A case report on the use of processed Glycyrrhiza uralensis extract and Korean medical treatment for a patient with Amyotrophic Lateral Sclerosis(ALS)

Article information

Acupunct. 2016;33(2):201-210
1Department of Acupuncture & Moxibustion Medicine, Wonkwang University Gwangju Korean Medical Hospital
2Nervous & Muscular System Disease Clinical Research Center of Wonkwang University Gwangju Korean Medical Hospital
3Department of Nursing, Gwang-Ju Womens University
*Corresponding author: Department of Acupuncture & Moxibustion Medicine, Wonkwang Gwangju Oriental Medical Hospital, 543-8, Juwol-Dong, Nam-gu. Gwangju, Republic of Korea, Tel: +82-62-670-6441, E-mail: kscndl@hanmail.net
Received 2016 May 11; Revised 2016 May 29; Accepted 2016 June 03.

Abstract

Objectives:

The serum creatine kinase(CK) level of Amyotrophic Lateral Sclerosis(ALS) patients suggests that it may be an independent prognostic factor for the survival of ALS. We report the changes of serum CK level of ALS patients treated by administering processed Glycyrrhiza uralensis extracts and Korean medical treatments.

Methods:

We provided an ALS patient with processed Glycyrrhiza uralensis extracts and Korean medical treatments including acupuncture, pharmacopuncture and herbal medicine. The serum CK level was checked every month. The changes of ALSFRS-R and MRC grade were checked every month for additional result.

Results:

The serum CK level as the prognostic factor for the survival of ALS gradually decreased for three months. However, ALSFRS-R decreased by two points at the second trial. MRC rate had no change for three months.

Conclusion:

Combined administration of processed Glycyrrhiza uralensis extracts and Korean medical treatment could be meaningful possibilities in the treatment of ALS. We should conduct further studies to solve the limitations of this case study.

Processed Glycyrrhiza uralensis extract administration

Herbal Medicine Treatment

Changes of serum creatine kinase level

Changes of ALSFRS-R score

Changes of MRC grade

Changes of liver function test

Notes

This study was supported by the Traditional Korean Medicine R&D Program funded by the Ministry of Health & Welfare through the Korea Health Industry Development Institute(KHIDI) (HI11C2142).

References

1. Carlesi C, Pasquali L, Piazza S, et al. Strategies for clinical approach of neurodegeneartion in amyotrophic lateral sclerosis. Archives itallenes de bilologie 2011;149(1):151.
2. Richard W. Orell. Motor neuron disease: systematic reviews of treatment for ALS and SMA. British Medical Bulletin 2010;93(1):145–6.
3. Lacomblex L, Bensimon G, Leigh PN, et al. Dose-ranging study of riluzole in amyotrophic lateral sclerosis. Amyotrophic Lateral Sclerosis/Riluzole Study group II. Lancet 1996;347(9013):1425–31.
4. Yoon MY, Jun KI, Son ES, et al. Induction of Glutathione S-transferase Activity by the Extracts of Glycyrrhiza uralensis Fischer. Appl Biol Chem J 2008;51(3):228–9.
5. Gibson SB, Kasarskis EJ, Hu N, et al. Relationship of creatine kinase to body composition, disease state, and logevity in ALS. Amyotroph Lateral Scler Frontotemporal Degener 2015;16(7–8):473–7.
6. Ince PG, Lowe J, Shaw PJ. Amyotrophic lateral sclerosis: Current issues in classification, pathogenesis and molecular pathology. Neuropathol Appl Neurobiol 1998;24(2):104–17.
7. Andersen PM, Abrahams S, Borasio GD, et al. EFNS guidelines on the clinical management of amyotrophic lateral sclerosis (MALS)-revised report of an EFNS task force. Eur J Neurol 2012;19(3):360.
8. Bae JS, Hong YH, Baek W, et al. Current status of the diagnosis and management of amyotrophic lateral sclerosis in Korea: A multicenter cross-sectional study. J Clinical Neurol 2012;8(4):293–300.
9. Data of Electronic Media Morse SS. Wikipedia. Liquorice Available from: URL: https://en.wikipedia.org/wiki/Liquorice.
10. Wang D, Guo TQ, Wang ZY, et al. ERKs and mitochondria-related pathways are essential for glycyrrhizic acid-mediated neuroprotection against glutamate-induced toxicity in differentiated PC12 cells. Braz J Med Biol Res 2014;47(9):777–8.
11. Blasco H, Mavel S, Corcia P, Gordon PH. The glutamate hypothesis in ALS: pathophysiology and drug development. Curr Med Chem 2014;21(31):3551.
12. Jo SG, Im BG, Jo HG, et al. Licorice induced hypokalemia. Kidney research and clinical practice 2001;20(6):1021–5.
13. Park KA, Seok SJ, Kim SJ, et al. A Case of licorice-Induced hypokalemic rhabdomyolysis in a patient using a diuretic drug. Korean J Med 2011;80(2):258.
14. Ahn SG, Lee SR, Yang YS. The treatise research on Hua-Tuo-Jia-Ji-Xue. The Acupuncture 2000;17(4):139.
15. Lee SM, Yang EJ, Choi SM, et al. Effects of Bee Venom on Glutamate-Induced Toxicity in Neuronal and Glial Cells. Evid Based Complement Alternat Med 2012;2012:368196.
16. Jeon HJ, Nam SS, Kim YS. Neuroprotection of Dopaminergic Neurons by Hominis placenta Herbal Acupuncture in in vitro and in vivo Models of Parkinson’s Disease Induced by MPP+/MPTP Toxicity. The Acupuncture 2015;32(1):23–36.
17. Guo L, Cho SY, Kang SS, et al. Orthogonal array design for optimizing extraction efficiency of active constituents from jakyakgamcho decoction, the complex formula of herbal medicines, paeoniae radix and glycyrrhizae radix. J Ethnopharmacol 2007;113(2):306–11.
18. Rafiq MK, Lee E, Bradburnb M, et al. Creatine kinase enzyme level correlates positively with serum creatinine and lean body mass, and is a prognostic factor for survival in amyotrophic lateral sclerosis. Eur J Neurol 2016;23(6):1071–8.
19. Cedarbaum JM, Stambler N, Malta E, et al. The ALSFRS-R: a revised ALS functional rating scale that incorporates assessments of respiratory function. BDNF ALS Study Group (Phase III). J Neurol Sci 1999;169(1–2):13–21.
20. Kim SC, Na WM, Lim NR, et al. A pilot clinical study on the Traditional Korean Medicine treatment of Amyotrophic lateral sclerosis. J pharmacopuncture 2009;12(1):59.

