patients company with pure mild pharyngeal swallowing disorder,9 patients (60%) merge stage oral cavity and pharynx deglutition obstacles. During patients with swallow obstacle performance, the bulbar-onset ALS, in comparison with the limb-onset ALS, there is no statistical significant difference in VGF stage, oral cavity, pharynx phase.3. In 4 weeks,8 weeks,12 weeks during the treatment, Kubota test score, Frenchay total score, compared between experimental group and control group, there is no statistical significant difference in speech-ALSSS, swallowing-ALSSS, ALSFRS-R, bulbar symptoms self-score. Conclusion1. The speech-ALSSS and Frenchay evaluation is applied in ALS patients dysarthria assessment, the score value of patients with dysarthria symptom decreased significantly, suggests that speaking function declined. Both assessments method are simple, economic, noninvasive, and helpful to assess dysarthria grading.2. The study shows that ALS dysphagia mainly focused on oral cavity and pharynx phase. Limb-onset ALS do not seem to have obvious advantages than bulbar-onset ALS. VGF score suggests ALS patients without swallowing disorder manifestation suffer some swallowing function decline of oral and/or oropharyngeal phase, underlying risk of aspiration.3. Jianpiyifei decoction treatment-experimental group, compared with control group, there is no obvious differences, in terms of swallowing and speeching function, as well as decline speed of patients’overall function. Jianpiyifei decoction plays a role in delaying the development of ALS.