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Meta-Analysis
. 2014 May 7;2014(5):CD005062.
doi: 10.1002/14651858.CD005062.pub4.

Acupuncture for epilepsy

Daniel K L Cheuk  1 , Virginia Wong
Affiliations
Meta-Analysis

Acupuncture for epilepsy

Daniel K L Cheuk et al. Cochrane Database Syst Rev. .

Abstract

Background: Acupuncture is increasingly used in people with epilepsy. It remains unclear whether existing evidence is rigorous enough to support its use. This is an update of a Cochrane review first published in 2008.

Objectives: To determine the effectiveness and safety of acupuncture in people with epilepsy.

Search methods: We searched the Cochrane Epilepsy Group Specialised Register (June 2013) and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2013, Issue 5), MEDLINE, EMBASE, CINAHL, AMED and other databases (from inception to June 2013). We reviewed reference lists from relevant trials. We did not impose any language restrictions.

Selection criteria: Randomised controlled trials (RCTs) comparing acupuncture with placebo or sham treatment, antiepileptic drugs or no treatment; or comparing acupuncture plus other treatments with the same other treatments, involving people of any age with any type of epilepsy.

Data collection and analysis: We used standard methodological procedures expected by The Cochrane Collaboration.

Main results: We included 17 RCTs with 1538 participants that had a wide age range and were suffering mainly from generalized epilepsy. The duration of treatment varied from 7.5 weeks to 1 year. All included trials had a high risk of bias with short follow-up. Compared with Chinese herbs, needle acupuncture plus Chinese herbs was not effective in achieving at least 50% reduction in seizure frequency (80% in control group versus 90% in intervention group, RR 1.13, 95% CI 0.97 to 1.31, 2 trials; assumed risk 500 per 1000, corresponding risk 485 to 655 per 1000). Compared with valproate, needle acupuncture plus valproate was not effective in achieving freedom from seizures (44% in control group versus 42.7% in intervention group, RR 0.97, 95% CI 0.72 to 1.30, 2 trials; assumed risk 136 per 1000, corresponding risk 97 to 177 per 1000) or at least 50% reduction in seizure frequency (69.3% in control group versus 81.3% in intervention group, RR 1.34, 95% CI 0.52 to 3.48, 2 trials; assumed risk 556 per 1000, corresponding risk 289 to 1000 per 1000) but may have achieved better quality of life (QOL) after treatment (QOLIE-31 score (higher score indicated better QOL) mean 170.22 points in the control group versus 180.32 points in the intervention group, MD 10.10 points, 95% CI 2.51 to 17.69 points, 1 trial). Compared with phenytoin, needle acupuncture was not effective in achieving at least 50% reduction in seizure frequency (70% in control group versus 94.4% in intervention group, RR 1.43, 95% CI 0.46 to 4.44, 2 trials; assumed risk 700 per 1000, corresponding risk 322 to 1000 per 1000). Compared with valproate, needle acupuncture was not effective in achieving seizure freedom (14.1% in control group versus 25.2% in intervention group, RR 1.75, 95% CI 0.93 to 3.27, 2 trials; assumed risk 136 per 1000, corresponding risk 126 to 445 per 1000) but may be effective in achieving at least 50% reduction in seizure frequency (55.3% in control group versus 73.7% in intervention group, RR 1.32, 95% CI 1.05 to 1.66, 2 trials; assumed risk 556 per 1000, corresponding risk 583 to 923 per 1000) and better QOL after treatment (QOLIE-31 score mean 172.6 points in the control group versus 184.64 points in the intervention group, MD 12.04 points, 95% CI 4.05 to 20.03 points, 1 trial). Compared with antiepileptic drugs, catgut implantation at acupoints plus antiepileptic drugs was not effective in achieving seizure freedom (13% in control group versus 19.6% in intervention group, RR 1.51, 95% CI 0.93 to 2.43, 4 trials; assumed risk 127 per 1000, corresponding risk 118 to 309 per 1000) but may be effective in achieving at least 50% reduction in seizure frequency (63.1% in control group versus 82% in intervention group, RR 1.42, 95% CI 1.07 to 1.89, 5 trials; assumed risk 444 per 1000, corresponding risk 475 to 840 per 1000) and better QOL after treatment (QOLIE-31 score (higher score indicated worse quality of life) mean 53.21 points in the control group versus 45.67 points in the intervention group, MD -7.54 points, 95% CI -14.47 to -0.61 points, 1 trial). Compared with valproate, catgut implantation may be effective in achieving seizure freedom (8% in control group versus 19.7% in intervention group, RR 2.82, 95% CI 1.61 to 4.94, 4 trials; assumed risk 82 per 1000, corresponding risk 132 to 406 per 1000) and better QOL after treatment (QOLIE-31 score (higher score indicated better quality of life) mean 172.6 points in the control group versus 191.33 points in the intervention group, MD 18.73 points, 95% CI 11.10 to 26.36 points, 1 trial) but not at least 50% reduction in seizure frequency (65.6% in control group versus 91.7% in intervention group, RR 1.31, 95% CI 0.94 to 1.84, 4 trials; assumed risk 721 per 1000, corresponding risk 677 to 1000 per 1000). Acupuncture did not have excess adverse events compared to control treatment in the included trials.

