Download PDF
Pharmacopsychiatry 2016; 49(03): 107-111
DOI: 10.1055/s-0042-102884
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

Extract of Ginkgo biloba for Tardive Dyskinesia: Meta-analysis of Randomized Controlled Trials

W. Zheng
1   Guangzhou Brain Hospital (Guangzhou Huiai Hospital), Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
,
Y.-Q. Xiang
2   National Clinical Research Center for Mental Disorders, Beijing, China & Center of Depression, Beijing Institute for Brain Disorders, China
3   Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
,
C. H. Ng
4   Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
,
G. S. Ungvari
5   School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia
,
H. F. K. Chiu
6   Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
,
Y.-T. Xiang
7   Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macau SAR, China
› Author Affiliations
Further Information

Publication History

received 15 November 2015
revised 20 January 2016

accepted 31 January 2016

Publication Date:
15 March 2016 (online)

Also available at
    Permissions and Reprints

Abstract

Objective: Free radicals may be involved in the pathogenesis of tardive dyskinesia (TD). We conducted this meta-analysis to systematically examine the efficacy of extract of Ginkgo biloba (EGb), a potent antioxidant possessing free radical-scavenging properties, as a treatment for TD in schizophrenia using randomized controlled trial (RCT) data.

Method: Drawn from English and Chinese databases, 3 RCTs of EGb augmentation of antipsychotics (APs) vs. AP plus placebo or AP monotherapy were identified. 2 evaluators extracted data. The primary outcome measure was the severity of TD symptoms assessed by the Abnormal Involuntary Movement Scale (AIMS). Weighted mean difference (WMD) and risk ratio (RR) ±95% confidence intervals (CI) were calculated. Statistical analyses were performed using Review Manager (version 5.1.7.0) and STATA (version 12.0).

Results: The 3 RCTs (n=299) from China, of 12 weeks duration, involved schizophrenia patients with TD of 55.9±13.4 years old. EGb (240 mg/day) outperformed the control group in reducing the severity of TD and clinical symptoms as measured by the AIMS (trials=3, n=299, WMD: –2.30 (95%CI: − 3.04, −1.55), P<0.00001) and the adverse drug reactions as assessed by the Treatment Emergent Symptom Scale (TESS) (trials=2, n=142, WMD: −2.38 (95%CI: –4.01, –0.74), P=0.004). Both the Positive and Negative Syndrome Scale (PANSS) total score (trials=2, n=239, P=0.87) and all-cause discontinuation (trials=3, n=299, P=0.21) were similar between the EGb and control group.

Conclusion: This meta-analysis suggests that adjunctive EGb appeared to be an effective and safe option for improving TD in the treatment of schizophrenia patients. However, better RCTs are needed to demonstrate its efficacy and safety especially on cognitive function in TD.

