Symptomatic Treatments for Amyotrophic Lateral Sclerosis/Motor Neuron Disease
The evidence is insufficient to evaluate the benefits or risks of symptomatic treatments in motoneuron disease. Level of evidence: "D"Comment: The quality of evidence is downgraded by study quality (high drop-out rate, lack of blinding), inconsistency (heterogeneity in interventions) and imprecise results (few small trials for most of the comparisons).
Summary
A Cochrane review [Abstract] 1 included 9 Cochrane Systematic Reviews of interventions to treat symptoms in people with motor neuron disease (MND).
- Drug therapy for pain:There is no RCT evidence exploring the efficacy of drug therapy for pain in MND.
- Treatment for cramps (13 RCTs, N = 4012):Memantine and tetrahydrocannabinol are probably ineffective, vitamin E may have little or no effect, andthe effects of L-threonine, gabapentin, xaliproden, riluzole, and baclofen are uncertain.The review reported adverse effects of riluzole, but it is not clear whether other interventions had adverse effects.
- Treatment for spasticity (1 RCT, N = 25):It is uncertain whether an endurance-based exercise programme improved spasticity or quality of life, measured at 3 months after the programme. No RCTs are available of the use of other drugs, such as baclofen.
- Mechanical ventilation for supporting respiratory function (1 RCT, N = 41):Non-invasive ventilation (NIV) probably improves median survival and quality of life in people with respiratory insufficiency and normal to moderately impaired bulbar function compared to standard care, and improves quality of life but not survival for people with poor bulbar function.
- Treatment for sialorrhoea (1 RCT, N = 20):A single session of botulinum toxin type B injections to parotid and submandibular glands probably improves sialorrhoea and quality of life at up to 4 weeks compared to placebo injections, but not at 8 or 12 weeks afterwards.
- Enteral tube feeding for supporting nutrition:There is no RCT evidence to support benefit or harms of enteral tube feeding in MND.
- Repetitive transcranial magnetic stimulation (3 RCTs, N = 50):It is uncertain whether repetitive transcranial magnetic stimulation (rTMS) improves disability or limitation in activity in MND in comparison with sham rTMS.
- Therapeutic exercise (2 RCTs, N = 43):Exercise may improve disability in MND at 3 months after the programme, but not quality of life, in comparison with "usual activities" or "usual care" including stretching.
- Multidisciplinary care:There is no RCT evidence to demonstrate any benefit or harm for multidisciplinary care in MND.
None of the reviews, other than the review of treatment for cramps, reported about adverse events. However, the trials were too small for reliable adverse event reporting.
Clinical comments
Note
References
- Ng L, Khan F, Young CA et al. Symptomatic treatments for amyotrophic lateral sclerosis/motor neuron disease. Cochrane Database Syst Rev 2017;1():CD011776. [PubMed]