Integrated approach of scalp electroacupuncture and pharmacotherapy in managing Parkinson's disease: A systematic review, meta-analysis, and trial sequential analysis of randomized clinical trials.

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Parkinson disease (PD) is a progressive neurological disorder that may be managed with therapies like scalp electroacupuncture (SEA). The combination of SEA and medication could potentially offer a new approach for managing PD symptoms. The systematic review and meta-analysis aimed to assess the combined impact of SEA and medication on PD through a comprehensive analysis of randomized clinical trials, focusing on outcomes like effective rate and various scores (total Unified Parkinson Disease Rating Scale (UPDRS), UPDRS III, and Webster). It was conducted an unrestricted search from the beginning of each database until April 19, 2024, across 7 databases. These included 4 international databases: PubMed, Web of Science, Scopus, and Cochrane Library, and 3 Chinese databases: CNKI, VIP, and Wanfang. Review Manager, version 5.3 was used to calculate the mean difference (MD) or risk ratio along with a 95% confidence interval (CI). The Comprehensive Meta-Analysis version 3.0 was employed for conducting bias analyses, meta-regression, and sensitivity analyses. From 1422 records identified in the databases, 17 articles were included in both the systematic review and meta-analysis. The pooled risk ratio and its 95%CI in the intervention (SEA + medication) group compared to the control (medication) group for the effective rate is 1.24 [1.17, 1.32] with a P < .00001. The pooled MD and its 95%CI for the Webster score is -0.51 [-6.36, 5.35] with a P = .86. The pooled MD and its 95%CI for total UPDRS is 8.73 [2.88, 14.58] with a P = .003. The pooled MD and its 95%CI for UPDRS III is 4.42 [3.23, 5.61] with a P < .00001. The results for total UPDRS and UPDRS III showed that intervention reduced the severity and progression of PD in patients more than medication. The intervention (SEA + medication) has shown significant effectiveness compared to the control (medication) in terms of the effective rate, total UPDRS, and UPDRS III in PD patients. However, it did not show a significant effect on the Webster score.