Acupuncture as Add-on Therapy May Further Ease Disease Symptoms

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by Vanda Pinto PhD |

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People with Parkinson’s disease who combine standard medication with various types of acupuncture treatments may see improvements in their motor function and quality of life, a review study from China suggests.

However, its researchers noted that additional clinical trials are necessary to validate these findings.

The study, “Acupuncture-Related Therapies for Parkinson’s Disease: A Meta-Analysis and Qualitative Review,” was published in the journal Frontiers in Aging Neuroscience.

While treatments are available to help manage Parkinson’s symptoms, none can reverse or significantly delay disease progression.

Previous studies also have shown that levodopa, the standard used to treat Parkinson’s motor symptoms, loses effectiveness over time, resulting in what are known as off periods: times between doses when levodopa stops working and symptoms re-emerge.

Such limitations have led at least 40% of patients to turn to alternative treatments as add-ons to conventional therapies to help with their symptoms. Acupuncture, this study noted, is the most common alternative adjunctive therapy used by people with Parkinson’s.

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Several systematic reviews previously examined the efficacy of acupuncture, but focused mainly on classical and electroacupuncture.

A group of researchers at institutions in Zhengzhou and Guangzhou analyzed trials that evaluated a variety of different types of acupuncture.

Among the different techniques used were traditional body needling, manual acupuncture, electroacupuncture (a form of acupuncture where a mild electric current is passed between pairs of acupuncture needles), bee venom acupuncture (BVA; often involves injecting diluted bee venom into acupuncture points), and acupressure (a technique where physical pressure is applied to acupuncture points).

Acupuncture-related therapies included forms like warm needling that is used with moxibustion (a traditional Chinese therapy consisting of burning dried herbs near the skin), and acupoint injection, hydroacupuncture (injection of sterile solutions into traditional acupuncture points), or herbal decoction, used either with moxibustion or with medications.

A systematic review and meta-analysis of randomized controlled trials compared acupuncture-related therapies combined with standard treatment versus standard medication alone in Parkinson’s patients. Standard medications included Madopar (levodopa and benserazide hydrochloride), levodopa, carbidopa, and Mirapex (pramipexole), used alone or in combination.

Data reviewed came from 66 published trials, with 61 selected for the meta-analysis. High-quality articles were defined as those with a low risk of bias in four or more domains. Based on this definition, only 10 (15%) articles were considered high quality.

These studies assessed as their primary goal changes in symptom severity as measured by changes in the Unified Parkinson’s Disease Rating Scale (UPDRS) total score, as well as in the specific segments related to activities of daily living (UPDRS-II), and motor function (UPDRS-III). A score of 199 on the UPDRS scale represents total disability, while a score of zero represents no disability.

Other outcome measures included assessments of mentation, behavior, and mood (UPDRS-I), and therapy complications (UPDRS-IV); the 39-item Parkinson’s Disease Questionnaire (PDQ-39, evaluating quality of life), changes in Madopar doses; the Mini-Mental State Examination (MMSE, measuring Parkinson’s-related cognitive impairment); and the 17-item Hamilton Depression Scale (HAMD, to measure the severity of depressive symptoms).

Patients given acupuncture-related therapies with conventional medication showed improvements, relative to control groups not given these add-on therapies, in the UPDRS total score (a mean drop of 7.37 points). Improvements were also observed in the total motor subscores (mean drop of 3.90 points) and activities of daily living subscores (mean drop of 3.96 points).

Statistically significant improvements in UPDRS-I and UPDRS-IV scores, PDQ-39, and Madopar dosing were also seen.

“Our results are consistent with most previous reviews in that acupuncture-related therapies combined with CM [conventional medication] as an adjunctive treatment can significantly improve motor and non-motor symptoms of [Parkinson’s],” the researchers wrote.

The team also performed subgroup tests to investigate differences in treatment effects among the different types of acupuncture methods. Significant differences in outcomes were found in the UPDRS-III, UPDRS-I, UPDRS-IV, PDQ-39 scores, and by Madopar dose. No significant changes were detected with the UPDRS-total, UPDRS-II, HAMD, and MMSE scores.

Importantly, the team highlighted that only a few of the reviewed trials had methodological quality. Thus, their findings should be considered with caution.

“To our knowledge, this is the first meta-analysis to investigate the effects of different types of acupuncture as an adjuvant for treating patients with [Parkinson’s]. Acupuncture-related therapies in combination with [conventional medication] were noted to be safe and feasible. In addition, our review emphasizes the differences between varieties of acupuncture therapies being used in [Parkinson’s],” the researchers said.

“Our review findings should be considered with caution because of the methodological weaknesses in the included trials,” they concluded. “Future, large, randomized trials of acupuncture-related therapies for [Parkinson’s] with high methodological quality are warranted.”

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