Article information Continued

Table 1

Processed Glycyrrhiza uralensis extract administration

Date 2016.1.4–2016.2.11 2016.2.12–2016.2.18 2016.2.19–2016.4.22

Dose 4.32 g/d ceased 4.32 g/d

Table 2

Herbal Medicine Treatment

Date Herbal medicine
2016.1.4~2.10 Curcuma longa 6 g, Salvia miltiorrhiza 6 g, Gastrodia elata 8 g, Chaenomeles sinensis 6 g, Polygala tenuifolia 6 g, Paeonia japonica 6 g, Atractylodes japonicam 6 g and processed Aconitum carmichaeli (manufactured by Hanpoong Co., Ltd. Aconibal Tab.)
2016.2.17.~3.1 Panax ginseng 10 g, Astragalus membranaceus 10 g, Salvia miltiorrhiza 15 g, Chaenomeles sinensis 4 g, Crataegus pinnatifida 4 g, Amomum cadamomum Linné 4 g, Amomum villosum 4 g, Atractylodes japonica 8 g
2016.3.4~4.22 Curcuma longa 6 g, Salvia miltiorrhiza 6 g, Gastrodia elata 8 g, Chaenomeles sinensis 6 g, Polygala tenuifolia 6 g, Paeonia japonica 6 g, Atractylodes japonicam 6 g and processed Aconitum carmichaeli (manufactured by Hanpoong Co., Ltd. Aconibal Tab.)

Table 3

Changes of serum creatine kinase level

Date Creatine Kinase level (reference value: 24–195)
2016.1.4 250.0H
2016.2.13 242.0H
2016.3.14 212.0H

Table 4

Changes of ALSFRS-R score

2016.1.5 2016.2.15 2016.3.15
Speech 3 3 3
Salivation 4 4 4
Swallowing 4 4 4
Handwriting 3 2 2
Cutting food and Handling utensils (patients without gastrostomy-feeding tube) 3 2 2
Dressing and Hygiene 3 3 3
Turning in Bed and Adjusting Bed Clothes 2 2 2
Walking 2 2 2
Climbing Stairs 1 1 1
Dyspnea 4 4 4
Orthopnea 4 4 4
Respiratory insufficiency 4 4 4
K-ALSFRS-R 37 35 35
Score

Table 5

Changes of MRC grade

2016.1.4 2016.2.15 2016.3.15

right left right left right left
shoulder 4+ 4+ 4+ 4+ 4+ 4+
elbow 4+ 4+ 4+ 4+ 4+ 4+
wrist 4 4 4 4 4 4
finger 4+ 4+ 4+ 4+ 4+ 4+
hip 4+ 4+ 4+ 4+ 4+ 4+
knee 4+ 4+ 4+ 4+ 4+ 4+
ankle 4+ 4+ 4+ 4+ 4+ 4+
1st toe 4+ 4+ 4+ 4+ 4+ 4+

Table 6

Changes of liver function test

AST(12–33) ALT(5–35) ALP(96–254)
2016.1.4 22.0 25.0 153.0
2016.2.13 27.0 46.0 136.0
2016.3.14 20.0 32.0 119.0