Herbal Medicine Formulas for Parkinson's Disease: A Systematic Review and Meta-Analysis of Randomized Double-Blind Placebo-Controlled Clinical Trials - PubMed (original) (raw)

Herbal Medicine Formulas for Parkinson's Disease: A Systematic Review and Meta-Analysis of Randomized Double-Blind Placebo-Controlled Clinical Trials

Chun-Shuo Shan et al. Front Aging Neurosci. 2018.

Abstract

Background: Parkinson's disease (PD) is a debitlitating, chronic, progressive neurodegenerative disorder without modifying therapy. Here, we aimed to evaluate the available evidence of herbal medicine (HM) formulas for patients with PD according to randomized double-blind placebo-controlled clinical trials. Methods: HM formulas for PD were searched in eight main databases from their inception to February 2018. The methodological quality was assessed using Cochrane Collaboration risk of bias tool. Meta-analysis was performed using RevMan 5.3 software. Results: Fourteen trials with Seventeen comparisons comprising 1,311 patients were identified. Compared with placebo groups, HM paratherapy (n = 16 comparisons) showed significant better effects in the assessments of total Unified Parkinson's Disease Rating Scale (UPDRS) (WMD: -5.43, 95% CI:-8.01 to -2.86; P < 0.0001), UPDRS I (WMD: -0.30, 95% CI: -0.54 to -0.06; _P_ = 0.02), UPDRS II (WMD: -2.21, 95% CI: -3.19 to -1.22; _P_ < 0.0001), UPDRS III (WMD: -3.26, 95% CI:-4.36 to -2.16; _P_ < 0.00001), Parkinson's Disease Quality of Life Questionnaire (_p_ < 0.01) and Parkinson's Disease Questionnaire-39 (WMD: -7.65, 95% CI: -11.46 to -3.83; _p_ < 0.0001), Non-motor Symptoms Questionnaire (_p_ < 0.01) and Non-Motor Symptoms Scale (WMD: -9.19, 95% CI: -13.11 to -5.28; _P_ < 0.00001), Parkinson's Disease Sleep Scale (WMD: 10.69, 95% CI: 8.86 to 12.53; _P_ < 0.00001), and Hamilton depression rating scale (WMD: -5.87, 95% CI: -7.06 to -4.68; _P_ < 0.00001). The efficiency of HM monotherapy (_n_ = 1 comparison) was not superior to the placebo according to UPDRS II, UPDRS III and total UPDRS score in PD patients who never received levodopa treatment, all _P_ > 0.05. HM formulas paratherapy were generally safe and well tolerated for PD patients (RR: 0.41, 95% CI: 0.21 to 0.80; P = 0.009). Conclusion: The findings of present study supported the complementary use of HM paratherapy for PD patients, whereas the question on the efficacy of HM monotherapy in alleviating PD symptoms is still open.

Keywords: Parkinson's disease; meta-analysis; randomized double-blind placebo-controlled clinical trial; systematic review; traditional Chinese medicine.

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Figures

Figure 1

Figure 1

Flow diagram of the search process.

Figure 2

Figure 2

Risk of bias of the included studies. (A) Risk of bias summary: judgements about each risk of bias item for each included study. (B) Risk of bias graph: judgements about each risk of bias item presented as percentages across all included studies. +, low risk of bias; -, high risk of bias; ?, unclear risk of bias.

Figure 3

Figure 3

Forest plot of HM plus WCM vs. placebo plus WCM in terms of (A) UPDRS I, (B) UPDRS II, (C) UPDRS III, (D) UPDRS IV, and (E) Total UPDRS Score. (HM, herbal medicine; WCM, western conventional medicine; UPDRS, Unified Parkinson's Disease Rating Scale).

Figure 4

Figure 4

Forest plot of HM plus WCM vs. placebo plus WCM in terms of (A) PDQ-39, (B) NMSS, (C) PDSS, and (D) HAMD. (HM, herbal medicine; WCM, western conventional medicine; PDQ-39, Parkinson's Disease Questionnaire-39; NMSS, Non-Motor Symptoms Scale; PDSS, Parkinson's Disease Sleep Scale; HAMD, Hamilton depression rating scale).

Figure 5

Figure 5

Forest plot of HM plus WCM vs. placebo plus WCM in terms of adverse events.

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