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A Clinical Study of Integrating Acupuncture and Western Medicine in Treating Patients with Parkinson's Disease

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Complementary therapy with acupuncture for Parkinson's disease (PD) has been studied for quite a long time, but the effectiveness of the treatment still remains unclear. The aim of this study is to evaluate the integrated effects of acupuncture treatment in PD patients who received western medicine. In the short-term acupuncture treatment study, 20 patients received acupuncture therapy twice a week in acupoints DU 20, GB 20, LI 11, LI 10, LI 4, GB 31, ST 32, GB 34 and GB 38 along with western medicine for 18 weeks, and 20 controlled patients received western medicine only. In the long-term acupuncture treatment, 13 patients received acupuncture treatment twice a week for 36 weeks. The outcome parameters include Unified Parkinson's disease rating scale (UPDRS), Beck Anxiety Inventory (BAI), Beck Depression Inventory-Version 2 (BDI-II), and WHO quality of life (WHOQOL). In the short-term clinical trial, a higher percentage of patients in the acupuncture group had score improvement in UPDRS total scores (55% vs. 15%, p = 0.019), sub-score of mind, behavior and mood (85% vs. 25%, p < 0.001), activity of daily living (65% vs. 15%, p = 0.003), mobility (40% vs. 15%, p = 0.155) and complication of treatment (75% vs. 15%, p < 0.001), BDI-II score (85% vs. 35%, p = 0.003), and WHOQOL score (65% vs. 15%, p = 0.003) when compared to control group at the end of the 18 weeks' follow up. After 36 weeks of long-term acupuncture treatment, the mean UPDRS total scores and sub-score of mentation, behavior and mood, sub-score of complications of therapy and BDI-II score decreased significantly when compared to the pretreatment baseline. In conclusion, acupuncture treatment had integrated effects in reducing symptoms and signs of mind, behavior, mood, complications of therapy and depression in PD patients who received Western medicine.
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A Clinical Study of Integrating Acupuncture
and Western Medicine in Treating Patients
with Parkinsons Disease
Fang-Pey Chen,
*,x,{
Ching-Mao Chang,
*
Jing-Huei Shiu,
{
Jen-Hwey Chiu,
{
Ta-Peng Wu,
*
Jen-Lin Yang,
*,{
Yen-Ying Kung,
*,x,{
Fun-Jou Chen,
||
Chang-Ming Chern
y
and Shinn-Jang Hwang
z
,
x
*
Center for Traditional Medicine
y
Department of Neurology
z
Department of Family Medicine
Taipei Veterans General Hospital,Taipei,Taiwan
x
National Yang-Ming University School of Medicine,Taipei,Taiwan
{
Institute of Traditional Medicine,School of Medicine
National Yang-Ming University,Taipei,Taiwan
||
School of Chinese Medicine,China Medical University,Taichung,Taiwan
Published 5 May 2015
Abstract: Complementary therapy with acupuncture for Parkinsons disease (PD) has been
studied for quite a long time, but the effectiveness of the treatment still remains unclear. The
aim of this study is to evaluate the integrated effects of acupuncture treatment in PD patients
who received western medicine. In the short-term acupuncture treatment study, 20 patients
received acupuncture therapy twice a week in acupoints DU 20, GB 20, LI 11, LI 10, LI 4,
GB 31, ST 32, GB 34 and GB 38 along with western medicine for 18 weeks, and 20
controlled patients received western medicine only. In the long-term acupuncture treatment,
13 patients received acupuncture treatment twice a week for 36 weeks. The outcome para-
meters include Unified Parkinsons disease rating scale (UPDRS), Beck Anxiety Inventory
(BAI), Beck Depression Inventory-Version 2 (BDI-II), and WHO quality of life (WHO-
QOL). In the short-term clinical trial, a higher percentage of patients in the acupuncture
group had score improvement in UPDRS total scores (55% vs. 15%, p¼0:019), sub-score
of mind, behavior and mood (85% vs. 25%, p<0:001), activity of daily living (65% vs.
15%, p¼0:003), mobility (40% vs. 15%, p¼0:155) and complication of treatment (75%
vs. 15%, p<0:001), BDI-II score (85% vs. 35%, p¼0:003), and WHOQOL score (65% vs.
15%, p¼0:003) when compared to control group at the end of the 18 weeksfollow up.
Correspondence to: Prof. Shinn-Jang Hwang and Associate Prof. Chang-Ming Chern, Department of Family
Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Beitou District, Taipei 112, Taiwan,
ROC. Tel: (þ886) 2-2875-7460, Fax: (þ886) 2-2873-7901, E-mail: sjhwang@vghtpe.gov.tw (S.-J. Hwang);
Tel: (þ886) 2-2875-7578, Fax: (þ886) 2-2875-7579, E-mail: cmchern@vghtpe.gov.tw (C.-M. Chern)
The American Journal of Chinese Medicine, Vol. 43, No. 3, 407423
© 2015 World Scientic Publishing Company
Institute for Advanced Research in Asian Science and Medicine
DOI: 10.1142/S0192415X15500263
407
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After 36 weeks of long-term acupuncture treatment, the mean UPDRS total scores and sub-
score of mentation, behavior and mood, sub-score of complications of therapy and BDI-II
score decreased signicantly when compared to the pretreatment baseline. In conclusion,
acupuncture treatment had integrated effects in reducing symptoms and signs of mind, be-
havior, mood, complications of therapy and depression in PD patients who received Western
medicine.
Keywords: Parkinsons Disease; Acupuncture; Integrative Therapy; QOL.
Introduction
Parkinsons disease (PD) is the second most common neurodegenerative disorder, fol-
lowing only Alzheimers disease, and is considered as the most commonly seen serious
dyskinesia disease (de Lau et al., 2006). This disease affects about 3% of the elderly above
65 (Joh et al.,2010), and the percentage is higher for males. About 0.9% of people in
Taiwan have PD (Chen et al.,2009). In China, more than two million of people are affected
with a male: female rate of 1.7%: 1.6%, and the rate increases with age (Zhang et al.,2005;
Chen et al.,2009).
PD occurs mainly due to the degeneration of dopaminergic neurons in substantia nigra,
which leads to a decrease in dopamine and then results in the loss of the basal ganglias
activities and the onset of neurodegenerative problems (Fahn,2003;Schober,2004). The
clinical symptoms include resting tremor, rigidity, bradykinesia, postural instability and
signs of autonomic dysfunctions (Jankovic,2008). Physical functions of PD patients will
decline if left untreated and lead to an inability to take care of their own daily lives. With
the progression of PD, symptoms other than motor symptoms, including cognitive function
problems such as apathy, depression, anxiety and hallucinations occur (Mercury et al.,
2007).
The most commonly used drugs to treat PD include levodopa and anticholinergic drugs.
However, its effectiveness decreases as the duration of treatment is prolonged. About 90%
of patients show good response to levodopa, but 30%, 50%, and 7080% of patients had
adverse reactions after taking levodopa for 3 years, 5 years, and 10 years, respectively.
Motor uctuations and dyskinesia are the most common side effects of using levodopa and
anticholinergic drugs in treating PD patients (Sweet and McDowell,1975;Verhagen
Metman,2002). More and more PD patients are actively looking for other methods of
treatment, such as complementary and alternative medicine (CAM) (Suchowersky et al.,
2006;Wang et al.,2013;Bega and Zadikoff,2014;Li et al.,2014).
Acupuncture has shown good preliminary results for the improvement of the symptoms
of PD, but the practical clinical efcacy in patients is still unknown. In the Chinese
population, few studies of acupuncture therapy for PD treatment have used the currently
accepted Unied Parkinsons disease rating scale (UPDRS) to evaluate the treatment
responses. Hence, the purpose of this study is to evaluate the integrated effects of acu-
puncture treatment in PD patients who received Western medicine. We apply rigorous
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assessment tools, including the UPDRS, Hoehn & Yahr staging of PD, Beck Anxiety
Inventory (BAI), Beck Depression Inventory-Version 2 (BDI-II), and WHO quality of life
(WHOQOL), to explore the efcacy of clinical study.
