Turalde Christian Wilson R, Espiritu Adrian I, Anlacan Veeda Michelle M
Department of Neurosciences, College of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines.
Front Neurol. 2021 Feb 15;11:574748. doi: 10.3389/fneur.2020.574748. eCollection 2020.
Multiple sclerosis (MS), a disabling demyelinating disease of the central nervous system, is associated with cognitive impairment, spasticity, and fatigue. There are still no established guidelines on the management of MS-related sequela. Memantine has the potential to reduce glutamate toxicity, thereby reducing consequent cognitive impairment, spasticity, and fatigue. This study aims to determine the efficacy and safety of memantine in preventing cognitive impairment, reducing spasticity and fatigue, and controlling disability in MS patients through a review of relevant randomized trials. MEDLINE, CENTRAL, Scopus, Embase, LILACS, ClinicalTrials.gov, and HERDIN were searched from inception to May 2020 for relevant trials. The search yielded 203 articles; four studies were included in the analysis. Pooled evidence shows that memantine compared with placebo does not significantly improve PASAT, ASS, MFIS, and EDSS scores of patients with MS. Memantine is associated with mild adverse drug events such as dizziness, fatigue, and anxiety. There is not enough evidence to support the efficacy of memantine in preventing cognitive decline, controlling spasticity, reducing fatigue, and preventing disability. Future researches should consider the different MS subtypes, effect of co-administration of disease-modifying therapies, longer duration of administration, and more sensitive outcome measures to evaluate the potential benefit of memantine in MS.
多发性硬化症（MS）是一种使中枢神经系统致残的脱髓鞘疾病，与认知障碍、痉挛和疲劳相关。目前仍没有关于MS相关后遗症管理的既定指南。美金刚有降低谷氨酸毒性的潜力，从而减轻随之而来的认知障碍、痉挛和疲劳。本研究旨在通过回顾相关随机试验，确定美金刚在预防MS患者认知障碍、减轻痉挛和疲劳以及控制残疾方面的疗效和安全性。检索了MEDLINE、CENTRAL、Scopus、Embase、LILACS、ClinicalTrials.gov和HERDIN，从建库至2020年5月查找相关试验。检索得到203篇文章；四项研究纳入分析。汇总证据表明，与安慰剂相比，美金刚并未显著改善MS患者的PASAT、ASS、MFIS和EDSS评分。美金刚与头晕、疲劳和焦虑等轻度药物不良事件相关。没有足够证据支持美金刚在预防认知衰退、控制痉挛、减轻疲劳和预防残疾方面的疗效。未来研究应考虑不同的MS亚型、疾病修饰疗法联合使用的效果、更长的给药持续时间以及更敏感结局指标，以评估美金刚在MS中的潜在益处。