Trial registration: PROSPERO: CRD42015024930

Key words

antipsychotic - ginkgo biloba - tardive dyskinesia - meta-analysis
 

  • References

  • 1 Greenberg DB. Tardive dyskinesia: a task force report of the American Psychiatric Association. Psychosomatics 1993; 282-283
    PubMedGoogle Scholar
  • 2 Jankelowitz SK. Treatment of neurolept-induced tardive dyskinesia. Neuropsychiatr Dis Treat 2013; 9: 1371-1380
    PubMedGoogle Scholar
  • 3 McGrath JJ, Soares KV. Miscellaneous treatments for neuroleptic-induced tardive dyskinesia. Cochrane Database Syst Rev 2000; CD000208
    PubMedGoogle Scholar
  • 4 Zhang WF, Tan YL, Zhang XY et al. Extract of Ginkgo biloba treatment for tardive dyskinesia in schizophrenia: a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry 2011; 72: 615-621
    CrossrefPubMedGoogle Scholar
  • 5 Zhang XY, Zhang WF, Zhou DF et al. Brain-derived neurotrophic factor levels and its Val66Met gene polymorphism predict tardive dyskinesia treatment response to Ginkgo biloba. Biol Psychiatry 2012; 72: 700-706
    CrossrefPubMedGoogle Scholar
  • 6 Huang XF, Feng F, Huang XQ et al. Clinical comparative study of the effect of Ginkgo biloba extract and clozapine in the treatment of tardive dyskinesia (In Chinese). Journal of Neuroscience and Mental Health 2015; 15: 389-390
    PubMedGoogle Scholar
  • 7 Xu XM. A comparison study of extract of Ginkgo biloba in treatment of tardive dyskinesia in schizophrenia (In Chinese). Journal of Chinese Physicians 2012; 14: 843-845
    PubMedGoogle Scholar
  • 8 Howland RH. Drug therapies for tardive dyskinesia: part 2. J Psychosoc Nurs Ment Health Serv 2011; 49: 17-20
    PubMedGoogle Scholar
  • 9 Soares-Weiser K, Maayan N, McGrath J. Vitamin E for neuroleptic-induced tardive dyskinesia. Cochrane Database Syst Rev 2011; CD000209
    PubMedGoogle Scholar
  • 10 Lerner V, Miodownik C, Kaptsan A et al. Vitamin B6 treatment for tardive dyskinesia: a randomized, double-blind, placebo-controlled, crossover study. J Clin Psychiatry 2007; 68: 1648-1654
    CrossrefPubMedGoogle Scholar
  • 11 Lerner V, Miodownik C, Kaptsan A et al. Vitamin B(6) in the treatment of tardive dyskinesia: a double-blind, placebo-controlled, crossover study. Am J Psychiatry 2001; 158: 1511-1514
    CrossrefPubMedGoogle Scholar
  • 12 Libov I, Miodownik C, Bersudsky Y et al. Efficacy of piracetam in the treatment of tardive dyskinesia in schizophrenic patients: a randomized, double-blind, placebo-controlled crossover study. J Clin Psychiatry 2007; 68: 1031-1037
    CrossrefPubMedGoogle Scholar
  • 13 Malykh AG, Sadaie MR. Piracetam and piracetam-like drugs: from basic science to novel clinical applications to CNS disorders. Drugs 2010; 70: 287-312
    CrossrefPubMedGoogle Scholar
  • 14 Castro F, Carrizo E. Prieto de Rincon D et al. Effectiveness of melatonin in tardive dyskinesia. Invest Clin 2011; 52: 252-260
    PubMedGoogle Scholar
  • 15 Rana AQ, Chaudry ZM, Blanchet PJ. New and emerging treatments for symptomatic tardive dyskinesia. Drug Des Devel Ther 2013; 7: 1329-1340
    PubMedGoogle Scholar
  • 16 Yang SF, Wu Q, Sun AS et al. Protective effect and mechanism of Ginkgo biloba leaf extracts for Parkinson disease induced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine. Acta Pharmacol Sin 2001; 22: 1089-1093
    PubMedGoogle Scholar
  • 17 Alimi M, Gaillard P, Camus V et al. Treatment of tardive dyskinesia: A systematic review (1997–2011). Eur J Psychiatry 2013; 27: 160-173
    CrossrefPubMedGoogle Scholar
  • 18 Fan B. The Chinese version of the Abnormal Involuntary Movement Scale (AIMS) (in Chinese). Shanghai Archives of Psychiatry 1984; 2: 80-81
    PubMedGoogle Scholar
  • 19 Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13: 463-468
    CrossrefPubMedGoogle Scholar
  • 20 DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177-188
    CrossrefPubMedGoogle Scholar
  • 21 Egger M, Davey Smith G, Schneider M et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629-634
    CrossrefPubMedGoogle Scholar
  • 22 Higgins J, Higgins J, Prof Cochrane. Handbook for Systematic Reviews of Interventions. John Wiley & Sons; 2008
    CrossrefGoogle Scholar
  • 23 Jadad AR, Moore RA, Carroll D et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials 1996; 17: 1-12
    CrossrefPubMedGoogle Scholar
  • 24 Liu X, Hao W, Qin Y et al. Long-term treatment with Ginkgo biloba extract EGb 761 improves symptoms and pathology in a transgenic mouse model of Alzheimer's disease. Brain Behav Immun 2015; 46: 121-131
    CrossrefPubMedGoogle Scholar
  • 25 Gavrilova SI, Preuss UW, Wong JW et al. Efficacy and safety of Ginkgo biloba extract EGb 761 in mild cognitive impairment with neuropsychiatric symptoms: a randomized, placebo-controlled, double-blind, multi-center trial. Int J Geriatr Psychiatry 2014; 29: 1087-1095
    CrossrefPubMedGoogle Scholar