근위축성

53 DOI : 10.3831/KPI.2009.12.1.053 Received : 09. 02-18 Revised : 09. 02-21 Accepted : 09. 02-22 Key Words: Amyotrophic lateral sclerosis(als), ALS Functional Rating Scale-Revised(ALSFRS- R), Medical Research Council(MRC) Scale A pilot clinical study on the Traditional Korean Medicine treatment of Amyotrophic lateral sclerosis Kim Sung-chul, Na Won-min, Lim Na-ra, Lee Do-sang, Jang Eun-ha*, Song Bong-keun** * Dept. of Acupuncture & Moxibustion, Gwang-Ju Oriental Medical Hospital, Wonkwang University ** Dept. of Internal Medicine, Gwang-Ju Oriental Medical Hospital, Wonkwang University ABSTRACT Objectives : This study was to investigate the effect of Oriental medical treatment on ALS. Methods : We investigated 12 ALS patients which were admitted to Gwang-Ju O.M. hospital from Oct. 14, 2008 to Nov. 14, 2008. All patients were treated by SAAM-acupuncture, herb medication, Bee venom Pharmacopuncture therapy, Needle-embedding therapy, etc. We evaluated patients using the Amyotrophic lateral sclerosis Functional Rating Scale-Revised(ALS- FRS-R), Medical Research Council (MRC) Scale. Results : After 30 days, mean ALSFRS-R score of patients was improved from 28.42 7.83 to 29.08 7.99, and mean MRC Scale of patients was improved from 24.79 8.37 to 25.34 8.45. But in both cases, the variation was not statistically significant. After 30 days, mean ALSFRS-R score and mean MRC Scale of patients was more improved in subjects with bulbar-onset, onset age: 51-60yrs., disease duration: 24-48mo. And the results showed partially significant difference. Conclusions : We think that the results of this case be a pilot study that proves the effect of Oriental Medical treatment on ALS. I Amyotrophic lateral sclerosis, ALS 2-4 10 1~3 4~6 1.5 ALS 2005 1,300 ALS 3-5 symptomatic treatment supprotive Correspondence: Kim Sung-chul, Dept. of Acupuncture & Moxibustion, Gwang-Ju Oriental Medical, Hospital in WonKwang University (Tel. 062-670-6442) E-mail : kscndl@hanmail.net

54 12 1 2009 3 therapy FDA 4 2008 10 14 2008 11 14 ALS 12 II 1 ALS 2 2008 10 14 ALS El Escorial criteria World Federation of Neurology 1998 EMG biopsy ALS 12 3 ALS 1 1 limbtype HT8 SP2 LR1 SP1 KI10 LR8 LU8 LR4 SP3 LU9 HT8 LU10 0.3 30 1 0.5 30 8~20mm 20 1 3 0.4 75 1 3~4 2 1 1 3 LR3 2 0.1cc 2 2 0.4cc ST36 SP9 LR3 1.0 1 26gage 5mm 2 3 1 3 0.03g 10 1.0 1 26gage 0.5

55 CV12 CV4 CV4 3 4 1 2 1.0 1 26gage 1.0 CV12 CV4 CV4 Council MRC Scale MRC scale 4 5 4+.4-,5-9 8 MRC MRC 5 = 5.00; MRC 5- = 4.67; MRC 4+ = 4.33; MRC 4 = 4.00; MRC 4- = 3.67; MRC 3 = 3.00; MRC 2 = 2.00; MRC 1 = 1.00; MRC 0 = 0.00; maximum score, 40) 3 3 5 1 3.0cm, 6.0cm, 9.0cm CV23 CV17 GV1 LI11 ST36 SP6 SP6 4 1 2-3 3 5 SPSS PC program version 12.1 0.05 1 2 15 30 ALS- FRS-R, MRC scale paired t-test, Wilcoxon signed rank test 4 1 15 ALS Functional Rating Scale-Revised ALSFRS-R ALSFRS-R 12 gross motor function 4 2 15 Medical Research 3 ALSFRS-R, MRC scale ANOVA III 1 Table 1 6 50% 6 50% 50 41 50 7 51 5 5 6 1 Table 2

56 12 1 2009 3 47.25 31 40 2 41 50 6 51 4 limb-type bulbar-type 9 3 3 5 4 43.41 24 4 24-48 5 48 3 ALS El Escorial criteria ALS definite- probable- 10 2 9 3 6 3 3 1 12 ALS 12 7 ALS 2 1 ALSFRS-R MRC scale 15 30 ALSFRS-R MRC scale ALSFRS-R score Max score 48 28.42 7.83 15 28.50 7.85, 30 29.08 7.99 0.67 1.95 Table 3 MRC scale Max score 40 24.79 8.37, 15 24.95 8.49, 30 25.34 8.45 0.56 1.11 Table 3 2 ALSFRS-R MRC scale ALSFRS-R 15 0.08 1.35 30 15 0.58 1.53 Table 4 MRC scale 15 0.17 0.80 30 15 0.39 0.85 p=0.039 Table 4 3 ALSFRS-R score MRC scale ALSFRS-R score bulbar-onset 1.83 1.30 limb-onset 0.28 1.80 Table 5 MRC scale bulbar-onset 0.77 1.06 limb-onset 1.18 Table 5 4 ALSFRS-R score MRC scale ALSFRS-R score 30 0.00 0.71 40 0.08 2.11, 50 1.86 1.84 Table 6 MRC scale 30 0.34 0.00 40 0.05 0.68 50 1.58 1.26 p=0.049 Table 6 5 ALSFRS-R score MRC scale ALSFRS-R score 24