Materials and Methods
Study Design and Subjects
The investigation was based on non-random sample and comparison clinical trials. There
were two phases in this intervention: short-term (18 weeks) and long-term acupuncture
treatment (36 weeks). The subjects were categorized into two groups according to their
intentions: Acupuncture integrated with Western medicine group and Western medicine
only group (control group). Sample size calculation of the study was based on a previous
study (Shulman et al.,2002), with the power of 0.8 (1) and a signicant value less
than 0.05 (two-tailed). Consecutively 40 PD patients were recruited, with 20 in each group.
Inclusion and Exclusion Criteria
Patients were selected from the Department of Neurology at Taipei Veterans General
Hospital and referred to the Center for Traditional Medicine. Inclusion criteria of patients
were aged over 55 years old who had been diagnosed with PD for over 6 months by the
criteria of the Core Assessment Program for Intracerebral Transplantation (CAPIT).
Patients with severe diseases of the heart, brain, liver, kidneys, endocrine, or hematopoietic
system, patients with psychosis or dementia and patients who did not agree to participate in
the study were excluded.
Ethics Statement
This experiment was processed in Taipei Veterans General Hospital with the approval of
IRB at the same hospital (VGHIRB 97-10-08). Written informed consents were obtained
from each patient.
Acupuncture Intervention
The acupuncture points were chosen for treating PD patients were according to Lees
Report (Lee et al.,2007) with modication by TCM doctors with over 5 years of expe-
rience at the Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei,
Taiwan. The principle of operation and acupuncture points chosen were based on TCM
theory, and TCM doctors all received complete TCM training from China Medical Uni-
versity, Taichung, Taiwan. The revised Standards for reporting Interventions in Clinical
Trials of Acupuncture (STRICTA) guidelines were followed in our study and are listed in
Table 1.
The scalp acupuncture included the Chorea-Trembling Controlled Area, Baihui (DU
20), and Fengchi (GB 20). The body acupuncture included the Quchi (LI 11), Showsangli
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Table 1. The STRICTA 2010 Assessment of Acupuncture Efcacy in Patients with Parkinsons Disease
Item Detail Our Study
1 Acupuncture
rationale
(1a) Style of acupuncture (e.g., Tradi-
tional Chinese Medicine, Japanese,
Korean, Western medical, Five Ele-
ment, ear acupuncture, etc.)
Traditional Chinese Medicine
(1b) Reasoning for treatment provided,
based on historical context, literature
sources, and/or consensus methods,
with references where appropriate
The purpose of this study is to eval-
uate the integrated effects of
acupuncture treatment in PD
patients who received Western
medicine
(1c) Extent to which treatment was varied Parkinsons Disease
2 Details of needling (2a) Number of needle insertions per
subject per session (mean and range
where relevant)
19
(2b) Names (or location if no standard
name) of points used (uni/bilateral)
Baihui (DU 20), Fengchi (GB 20),
Quchi (LI 11), Showsangli (LI
10), Hegu (LI 4), Fengshi (GB
31), Futu (ST 32), Yanglingquan
(GB 34), and Juegu (GB 38)
All acupuncture points were bilateral
except DU 20
(2c) Depth of insertion, based on a
specied unit of measurement, or on
a particular tissue level
530 mm
(2d) Response sought (e.g., de qi or
muscle twitch response)
De-Qi: soreness, numbness, dis-
tention and pain
(2e) Needle stimulation (e.g., manual,
electrical)
Manual
(2f) Needle retention time 15 min
(2g) Needle type (diameter, length, and
manufacturer or material)
Diameter: 0.27mm
Length: 25 or 40 mm
Manufacturer: Ching Ming Medical
Device Co., Ltd., New Taipei,
Taiwan
Material: Disposable stainless steel
needles
3 Treatment
regimen
(3a) Number of treatment sessions Short-term: 36 sections
Long-term: 72 sections
(3b) Frequency and duration of treatment
sessions
Short-term: 18 weeks, twice a week
Long-term: 36 weeks, twice a week
4 Other components
of treatment
(4a) Details of other interventions ad-
ministered to the acupuncture group
(e.g., moxibustion, cupping, herbs,
exercises, lifestyle advice)
No other interventions in the acu-
puncture group except Western
medicine
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(LI 10), and Hegu (LI 4) for the upper limbs, and Fengshi (GB 31), Futu (ST 32),
Yanglingquan (GB 34), and Juegu (GB 38) for the lower limbs. All acupuncture points
were bilateral except DU 20.
Disposable stainless steel 0:27 25 mm (diameter length) and 0:27 40 mm needles
were used in this study (Ching Ming Medical Device Co., Ltd., New Taipei, Taiwan). The
depth of acupuncture points were about 530 mm and De-Qisensation about soreness,
numbness, distention and pain was asked for all the acupuncture points for all patients with
manual stimulation by TCM doctors about 15 minutes per session. After the end of the
session, all the needles were removed from the subjects.
Study Protocol
Study protocol of the short-term clinical trial is listed in Fig. 1. Patients in the acupuncture
treatment group received an integrated acupuncture therapy twice a week and each section
lasted for 15 minutes besides Western medicine. This phase lasted for 18 weeks and a total
of 36 sections of acupuncture treatments were performed. Patients in the control group
received Western medicine only. All study patients were assessed before the study, in the
middle of the study (9th week), and at the end of the study (18th week). Study protocol of
long-term acupuncture treatment is listed in Fig. 2. They received an integrated acu-
puncture therapy twice a week and each section lasted for 15 minutes besides Western
medicine. This phase lasted for 36 weeks and a total of 72 sections of acupuncture treat-
ments were performed. All study patients were assessed before study, in the middle of the
study (18th week), and at the end of the study (36th week).
Table 1. (Continued)
Item Detail Our Study
(4b) Setting and context of treatment,
including instructions to practitioners,
and information and explanations to
patients
Center for Traditional Medicine,
Taipei Veterans General Hospital,
Taipei, Taiwan
5 Practitioner back-
ground
(5) Description of participating acu-
puncturists (qualication or profes-
sional afliation, years in acupuncture
practice, other relevant experience)
TCM doctors (experienced over
5 years) all received complete
TCM training from China Medi-
cal University, Taichung, Taiwan
6 Control or com-
parator inter-
ventions
(6a) Rationale for the control or com-
parator in the context of the research
question, with sources that justify this
choice
Western medicine including
Levodopa
(6b) Precise description of the control or
comparator. If sham acupuncture or
any other type of acupuncture-like
control is used, provide details as for
Items 1 to 3 mentioned in this table.
Yes
Note: STRICTA: The revised Standards for reporting Interventions in Clinical Trials of Acupuncture Guidelines.
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Outcome Measurement
Four parameters were used for evaluating treatment efcacy, including UPDRS (total score
and sub-score I: mentation, behavior and mood, sub-score II: activities of daily living, sub-
score III: motor evaluation, sub-score IV: complication of therapy), BDI-II, BAI, and
Figure 1. Study protocol of short-term clinical trial. Patients in the acupuncture treatment group received an
integrated acupuncture therapy twice a week and each session lasted for 15 minutes besides Western medicine.
This phase lasted for 18 weeks and a total of 36 sections of acupuncture treatments were performed. Patients in the
control group received Western medicine only.
Figure 2. Study protocol of long-term acupuncture treatment. They received an integrated acupuncture therapy
twice a week and each session lasted for 15 minutes besides Western medicine. This phase lasted for 36 weeks and
a total of 72 sections of acupuncture treatments were performed. All study patients were assessed before study, in
the middle of the study (18th week), and at the end of the study (36th week).
