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The left or right of the body; further from the midline.

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Drug therapy for pain in amyotrophic lateral sclerosis or motor neuron disease

Amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND), is the most common neurodegenerative disorder of the motor system in adults. Pain is a frequent symptom and may have a pronounced impact on quality of life and suffering. Despite an extensive search of different medical databases, this review was not able to identify any randomised controlled trials on drug therapy for pain in ALS. Currently (to July 2012) no evidence exists for using one type of treatment over another.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Antioxidants for treating amyotrophic lateral sclerosis

There is no cure for amyotrophic lateral sclerosis, also known as motor neuron disease, which is a progressively disabling and ultimately fatal disease. Antioxidants, including vitamins C, E, selegiline, selenium, methionineacetylcysteine, and coenzyme Q10, have been suggested as possible treatments and some of these are commonly advised by physicians treating people with amyotrophic lateral sclerosis. In this updated review, we identified 10 studies involving a total of 1015 participants. We did not find any well‐designed randomized controlled trial evidence to support the use of these medications. Trials of antioxidants identified in this review were generally of poor methodological quality and lacked statistical power. However, antioxidants are generally well tolerated without serious adverse effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Multidisciplinary care for adults with amyotrophic lateral sclerosis (ALS)/motor neuron disease (MND)

This review did not find any high quality randomised controlled trials that examined the effectiveness of such multidisciplinary care, either when originally published in 2009 or for the update in 2011. The evidence from low quality studies suggests that such care may improve some aspects of quality of life, reduce the frequency of hospitalisation and hospital length of stay and improve disability in persons with ALS or MND. The evidence for multidisciplinary care on survival is conflicting.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Hands and knees posture in late pregnancy or labour for fetal malposition (lateral or posterior)

Assuming the hands and knees posture in late pregnancy does not improve pregnancy outcomes but use in labour is beneficial.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Creatine for amyotrophic lateral sclerosis/motor neuron disease

Amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND), is a progressive neurodegenerative disease that results in widespread paralysis and shortened life. Recently, a naturally‐occurring organic acid called creatine has gained attention as a potential therapy for ALS/MND. However, human trials have shown mixed results thus far. Therefore, we systematically reviewed all available clinical trial evidence as of July 2012 to determine if creatine benefits or harms people with ALS/MND. This review included three well‐designed clinical trials involving a total of 386 participants receiving either creatine or placebo. Overall, creatine was well‐tolerated with no serious side effects. Using various statistical methods, we found that creatine at a dose of 5 to 10 g per day did not improve ALS survival or slow ALS progression in any meaningful way. There was a hint that creatine may slightly worsen breathing ability, but this may have just been misleading statistical variability.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Cell‐based therapies for amyotrophic lateral sclerosis/motor neuron disease (ALS/MND)

ALS/MND is a condition in which nerves in the brain and spinal cord that control movement (motor neurons) stop working. A person with ALS/MND has difficulty moving, swallowing, chewing and speaking, which become worse over time. Half of people with ALS/MND die within three years of their first symptoms. Weakness of muscles used in breathing often leads to death. The condition currently has no cure. Current treatment regimens largely focus on relieving symptoms to improve the quality of life of those affected. Cell‐based therapy can be defined as injection of cellular material into a person to treat disease. Based on early studies, cell‐based therapy is a promising new treatment. Various types of cell‐based therapies can be used in ALS/MND, including stem cell therapy. Stem cell therapy aims to provide new motor neurons, which may help stop or slow down disease progression in people with ALS.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Treatment for cramps in amyotrophic lateral sclerosis/motor neuron disease

