Effect of Acupuncture on Movement Function in Patients with Parkinson's Disease: Network Meta-Analysis of Randomized Controlled Trials.

Moon Joo Cheong,Miri Kwon,Jungtae Leem,Tae-Hun Kim

doi:10.3390/healthcare9111502

Abstract

We aimed to compare the effectiveness of some different acupuncture modalities on motor function using the unified Parkinson disease rating scale (UPDRS)-III scores of idiopathic Parkinson’s disease (PD) via pairwise and network meta-analyses (NMA) of randomized controlled trials (RCTs). The Cochrane risk of bias assessment tool was used to assess the methodological quality of the included RCTs. A frequentist approach-based random effect model NMA was performed. Seventeen RCTs with 1071 participants were included. The five following modalities were identified: combination of conventional medication (levodopa) with (1) electroacupuncture (ELEC), (2) manual acupuncture (MANU), (3) bee venom acupuncture (BEEV), (4) sham acupuncture (SHAM), and (5) conventional medication alone (CONV). In NMA on UPDRS-III, BEEV was the best modality compared to CONV (mean difference [MD]) −7.37, 95% confidence interval [−11.97, −2.77]). The comparative ranking assessed through NMA was suggested to be BEEV, MANU, ELEC, SHAM, and CONV. Regarding daily activity assessment (UPDRS-II), the magnitude of effectiveness was in the order of BEEV, ELEC, MANU, SHAM, and CONV. Combination treatment with BEEV (MANU or ELEC) and CONV can be recommended to improve motor function in PD patients. Due to the limited number of included RCTs, further NMA with more rigorous RCTs are warranted.

Highlights

Parkinson’s disease (PD) is a degenerative neurological disorder associated with dopaminergic cell loss in the substantia nigra and other brain structures characterized by several movement symptoms, such as tremor, rigidity, tremor at rest, and postural instability [1]
This study aimed to compare the effect on movement symptom improvement in patients with PD about several acupuncture types combined with conventional medication (CM), such as manual acupuncture (MA), electroacupuncture (EA), and bee venom acupuncture (BVA), compared with placebo acupuncture or conventional medication only
The purpose of this pairwise meta-analysis (PMA) and network meta-analysis (NMA) was to explore which acupuncture treatment modality combined with conventional drug therapy is more effective than conventional drug therapy alone for the improvement of motor symptoms (UPDRS-III) and activity of daily living (UPDRS-II) in PD

Summary

Introduction

Parkinson’s disease (PD) is a degenerative neurological disorder associated with dopaminergic cell loss in the substantia nigra and other brain structures characterized by several movement symptoms, such as tremor, rigidity, tremor at rest, and postural instability [1]. The prevalence of PD is increasing faster than in other neurological diseases [1,2]. Levodopa-induced dyskinesia impairs the quality of life of patients with PD, making effective treatment difficult [7]. More than 40% of patients with PD experienced wear-off and levodopa-induced dyskinesia, which lowered drug adherence [8]. In addition to conventional management, alternative therapeutic options are needed to manage various symptoms considering the characteristics of PD, which has a long disease duration

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