Authors' conclusions: Available RCTs are small, heterogeneous and have high risk of bias. The current evidence does not support acupuncture for treating epilepsy.

PubMed Disclaimer

Conflict of interest statement

None known

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: 1 Needle acupuncture plus Chinese herbs versus Chinese herbs alone, outcome: 1.1 50% or greater reduction in seizure frequency.
5
5
Forest plot of comparison: 2 Needle acupuncture plus valproate (VPA) versus valproate (VPA) alone, outcome: 2.2 50% or greater reduction in seizure frequency.
6
6
Forest plot of comparison: 6 Catgut implantation at acupoints plus antiepileptic drugs (AED) versus antiepileptic drugs (AED) alone, outcome: 6.2 50% or greater reduction in seizure frequency.
1.1
1.1. Analysis
Comparison 1 Needle acupuncture plus Chinese herbs versus Chinese herbs alone, Outcome 1 50% or greater reduction in seizure frequency.
1.2
1.2. Analysis
Comparison 1 Needle acupuncture plus Chinese herbs versus Chinese herbs alone, Outcome 2 75% or greater reduction in seizure frequency.
1.3
1.3. Analysis
Comparison 1 Needle acupuncture plus Chinese herbs versus Chinese herbs alone, Outcome 3 25% or greater reduction in seizure frequency.
1.4
1.4. Analysis
Comparison 1 Needle acupuncture plus Chinese herbs versus Chinese herbs alone, Outcome 4 75% or greater reduction in seizure duration.
1.5
1.5. Analysis
Comparison 1 Needle acupuncture plus Chinese herbs versus Chinese herbs alone, Outcome 5 50% or greater reduction in seizure duration.
1.6
1.6. Analysis
Comparison 1 Needle acupuncture plus Chinese herbs versus Chinese herbs alone, Outcome 6 4 points or greater improvement in EEG.
1.7
1.7. Analysis
Comparison 1 Needle acupuncture plus Chinese herbs versus Chinese herbs alone, Outcome 7 2 points or greater improvement in EEG.
1.8
1.8. Analysis
Comparison 1 Needle acupuncture plus Chinese herbs versus Chinese herbs alone, Outcome 8 Post‐treatment EEG abnormality.
2.1
2.1. Analysis
Comparison 2 Needle acupuncture plus valproate (VPA) versus valproate (VPA) alone, Outcome 1 Seizure freedom.
2.2
2.2. Analysis
Comparison 2 Needle acupuncture plus valproate (VPA) versus valproate (VPA) alone, Outcome 2 50% or greater reduction in seizure frequency.
2.3
2.3. Analysis
Comparison 2 Needle acupuncture plus valproate (VPA) versus valproate (VPA) alone, Outcome 3 Post‐treatment quality of life score (QOLIE‐31 score).
2.4
2.4. Analysis
Comparison 2 Needle acupuncture plus valproate (VPA) versus valproate (VPA) alone, Outcome 4 Frequency of adverse effects.
2.5
2.5. Analysis
Comparison 2 Needle acupuncture plus valproate (VPA) versus valproate (VPA) alone, Outcome 5 75% or greater reduction in seizure frequency.
2.6
2.6. Analysis
Comparison 2 Needle acupuncture plus valproate (VPA) versus valproate (VPA) alone, Outcome 6 25% or greater reduction in seizure frequency.
2.7
2.7. Analysis
Comparison 2 Needle acupuncture plus valproate (VPA) versus valproate (VPA) alone, Outcome 7 Post‐treatment epilepsy score.
2.8
2.8. Analysis
Comparison 2 Needle acupuncture plus valproate (VPA) versus valproate (VPA) alone, Outcome 8 70% or greater reduction in epilepsy score.
2.9
2.9. Analysis
Comparison 2 Needle acupuncture plus valproate (VPA) versus valproate (VPA) alone, Outcome 9 40% or greater reduction in epilepsy score.
2.10
