Summary of evidence-based guideline: complementary and alternative medicine in multiple sclerosis: report of the guideline development subcommittee of the American Academy of Neurology.
Yadav et al.·NeurologyImpact 1.0
GemischtGRADEHoch183 Zitate
StichprobeMeta-Analyse
DauerLiteratursuche 1970–September…
KontrollePlacebo
EndpunktSpastik, Schmerz, weitere…
Verblindungunklar
DesignMeta-Analyse
Cannabinoidkombination
THC:CBD1:1
”Kernaussage
Cannabinoide zeigen möglichen Nutzen für Spastizität und Schmerz (Level B), sind aber wahrscheinlich unwirksam für objektive Spastizität und Tremor; andere CAM-Interventionen zeigen überwiegend geringe oder fehlende Wirksamkeit.
Zusammenfassung
Evidenzbasierte Leitlinie der American Academy of Neurology zu komplementären/alternativen Therapien bei MS (Literatur 1970–2013). Orales Cannabis-Extrakt: Level A für Spastik-Symptome und Schmerz (außer zentraler neuropathischer Schmerz); THC: Level B für Spastik-Symptome/Schmerz; Nabiximols (Sativex): Level B für Spastik-Symptome, Schmerz, Harnfrequenz. Cannabinoide wahrscheinlich ineffektiv für objektive Spastik (kurzfristig)/Tremor (Level B), wahrscheinlich ineffektiv für Harninkontinenz (Level B). Warnung vor unerwünschten Wirkungen und Qualitätskontrolle bei nicht-standardisierten Extrakten.
P
PopulationErwachsene mit Multipler Sklerose (MS)
I
InterventionKomplementäre und alternative Medizin (CAM) inkl. orales Cannabis-Extrakt, THC, Nabiximols (Sativex), Magnettherapie, Fischöl, Ginkgo biloba, Reflexologie u.a.
C
KontrollePlacebo (in eingeschlossenen Studien)
O
OutcomeLevel A für orales Cannabis-Extrakt bei Spastik/Schmerz; Level B für THC und Nabiximols bei Spastik/Schmerz; wahrscheinlich unwirksam für objektive Spastik/Tremor (Level B); diverse Evidenzgrade für andere CAM-Interventionen
Vertrauen in die Evidenz
Sehr niedrigNiedrigModeratHoch
Hoch
Höchste von vier GRADE-Stufen, die Effektschätzung ist sehr verlässlich.
Qualitätsprofil
Größe—
Verblindung—
EffektstärkeGemischt
Zitate / Jahr★★★★★
Autoren
Yadav V, Bever C Jr, Bowen J, Bowling A, Weinstock-Guttman B, Cameron M, Bourdette D, Gronseth GS, Narayanaswami P
Objective: To develop evidence-based recommendations for complementary and alternative medicine (CAM) in multiple sclerosis (MS).
Methods: We searched the literature (1970-March 2011; March 2011-September 2013 MEDLINE search), classified articles, and linked recommendations to evidence.
Results And Recommendations: Clinicians might offer oral cannabis extract for spasticity symptoms and pain (excluding central neuropathic pain) (Level A). Clinicians might offer tetrahydrocannabinol for spasticity symptoms and pain (excluding central neuropathic pain) (Level B). Clinicians should counsel patients that these agents are probably ineffective for objective spasticity (short-term)/tremor (Level B) and possibly effective for spasticity and pain (long-term) (Level C). Clinicians might offer Sativex oromucosal cannabinoid spray (nabiximols) for spasticity symptoms, pain, and urinary frequency (Level B). Clinicians should counsel patients that these agents are probably ineffective for objective spasticity/urinary incontinence (Level B). Clinicians might choose not to offer these agents for tremor (Level C). Clinicians might counsel patients that magnetic therapy is probably effective for fatigue and probably ineffective for depression (Level B); fish oil is probably ineffective for relapses, disability, fatigue, MRI lesions, and quality of life (QOL) (Level B); ginkgo biloba is ineffective for cognition (Level A) and possibly effective for fatigue (Level C); reflexology is possibly effective for paresthesia (Level C); Cari Loder regimen is possibly ineffective for disability, symptoms, depression, and fatigue (Level C); and bee sting therapy is possibly ineffective for relapses, disability, fatigue, lesion burden/volume, and health-related QOL (Level C). Cannabinoids may cause adverse effects. Clinicians should exercise caution regarding standardized vs nonstandardized cannabis extracts and overall CAM quality control/nonregulation. Safety/efficacy of other CAM/CAM interaction with MS disease-modifying therapies is unknown.