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Intervention Review

Treatment for spasticity in amyotrophic lateral sclerosis/motor neuron disease

  1. Nigel L Ashworth1,*,
  2. L E Satkunam1,
  3. Dan Deforge2

Editorial Group: Cochrane Neuromuscular Disease Group

Published Online: 25 JAN 2006

Assessed as up-to-date: 28 APR 2008

DOI: 10.1002/14651858.CD004156.pub3


How to Cite

Ashworth NL, Satkunam LE, Deforge D. Treatment for spasticity in amyotrophic lateral sclerosis/motor neuron disease. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD004156. DOI: 10.1002/14651858.CD004156.pub3.

Author Information

  1. 1

    University of Alberta, Physical Medicine & Rehabilitation, Edmonton, Alberta, Canada

  2. 2

    University of Ottawa, Division of Physical Medicine and Rehabilitation, Ottawa, Ontario, Canada

*Nigel L Ashworth, Physical Medicine & Rehabilitation, University of Alberta, Glenrose Rehabilitation Hospital, 10230-111 Avenue, Edmonton, Alberta, T5G 0B7, Canada. nigel.ashworth@albertahealthservices.ca.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 25 JAN 2006

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

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.

Objectives

The objective of this review is to systematically review treatments for spasticity in amyotrophic lateral sclerosis, also known as motor neuron disease.

Search methods

We searched the Cochrane Neuromuscular Disease Group trials register (January 2003, January 2005, April 29 2008), MEDLINE (January 1966 to April 29 2008), EMBASE (January 1980 to April 29 2008), CINAHL (January 1982 to April 29 2008), AMED (January 1985 to April 29 2008) and LILACS (January 1982 to April 29 2008). We reviewed the bibliographies of the randomized controlled trials identified, and contacted authors and experts in the field.

Selection criteria

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.

Data collection and analysis

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.

Main results

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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

A single trial of moderate intensity endurance type exercise for spasticity in people with amyotrophic lateral sclerosis was too small to determine whether it was beneficial or harmful

Spasticity commonly causes a 'stiffness' or 'tightness' in the already weakened muscles of a person with amyotrophic lateral sclerosis (also known as motor neuron disease). This can lead to even greater difficulties in the ability to perform day-to-day activities. This review found only one randomized trial of treatment for spasticity in motor neuron disease. The trial was too small to determine whether individualised moderate intensity endurance type exercises for the trunk and limbs are beneficial or harmful. No other trials of different treatments or therapies were found. Further research is needed to determine if exercise or other therapies such as anti-spasticity medication are beneficial or harmful.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

治療肌萎縮性脊髓側索硬化症/運動神經元疾病的痙攣狀態

運動神經元疾病病人常有痙攣,常導致肌肉失能惡化,增加日常生活活動的難度以及生活品質變差。

目標

目標是系統性的回顧肌萎縮性脊髓側索硬化症又稱運動神經元疾病的痙攣狀態的治療

搜尋策略

我們搜尋了考科藍神經肌肉疾病群組試驗登錄(2003年1月及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)以及LILACS(1982年1月至2003年1月)。我們回顧了確認出的隨機對照試驗文獻並連絡這個領域的作者及專家。

選擇標準

依據El Esocorial原版或修訂版診斷標準或Airlie House修訂版診斷標準,我們收錄了可能或確定是肌萎縮性脊髓側索硬化症的準隨機試驗或隨機對照試驗,任何包括物理治療、不同方法學、處方藥物、非處方藥物、化學神經分離術、手術以及替代療法的試驗,主要預後指標為經過3個月治療後,以Ashworth原版或修訂版的痙攣量表的下降程度。我們次要預後指標包括經過驗證的病史及身體檢查指標,生理學指標,功能性指標,生活品質指標,嚴重不良反應,及費用指標。

資料收集與分析

我們找到符合收錄標準的文獻只有一篇隨機對照試驗,經由二位作者分析資料,我們還連絡了這篇論文的作者,並且取得在文章發表以外的資訊。

主要結論

這篇收錄的研究是一個在25位肌萎縮性脊髓側索硬化病人中,比較中等強度的耐力型運動以及平時活動,病人經過3個月的每日二次、每次15分鐘的運動可明顯減少痙攣(治療組 −0.43, 95% CI −1.03 to +0.17對照組+0.25, 95% CI −0.46 to +0.96),不過群組之間平均Ashworth評量上的改變卻不明顯(−0.68, 95% CI −1.62 to +0.26)。

作者結論

這個單一試驗規模太小所以無法得到結論,究竟個體化的軀幹及肢體中等強度耐力型運動是有益或有害,在這個病人族群沒有其他經隨機試驗評估藥物、手術或替代療法的效果,目前需要更多的研究。

翻譯人

本摘要由新光醫院吳亞縈翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

單個試驗對肌萎縮性脊髓側索硬化病人實行中等強度的耐力型運動,規模太小所以無法得知對痙攣是有益或有害,若病人有肌萎縮性脊髓側索硬化症又稱運動神經元疾病,痙攣經常使得無力的肌肉會僵硬或緊繃,導致每日活動的能力更加困難。這篇回顧找到只有一篇隨機試驗,研究的運動神經元疾病痙攣狀態的治療,這個單一試驗規模太小所以無法得到結論,究竟個體化的軀幹及肢體中等強度耐力型運動是有益或有害,目前沒有關於其他治療的研究,需要更多的研究來探討運動或者其他療法例如抗痙攣藥物是有益或有害。