A cramp is a sudden, involuntary painful contraction of a muscle. Many people with amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND), experience cramps during the course of the disease. These range from mild cramps that do not affect daily activities and sleep, through to very severe, painful cramps. Some medications that are used to treat cramps in people with no medical condition or with conditions other than ALS have been tested in ALS clinical trials. These medicines include vitamin E, creatine, quinidine, and gabapentin. Other medications such as quinine sulfate, magnesium, lioresal, dantrolene, clonazepam, diphenylhydantoin, and gabapentin have been used to treat cramps in people with ALS but their effectiveness is unknown. In 2006 and 2010 the US Food and Drugs Administration issued warnings concerning the use of quinine sulfate, which was the previously most widely prescribed medication for cramps in the US. This review sought to find out how effective medications and physical treatments for cramps are for people with ALS. The reviewers identified 20 randomised controlled trials in people with ALS comprising a total of 4789 participants. Only one trial, of the drug tetrahydrocannabinol (THC), directly investigated the effectiveness of an intervention for cramps. Thirteen randomised controlled ALS trials investigated cramps secondarily among other variables. The medications comprised vitamin E, baclofen, riluzole, L‐threonine, xaliproden, indinavir, and memantine. Six randomised controlled ALS trials investigated cramps as adverse events. The medications comprised creatine, gabapentin, dextromethorphan, quinidine and lithium. None of the 20 studies could demonstrate any benefit, but the studies were small. Current evidence on the treatment of cramps in ALS is lacking and more research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Ciliary neurotrophic factor (CNTF) for amyotrophic lateral sclerosis, also known as motor neuron disease

Amyotrophic lateral sclerosis (ALS) or motor neuron disease (MND) is a fatal neuromuscular disease characterized by progressive muscle weakness that results in paralysis. Ciliary neurotrophic factor (CNTF) has been shown to slow disease progression and improve muscle strength in an animal model of MND, through survival‐promoting effects on motor neurons. Ciliary neurotrophic factor treatment did not show any significant effect on the progression of amyotrophic lateral sclerosis and side effects were observed at high concentrations.The review found only two eligible trials with a total of 1300 participants; the risk of bias was low for one trial but was unclear for the other trial; they did not show any significant effect of ciliary neurotrophic factor on progression of ALS or MND in man. On the other hand, several adverse effects were observed after treatment with ciliary neurotrophic factor. An updated search was performed in April 2011, but no new studies were found.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Enteral feeding (tube feeding) in people with amyotrophic lateral sclerosis, also known as motor neuron disease

Amyotrophic lateral sclerosis/motor neuron disease is a progressive neuromuscular disease causing muscle weakness resulting in paralysis. It is usually fatal. At some stage in the disease, most people have difficulty chewing and swallowing (dysphagia). This can cause significant weight loss. At this stage enteral feeding, or the placing of a feeding tube through the abdominal wall into the stomach (also known as percutaneous endoscopic gastrostomy), may be recommended to maintain adequate nutrition. This review looked for evidence from randomized clinical trials in which patients who underwent tube feeding were compared with patients not on tube feeding with regards to survival, maintaining adequate nutrition and quality of life and complications of feeding tube placement. No randomized controlled trials were found. Non‐randomized evidence suggested a benefit from enteral feeding but this needs to be confirmed in a large randomized controlled trial.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Riluzole for amyotrophic lateral sclerosis (ALS)/motor neuron disease (MND)

Amyotrophic lateral sclerosis (ALS)/motor neuron disease (MND) is a fatal neurological disease which produces paralysis of the limb, swallowing and breathing muscles. There is no available treatment to stop or reverse its progressive course. In this review, we examine the evidence from four randomized clinical trials involving 1477 people with ALS. The methodological quality of the trials was acceptable and three of the trials were easily comparable (although one of them included older patients with more advanced ALS). The searches for this review were last updated in 2011, when we found no new randomized controlled trials. The results indicate that riluzole 100 mg probably prolongs median survival in people with ALS by two to three months and the safety of the drug is not a major concern. The evidence from randomized controlled trials indicates that participants taking riluzole probably survive longer than participants taking placebo. The beneficial effects are very modest and the drug is expensive. There was a small beneficial effect on both bulbar and limb function, but not on muscle strength. Adverse effects from riluzole are relatively minor and for the most part reversible after stopping the drug.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Deep transverse friction massage for the treatment of lateral elbow or lateral knee tendinitis