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WHOQOL-BREF. Cases (%) with score improvement were compared between the acu-
puncture treatment and Western medicine (acupuncture group) and Western medicine only
(control group) at each study time point.
Monitor Side Effects and Adverse Events
During the study, the side effects or serious adverse events of patients were collected. The
subjects were allowed to leave the experiment whenever they wanted, and they were
allowed to continue receiving the Western medicine therapy. The Western medicine
therapy included levodopa, dopamine agonists, and anticholinergics.
Statistical Analysis
The software SPSS (Version 17.0, Chicago, IL) was employed to analyze the results.
Fisher exact test was used to analyze score improvement response rate between acu-
puncture treatment group and control group. Wilcoxon signed rank test were used for
comparing the changes before and after interventions. All the tests were examined with a
two-tail test, and the pvalue of 0.05 was the threshold of statistical signicance.
Results
Analysis of Short-Term (18 Weeks) Clinical Trial
A total of 40 patients participated in the short-term (18 week) clinical trial. Demographic
data of the patients, such as age, sex, disease duration and Hoehn & Yahr stages, BDI-II,
BAI, and WHOQOL-BREF, are listed in Table 2, and it showed no signicant difference
between acupuncture treatment group and control group before treatment. Table 3showed
that there were signicantly more patients in the acupuncture group who had score im-
provement of UPDRS total scores (55% vs. 15%, p¼0:019), sub-score I of mentation,
behavior and mood (85% vs. 25%, p<0:001); sub-score II of activities of daily living
(65% vs. 15%, p¼0:003), and sub-score IV of complication of therapy (75% vs. 15%,
p<0:001); BDI-II score (85% vs. 35%, p¼0:003); and WHOQOL score (65% vs. 15%,
p¼0:003) when compared to control group at the end of 18 weeksfollow up. There were
more patients in the acupuncture group who had score improvement of UPDRS sub-score
of motor evaluation and BAI score when compared to control group at the end of 18
weeksfollow up. However, the difference did not reach statistical signicance.
Changes of UPDRS, BDI-II, BAI and WHOQOL Scores During and After Treatment
Table 4shows the changes of mean scores of UPDRS, BAI, BDI-II, and WHOQOL
before, at the end of 9 weeks and 18 weeks treatment in both acupuncture treatment and
control groups. Figure 3shows the mean UPDRS sub-score I of mentation, behavior
and mood and BDI-II score in the acupuncture treatment group showed a signicant
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Table 2. Comparisons of Demographic Characteristics in the Baseline Between Subjects with
18 Weeks Acupuncture Plus Western Medicine and Western Medicine Only Group
Acupuncture and Western
Medicine (n¼20)
Western Medicine
Only (n¼20)pvalue
Age (years) 72.1 8.5 75.4 12.2 0.184
Male/Female 15/5 15/5 0.708
Disease duration (years) 3.9 3.6 4.0 3.3 0.902
Hoehn & Yahr stages 1.3 0.6 1.6 1.1 0.449
UPDRS total score 22.1 13.0 21.2 17.4 0.862
Sub-score I 3.3 1.7 3.8 2.6 0.474
Sub-score II 8.2 4.5 8.8 7.7 0.765
Sub-score III 6.5 6.2 8.7 8.9 0.380
Sub-score IV 4.1 3.7 4.5 3.5 0.728
BDI-II 13.6 9.2 13.0 9.9 0.884
BAI 10.3 9.1 11.0 5.8 0.881
WHOQOL Global 12.2 2.6 11.3 2.8 0.302
Physical 12.7 2.5 11.7 2.8 0.268
Psychological 13.9 2.4 13.3 2.7 0.487
Social 14.1 2.5 13.5 2.6 0.497
Environment 16.0 2.0 15.7 2.5 0.667
Notes: Data are expressed as mean standard deviation. UPDRS: Unied Parkinsons disease rating
score, sub-score I: mentation, behavior and mood, sub-score II: activities of daily life, sub-score III:
motor examination, sub-score IV: complications of therapy, BDI-II: Beck Depression Inventory,
version 2, BAI: Beck Anxiety Inventory, WHOQOL: World Health Organization quality of life.
Table 3. Comparison of Treatment Outcomes Between 18 Weeks Acupuncture Plus Western
Medicine and Western Medicine Only Group
Acupuncture and Western
Medicine (n¼20)
Western Medicine
Only (n¼20)
Parameters
Cases (%) with Score
Improvement
Cases (%) with Score
Improvement pvalue
UPDRS total 11(55) 3(15) 0.019*
Sub-score I 17(85) 5(25) 0.000*
Sub-score II 13(65) 3(15) 0.003*
Sub-score III 8(40) 3(15) 0.155
Sub-score IV 25(75) 3(15) 0.000*
BDI-II 17(85) 7(35) 0.003*
BAI 9(45) 6(30) 0.514
WHOQOL 13(65) 3(15) 0.003*
Notes: UPDRS: Unied Parkinsons disease rating score, sub-score I: mentation, behavior and
mood, sub-score II: activities of daily life, sub-score III: motor examination, sub-score IV: com-
plications of therapy, BDI-II: Beck Depression Inventory, version 2, BAI: Beck Anxiety Inventory,
WHOQOL: World Health Organization quality of life. *: p<0:05.
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Table 4. Changes of Parameters at 9 Weeks and 18 Weeks Treatment Between 18 Weeks Acupuncture Plus
Western Medicine and Western Medicine Only Group
Acupuncture and Western Medicine (n¼20) Western Medicine Only (n¼20)
Baseline 9 Weeks 18 Weeks Baseline 9 Weeks 18 Weeks
UPDRS
total score
22.1 13.0 20.2 10.0 19.6 10.7 21.2 17.4 25.9 20.0* 25.9 20.1*
Sub-score I 3.3 1.7 3.1 1.9* 2.6 2.1* 3.8 2.6 3.2 2.1 3.1 2.2
Sub-score II 8.2 4.5 7.3 4.2 7.0 3.7 8.8 7.7 8.6 7.1 8.7 7.1
Sub-score III 6.5 6.2 6.8 4.1 7.8 5.2 8.7 8.9 9.6 10.2 9.6 10.2
Sub-score IV 4.1 3.7 3.2 3.7 2.3 2.1* 4.5 3.5 4.5 3.3 4.6 3.2
BDI-II 13.6 9.2 10.2 7.1* 10.0 8.7* 13.0 9.9 11.3 7.4 11.2 7.5
BAI 10.3 9.1 10.3 6.9 9.5 7.6 11.0 5.8 10.2 5.8 10.2 5.9
WHOQOL
Global
12.2 2.6 11.8 2.2 11.5 2.3 11.3 2.8 11.4 2.7 11.4 2.7
Physical 12.7 2.5 13.1 2.4 13.2 2.4 11.7 2.8 11.5 2.7 11.5 2.7
Psychological 13.9 2.4 14.1 2.4 14.1 2.4 13.3 2.7 12.9 2.3 12.9 2.3
Social 14.1 2.5 14.5 2.4 14.5 2.4 13.5 2.6 13.5 2.5 13.5 2.5
Environment 16.0 2.0 15.6 2.2 15.3 2.1 15.7 2.5 15.7 2.2 15.7 2.2
Notes: Data are expressed as mean standard deviation. UPDRS: Unied Parkinsons disease rating score, sub-
score I: mentation, behavior and mood, sub-score II: activities of daily life, sub-score III: motor examination, sub-
score IV: complications of therapy, BDI-II: Beck Depression Inventory, version 2, BAI: Beck Anxiety Inventory,
WHOQOL: World Health Organization quality of life. *: compare with baseline, p<0:05.
