Ashworth N L, Satkunam L E, Deforge D
University of Alberta, Division of Physical Medicine and Rehabilitation, Glenrose Rehabilitation Hospital, 1226 GW, 10230 - 111 Avenue, Edmonton, Alberta, Canada, T5G 0B7.
Cochrane Database Syst Rev. 2006 Jan 25(1):CD004156. doi: 10.1002/14651858.CD004156.pub3.
Spasticity commonly affects patients with motor neuron disease. It is likely to contribute to worsening muscle dysfunction, increased difficulty with activities of daily living and deteriorating quality of life.
The objective of this review is to systematically review treatments for spasticity in amyotrophic lateral sclerosis, also known as motor neuron disease.
We searched the Cochrane Neuromuscular Disease Group trials register (January 2003 and January 2005), MEDLINE (January 1966 to February 2005), EMBASE (January 1980 to February 2005), CINAHL (January 1982 to February 2005), AMED (January 1985 to February 2005) and LILACS (January 1982 to January 2003). We reviewed the bibliographies of the randomized controlled trials identified, and contacted authors and experts in the field.
We included quasi-randomized or randomized controlled trials of participants with probable or definite amyotrophic lateral sclerosis according to the El Escorial diagnostic criteria (or a revised version) or the Airlie House revision. We would have included trials of physical therapy, modalities, prescription medications, non-prescription medications, chemical neurolysis, surgical interventions, and alternative therapies. Our primary outcome measure was reduction in spasticity at three months or greater as measured by the Ashworth (or modified Ashworth) spasticity scale. Our secondary outcome measures were: validated measures based on history, physical examination, physiological measures, measures of function, measures of quality of life, serious adverse events, and measures of cost.
We identified only one randomized controlled trial that met our inclusion criteria. Two authors extracted the data. We also contacted the author of the paper and obtained information not available in the published article.
The included study was a trial of moderate intensity, endurance type exercise versus 'usual activities' in 25 patients with amyotrophic lateral sclerosis. At three months patients performing the 15 minute twice daily exercises had significantly less spasticity overall (mean reduction of -0.43, 95% CI -1.03 to +0.17 in the treatment group versus an increase of +0.25, 95% CI -0.46 to +0.96 in control) but the mean change between groups was not significant (-0.68, 95% CI -1.62 to +0.26), as measured by the Ashworth scale.
AUTHORS' CONCLUSIONS: The single trial performed was too small to determine whether individualised moderate intensity endurance type exercises for the trunk and limbs are beneficial or harmful. No other medical, surgical or alternative treatment and therapy has been evaluated in a randomized fashion in this patient population. More research is needed.
痉挛常见于运动神经元病患者。它可能导致肌肉功能障碍加重、日常生活活动困难增加以及生活质量下降。
本综述的目的是系统评价肌萎缩侧索硬化症（又称运动神经元病）中痉挛的治疗方法。
我们检索了Cochrane神经肌肉疾病组试验注册库（2003年1月和2005年1月）、MEDLINE（1966年1月至2005年2月）、EMBASE（1980年1月至2005年2月）、CINAHL（1982年1月至2005年2月）、AMED（1985年1月至2005年2月）和LILACS（1982年1月至2003年1月）。我们查阅了已确定的随机对照试验的参考文献，并联系了该领域的作者和专家。
我们纳入了根据埃尔埃斯科里亚尔诊断标准（或修订版）或艾利屋修订版，患有可能或确诊肌萎缩侧索硬化症的参与者的半随机或随机对照试验。我们本应纳入物理治疗、治疗方式、处方药、非处方药、化学神经溶解、手术干预和替代疗法的试验。我们的主要结局指标是根据Ashworth（或改良Ashworth）痉挛量表测量，三个月或更长时间时痉挛的减轻。我们的次要结局指标是：基于病史、体格检查、生理指标、功能指标、生活质量指标、严重不良事件和成本指标的有效测量。
我们仅确定了一项符合我们纳入标准的随机对照试验。两名作者提取了数据。我们还联系了该论文的作者，并获得了已发表文章中未提供的信息。
纳入的研究是一项针对25例肌萎缩侧索硬化症患者的中等强度耐力型运动与“日常活动”的试验。三个月时，每天进行两次15分钟运动的患者总体痉挛明显减轻（治疗组平均降低-0.43，95%CI为-1.03至+0.17，而对照组增加+0.25，95%CI为-0.46至+0.96），但根据Ashworth量表测量，两组间的平均变化不显著（-0.68，95%CI为-1.62至+0.26）。
所进行的单一试验规模太小，无法确定针对躯干和四肢的个体化中等强度耐力型运动是有益还是有害。在该患者群体中，尚未以随机方式评估其他医学、手术或替代治疗方法。需要更多的研究。