We conducted an update of the review of the effects of deep transverse friction massage (DTFM) for people with lateral elbow or knee tendinitis. We found two studies (no new additional studies in this update) with 57 people.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Repetitive transcranial magnetic stimulation (rTMS) for treating amyotrophic lateral sclerosis (ALS)

Amyotrophic lateral sclerosis (ALS), which is also known as motor neuron disease (MND), is a fatal disease in which the nerves in the brain and spinal cord that control movement degenerate. Treatments have little effect on how the disease progresses. People with ALS develop muscle weakness and paralysis of limb muscles and muscles involved in swallowing and breathing. Repetitive transcranial magnetic stimulation (rTMS) is a method for exciting nerve cells in superficial areas of the brain. It applies pulsed magnetic fields to the surface of the brain via an electrode on the scalp. There have been trials to see if rTMS is effective in people with ALS.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Lateral pararectal versus transrectal stoma placement for prevention of parastomal herniation

A parastomal hernia is defined as an incisional hernia related to a stoma and belongs to the most common stoma‐related complications. Many factors concerning the operative technique that are considered to influence the incidence of parastomal herniation have been investigated. However, it remains unclear whether the enterostomy should be placed through or lateral to the rectus abdominis muscle in order to prevent parastomal herniation and other important stoma complications for patients.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Treatment for spasticity (muscle tightness and spasm) in people with amyotrophic lateral sclerosis/motor neuron disease

Spasticity commonly causes a 'stiffness' or 'tightness' in the already weakened muscles of a person with amyotrophic lateral sclerosis (also known as motor neuron disease). This can lead to even greater difficulties in the ability to perform day‐to‐day activities. This review found only one randomized trial of treatment for spasticity in motor neuron disease, which involved 25 participants, and no further trials have been found in subsequent updates. There were a number of issues with the design of the study which unfortunately reduced the certainty of the findings. At three months participants performing the 15 minute twice daily exercises had significantly less spasticity overall than control participants (mean reduction of ‐0.43, 95% confidence interval (CI) ‐1.03 to +0.17 in the treatment group versus an increase of +0.25, 95% CI ‐0.46 to +0.96 in control) but the mean change between groups was not significant, as measured by the Ashworth scale (a scale of spasticity, with a range of 0 to 5, where higher is worse). The trial was too small to determine whether individualized moderate intensity endurance type exercises for the trunk and limbs are beneficial or harmful. No side effects from exercise were reported. No other randomized trials of different treatments or therapies were found. Further research is needed to determine if exercise or other therapies such as anti‐spasticity medication are beneficial or harmful.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Treatment for familial amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND) and Lou Gehrig's disease, is a rare disease in which degeneration of motor nerves leads to progressive weakness and wasting of muscles. For the most part, the cause of ALS is unknown. In a small proportion of cases there is a family history of ALS/MND and in an even smaller proportion, the disease is known to result from a change in one of several genes including SOD1, TDP‐43 and FUS. An understanding of the genetic basis for one familial form of ALS/MND has permitted the construction of an animal model of ALS/MND (the SOD1 mouse) that has been used extensively to study potential therapeutic agents for the human disease. None of the drugs found to be effective in the mouse have translated into therapeutic benefits for humans with ALS/MND. There are several possible explanations for this finding, one of which is that people with familial and sporadic ALS may respond differently to the same treatment and that the SOD1 mouse may be a better model of familial ALS (or at least familial ALS due to mutations in the SOD1 gene) than it is of sporadic ALS. In an effort to begin to address this question, this review was undertaken in order to ask whether or not people with the familial form of the disease respond differently to treatment compared to people with the sporadic (or non‐familial) form of ALS/MND.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Therapeutic exercise for people with amyotrophic lateral sclerosis or motor neuron disease

