A Meta-analysis Of Randomized Controlled Trials On Relieving Spasm By Subduing Liver-wind Treatment In Children With Epilepsy

Objective: To conduct Meta analysis for the clinical effect of treating Epilepsy(EP)using relieving spasm by subduing liver-wind in Randomized Controlled Trial(RCT)guided by evidence-based medicine.Methods: the search strategy is made, and the following databases are searched by two personnel independently: Chinese Higher Education Periodical Literature Database, Chinese Biological Medicine Digest System, Wan fang Medical Database, Chinese Master and Doctoral Academic Dissertation Full-text Database, VIP, Cochrane Library, Pub Med Database and EMbase. RCT about treating EP using relieving spasm by subduing liver-wind is collected. The deadline of literature publication is October 31, 2015. The literature is screened by two personnel independently, and the relevant literature information is extracted. The qualitative evaluation is conducted for the literature quality using the Cochrane bias risk assessment tool. Review Manager5.2 software provided by Cochrane Collaboration is used for statistic analysis. The heterogeneity test is conduced for the literature included, and the effect model is chosen according to heterogeneity test result.Through the forest map, the clinical effect of treating EP using relieving spasm by subduing liver-wind and conventional western medicine therapy is compared; change effect model to explore the stability of the results through the sensitivity analysis. The publication bias is presented by the funnel plot.Results: A total of 12 literatures were included after searching and screening. There were a total of 1434 cases of EP, including 831 cases in treatment group, and 603 cases in the control group. Meta analysis showed.1. compared to the conventional western medicine, the relieving spasm by subduing liver-wind could enhance the total clinical efficacy rate of EP(RR=1.27, 95%CI[1.19, 1.34], P<0.00001); improve the EEG of EP children patient(RR=1.28, 95%CI [1.08, 1.51], P=0.005); reduce the EEG focal discharge frequency(RR=1.32, 95%CI [1.01, 1.72], P=0.04) and focal discharge area(RR=1.58, 95%CI [1.13,2.21], P=0.008); shorten the onset time of EP(RR=1.20, 95%CI [1.06, 1.37], P=0.005);reduce the seizure frequency(OR=3.69, 95%CI [1.53, 8.92], P=0.004). 2.the subgroup analysis showed: the total efficacy rate of relieving spasm by subduing liver-wind drug alone,relieving spasm by subduing liver-wind drug + anti-epileptic drug, relieving spasm by subduing liver-wind drug + external therapy treatment group was higher than that of anti-epileptic western medicine control group. RR values were 1.26, 1.28 and 1.26. there were no significant differences in the total clinical efficacy rate of the three types ofinterventions.3.there was no significant difference between the relieving spasm by subduing liver-wind and anti-epileptic western medicine in TCM curative effect(P=0.23) and adverse reaction(P=0.25).Conclusion: The clinical effect of treating EP using relieving spasm by subduing liver-wind is superior to that of the conventional western medicine, but only a little number of literature and cases are included and there is little literature about the adverse reaction,safety and follow-up situation, so the safety and long-term effect of relieving spasm by subduing liver-wind remain unknown. Moreover, many bias factors influence the reliability of the result. The research evidence is insufficient to recommend the relieving spasm by subduing liver-wind as the clinical routine method. The advantage of its clinical effect is worth further study, and more high-quality, multi-center, large-sample random and double-blind control tests are needed to verify it.