Daniel K L Cheuk1, Virginia Wong. 1. Department of Pediatrics and Adolescent Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, China. cheukkld@hkucc.hku.hk
Abstract
BACKGROUND: Seizures are poorly controlled in many people with epilepsy despite adequate current antiepileptic treatments. There is increasing interest in alternative therapies such as acupuncture; however, it remains unclear whether the existing evidence is rigorous enough to support the use of acupuncture. This is an update of a Cochrane review first published in 2006. OBJECTIVES: To determine the effectiveness and safety of acupuncture in people with epilepsy. SEARCH STRATEGY: We searched the Cochrane Epilepsy Group's Specialized Register (March 2008) and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2008), MEDLINE, EMBASE, and other databases from inception to March 2008. Reference lists from relevant trials were reviewed. No language restrictions were imposed. SELECTION CRITERIA: Randomised controlled trials 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: Two review authors independently extracted trial data and assessed trial quality. MAIN RESULTS: Eleven small trials with 914 participants, of generally poor methodological quality and with short follow up met the inclusion criteria. Ten trials were carried out in China and one in Norway.Two trials found that more children treated with needle acupuncture plus Chinese herbs achieved 75% or greater reduction in seizure frequency (RR 1.52, 95% CI 1.12 to 2.05) and 50% or greater reduction in seizure duration (pooled RR 1.29, 95% CI 1.03 to 1.62) compared with Chinese herbs alone. However, after combining the results of four trials that compared the treatment group with a control group that could yield the net effect of needle acupuncture, we found that there was no significant difference between the treatment and the control groups in any reduction of seizure frequency (pooled RR 1.05, 95% CI 0.97 to 1.17). Compared to phenytoin, the pooled results from two trials showed that patients who received needle acupuncture appeared more likely to achieve 75% or greater reduction in seizure frequency (pooled RR 2.14, 95% CI 1.47 to 3.1). Compared to valproate, the pooled results from three trials showed catgut implantation at acupoints appeared more likely to result in 75% or greater reduction in seizure frequency (pooled RR 2.33, 95% CI 1.01 to 5.36). AUTHORS' CONCLUSIONS: The current evidence does not support acupuncture as a treatment for epilepsy.
BACKGROUND: Seizures are poorly controlled in many people with epilepsy despite adequate current antiepileptic treatments. There is increasing interest in alternative therapies such as acupuncture; however, it remains unclear whether the existing evidence is rigorous enough to support the use of acupuncture. This is an update of a Cochrane review first published in 2006. OBJECTIVES: To determine the effectiveness and safety of acupuncture in people with epilepsy. SEARCH STRATEGY: We searched the Cochrane Epilepsy Group's Specialized Register (March 2008) and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2008), MEDLINE, EMBASE, and other databases from inception to March 2008. Reference lists from relevant trials were reviewed. No language restrictions were imposed. SELECTION CRITERIA: Randomised controlled trials 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: Two review authors independently extracted trial data and assessed trial quality. MAIN RESULTS: Eleven small trials with 914 participants, of generally poor methodological quality and with short follow up met the inclusion criteria. Ten trials were carried out in China and one in Norway.Two trials found that more children treated with needle acupuncture plus Chinese herbs achieved 75% or greater reduction in seizure frequency (RR 1.52, 95% CI 1.12 to 2.05) and 50% or greater reduction in seizure duration (pooled RR 1.29, 95% CI 1.03 to 1.62) compared with Chinese herbs alone. However, after combining the results of four trials that compared the treatment group with a control group that could yield the net effect of needle acupuncture, we found that there was no significant difference between the treatment and the control groups in any reduction of seizure frequency (pooled RR 1.05, 95% CI 0.97 to 1.17). Compared to phenytoin, the pooled results from two trials showed that patients who received needle acupuncture appeared more likely to achieve 75% or greater reduction in seizure frequency (pooled RR 2.14, 95% CI 1.47 to 3.1). Compared to valproate, the pooled results from three trials showed catgut implantation at acupoints appeared more likely to result in 75% or greater reduction in seizure frequency (pooled RR 2.33, 95% CI 1.01 to 5.36). AUTHORS' CONCLUSIONS: The current evidence does not support acupuncture as a treatment for epilepsy.
Authors: Eric Manheimer; Susan Wieland; Elizabeth Kimbrough; Ker Cheng; Brian M Berman Journal: J Altern Complement Med Date: 2009-09 Impact factor: 2.579