Muscle weakness is very common in people with amyotrophic lateral sclerosis (ALS), which is also known as motor neuron disease (MND). A weak muscle can be damaged if overworked because it is already functioning close to its maximal limits. Because of this, some experts have discouraged exercise programs for people with ALS. However, if a person with ALS is not active, deconditioning (loss of muscle performance) and weakness from lack of use occurs, on top of the deconditioning and weakness caused by the disease itself. If the reduced level of activity persists, many organ systems can be affected and a person with ALS can develop further deconditioning and muscle weakness, and muscle and joint tightness may occur leading to contractures (abnormal distortion and shortening of muscles) and pain. These all make daily activities harder to do. This review found only two randomised studies of exercise in people with ALS. The trials compared an exercise program with usual care (stretching exercises). Combining the results from the two trials (43 participants), exercise produced a greater average improvement in function (measured using an ALS‐specific measurement scale) than usual care. There were no other differences between the two groups. There were no reported adverse events due to exercise. The studies were too small to determine to what extent exercise for people with ALS is beneficial or whether exercise is harmful. We found no new trials when we updated the searches in 2012. More research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Chronic lateral ankle instability may be treated with or without surgery

Chronic ankle instability is common after an acute lateral ankle sprain. Initial treatment is conservative, either with bracing or neuromuscular training. However, if symptoms persist and the ligaments on the outside of the ankle are elongated or torn, surgery is usually considered.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Treatment with the growth factor, recombinant human insulin‐like growth factor I, for amyotrophic lateral sclerosis (motor neuron disease)

Recombinant human insulin‐like growth factor (rhIGF‐I) is a genetically engineered human protein. Theoretically, it is expected to enhance the survival of motor neurons which degenerate in amyotrophic lateral sclerosis (ALS, also known as motor neuron disease (MND)). It is given by daily subcutaneous injection (injection under the skin). Three randomised controlled trials (RCTs) involving 779 participants measured disease progression on special clinical rating scales of disease severity in ALS. The review authors collected data about adverse events from the included trials. The combined results from the two included studies that used the rating scale (AALSRS) showed a small significant benefit in favour of rhIGF‐I. Significant flaws in the trial designs make the statistically significant benefits in some outcomes of questionable relevance. There was an increased risk of injection site reactions with rhIGF‐I. A third study using a different outcome measure showed no difference between treatment and placebo. Taken together, the available RCTs do not provide information supporting the hypothesis that rhIGF‐I is an effective disease modifying treatment for ALS. All three included studies showed a high risk of bias. These issues very seriously detracted from the ability of this review to fulfil its objectives.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Non‐invasive ventilation for people with amyotrophic lateral sclerosis or motor neuron disease

Management of amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND), has evolved rapidly in the last ten years and although still incurable, ALS is not untreatable. In this updated review we examined the evidence from two randomised trials, involving 54 participants in total, of non‐invasive ventilation (using a face or nasal mask and a small portable ventilator) in people with ALS. Complete data were only available from a single trial of 41 participants. The results of this trial indicate that non‐invasive ventilation significantly prolongs survival and improves or maintains quality of life compared to standard care. Average survival was increased by 48 days from 171 to 219 days (estimated 95% CI 12 to 91 days). The survival benefit from non‐invasive ventilation was shown to be much greater in those people with ALS who had normal or only moderately impaired bulbar function (impairments to the muscles used for speaking, chewing and swallowing). Among these 20 participants, the average survival for those treated with non‐invasive ventilation was increased by 205 days (survival was 216 days with non‐invasive ventilation, compared to 11 days with standard care). The quality of life was also maintained in participants with mild to moderate bulbar impairment. In the 21 participants with severe bulbar impairment, non‐invasive ventilation significantly improved sleep‐related symptoms compared to standard care but did not prolong survival. Neither trial reported on adverse effects due to the intervention. Future studies should examine the health economics of non‐invasive ventilation and factors that influence access to non‐invasive ventilation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Lateral positioning for critically ill adult patients

We reviewed the evidence on the effects of turning critically ill adults from side to side while lying on a hospital bed. We found 24 studies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

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