Figure 3. Changes of parameters at baseline, 9 weeks and 18 weeks treatment in the acupuncture plus Western
medicine group. *p<0:05, when compared to baseline.
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improvement at the end of 9 weeks of acupuncture treatment when compared to pre-
treatment values (p<0:05). Mean UPDRS sub-score I of mentation, behavior and mood;
sub-score IV of complication of therapy, and BDI-II score in the acupuncture treatment
group showed a signicant improvement at the end of 18 weeks acupuncture treatment
when compared to the pretreatment values (p<0:05). Figure 4shows the mean total
UPDRS score, sub-score II of activities of daily living, sub-score III of motor evaluation,
BAI, and WHOQOL score in the acupuncture treatment group and all parameters in the
control group did not show signicant improvement at the end of 9 weeks and 18 weeks
study time points when compared to pretreatment values. On the contrary, mean total
UPDRS score in the control group signicantly worsened at the end of 9 weeks and 18
weeks study time points when compared to pretreatment values (p<0:05).
Results of Long-Term (36 weeks) Acupuncture Treatment
Among the 20 subjects in the short-term acupuncture treatment, 13 of them received long-
term (36 weeks) acupuncture treatment. Their mean age was 72:79:8years old and the
ratio of male to female was 9 (69.2%) to 4 (30.8%). The mean duration of PD was
3:43:0years. Their mean Hoehn & Yahr stage was 1:30:6.
Figure 4. Changes of parameters at baseline, 9 weeks and 18 weeks treatment in the Western medicine group only.
*p<0:05, when compared to baseline.
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Table 5shows the changes of mean scores of UPDRS, BAI, BDI-II, and WHOQOL
before, at the end of 18 weeks and 36 weeks acupuncture treatment. Mean UPDRS total
score, sub-score I of mentation, behavior and mood, sub-score IV of complication of
therapy and BDI-II score showed a signicant improvement at the end of 18 weeks
acupuncture treatment when compared to pretreatment values (p<0:05). Mean UPDRS
total score, sub-score I of mentation, behavior and mood and sub-score IV of complication
of therapy and BDI-II score showed a signicant improvement at the end of 36 weeks
acupuncture treatment when compared to pretreatment values (p<0:05). Mean UPDRS
sub-score II of activities of daily living, sub-score III of motor evaluation, BAI and
WHOQOL score did not show signicant improvement at the end of 18 weeks and 36
weeks acupuncture treatment when compared to pretreatment values.
Side Effects and Adverse Events
There were no side effects or serious adverse events in both the acupuncture treatment
group and control group during the study period.
Discussion
The most classic therapy of Western medicine for PD is levodopa, but its efcacy declines
and its adverse effect increases as the disease progress. More and more PD patients, up to
40% to 60% in Europe and Singapore, are actively looking for other methods of treatment,
Table 5. Changes of Parameters at 18 Weeks and 36 Weeks Treatment in 13 Patients with PD Who
Received Long-Term Acupuncture and Western Medicine Treatment
Acupuncture Treatment and Western Medicine
Baseline 18 Weeks 36 Weeks pvalue 1 pvalue 2 pvalue 3
UPDRS total score 26.1 14.2 18.2 11.6 15.1 11.8 0.046 0.006* 0.069
Sub-score I 4.0 1.7 2.6 2.2 1.1 1.8 0.014 0.002*0.010*
Sub-score II 8.9 4.6 6.3 4.7 6.0 5.3 0.098 0.065 0.373
Sub-score III 7.7 7.3 7.2 5.3 6.1 4.8 1.000 0.328 0.195
Sub-score IV 5.5 3.6 2.2 2.2 1.9 2.3 0.025* 0.012 0.681
BDI-II 15.8 10.4 10.9 10.3 7.6 8.1 0.044 0.018 0.126
BAI 12.3 10.8 10.3 9.5 8.9 15.6 0.720 0.202 0.373
WHOQOL Global 11.9 2.9 11.3 2.2 12.4 1.7 0.457 0.476 0.084
Physical 12.2 2.4 13.0 2.5 12.6 2.6 0.206 0.677 0.591
Psychological 13.2 2.8 13.9 3.2 13.6 2.6 0.405 0.778 0.953
Social 13.5 3.0 14.1 2.7 13.8 1.8 0.546 0.953 0.796
Environment 15.7 2.5 14.8 2.6 15.1 2.0 0.341 0.384 0.878
Notes: Data are expressed as mean standard deviation. UPDRS: Unied Parkinsons disease rating score, sub-
score I: mentation, behavior and mood, sub-score II: activities of daily life, sub-score III: motor examination, sub-
score IV: complications of therapy, BDI-II: Beck Depression Inventory, version 2, BAI: Beck Anxiety Inventory,
WHOQOL: World Health Organization quality of life. *: pvalue 1: 18 weeks vs. baseline, pvalue 2: 36 weeks vs.
baseline, pvalue 3: 36 weeks vs. 18 weeks.
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such as traditional Chinese medicine (TCM) (Li et al.,2014), acupuncture (Cristian et al.,
2005), Tai Chi (Li et al.,2007;Hackney and Earhart,2008), health food supplement (Tan
et al.,2006) and CAM (Suchowersky et al.,2006). In South Korea, 76% of the PD patients
used CAM, including homeopathy, hypnosis, herbal medicine, other drugs from health
drug store, diet changes, zone therapy, acupuncture, magnetic eld treatment, iris diag-
nostics and hair/mineral analysis, and nearly 60% of them have shown improvement in
motor symptoms (57.6%), physical fatigue (19.6%), pain (4.3%), and constipation (5.4%)
(Kim et al.,2009). In Sweden, up to 34% of PD patients utilize CAM, and acupuncture
treatment accounted for the highest proportion (Lokk and Nilsson,2010).
TCM clinicians regard PD as tremor paralysis or a trembling disease in the book of
Yellow Emperors Internal Classicsince 2000 years ago, which results from lesions in
three human organs, the kidney, spleen, and liver (Zhang and Liu,2006). Lesions in the
kidneys lead to inertia. Deciency of the qi in the spleen leads to muscle dystrophy. Liver
windleads to tremors. Based on the diagnosis and treatment, the symptoms can be divided
into liver and kidney deciencies, Qiblood deciency, wind phlegm, meridian blockage,
and spleen phlegm (Li et al.,2006;Zhang et al.,2006). TCM clinicians usually use
Tianma-Gouteng-Yin to calm down the wind, Rencan-Yangrong-Tang, Huanglian-Jiedu-
Tang or Xiefu-Zhuyu-Tang for treatment (Li,1995;Zhuang and Wang,2000;Chen et al.,
2003;Chung et al.,2006).
Integrated medicine serves as some adjuncts, which when combined with the con-
ventional treatment, includes these dimensions about minds and spirits into diagnosis and
treatment while elevating the efcacy, reducing the side-effect and raising the quality of life
of the patient (Astin,1998;Rees and Weil,2001). Acupuncture, one of the integrated
treatments, has been used for more than 2000 years in the Chinese population. Acu-
puncture has been reported as an adjunctive treatment for chemotherapy-induced nausea/
vomiting (Garcia et al.,2013). However, mechanisms of acupuncture treatment are com-
plex. In Western countries, the utilization of acupuncture to treat chronic pain problems
continues to increase. Other disorders of the nervous system and other disorders of the
central nervous system were reported in Taiwan as the top 20 diseases treated with acu-
puncture treatment (Chen et al.,2006).
Several reports have indicated that the mechanism of using acupuncture in treating PD
is closely related to the neurological system. The messages can be integrated and pass
through nerve pathways to the central nervous system when acupuncture points are
stimulated, and consequently, the surrounding tissue is effected (Langevin et al.,2001).
