Meta Analysis For Treatment Of Amyotrophic Lateral Sclerosis With Chinese Medicine Tonic Class Prescription

Objective: Amyotrophic Lateral Sclerosis(ALS)is a chronic progressive degenerative disease with a selective damage to the spinal anterior horn cell,brainstem motor neurons,cortical pyramidal cells and pyramidal tract.It is the most common type of Motor Neuron Disease(MND),and most diseases of MND will also develop into ALS,so it is very significant for study ALS.Mortality rate of ALS is very high,it's known as "the cancer of not cancer ".The average survival period of ALS is from 3 to 5 years.At present,for the treatment of ALS,there is still no special effects tools and methods.Riluzole is the only drug to delay the process of ALS and confirmed by American Food and Drug Administration(FDA),which extend the period from light or moderate damage to severe or end-stage time for the patients.But Riluzole does not significantly improve symptoms for amyotrophic lateral sclerosis(ALS),and is expensive.Most families can not afford such huge treatment price.This study is to evaluate the efficacy and safety for the treatment of ALS through using Chinese Medicine Tonic Class Prescription,which can help us find more effective measures for the treatment of ALS.Methods: Search the major electronic databases up to December 31,2014 in order to retrieve any potential Randomized Controlled Trials(RCTs)of the Chinese Medicine Tonic Class Prescription for ALS in any language and any country.Those major electronic databases include Pubmed,EMBASE,Cochrane Library,Chinese Biomedical,Chinese National Knowledge Infrastructure,Chinese Scientific & Technology Journal and Wanfang Data Knowledge Service Platform.One investigator conducts the data extraction and quality assessment three times for those retrieved documents,and selects Randomized Controlled Trial(RCTs)for this study.Meta Analysis is performed by using Review Manager Software(Revision 5.2).Results: 7 RCTs are selected with 411 participants,including 257 cases in treatment group and 154 cases in control group.The treatment group are treated with Chinese Medicine Tonic Class Prescription without limiting medicine dose.6 RCTs of the control group are treated with the Western medicine of Riluzole,twice take 50 mg orally per day,and 1 RCTs of the control group is treated with snake nerve poison.The main outcome indexes are clinical effective rate,Modified Norris Scale scores,ALS Functional Rating Scale(ALSFRS)scores,and the CMAP of EMG.The results are as follows,1)5 RCTs compared the clinical effective rate,the results show that the treatment group with Chinese Medicine Tonic Class Prescription has better symptom improvement than the control group for ALS treatment.2)3 RCTs adopt Norris scores to determine the therapeutic effect before and after treatment,the results show that the Norris scores reduction rate of the treatment group is less than the control group.So Chinese Medicine Tonic Class Prescription is better than Riluzole in delaying disease process for ALS patients.3)2 RCTs determine the therapeutic effect by Chinese medicine flaccidity syndrome score before and after treatment.The results show that Chinese Medicine Tonic Class Prescription is better than Riluzole in Chinese medicine flaccidity syndrome.4)2 RCTs measure the median nerve compound muscle action potential amplitude(CMAP)of EMG(all record the right)before and after treatment,the results show that Chinese Medicine Tonic Class Prescription can not change the patients' CMAP,the same with Riluzole.5)3 RCTs record adverse effects from gastrointestinal symptoms,liver and kidney function,and there is no serious adverse reactions.Conclusion: Chinese Medicine Tonic Class Prescription in delaying the development of ALS is better than Riluzole,but can not significantly improve symptoms and even cure ALS.Compared with the western medicine of Riluzole,Chinese Medicine Tonic Class Prescription is cheaper,and can be preserved easily.So it can reduce the financial burden for patients.However,the results are of limited value due to the low quality included RCTs.So whether Chinese Medicine Tonic Class Prescription medicine can be deemed as a routine treatment for ALS or not need further large-scale high-quality clinical research.Therefore,further RCTs with well-designed and high-quality are needed to access the efficient of Chinese Medicine Tonic Class Prescription for ALS.