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Neurology：AAN发布多发性硬化补充替代治疗指南

2014-04-22 辛夷籽 丁香园

多发性硬化补充替代治疗
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近日，美国神经病学学会协会发布了以循证医学为依据的多发性硬化症（MS）补充替代疗法指南。而3月25日Neurology杂志上发表的文章，涵盖了该指南中大量重要信息。该研究由来自俄勒冈健康与科学大学的Yadav博士等开展，检索了1970到到2013年9月间发表的大量文献，并通过相关专家小组对这些文献进行评估。评估结果主要包括： 一．无足够证据支持的MS补充替代疗法（CAM）

近日，美国神经病学学会协会发布了以循证医学为依据的多发性硬化症（MS）补充替代疗法指南。而3月25日Neurology杂志上发表的文章，涵盖了该指南中大量重要信息。该研究由来自俄勒冈健康与科学大学的Yadav博士等开展，检索了1970到到2013年9月间发表的大量文献，并通过相关专家小组对这些文献进行评估。评估结果主要包括：

一．无足够证据支持的MS补充替代疗法（CAM）

身心治疗

生物基础的治疗

肢体可控性训练

能量疗法

生物反馈，音乐疗法，

正念疗法，催眠

亚油酸， 肌酸一水化物，肌苷，苏氨酸，氨基葡萄糖硫酸盐，低剂量纳曲酮，高压氧疗

马术治疗，瑜伽，按摩疗法，中国针灸，电针，渐进性肌肉放松治疗

神经疗法，

自然疗法

二．有足够证据支持的MS补充替代疗法(CAM)

CAM干预措施

研究级别与数量

MS类型

预后

推荐级别

口服大麻提取物（OCE）

两项1级研究

一项II级研究

一项III级研究

缓解复发型MS(RRMS)

继发进展型MS(SPMS)

原发进展型MS(PPMS)

MS类型不明（MSU）

痉挛症状和疼痛（不包括中央神经性疼痛。）

A级有效

一项1级研究

RRMS,PPMS,SPMS

短期痉挛或短期震颤体征

B级无效

一项II级研究

MSU

长期痉挛症状体征

C级有效

两项1级研究

一项II级研究

 

RRMS,PPMS,SPMS,MSU

膀胱功能，急迫性尿失禁

U(证据不足以判断是否有效)

四氢大麻酚合成物

一项1级研究

一项II级研究

 

RRMS, SPMS, PPMS

痉挛症状和疼痛（包括中枢神经性疼痛在内的疼痛）

B级有效

一项1级研究

RRMS, SPMS, PPMS

短期痉挛或短期震颤体征

B级无效

一项II级研究

 

MSU

长期痉挛症状体征

C级有效

一项1级研究

一项II级研究

一项III级研究

RRMS, SPMS, PPMS,

MSU

膀胱功能，急迫性尿失禁，中枢性神经痛

U级

Sativex口腔黏膜喷雾

三项1级研究

两项II级研究

三项III级研究

MSU

痉挛症状，疼痛，尿频

B级有效

尿失禁

B级无效

震颤

C级无效

焦虑/睡眠，疲劳，认知，生活质量

U

吸入性大麻

两项III级研究

RRMS, SPMS, MSU

痉挛，疼痛，姿势平衡，认知

U

其它CAM

 

 

 

 

银杏叶

三项1级研究

两项II级研究

RRMS, SPMS, PPMS

疲劳

C级有效

认知能力

A级无效

CariLoder方案（洛非帕明+苯丙氨酸+维生素B12）

 

一项II级研究

 

RRMS, SPMS, PPMS

残疾，抑郁，疲劳

C级无效

反射疗法

一项1级研究

两项II级研究

一项III级研究

MSU

感觉异常

C级有效

疼痛，健康相关生活质量，残疾，痉挛，疲劳，认知，膀胱功能，抑郁，焦虑，失眠

U

蜂毒

一项II级研究

 