2.10. Analysis
Comparison 2 Needle acupuncture plus valproate (VPA) versus valproate (VPA) alone, Outcome 10 20% or greater reduction in epilepsy score.
2.11
2.11. Analysis
Comparison 2 Needle acupuncture plus valproate (VPA) versus valproate (VPA) alone, Outcome 11 Post‐treatment EEG abnormality.
3.2
3.2. Analysis
Comparison 3 Needle acupuncture versus sham acupuncture, Outcome 2 Improvement in quality of life score (QOLIE‐89 score).
3.3
3.3. Analysis
Comparison 3 Needle acupuncture versus sham acupuncture, Outcome 3 Withdrawal due to lack of efficacy.
3.4
3.4. Analysis
Comparison 3 Needle acupuncture versus sham acupuncture, Outcome 4 Reduction in seizure frequency.
3.5
3.5. Analysis
Comparison 3 Needle acupuncture versus sham acupuncture, Outcome 5 No increase in seizure frequency.
4.1
4.1. Analysis
Comparison 4 Needle acupuncture versus phenytoin, Outcome 1 50% or greater reduction in seizure frequency.
4.2
4.2. Analysis
Comparison 4 Needle acupuncture versus phenytoin, Outcome 2 75% or greater reduction in seizure frequency.
4.3
4.3. Analysis
Comparison 4 Needle acupuncture versus phenytoin, Outcome 3 25% or greater reduction in seizure frequency.
4.4
4.4. Analysis
Comparison 4 Needle acupuncture versus phenytoin, Outcome 4 Post‐treatment seizure frequency.
5.1
5.1. Analysis
Comparison 5 Needle acupuncture versus valproate, Outcome 1 Seizure freedom.
5.2
5.2. Analysis
Comparison 5 Needle acupuncture versus valproate, Outcome 2 50% or greater reduction in seizure frequency.
5.3
5.3. Analysis
Comparison 5 Needle acupuncture versus valproate, Outcome 3 Post‐treatment quality of life score (QOLIE‐31 score).
5.4
5.4. Analysis
Comparison 5 Needle acupuncture versus valproate, Outcome 4 Frequency of adverse effects.
5.5
5.5. Analysis
Comparison 5 Needle acupuncture versus valproate, Outcome 5 75% or greater reduction in seizure frequency.
5.6
5.6. Analysis
Comparison 5 Needle acupuncture versus valproate, Outcome 6 25% or greater reduction in seizure frequency.
5.7
5.7. Analysis
Comparison 5 Needle acupuncture versus valproate, Outcome 7 Post‐treatment epilepsy score.
5.8
5.8. Analysis
Comparison 5 Needle acupuncture versus valproate, Outcome 8 70% or greater reduction in epilepsy score.
5.9
5.9. Analysis
Comparison 5 Needle acupuncture versus valproate, Outcome 9 40% or greater reduction in epilepsy score.
5.10
5.10. Analysis
Comparison 5 Needle acupuncture versus valproate, Outcome 10 20% or greater reduction in epilepsy score.
5.11
5.11. Analysis
Comparison 5 Needle acupuncture versus valproate, Outcome 11 Post‐treatment EEG abnormality.
6.1
6.1. Analysis
Comparison 6 Catgut implantation at acupoints plus antiepileptic drugs (AED) versus antiepileptic drugs (AED) alone, Outcome 1 Seizure freedom.
6.2
6.2. Analysis
Comparison 6 Catgut implantation at acupoints plus antiepileptic drugs (AED) versus antiepileptic drugs (AED) alone, Outcome 2 50% or greater reduction in seizure frequency.
6.3
6.3. Analysis
Comparison 6 Catgut implantation at acupoints plus antiepileptic drugs (AED) versus antiepileptic drugs (AED) alone, Outcome 3 Post‐treatment quality of life score (QOLIE‐31 score).
6.4
6.4. Analysis
Comparison 6 Catgut implantation at acupoints plus antiepileptic drugs (AED) versus antiepileptic drugs (AED) alone, Outcome 4 Frequency of adverse effects.
6.5
6.5. Analysis