Some other possible mechanisms of acupuncture treatment found in animal studies have
pointed out that acupuncture has a neuroprotective effect, and increases the variety of
neuroprotective required substances such as brain-derived neurotrophic factor (BDNF),
glial cell line-derived neurotrophic factor (GDNF), etc. In addition, acupuncture treatment
can also reduce cell death and slow down the process of cellular oxidative stress in the
substantia nigra dopaminergic neurons (Joh et al.,2010). Other animal studies have also
shown that acupuncture treatment can repair the trkB dopamine neurons and cyclophilin A
and also repair the gene expression of Art (Park et al.,2003;Jeon et al.,2008;Kim et al.,
2011). An experiment on rats using electroacupuncture showed that the neuroprotective
418 F.-P. CHEN et al.
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effects and damage repair functions increase the dopamine levels in the striatum and
promote the expression of the dopamine transporter (Lee et al.,2007).
Complementary therapy with acupuncture for Parkinsons disease has been studied for
quite a long time, but the precise acupuncture points and effective treatment sessions still
remain unclear. Scalp acupuncture points and body acupuncture points are often combined
in treating PD patients. Scalp acupuncture points for PD includes the Baihui, occiput-
vertex, Fronto-parietal bands, sports zone and chorea-trembling zone acupoints (Lee et al.,
2013). Body acupuncture points include Fengfu (GV 16), Hegu (LI 4), Yanglingquan (GB
34) and Taichong (LV 3), etc. (Liu and Sadove,1974;Wang et al.,2002;Lam et al.,2008;
Yeo et al.,2012,2014). Since acupuncture might offer two-way adjustment of the human
body, it can improve blood ow in the brain, and anti-free radical activity (Ren et al.,
2012). Acupuncture can improve physical activity function, decrease tremor frequency and
slow down the progression of the disease, leading to reduced dosage of medication and the
enhanced physical function of PD patients (Kim et al.,2014). Moreover, there are few side
effects of acupuncture treatment and can be used for the long-term (Rajendran et al.,2001;
Shulman et al.,2002). One report showed that after 5 to 8 weeks of treatment with
acupuncture, PD patients had improved hand writing ability, and had less tremors, dif-
culty walking and other symptoms (Shulman et al.,2002).
Although our study is not a randomized, blinded clinical trial, we compared the clinical
parameters before and after acupuncture treatment to avoid the bias between study subjects.
We also followed the STRICTA Guideline of Acupuncture Clinical Trial, and our results
warrant attention.
Sham control in acupuncture clinical studies usually use the methods of non-acupoints,
minimal acupuncture, supercial insertion or no de-qi. However, the inter-practitioner
variability, the patients knowledge and experience of acupuncture and the visual impact of
needling may be the potential factors when performed in the acupuncture studies (Tsu-
kayama et al.,2006). Because the two criteria of the sham control are to mimic those
aspects of the real treatmentand not mimic those aspects of treatment that have benecial
effects(Hammerschlag and Zwickey,2006), we do not use the sham control to compare
with our acupuncture group.
PD is a chronic degenerative disease. Except for suffering from the symptoms, patients
are also greatly impacted emotionally. Decrease of dopamine in the limbic system plays a
role in emotional stress and depression (Remy et al.,2005). Clinically, anxiety and de-
pression were commonly found in PD patients. Previous research has found that the
probability of depression ranged from 7% to 76% in PD patients (Veazey et al.,2005). Many
studies have found that the quality of life of PD patients decreases due to anxiety, depression
or other emotional problems (Kasten et al.,2012). Few studies have applied rigorous clinical
parameters to evaluate the efcacy of acupuncture in treating PD patients. This study used a
comprehensive symptom scoring system and questionnaires to compare the differences
before and after acupuncture treatment. UPDRS is currently the most commonly used
assessment tool. Since PD has been shown to be related to anxiety and depression, we also
used psychological evaluating tools including the Beck Anxiety and Depression Inventory.
To assess the health-related quality of life, WHOQOL-BREF was used.
INTEGRATIVE ACUPUNCTURE FOR PARKINSONS DISEASE 419
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Our results showed that a signicantly higher percentage of patients in the 18 weeks
acupuncture treatment group had score improvement in UPDRS total scores, sub-score of
mentation, behavior and mood, activity of daily living and complication of treatment, when
compared to control group at the end of follow up. After 36 weeks long-term acupuncture
treatment, the mean UPDRS total scores and sub-score of mentation, behavior and mood,
sub-score of complications of therapy improved signicantly when compared to the pre-
treatment values. Our results were consistent with Changs Report that needling the
Shenting, Baihui, Sishencong points improved overall UPDRS scores, and Zhuang &
Wangs Report that acupuncture treatment could improve clinical symptoms, slow down
degeneration and reduce drugs side effects (Zhuang and Wang,2000;Chang et al.,2008).
These ndings indicate that acupuncture could improve the clinical symptoms of PD.
Our results also showed that 18 weeksacupuncture treatment signicantly reduced
depression score and increased quality of life score when compared to those of the control
group. Decreased physical symptoms, reduced treatment adverse effects and motivating
patients to perform daily activities might account for the differences. In addition to the
effects of acupuncture treatment, frequent contact with medical care staff during the study
period might offer the patients more psychological support, while patients with Western
medicine only visited the physician every one or three months. Scholars regard acu-
puncture as a hopeful approach for the treatment of Parkinsons disease patients (Eng et al.,
2006).
The average disease course of PD in this study was approximately 4 years. However,
experiments on mice have generally been carried out at the early stage of their PD. If the
acupuncture therapy in human trials can be studied as soon as the patients are diagnosed,
the effects of the improvement and the delay of disease progression might be achieved.
Conclusions
Acupuncture treatment can reduce overall UPDRS scores, depression and improve the
quality of life in PD patients. Further clinical trials with larger sample size or longer length
of treatment time deserve further evaluation.
Acknowledgments
This study was supported by a grant from the Ministry of Science and Technology, Taiwan
[NSC97-2627-B-008-003]. This study was also supported by National Yang-Ming University
under the Aim for Top University Plan of the Ministry of Education, Taiwan, R.O.C.
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... The key clinical manifestation is the dysfunction of voluntary motor regulation, including bradykinesia, resting tremor, myotonia, and postural instability [1]. In addition to motor dysfunction, nonmotor symptoms may arise during progression of PD, including cognitive dysfunction, emotional disorders such as apathy, depression, anxiety, and hallucinations, and autonomic nervous dysfunction, such as constipation, hyposmia, and sleep disorders [2]. PD has a prevalence of 0.3% and is thus the second most common neurodegenerative disease after Alzheimer's disease [3]. ...
... Pathologically, PD is characterized by the loss and degeneration of dopaminergic neurons in the substantia nigra (SN), α-synuclein (α-syn) deposition, and Lewy body formation [5]. Current treatment options for PD include medication, surgery, and exercise therapy, although medication is the first choice for PD, with the most commonly prescribed drugs being dopaminergic and anticholinergic agents [2]. These have been shown to control the initial symptoms of patients rapidly and effectively [6], but after a so-called "honeymoon period" of treatment, the effectiveness often decreases and medication may no longer be beneficial for patients with advanced PD. ...
... Therefore, scalp acupoints are an indispensable part of PD acupuncture treatment. In clinical PD acupuncture trials, the acupoints LR3 (Taichong), GB34 (Yanglingquan), and ST36 (Zusanli) were the primary body acupoints used, followed by LI4 (Hegu), LI11 (Quchi), and SI3 (Houxi) [2]. Previous reports showed that GB34 significantly improves PD symptoms, in particular motor dysfunction, and attenuates dopaminergic neuronal loss in animal models of PD [36]. ...
