Chinese Herbal Medicine for the Treatment of Children with Cerebral Palsy: a Meta-Analysis of Randomized Controlled Trials with Core Herbs Exploration

Ying-Yu Huang ¹ Ya-Yun Cheng ² Hsing-Yu Chen ¹ Ren-Huei Fu ³ Yi-Jung Chang ⁴ Tsung-Hsien Yang ^5*

• ¹ Division of Chinese Internal and Pediatric Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
• ² Division of Chinese Acupuncture and Traumatology, Center of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
• ³ Department of Pediatrics and Neonatology, Chang Gung Memorial Hospital, Linkou, Taiwan
• ⁴ Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, Taiwan
• ⁵ Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan

Introduction: Chinese herbal medicine (CHM) taken orally is frequently utilized to enhance functional ability and independence in cerebral palsy (CP); nonetheless, there is a lack of current evidence regarding the efficacy of oral CHM in treating CP. Additionally, the general complexities of CHM prescriptions often obscure the underlying mechanisms. Our study aims to assess the efficacy of oral CHM in treating CP, a meta-analysis will be conducted on randomized clinical trials (RCTs). Materials and methods: We searched Cochrane Library, PubMed, Embase, Scopus, PubMed Central, ClinicalTrials.gov, and China National Knowledge Infrastructure (CNKI), from 1990 to 2022. The primary outcome was the improvement in Effectiveness rate (ER). The secondary outcome was the improvement of motor function (GMFM). Subgroup analysis and trial sequential analysis (TSA) were conducted to confirm results consistency. Core CHMs were investigated through system pharmacology analysis. Results: Seventeen RCTs were analyzed, in which CHMs with Standard treatment (ST) were compared to ST alone. All participants were aged <11 years. More participants in the CHM group achieved prominent improvement in ER (RR: 1.21, 95% CI: 1.13–1.30, p-value < 0.001, I2 = 32%) and higher GMFM improvement (SMD: 1.49; 95%CI: 1.33–1.65, p-value < 0.001, I2 = 92%). TSA also showed similar results with proper statistical power. Core CHMs, such as Glycyrrhiza uralensis Fisch. Ex DC., Poria cocos (Schw.) Wolf, Paeonia lactiflora Pall., processed Rehmannia glutinosa (Gaertn.) DC., Astragalus mongholicus Bunge, and Angelica sinensis (Oliv.) Diels, exerted effects on immune modulation and metabolism systems. The subgroup analysis showed participants using core CHMs or longer CHM treatment duration, and studies enrolling CP with spastic or mixed type, or mild-to-moderate severity had better outcomes in CHM groups with less heterogeneity. Conclusion: CHMs may have a positive impact on managing pediatric CP; however, the potential bias in study design should be improved.