Comparison 6 Catgut implantation at acupoints plus antiepileptic drugs (AED) versus antiepileptic drugs (AED) alone, Outcome 5 75% or greater reduction in seizure frequency.
6.6
6.6. Analysis
Comparison 6 Catgut implantation at acupoints plus antiepileptic drugs (AED) versus antiepileptic drugs (AED) alone, Outcome 6 25% or greater reduction in seizure frequency.
6.7
6.7. Analysis
Comparison 6 Catgut implantation at acupoints plus antiepileptic drugs (AED) versus antiepileptic drugs (AED) alone, Outcome 7 Post‐treatment seizure frequency.
6.8
6.8. Analysis
Comparison 6 Catgut implantation at acupoints plus antiepileptic drugs (AED) versus antiepileptic drugs (AED) alone, Outcome 8 Post‐treatment epilepsy score.
6.9
6.9. Analysis
Comparison 6 Catgut implantation at acupoints plus antiepileptic drugs (AED) versus antiepileptic drugs (AED) alone, Outcome 9 70% or greater reduction in epilepsy score.
6.10
6.10. Analysis
Comparison 6 Catgut implantation at acupoints plus antiepileptic drugs (AED) versus antiepileptic drugs (AED) alone, Outcome 10 40% or greater reduction in epilepsy score.
6.11
6.11. Analysis
Comparison 6 Catgut implantation at acupoints plus antiepileptic drugs (AED) versus antiepileptic drugs (AED) alone, Outcome 11 20% or greater reduction in epilepsy score.
6.12
6.12. Analysis
Comparison 6 Catgut implantation at acupoints plus antiepileptic drugs (AED) versus antiepileptic drugs (AED) alone, Outcome 12 Post‐treatment Global Clinical Impression (GCI) score.
6.13
6.13. Analysis
Comparison 6 Catgut implantation at acupoints plus antiepileptic drugs (AED) versus antiepileptic drugs (AED) alone, Outcome 13 Post‐treatment EEG abnormality.
7.1
7.1. Analysis
Comparison 7 Catgut implantation at acupoints versus valproate, Outcome 1 Seizure freedom.
7.2
7.2. Analysis
Comparison 7 Catgut implantation at acupoints versus valproate, Outcome 2 50% or greater reduction in seizure frequency.
7.3
7.3. Analysis
Comparison 7 Catgut implantation at acupoints versus valproate, Outcome 3 Post‐treatment quality of life score (QOLIE‐31 score).
7.4
7.4. Analysis
Comparison 7 Catgut implantation at acupoints versus valproate, Outcome 4 Frequency of adverse effects.
7.5
7.5. Analysis
Comparison 7 Catgut implantation at acupoints versus valproate, Outcome 5 75% or greater reduction in seizure frequency.
7.6
7.6. Analysis
Comparison 7 Catgut implantation at acupoints versus valproate, Outcome 6 25% or greater reduction in seizure frequency.
7.7
7.7. Analysis
Comparison 7 Catgut implantation at acupoints versus valproate, Outcome 7 Post‐treatment epilepsy score.
7.8
7.8. Analysis
Comparison 7 Catgut implantation at acupoints versus valproate, Outcome 8 70% or greater reduction in epilepsy score.
7.9
7.9. Analysis
Comparison 7 Catgut implantation at acupoints versus valproate, Outcome 9 40% or greater reduction in epilepsy score.
7.10
7.10. Analysis
Comparison 7 Catgut implantation at acupoints versus valproate, Outcome 10 30% or greater reduction in epilepsy score.
7.11
7.11. Analysis
Comparison 7 Catgut implantation at acupoints versus valproate, Outcome 11 20% or greater reduction in epilepsy score.
7.12
7.12. Analysis
Comparison 7 Catgut implantation at acupoints versus valproate, Outcome 12 Post‐treatment EEG abnormality.
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Update of