Article
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Parkinson’s disease (PD) is a chronic and progressive neurodegenerative disease caused by degeneration of dopaminergic neurons in the substantia nigra. Existing pharmaceutical treatments offer alleviation of symptoms but cannot delay disease progression and are often associated with significant side effects. Clinical studies have demonstrated that acupuncture may be beneficial for PD treatment, particularly in terms of ameliorating PD symptoms when combined with anti-PD medication, reducing the required dose of medication and associated side effects. During early stages of PD, acupuncture may even be used to replace medication. It has also been found that acupuncture can protect dopaminergic neurons from degeneration via antioxidative stress, anti-inflammatory, and antiapoptotic pathways as well as modulating the neurotransmitter balance in the basal ganglia circuit. Here, we review current studies and reflect on the potential of acupuncture as a novel and effective treatment strategy for PD. We found that particularly during the early stages, acupuncture may reduce neurodegeneration of dopaminergic neurons and regulate the balance of the dopaminergic circuit, thus delaying the progression of the disease. The benefits of acupuncture will need to be further verified through basic and clinical studies.
... Os achados indicaram que a acupuntura pode melhorar os sintomas clínicos da DP (CHO et al., 2012;ARANKALLE et al., 2013;CHEN et al., 2015;DOO et al., 2015;KLUGER et al., 2016;LEI et al., 2016;CHO et al., 2018;CAO et al., 2020;PEREIRA et al., 2021), com melhora significativa dos sintomas, como tremor, bradicinesia, instabilidade postural e distúrbio da marcha (DOO et al., 2015). ...
... Ademais, a terapia reduziu de forma expressiva o escore de depressão, bem como aumentou o escore de qualidade de vida se comparado ao grupo controle (CHEN et al., 2015) e combinada ao tratamento farmacológico demonstrou maior eficácia se comparado à terapia isolada (CAO et al., 2020). ...
... Em um ensaio clínico controlado (CHEN et al., 2015) houve uma porcentagem maior de pacientes no grupo de tratamento com acupuntura obtendo melhora nos escores totais de comportamento e humor, atividade de vida diária, quando comparados ao grupo de controle, bem como se percebeu o aumento do interesse pela socialização, resultando, de forma geral, em uma melhor adesão ao plano terapêutico (ARANKALLE et al., 2013;CHEN et al., 2015). ...
Book
Full-text available
Este opúsculo intitulado “Qualidade de vida relacionada à saúde: aspectos gerais e impactos de intervenções” foi proposto para trazer, de forma simples e didática, uma reflexão sobre a qualidade de vida, em uma abordagem interdisciplinar e contemporânea. Afi- nal, tem sido cada vez mais latente a busca humana por melhores padrões de vida. Ademais, é fundamental compreender que a qualidade de vida não necessariamente está presente exclusivamente em in- divíduos considerados saudáveis. É possível gozar de um bom padrão de vida ainda que sejamos doentes crônicos. É preciso reconhecer os caminhos para uma vida com mais qualidade e descobrir como vencer as dificuldades inerentes aos processos de adoecimento. Propomos, portando, falar sobre a temática em 11 capítulos, os quais foram distribuídos em três partes: Parte I – aspectos gerais sobre a qualidade de vida de indivíduos com agravos; Parte II – impactos de intervenções na qualidade de vida; e Parte III – qualidade de vida relacionada ao trabalho. Desejamos uma boa leitura!
... The collected data of the selected studies [15,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37], such as participant baseline characteristics, type of acupuncture treatment, frequency of treatment, and outcome measures were narratively synthesized in Table 1. ...
... The collected data of the selected studies [15,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37], such as participant baseline characteristics, type of acupuncture treatment, frequency of treatment, and outcome measures were narratively synthesized in Table 1. Acupuncture may improve PD-related fatigue, but real acupuncture offers no greater benefit than sham treatments. ...
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Background: Parkinson’s disease (PD) is the second most common neurodegenerative disease. Several pharmacological and surgical therapies have been developed; however, they are accompanied by some adverse effects. As a result, many patients have been resorting to complementary medicine, namely acupuncture, in the hope of obtaining symptomatic improvements without having disruptive side effects. Therefore, advances in research in this area are very important. This work presents a systematic review of the effectiveness of acupuncture treatments in relieving PD symptoms. Methods: EMBASE, Medline, Pubmed, Science Direct, The Cochrane Library, Cochrane Central Register of Controlled Trials (Central) and Scielo databases, were systematically searched from January 2011 through July 2021. Randomised controlled trials (RCTs) published in English with all types of acupuncture treatment were included. The selection and analysis of the articles was conducted by two blinding authors through Rayyan application. Results: A total of 720 potentially relevant articles were identified; 52 RCTs met our inclusion criteria. After the exclusion of 35 articles, we found 17 eligible. The included RCTs reported positive effects for acupuncture plus conventional treatment compared with conventional treatment alone in the UPDRS score. Conclusions: Although all the studies reviewed pointed out a positive effect of acupuncture on improving motor and non-motor symptoms in Parkinson’s disease, we found great discrepancies regarding the studies’ design and methodology, making difficult any comparison between them.
... Furthermore, acupuncture appeared to reduce the use of medications and improve pain-related quality of life [9]. Acupuncture is a typical alternative therapy [10][11][12] that has been proven to treat different types of pain, including backache [13] and dysmenorrhea [14], and to effectively treat chronic arthralgia secondary to hypertrophic arthritis [15]. With regard to operative treatments, acupuncture is an effective way to manage postoperative pain after laparoscopic aspiration [16], hemorrhoidectomy [17], cardiac surgery [18], and shoulder arthroscopy [19]. ...
... The confidence interval did not include zero, indicating the statistical significance of the results reported in the reviewed studies with regard to acupuncture's analgesic effects after TKR. These results corresponded to the findings of Chen et al. [10], who reported that ear acupuncture and electric stimulation can reduce pain during the perioperative period of TKR. Tzeng et al. [34] used 2-Hz electroacupuncture to stimulate the Yanglingquan and Zusanli acupoints of patients undergoing TKR and found that electroacupuncture could provide instantaneous pain relief and alleviate postoperative pain. ...
Article
Objective To identify the effectiveness of the analgesic acupuncture after total knee replacement by systematic review. Methods A search of randomized controlled trials was conducted in 5 English medical electronic databases and 5 Chinese databases. Two reviewers independently conducted in 5 English medical electronic databases and 5 Chinese databases. Two reviewers independently retrieved related studies, assessed the methodological quality, and extracted data with a standardized data retrieved related studies, assessed the methodological quality, and extracted data with a standardized data form. Meta-analyses were performed using all time-points meta-analysis. Results A total of 7 studies with 891 participants were included. The meta-analysis results indicated that acupuncture had a statistically significant influence on pain relief (SMD = -0.705, 95% CI -1.027 to -0.382, p = 0.000). The subgroup analysis results showed that acupuncture’s effects on analgesia had a statistically significant influence (SMD = -0.567, 95% CI -0.865 to -0.269, p = 0.000). The main acupuncture points that produced an analgesic effect when they were used after total knee replacement included the Xuehai, Liangqiu, Dubi, Neixiyan, Yanglingquan, and Zusanli points. Electro acupuncture frequency ranged between 2-100 Hz. Conclusions As adjunct modalities, the use of acupuncture is associated with reduced pain and use of analgesic medications in postoperative patients. In particular, ear acupuncture one day before surgery could reduce analgesia.
... Therefore, nondrug therapy has attracted more and more attention and is recommended as the first-line therapy before starting drug therapy. Acupuncture, as a common supplementary and placement therapy for PD, is used by 25.7%-76% of Parkinson's disease patients [7,8]. ...
