Network Meta-Analysis Of Different Interventions In The Treatment Of Spasm Caused By Multiple Sclerosis

Objective:To evaluate the curative effect and security of different interventions in the treatment of spasm caused by multiple sclerosis.Meanwhile, rank the curative effect and adverse effect of different interventions in order to select the best treatment, which aims at providing evidence-based guidancefor clinical medication.Methods:Such databases as Pub Med、Cochrane Library、Embase and Ovid were searched for the RCTs about different interventions in the treatment of spasm caused by multiple sclerosis.The language was limited to English.Two professional reviewers independently collected the information of the included literature,evaluate the literature quality and conducted the network meta-analysis using stata13.0 software.Results:16 RCTs involving 2685 patients were included.Network meta-analysis showed that:Compared with the placebo group,Cannabis-based medication(CBM)[OR=0.68,95%CI(0.52,0.88)], transcutaneous electrical nerve stimulation(TENS)[OR = 3.03, 95%CI(1.01,9.07)],baclofen[OR=0.52,95%CI(0.29,0.92)] and tizanidine[OR=1.70, 95%CI(1.10,2.63)] could significantly improve the spasm of patients with multiple sclerosis,while there were no significant difffernce between any other pairwise comparison of these different interventions.Conclusion:TENS had clear curative effect on the treatment of spasm in patients with multiple sclerosis,and in principle,should be taken into consideration firstly.As for drug therapy,baclofen should be considered firstly and tizanidine could be the second choice.However,due to the diversified adverse effects of CBM, the application of CBM clinically should be cautious.Future research needs to lanch large, multicenter and high-quality clinical randomized controlled trials, in order to make clear the optimal treatment options of spasm caused by multiple sclerosis, which aims at improving the quality of patients life.