References

References to studies included in this review

Deng 2001a {published data only}
    1. Deng Y, Wang J, Lin Y, Liu W, Wang L. Clinical observation on treatment of epilepsy general tonic‐clonic attack with catgut implantation at acupoint plus antiepileptic Western medicine of small dose. Chinese Acupuncture and Moxibustion 2001;21(5):271‐3.
Han 2008 {published data only}
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Leng 2000 {published data only}
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Mao 2011 {published data only}
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Peng 2003 {published data only}
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Shi 2001 {published data only}
    1. Shi J. Absence seizures of epilepsy treated by scalp acupuncture combined with hydro‐acupuncture at renying point. Report of 45 cases. Shaanxi Journal of Chinese Traditional Medicine 2001;22(1):43‐4.
Xiong 2003 {published data only}
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Yi 2009 {published data only}
    1. Yi H. Observation of electro‐acupuncture treatment of vasoconstriction district for grand mal seizures. Thesis (MPhil). Guangzhou University of Traditional Chinese Medicine 2009.
Yu 1999 {published data only}
    1. Yu D, Ping X, Zhao X. Epilepsy treated by acupuncture with growing fluid and extinguishing wind. Report of 30 cases. Jiangsu Journal of Traditional Chinese Medicine 1999;20(11):37.
Zhang 2006a {published data only}
    1. Zhang J, Li Y, Zhuang L. Clinical observation on catgut implantation at acupoint for treatment of generalised tonic‐clonic epilepsy. Report of 90 cases . Journal of Clinical Acupuncture and Moxibustion 2006;22(6):8‐10. - PubMed
Zhang 2006b {published data only}
    1. Zhang J. Study of curative effect of generalized tonic‐clonic seizure (GTCS) treated by catgut implantation at acupoint. Thesis (M. Phil.). Guangzhou University of Traditional Chinese Medicine 2006.
Zhou 2000 {published data only}
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Zhuang 2004 {published data only}
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Zhuang 2006 {published data only}
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References to studies excluded from this review

Chui 2006 {published data only}
    1. Chui H, Pin J, Cao R. Catgut embedding and oral herbal medicines for treatment of 68 cases of epilepsy. Traditional Chinese Medicine Research 2006;19(9):61‐2.
Deng 2001b {published data only}
    1. Deng Y, Huang Z, Lin Y, Liu J, Huang L. Clinical observation on 88 cases of epilepsy with general tonicoclonic attack treated with medicated thread implantation at acupoint. Journal of Traditional Chinese Medicine 2001;42(7):406‐8.
Han 2005 {published data only}
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Kuang 1996 {published data only}
    1. Kuang K, Zhou D, Yu X. Clinical observation on 40 cases of epilepsy treated with acupuncture and Chinese herbs. Jiangxi Journal of Traditional Chinese Medicine 1996;27(6):47.
Li 2004 {published data only}
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Lin 2001 {published data only}
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Luo 2004 {published data only}
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Xu 2003 {published data only}
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Xu 2004 {published data only}
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Yi 2005 {published data only}
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References to ongoing studies

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References to other published versions of this review

Cheuk 2008
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