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Acupuncture can effectively improve the sleep state, and most PD patients have sleep disorders. In this study, we used acupuncture to intervene in the sleep state of PDSD, so as to observe the changes and dose effect of Acutreatment on PDSD. 57 patients with PDSD, during medical treatment, aged 40–70 years were recruited to enroll in this trial. Each participant completed one condition, namely, Acutreatment (n=30) and sham Acutreatment (placebo, stick flat needle on skin, n=27). The Acutreatment was applied for 30 min once a day for a 30-day observation. UPDRSIII scores for motor symptom assessment and sleeping quality were assessed by PDSS-2, ESS as well as ActiGraph. Scale evaluation was made on the first day of admission and the thirtieth day. There were significant differences on all outcome indicators, except UPDRSIII, on day 30 compared with day 1 (P
... Pharmacology and psychotherapy are the most commonly used treatments for PDA [5,7]. However, no clinical studies have been conducted to confirm the efficacy of these methods [8]. Unwanted side effects, decreased cognitive ability, balance complications, and sedation have all been linked to pharmacological treatments, putting patients at risk of falling [9]. ...
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Parkinson’s disease anxiety (PDA) is a nonmotor symptom of Parkinson’s disease (PD) that is often neglected. PDA poses a far-reaching challenge to the treatment of PD. Acupuncture could be successful in the treatment of PDA. However, the evidence for this is still limited. We propose a two-stage clinical trial. In stage 1, a total of 70 volunteers with PDA will be randomly assigned to either acupuncture (manual acupuncture) or control group (sham acupuncture) in a 1 : 1 ratio. Treatments will be performed for four weeks. The change in the Hamilton Rating Scale for Anxiety (HAMA) score from baseline to week 4 and week 12 will be the primary outcome. The levels of adrenocorticotropic hormone (ACTH), cortisol (CORT), serotonin (5-HT), and corticotropin-releasing factor (CRH) in the patients’ serum and the scores on the Hoehn–Yahr Rating Scale and the Unified Parkinson’s Disease Rating Scale (UPDRS) will all be considered among the secondary outcomes. Participants will be followed up until week 12. In stage 2, a total of 82 volunteers with PDA will be randomly assigned to either an acupuncture (manual acupuncture) or a control group (anti-Parkinson drugs only) in a 1 : 1 ratio. HAMA score will be the primary outcome. Universality, feasibility and cost effectiveness, Hoehn–Yahr Rating Scale, UPDRS, and serological indicators will be secondary outcomes. Participants will be followed up until week 4. The statistical analysis will include all the allocated individuals. The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine’s Research Ethical Committee authorized this procedure, and the trial is registered with ChiCTR2100047253.
... The findings of our study reveal a reduction in the total scores of activities of daily living (UPDRSII) in both groups. These results showed that dance rhythms can help to increase the individuals' ability to move, with their simultaneous, directional movements, turns in the same place, and due to the double task of listening to music, leading a partner, moving around the room, speak and perform movements [45,46], that is provide unpredictable movement patterns. Dance classes tend to assist in daily movements and in carrying out activities of daily living, promoting greater independence outside the dance class setting and facilitating daily life, as avoiding falls, improving mobility in the workplace, in the bed, when picking up objects, getting dressed and in routine activities [11,47,48]. ...
Article
This study aimed to compare the effect of a binary and quaternary rhythm protocol on cognition, mental activity, daily life, and quality of life among individuals with Parkinson’s Disease. A two-arm randomized clinical trial with 31 individuals diagnosed with Parkinson's disease, who were allocated to the binary group or quaternary group. Both groups underwent a 12-week intervention. The following variables were analyzed: personal and clinical information; MoCA; UPDRSI and II; PDQ-39. Both intervention groups improved cognition, mental activity, activities of daily living, and quality of life. In addition, there were intergroup differences in total UPDRSII, writing, and hygiene where the quaternary group was superior to the binary group. It concludes that the binary and quaternary rhythm positively influenced and presented similar effects on the complementary treatment of individuals with Parkinson's disease on the studied variables. Thus, it is believed that both interventions are possible and feasible for the health professionals involved in the area.
Article
Since the new century, there have been more and more survey reports on the use of acupuncture in the field of tremor and paralysis, reflect the health and accuracy of acupuncture in the field of tremor and paralysis, this article discusses the comparison of the therapeutic effects of acupuncture treatment for tremor paralysis with non-exercise disease, and proposes clinical guiding significance for the treatment of tremor paralysis by acupuncture and moxibustion, and the future-related clinical research can be improved. This paper aims to make acupuncture give full play to its own advantages in the treatment of non-motor symptoms of Parkinson's disease by studying the Meta-analysis of the efficacy of acupuncture and moxibustion in the treatment of non-motor symptoms of Parkinson's disease. This paper proposes a classification model of fifty-layer cyclotron neural network based on deep residual framework. After more than 80,000 clinical ECG assessments, the accurate classification of positive abnormal tremor paralysis has been achieved. In this study, a simple random method was used to randomly divide 120 patients into the treatment group (combined governor tremor group), the control group one (Tongdu acupuncture group), and the control group two (tremor three-needle group). After maintaining modern treatment, three types of acupuncture treatments with different main points are added. The combined group of governor and tremor takes Baihui, Shenting, Yintang, Suliao, Houxi, Shenmai, Sishenzhen, Fengchi, Hegu, and Taichong, Xingping replenishing and reducing technique; Tongdu acupuncture group takes Baihui, Shenting, Yintang, Suliao, Houxi, Shenmai, Xingping replenishing and reducing technique; trembling three-needle group takes Sishen needle, Fengchi, Hegu, Tai Chong, the method of replenishing, replenishing and reducing. Meta-analysis uniformly uses tremor paralysis NMS, SCOPA-UT, PDS and several other efficacy observation indicators. This article uses a fixed-effects model to meta-analyze the experimental conclusions. RR = 1.26, 94% CI is [1.24, 1.71], P = 0.0001 < 0.05, it is considered that the combined effect size is statistically significant, and the effectiveness of acupuncture.
Chapter
Parkinson’s disease (PD) is a neurodegenerative disorder that results from a progressive degeneration of striatum-projecting dopamine (DA) neurons in the substantia nigra pars compacta manifesting as static tremor, rigidity, bradykinesia, gait dysfunction, and postural instability. PD is classified as the second most common neurodegenerative disease following the Alzheimer’s disease (AD). Aside with conventional medication, acupuncture has been increased introducing to the treatment of PD, whatever motor symptomatology or non-motor symptomatology such as autonomic dysfunction, neuropsychiatric disorders, sleep disturbance, sensory symptoms to gastrointestinal syndromes, fatigue, et al. Acupuncture treatment for PD could be based on general points selection, and may add several unique techniques as well, for better results. The unique acupuncture techniques, such as scalp acupuncture and Dao-qi acupuncture technique, are more specifically the benefit for PD and similar neurological conditions. Both general acupuncture and unique Brain acupuncture treatments are all explained in detail. Clinical trials have indicated acupuncture may promote cerebral blood flow, protected dopaminergic neurons against toxic insults and increase dopamine production in the brain by inducing release of the neurotrophic factor, enhancing antioxidant agents, and inhibit inflammatory, restores neurogenesis impairment, et al. Functional magnetic resonance imaging (fMRI) is the most commonly applied method of functional neuroimaging.
