PDF(Pubmed)
Abstract：
Background: Intractable epilepsy (IE) is still a major concern in neurology, and existing therapies do not adequately control symptoms. Chinese Herbal Medicine (CHM) has been widely used as an adjunct to antiepileptic drugs (AEDs) for IE. However, because of the contradictory findings reported in previous studies, it is uncertain if the present evidence is robust enough to warrant its usage. The purpose of this meta-analysis was to systematically evaluate the efficacy of the combination of CHM and AEDs for IE. Methods: From inception to September 2021, Medline, Ovid, Embase, Cochrane Library, Chinese Biomedical Database, China National Knowledge Infrastructure, VIP Database, and Wanfang Database were searched. Only randomized controlled trials (RCTs) that assessed the efficacy of the combination of CHM and AEDs for IE were included. We defined monthly seizure frequency as the primary outcome. The secondary outcomes included the abnormal rate of electroencephalogram (EEG), seizure duration, quality of life (QoL), and adverse events (AEs). Results: Twenty studies with 1,830 patients were enrolled. Most trials had poor methodological quality. The meta-analysis showed that the combination of CHM and AEDs was more efficient than AEDs alone in reducing monthly seizure frequency [MD = -1.26%, 95% CI (-1.62, -0.91); p < 0.00001], the abnormal rate of EEG [RR = 0.66%, 95% CI (0.53, 0.82); p = 0.0002], and improving the QoL [MD = 6.96%, 95% CI (3.44, 10.49); p = 0.0001]. There was no significant difference in seizure duration between groups. Moreover, the combination of CHM and AEDs significantly reduced the AEs [RR = 0.45%, 95% CI (0.32, 0.64); p < 0.00001]. Conclusion: The combination of CHM and AEDs could improve seizure control by reducing monthly seizure frequency and abnormal rate of EEG with a decreased risk of adverse events in patients with IE. However, these findings must be interpreted carefully due to the high or uncertain risk of bias in the included trials. To provide stronger evidence for the use of CHM combined with AEDs in IE, high-quality RCTs will be urgently warranted in the future.
摘要：
背景：难治性癫痫（IE）仍然是神经病学的主要关注点，和现有的疗法不能充分控制症状。中草药（CHM）已被广泛用作IE的抗癫痫药（AEDs）的辅助药物。然而,由于以前的研究报告的矛盾发现，目前尚不确定目前的证据是否足以证明其使用。这项荟萃分析的目的是系统评估CHM和AED联合治疗IE的疗效。方法：从开始到2021年9月，Medline，奥维德,Embase,科克伦图书馆,中国生物医学数据库,中国国家知识基础设施，VIP数据库,并对万方数据库进行了检索。仅包括评估CHM和AED组合对IE的疗效的随机对照试验（RCT）。我们将每月癫痫发作频率定义为主要结果。次要结果包括脑电图（EEG）异常率，癫痫发作持续时间,生活质量（QoL），和不良事件（AE）。结果：纳入20项研究，1,830例患者。大多数试验的方法学质量较差。荟萃分析表明，CHM和AEDs的组合比单独的AEDs更有效地减少每月发作频率[MD=-1.26％，95%CI（-1.62，-0.91）；p<0.00001]，脑电图异常率[RR=0.66%，95%CI（0.53，0.82）；p=0.0002]，并提高QoL[MD=6.96%，95%CI（3.44，10.49）；p=0.0001]。两组之间的癫痫发作持续时间没有显着差异。此外，CHM和AED的组合显着降低了AE[RR=0.45%，95%CI（0.32，0.64）；p<0.00001]。结论：CHM和AEDs的联合治疗可以通过减少IE患者每月的发作频率和EEG异常率来改善癫痫发作控制，并降低不良事件的风险。然而,由于纳入试验的偏倚风险较高或不确定,因此必须谨慎解释这些发现.为在IE中使用CHM和AED提供更有力的证据，未来将迫切需要高质量的RCT。