RRMS, SPMS

MRI病灶体积与数量，疾病复发，残疾，疲劳，健康相关生活质量

C级无效

磁疗

一项1级研究

两项II级研究

三项III级研究

RRMS, SPMS, PPMS

疲劳

B级有效

抑郁

B级无效

含ω-3低脂饮食疗法

一项1级研究

一项II级研究

一项III级研究

RRMS

疾病复发，残疾，MRI病灶，疲劳，生活质量

B级无效

原始出处：

Yadav V1, Bever C Jr, Bowen J, Bowling A, Weinstock-Guttman B, Cameron M, Bourdette D, Gronseth GS, Narayanaswami P.Summary of evidence-based guideline: Complementary and alternative medicine in multiple sclerosis: Report of the Guideline Development Subcommittee of the American Academy of Neurology.Neurology. 2014 Mar 25;82(12):1083-92. doi: 10.1212/WNL.0000000000000250.【原文下载】

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    2014-11-03 w984445tii

    #治疗指南#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1934764, encodeId=dc751934e6426, content=<a href='/topic/show?id=1072646328c' target=_blank style='color:#2F92EE;'>#治疗指南#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64632, encryptionId=1072646328c, topicName=治疗指南)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6732482, createdName=w984445tii, createdTime=Mon Nov 03 00:23:00 CST 2014, time=2014-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1692822, encodeId=e4d61692822ed, content=<a href='/topic/show?id=e6d86032ee8' target=_blank style='color:#2F92EE;'>#替代治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=60327, encryptionId=e6d86032ee8, topicName=替代治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b79d29305168, createdName=wfang555, createdTime=Mon Sep 01 21:23:00 CST 2014, time=2014-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1999406, encodeId=60fc199940651, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Tue Jul 22 00:23:00 CST 2014, time=2014-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1889588, encodeId=bcf6188958834, content=<a href='/topic/show?id=760c430895a' target=_blank style='color:#2F92EE;'>#多发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43089, encryptionId=760c430895a, topicName=多发性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=04d6114, createdName=jml2009, createdTime=Fri Jul 04 11:23:00 CST 2014, time=2014-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1446415, encodeId=c8d1144641557, content=<a href='/topic/show?id=2e3016e437' target=_blank style='color:#2F92EE;'>#AAN#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1674, encryptionId=2e3016e437, topicName=AAN)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIt6X4iaHW8bDticcBSHUibNWk4Koe2icf0pdIOicSueicR3AKmviaSNPHkf9bCEicRK0anXEu3DjolU2EmkQ/132, createdBy=98ca5217513, createdName=bluefate123, createdTime=Thu Apr 24 05:23:00 CST 2014, time=2014-04-24, status=1, ipAttribution=)]
    2014-09-01 wfang555

    #替代治疗#

    0

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    2014-07-22 yinhl1978

    #Neurol#

    0

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    2014-07-04 jml2009

    #多发性#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1934764, encodeId=dc751934e6426, content=<a href='/topic/show?id=1072646328c' target=_blank style='color:#2F92EE;'>#治疗指南#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64632, encryptionId=1072646328c, topicName=治疗指南)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6732482, createdName=w984445tii, createdTime=Mon Nov 03 00:23:00 CST 2014, time=2014-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1692822, encodeId=e4d61692822ed, content=<a href='/topic/show?id=e6d86032ee8' target=_blank style='color:#2F92EE;'>#替代治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=60327, encryptionId=e6d86032ee8, topicName=替代治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b79d29305168, createdName=wfang555, createdTime=Mon Sep 01 21:23:00 CST 2014, time=2014-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1999406, encodeId=60fc199940651, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Tue Jul 22 00:23:00 CST 2014, time=2014-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1889588, encodeId=bcf6188958834, content=<a href='/topic/show?id=760c430895a' target=_blank style='color:#2F92EE;'>#多发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43089, encryptionId=760c430895a, topicName=多发性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=04d6114, createdName=jml2009, createdTime=Fri Jul 04 11:23:00 CST 2014, time=2014-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1446415, encodeId=c8d1144641557, content=<a href='/topic/show?id=2e3016e437' target=_blank style='color:#2F92EE;'>#AAN#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1674, encryptionId=2e3016e437, topicName=AAN)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIt6X4iaHW8bDticcBSHUibNWk4Koe2icf0pdIOicSueicR3AKmviaSNPHkf9bCEicRK0anXEu3DjolU2EmkQ/132, createdBy=98ca5217513, createdName=bluefate123, createdTime=Thu Apr 24 05:23:00 CST 2014, time=2014-04-24, status=1, ipAttribution=)]
    2014-04-24 bluefate123

    #AAN#

    0

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