57 0.25 1.32 24~48 1.80 2.28 48 0.67 1.26 Table 7 MRC scale 24 0.17 1.15 24~48 1.06 1.36 48 0.23 0.20 Table 7 6 12 1 skin test 12 1 24 2 0.2cc 0.4cc 1 Ice pack 24-48 3 3 5 1-2 24 IV ALS fasciculation ALS ALS ALS 10 1-3 10 4-6 57 2/3 50 70 1.5 2.0-3.4 2 ALS 3 5 3 50% 5 20-25% 10-16% 10 ALS mullul 55 52.1 55-74 48.5 75 16.4 Rosen 50 5 62.5% 50 31.5% 26.6 45.9 10.6 50% 6

58 12 1 2009 3 75% 12 16.6 42% 12 89% 24 39,27,25 10-15 ALS 10% Cu/Zn superoxide dismutase synaptic transmission cell death ALS ALS ALS ALS immunoglobulin ALS ALS ALS ALS ALS ALS ALS ALS 12 4 24% 13%:37% Percutaneous Endoscopic Gastrostomy, PEG non-invasive ventilation, NIV PEG, NIV ALS 12 6 18 AAL guidelines El escorial probable definite ALS 70 8 12 27%

59 3 ALS ALS Functional Rating Scale ALSFRS M- edical Research Council MRC scale ALSFRS ALS ALSFRS 2 ALSFRS- Revised ALSFRS-R ALSFRS-R 12 gross motor function ALS ALSFRS-R 2007 K-ALSFRS-R Medical Research Council MRC 4 MRC scale 4 5 4+.4-,5- ALS ALS Yun-Tao Ma sensory gyrus Jeremy Ross ALS cortisone

60 12 1 2009 3 2000 1 0.4cc Allergy 12 3-4 Ice pack 24-48 CV23 CV17 GV1 LI11 ST36 SP6 SP6 2008 10 14 11 21 12 ALS 1 ALSFRS-R score 12 7 5 2 3 3 2 2 0.5 MRCscale 12 7 3 2 22 25 3 ALSFRS-R score Max score 48 28.42 7.83 30 29.08 7.99 0.67 1.95 MRC scale Max score 40 24.79 8.37 30 25.34 8.45 0.56 1.11 ALSFRS-R score MRC scale 50 24-48 1 3 MRC grade 0 MRC grade 3 1 MRC grade 1 1 MRC grade 3 1 ALS 4 5 4 1 2 4 ALS 1 ALSFRS-R score MRC scale ALS ALS 2

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64 12 1 2009 3 Table 2. Clinical profile and Characteristics Variable Item N % Mean SD 30~39y 2 16.7 Age at symptom 40~49y 6 50.0 47.25 6.34 50~59y 4 33.3 Upper limb 5 41.7 Site of symptom onset Lower limb 4 33.3 Bulbar 3 25.0 24mo 4 33.3 Period of disease(months) 24~48mo 5 41.7 43.42 35.28 48mo 3 25.0 Definite 10 83.3 El Escorial criteria Probable Possible 2 0 16.7 0 Suspected 0 0 Table 3. Comparison of ALSFRS-R score, MRC scale between treatment and after 15,30 days Before teatment After 15days After 30days change W ALSFRS-R score 28.42 7.83 28.50 7.85 29.08 7.99 0.67 1.95 0.302 MRC scale 24.79 8.37 24.95 8.49 25.34 8.45 0.56 1.11 0.111 W: p value by Wilcoxon signed rank test Table 4. Change of ALSFRS-R score, MRC scale during treatment Before teatment -After 15days W After 15days -After 30days W ALSFRS-R score -0.08 1.35 0.799-0.58 1.53 0.210 MRC scale -0.17 0.80 0.414-0.39 0.85 0.039* W: p value by Wilcoxon signed rank test *: p 0.05 by Wilcoxon signed rank test

65 Table 5. Change of ALSFRS-R score, MRC scale according to the two onset types Measurement onset type (n=12) Change p-value ALSFRS-R score bulbar-onset(n=3) limb-onset(n=9) 1.83 1.30 0.28 1.80 0.248 MRC scale bulbar-onset(n=3) limb-onset(n=9) 0.77 1.06 0.48 1.18 0.716 P-value was evaluated using one-way Anova test. Table 6. Change of ALSFRS-R score, MRC scale according to the age at onset Measurement onset type (n=12) Change p-value ALSFRS-R score 30~39y(n=2) 40~49y(n=6) 0.00 0.71 0.08 2.11 0.345 50~59y(n=4) 1.86 1.84 30~39y(n=2) 0.34 0.00 MRC scale 40~49y(n=6) -0.05 0.68 0.049* 50~59y(n=4) 1.58 1.26 P-value was evaluated using one-way Anova test. Table 7. Change of ALSFRS-R score, MRC scale according to the disease duration Measurement disease duration (n=12) Change p-value 24mo(n=4) 0.25 1.32 ALSFRS-R score 24~48mo(n=5) 1.80 2.28 0.202 48mo(n=3) -0.67 1.26 24mo(n=4) 0.17 1.15 MRC scale 24~48mo(n=5) 1.06 1.36 0.450 48mo(n=3) 0.23 0.20 P-value was evaluated using one-way Anova test. *: p 0.05 by Wilcoxon signed rank test