Lu Haimei, Luo Mengxian, Chen Rongrong, Luo Yijun, Xi Anran, Wang Keer, Xu Zhenghao
Laboratory of Rheumatology & Institute of TCM Clinical Basic Medicine, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
Zhejiang Provincial Key Lab of Ophthalmology, Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Epilepsy Res. 2023 Jan;189:107075. doi: 10.1016/j.eplepsyres.2022.107075. Epub 2023 Jan 2.
To evaluate the efficacy and safety of Traditional Chinese Medicine (TCM) in the treatment of epilepsy.
A comprehensive search of the database in both Chinese and English was performed. Data from the selected studies were extracted and analyzed independently by two authors.
30 randomized controlled trials (RCTs) were included in the meta-analysis with a total of 2471 patients. Among them, 4 trials (n = 235) focused on TCM monotherapy, while the other 26 trials (n = 2236) assessed the benefit of TCM as an add-on therapy to antiseizure medications (ASMs). For the efficacy, the meta-analysis found (1) The effective rate in TCM monotherapy group was higher than that in control group (OR = 4.92, 95 % CI: 2.29-10.57, Z = 4.08, P 0.0001); (2) The add-on of TCM also increased the effective rate (OR = 3.37, 95 % CI: 2.65-4.30, Z = 9.85, P 0.00001) and seizure freedom rate (OR = 1.93, 95 % CI: 1.53-2.44, Z = 5.58, P 0.00001). In terms of safety, the add-on of TCM reduced the rate of total adverse events (OR = 0.46, 95 % CI: 0.31-0.67, Z = 3.96, P 0.0001) as well as adverse events of the gastrointestinal and nervous system. 26 different TCM prescriptions were used in these included RCTs. Among them, the 5 most frequently used herbs were Acorus tatarinowii (19 out of 26), Glycyrrhiza uralensis (13 out of 26), Gastrodia elata (12 out of 26), Pinellia ternata (11 out of 26) and Poria cocos (11 out of 26).
This study suggested that TCM may be a relatively efficacious and safe clinical strategy for the treatment of epilepsy. Several limitations still exist, such as the risk of bias in the included studies, the diversified composition of TCM prescriptions, and the relatively low quality of study design.
评估中医治疗癫痫的疗效和安全性。
对中英文数据库进行全面检索。两位作者独立提取并分析所选研究的数据。
荟萃分析纳入了30项随机对照试验（RCT），共2471例患者。其中，4项试验（n = 235）聚焦于中医单一疗法，而其他26项试验（n = 2236）评估了中医作为抗癫痫药物（ASM）附加疗法的益处。在疗效方面，荟萃分析发现：（1）中医单一疗法组的有效率高于对照组（OR = 4.92，95%CI：2.29 - 10.57，Z = 4.08，P < 0.0001）；（2）加用中医也提高了有效率（OR = 3.37，95%CI：2.65 - 4.30，Z = 9.85，P < 0.00001）和无癫痫发作率（OR = 1.93，95%CI：1.53 - 2.44，Z = 5.58，P < 0.00001）。在安全性方面，加用中医降低了总不良事件发生率（OR = 0.46，95%CI：0.31 - 0.67，Z = 3.96，P < 0.0001）以及胃肠道和神经系统不良事件发生率。这些纳入的RCT中使用了26种不同的中药方剂。其中，最常用的5种草药是石菖蒲（26种中有19种）、甘草（26种中有13种）、天麻（26种中有12种）、半夏（26种中有11种）和茯苓（26种中有11种）。
本研究表明，中医可能是一种治疗癫痫相对有效且安全的临床策略。但仍存在一些局限性，如纳入研究存在偏倚风险、中药方剂组成多样以及研究设计质量相对较低。
