Abstract
INTRODUCTION: amyotrophic lateral sclerosis (ALS) is a degenerative disease of quickly evolution and inexorably fatal, as a consequence of the degeneration in the motor neurons of cortex, bulb, and spinal cord. Its diagnosis requires upper and lower motor neuron signs. The excitotoxicidad by glutamates is one of its possible causes, but agrees to it understand as a multifactorial alterations. Riluzole is the only one approved medication (FDA in US) to improve the survival of patients with ALS.
OBJECTIVE: to evaluate the efficacy of riluzole in the survival free of assisted ventilation, time free of dysphagia, dysarthria and quality of life in adult patients with ALS compared with placebo or not treatment, a random assignation of patients to intervention and when cut points were measured in a valid an accurately way
RESULTS: of 233 articles, 200 were clinical controlled trials, 27 did not include the riluzole, one was done in children, four were repeated and another was already included in the Cochrane review of 2003. The study of Bensimon in 1999 showed improvement in survival for the patients with ALS of bulbar start. A new study, of the same author in 2001 with 168 patients with advanced illness failed to show differences in favor of the treatment, but concluded that the dose of 50 mgrs. twice a day had the best relation risk/benefit. The Cochrane reviews of 2004 and 2007 concluded that the dose of 100 mgrs day is reasonably safe and can prolong the average survival in two to three months.
CONCLUSION: riluzole can prolong the average life of the patients with ALS. A judicious analysis of cost/opportunity is recommended.
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