Adjuvant Acupuncture Treatment Linked With Daily Living, Motor Function Improvement in Parkinson Disease

Acupuncture-related therapies in combination with traditional anti-parkinsonian medications may provide significant motor and quality of life benefits for people with Parkinson disease (PD), according to study findings published in Frontiers in Aging Neuroscience.

Although the gold standard of treatment for PD, anti-parkinsonian therapies such as levodopa are known to wane in efficacy over time. In fact, prior research has indicated that prevalence of OFF periods, which is the recurrence of PD-related symptoms after a period of symptom control, increases from 40% in patients after 4-5 years of diagnosis to 70% after 9 years of levodopa use.

To address limitations of conventional treatments, researchers of the present study highlight that at least 40% of patients with PD use one or more forms of alternative interventions in addition to traditional therapies to improve symptoms. Notably, they say that acupuncture has emerged as the most commonly used adjuvant therapy in patients with PD.

Investigating a variety of different types of acupuncture methods, including traditional body needling, electroacupuncture, and those combined with moxibustion or medication, such as warm needling and hydroacupuncture, they conducted a systematic review and meta-analysis of randomized controlled trials that compared acupuncture-related therapies with conventional medication versus conventional medication in patients with PD.

Primary outcomes included the Unified Parkinson’s Disease Rating Scale (UPDRS)-II (activities of daily living), UPDRS-III (motor function), and UPDRS total score, with secondary outcome measures including UPDRS-I (Mentation, Behavior, and Mood), UPDRS-IV (complications), 39-item Parkinson’s Disease Questionnaire (PDQ-39), the dosage of madopar, Mini-Mental State Examination (MMSE), and 17-item Hamilton Depression Scale (HAMD).

A total of 66 trials were found to meet the inclusion criteria, with 61 selected for the meta-analysis. Defining high-quality articles as those with a low risk of bias in 4 or more domains, 10 (15.15%) articles were indicated to be of high quality.

In the meta-analysis, patients who underwent acupuncture-related therapies with conventional medication achieved significant benefits, compared with the control group, in the primary outcomes of UPDRS-III (mean difference [MD], −3.90; 95% CI, −4.33 to −3.49; P < .01), UPDRS total score (MD, −7.37; 95% CI, −8.91 to −5.82; P < .001), and UPDRS-II (MD, −3.96; 95% CI, −4.96 to −2.95; P < .01).

Statistically significant improvements were also observed in UPDRS-I, UPDRS-IV, PDQ-39, and by dosage of madopar.

Furthermore, researchers conducted subgroup difference tests to evaluate differences in treatment effects across different types of acupuncture used. From these tests, significant differences in outcomes were observed in the UPDRS-III, UPDRS-I, UPDRS-IV, PDQ-39 scores, and by madopar dosage, while non-significant differences existed with the UPDRS-total, UPDRS-II, HAMD, and MMSE scores.

“Our review findings should be considered with caution because of the methodological weaknesses in the included trials,” concluded the study authors. “Future, large randomized trials of acupuncture-related therapies for PD with high methodological quality are warranted.”

Reference

Wen X, Li K, Wen H, et al. Acupuncture-related therapies for Parkinson's disease: a meta-analysis and qualitative review. Front Aging Neurosci. Published online July 1, 2021. doi:10.3389/fnagi.2021.676827