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BACKGROUND: The probability of motor deficits after stroke is relatively high. At the same time many studies have reported that acupuncture and rehabilitation therapy have a significant effect on the treatment of stroke. OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the clinical value of acupuncture and rehabilitation therapy on brain eloquent areas and neurological function in ischemic stroke. METHODS: Seven databases were electronically searched to screen randomized controlled trials (RCTs) of different intervention methods (acupuncture, rehabilitation) in the treatment of ischemic stroke. The search time is from January 1, 2000 to April 20, 2023, and the search languages are limited to Chinese and English. Two researchers independently screened literature and extracted data. The methodological quality of the studies was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: A total of 17 randomized controlled studies were included, including 699 patients, with a maximum sample size of 144 cases and a minimum sample size of 11 cases. Among them, 3 studies reported the brain function in SM1 area. The effective rate of the experimental group was higher than that of the control group [relative risk (OR) = 3.24, 95%CI: 1.49 to 7.05, P < 0.05]. The FMA score of patients in the experimental group was higher than that in the control group [mean difference (MD) = 4.79, 95% CI: 3.86 to 5.71, P < 0.00001]. The NIHSS score of patients in the experimental group was lower than that in the control group [mean difference (MD) = -4.12, 95% CI: -6.99 to -1.26, P < 0.05].None of studies reported adverse events. CONCLUSIONS: Acupuncture rehabilitation for ischemic stroke can activate corresponding brain functional areas and improve neurological deficits. The therapeutic effect of acupuncture rehabilitation treatment is better than that of basic western medicine treatment, and it is more effective in improving neurological deficits. At the same time, clinical research needs to use high-quality randomized double-blind controlled trials with more detailed and larger sample designs, long-term efficacy evaluation and evidence-based research methods.
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Terapia por Acupuntura , Encéfalo , Accidente Cerebrovascular Isquémico , Rehabilitación de Accidente Cerebrovascular , Humanos , Terapia por Acupuntura/métodos , Accidente Cerebrovascular Isquémico/rehabilitación , Accidente Cerebrovascular Isquémico/fisiopatología , Accidente Cerebrovascular Isquémico/terapia , Rehabilitación de Accidente Cerebrovascular/métodos , Encéfalo/fisiopatología , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del TratamientoRESUMEN
Introduction: Acupuncture is widely utilized as a beneficial intervention for the treatment of motor dysfunction after stroke, and its effectiveness depends on the stimulation dose. Manipulation time is an important factor affecting the dose. This trial aimed use fMRI to explore the immediate neural effects in stroke patients with motor dysfunction by different acupuncture manipulation times, to reveal the neural mechanism of acupuncture manipulation. Methods: Thirty participants were divided into three groups according to different acupuncture times. Each group received the same acupoint prescription, although the continuous manipulation time of each acupoint in three groups was 1-min, 2-min, and 3-min, respectively. The NIHSS, FMA and fMRI-BOLD in each participant we obtained before and after acupuncture manipulation. Then, we used the regional homogeneity (ReHo) algorithm to analyze the changes of brain function and to compare the neural effects at different acupuncture manipulation times. Results: There were no significant differences in NIHSS and FMA scores between and within groups. Longitudinal analysis of ReHo values indicated that the right inferior frontal gyrus was activated in the 1-min group, the right insula in the 2-min group, and the right inferior temporal gyrus in the 3-min group. Compared with the 1-min group, the 2-min group showed the ReHo values of the right precentral gyrus was decreased, and the 3-min group showed the left cerebellum posterior lobe was increased, the right posterior cingulate gyrus and the right anterior cingulate gyrus were decreased. Compared with the 2-min group, the 3-min group showed the ReHo values of the right cerebellum anterior lobe was increased. Conclusion: Our findings suggest that acupuncture at different manipulation times caused different changes of the neural effects in stroke patients, and the volume of activated voxel clusters is positively correlated with the manipulation time. Longer acupuncture manipulation could drive SMN and DMN in stroke patients, which may be the potential neurological mechanism of acupuncture manipulation affecting the recovery of motor dysfunction.
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BACKGROUND: Facial paralysis is a common clinical disease, it was named intractable facial paralysis when the clinical course more than 2 months. Intractable facial paralysis will produce anxiety and depression, which will seriously affect patients' life and work. Electric acupuncture has been widely used in the treatment of intractable facial paralysis. However, the results of clinical studies on the efficacy and safety have been inconsistent. This study aims to evaluate the efficacy and safety of electric acupuncture for intractable facial paralysis patients by systematic review and meta-analysis, so as to provide clinical decision-making based on evidence-based medicine. METHODS: The following databases will be searched by electronic methods: PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, VIP Database, Wan-fang Data and Chinese Biomedical Database. All of them will be retrieved from the establishment date of the electronic database to March 2022, all included studies will be evaluated risk of bias by the Cochrane Handbook. The total effective rate will be the primary outcome. The systematic review will be conducted with the use of the RevMan5.3 software in this study. RESULTS: This study will obtain efficacy and safety of electric acupuncture for the treatment of intractable facial paralysis. DISCUSSION: This study will provide clinical decision-making based on evidence-based medicine that whether electric acupuncture could be used to treat intractable facial paralysis, and when and how it might be more effective and safety. It will help standardize electric acupuncture treatment strategies for intractable facial paralysis. PROSPERO REGISTRATION NUMBER: CRD42021278541.
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Terapia por Acupuntura , Parálisis Facial , Humanos , Parálisis Facial/terapia , Revisiones Sistemáticas como Asunto , Metaanálisis como Asunto , ElectricidadRESUMEN
BACKGROUND: Ischemic stroke is a major chronic noninfectious disease that seriously endangers health. Acupuncture is effective for ischemic stroke and less adverse reactions. However, there is not enough clinical trial data and solid evidence could confirm how acupuncture work to cerebral functional connectivity changes, and whether the changes is related to the different stimulation quantity. DESIGN: This is a multicenter, central-randomized, controlled, double-blind, noninferiority, 2 factors and 3 levels orthogonal clinical trial. A total of 100 participants with ischemic stroke aged from 40 to 80 were randomized into experimental group and control group, the experimental group was divided into 9 groups (A1-A9) according to different factors or levels, and each group have 10 participants. The whole study period is 17âdays, including 1âweek for baseline observation, 3âdays treatment and observation, and 1âweek follow-up. Primary outcome is the fMRI based on blood oxygenation level dependent. Secondary outcomes included National Institute of Health Stroke Scale, Modified Barthel Index, Brunnstrom stroke recovery, stroke Chinese medicine symptom. Clinical assessments will be evaluated at before and the 0âhour, 24âhours, 36âhours after treatment, and 1âweek follow-up. The primary outcome of the postacupuncture effect were investigated by paired T-test, and the continuous outcome variables will be analyzed with univariate repetitive measurement deviation analysis. Adverse events will be noted and recorded for the safety evaluation. CONCLUSION: The purpose of this study was to evaluate the central mechanism of acupuncture stimulation quantity using time and frequency as control conditions. This study will provide reasonable stimulation parameters and strong mechanism evidence of cerebral central network for the use of acupuncture for ischemic stroke. CHICTR REGISTRATION NUMBER: ChiCTR1900023169. Registered 15 May 2019.