Article
The non-motor symptoms (NMS) of Parkinson’s disease (PD) are found in more than 90% of patients with PD. Here, we explored the effects of electroacupuncture (EA) stimulation at Zhong wan (CV-12), Qihai (RN-7), Zusanli (ST-36) and Taichong (LR-3) on NMS and brain-gut peptides of PD. We found that EA intervention alleviated the motor deficit induced by 6-OHDA in rats indicated by the decreased abnormal involuntary movements (AIMs) scores and the net number of rotations and increased cylinder test grade. It also improved the spatial memory and attenuated anxiety-like and depression of PD model rats. EA treatment significantly inhibited neuronal apoptosis in PD model animals, as demonstrated by the increased number of TH positive cells and reduced number of apoptotic cells in the substantia nigra. The expression of cleaved caspase-3 and cleaved PARP in PD model rats was markedly suppressed by EA stimulation. Moreover, EA remarkably inhibited the inflammatory response in PD model rats, as revealed by the decreased levels of TNF-α, IL-1β, and COX-2 mRNA expression. It also attenuated the oxidative stress in rats, as indicated by the increased levels of SOD and GSH and the decreased level of MDA. EA treatment contributed to alleviating PD by regulating brain-gut peptides in rats, such as NPY, CCK, SST, GAS, and PYY. In conclusion, EA stimulation at CV-12, RN-7, ST-36, and LR-3 effectively alleviates the NMS of PD partly through regulating the levels of brain-gut peptides.
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The prevalence of Parkinson's disease (PD) appears to be lower in Asia compared to the Western world. It is unclear if this is related to the ubiquitous use of traditional medicine in Eastern healthcare, but the use of complementary and alternative medicine (CAM) modalities in countries like Korea may be as high as 76%. Among patients with PD, herbal medicines, health supplement foods, and acupuncture are interventions which are increasingly used throughout the world. Countries like Korea, China, India, and Japan have long embraced and incorporated traditional medicine into modern management of conditions such as PD, but research into various CAM modalities remains in its infancy limiting evidence-based recommendations for many treatments. We reviewed the literature on CAM treatments for PD, focusing on mind-body interventions and natural products. Based on evidence limited to randomized-controlled trials we found that mind-body interventions are generally effective forms of physical activity that are likely to foster good adherence and may reduce disability associated with PD. Based on the current data, modalities like Tai Chi and dance are safe and beneficial in PD, but better studies are needed to assess the effects of other frequently used modalities such as yoga and acupuncture. Furthermore, despite centuries of experience using medicinal herbs and plants in Eastern countries, and despite substantial preclinical data on the beneficial effects of nutritional antioxidants as neuroprotective agents in PD, there is insufficient clinical evidence that any vitamin, food additive, or supplement, can improve motor function or delay disease progression in PD.
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Acupuncture is increasingly used as an additional treatment for patients with Parkinson’s disease (PD). In this functional magnetic resonance imaging study, brain activation in response to acupuncture in a group of 12 patients with PD was compared with a group of 12 healthy participants. Acupuncture was conducted on a specific acupoint, the right GB 34 (Yanglingquan), which is a frequently used acupoint for motor function treatment in the oriental medical field. Acupuncture stimulation on this acupoint activates the prefrontal cortex, precentral gyrus, and putamen in patients with PD; areas that are known to be impaired in patients with PD. Compared with healthy participants, patients with PD showed significantly higher brain activity in the prefrontal cortex and precentral gyrus, especially visible in the left hemisphere. The neuroimaging results of our study suggest that in future acupuncture research; the prefrontal cortex as well as the precentral gyrus should be treated for symptoms of Parkinson’s disease and that GB 34 seems to be a suitable acupoint. Moreover, acupuncture evoked different brain activations in patients with Parkinson’s disease than in healthy participants in our study, stressing the importance of conducting acupuncture studies on both healthy participants as well as patients within the same study, in order to detect acupuncture efficacy. Trial registration KCT0001122 at cris.nih.go.kr (registration date: 20140530)
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Objective To define key issues in the management of Parkinson disease (PD) relating to neuroprotective strategies and alternative treatments, and to make evidence-based treatment recommendations.
Article
Parkinson's disease (PD) is a progressive neurological condition with debilitating symptoms, and depression is a common comorbid condition of this disease. The authors review existing literature on the prevalence and treatment of depression in PD. Prevalence estimates of depression vary widely, ranging from 7%-76%. This variation is due to inconsistent methodology. Treatment options for depression in PD include medication therapy, electroconvulsive therapy (ECT), and psychotherapy. There are few randomized controlled trials of these treatment options. The authors argue for more systematic and controlled research examining both the prevalence and treatment of depression in PD.
Article
Objective: To systematically summarize the progress of clinical application of the traditional Chinese medicine (TCM) treatment and preliminary study on Parkinson disease, and sum up the method and regularity of clinical application and effective mechanism research on TCM. Data source: To retrieve articles about the progress in therapy an d experimental study of TCM on Parkinson disease in Chinese journal full-text database and Chinese journal database of technology by computer from January 1994 to August 2005. The language was limited in Chinese and key words were "Parkinson, Chinese medicine". Study selection: All documents are examines to select the clinical and experimental study documents of TCM treatment on Parkinson disease, which includes treatment group and control group, and non-random studies are rejected. Whole test of the rest documents is selected. Inclusion criteria: 1 randomized controlled study; 2 experimental or clinical research including parallel control group; 3 combination of Chinese medicine with Western medicine or the single Chinese medicine group. Exclusion criteria: duplicated studies. Data extraction: There are 78 random and non-random articles about TCM therapy on Parkinson disease, and 25 experimental and clinical studies are in coincidence with conclusion criteria. Among 53 excluded articles, there are 39 titles because of non-random or duplicated studies and 14 review articles. Data synthesis: According to 25 experiments including 620 patients and 810 experimental animals, it is manifested that TCM can be used to treat Parkinson disease with clear, good, mild effect and no topical or side effects. Chinese medicine can preserve cellular nervosa; restrain oxidative stress reaction, rivalry excitability toxicity. The text summarizes the recently status of the TCM treatment of Parkinson disease, from four aspects, which includes the treatment based on syndrome differentiation, treatment with specific prescriptions, combination of Chinese and western medicine treatment, experimental study on unit medicine and prescriptions, and the method and rule of the clinical treatment and the study on pharmacological mechanisms of TCM. Conclusion: Parkinson disease is the refractoriness disease. At present, major reports are concentrated in summarizing the clinical experience, but the reports of large-scale random and double-blind clinical research are scarce. And preliminary experiments are less. Developing the central pharmacology research on Chinese medicine and identify effect mechanism of medicine, which will be the development trend in future.
Article
This article reviews the history and clinical applications of the recently developed technique of acupuncture on the scalp or "scalp needle therapy" for the treatment of central nervous system diseases and syndromes of various types resulting from chorea, parkinsonism, peripheral vascular injury, encephalitis and other conditions. The authors discuss several cases treated in this manner and report that it has resulted in significant clinical improvement in a small number of patients.
Article
Objective To analyze the clinical evaluation of Parkinson’s disease (PD) patients receiving integrated Chinese and Western medicine therapy. Methods One hundred and twenty patients were enrolled and randomly allocated to a control group or treatment group. Patients in the two groups received placebo and Bushen Huoxue Granule (补肾活血颗粒, BHG), respectively. Both groups received baseline levodopa and benserazide (Madopar). The effects of treatment were assessed monthly during the 9-month treatment. Means of evaluation included Unified PD Rating Scale (UPDRS) scores (II and III), sleep scale score, 10 m turn back test (getting up time, 10 m×2 times, and turning time), timing motor test (TMT)-left and TMT-right, which were treated as the dependent variables; and age, sex, duration of PD, Hoehn and Yahr (H-Y) stage and Madopar dosage of admitted PD patients were as the independent variables. Multiple linear regression was used to analyze these factors. Results H-Y stage significantly affected UPDRS II score, UPDRS III score, and getting up time (P
Article
This study first showed the behavioural benefits of novel combination therapy of L-dopa with acupuncture on Parkinson's disease, and its underlying mechanisms within basal ganglia. The previous study reported that acupuncture may improve the motor function of a Parkinson's disease (PD) mouse model by increasing the dopamine efflux and turnover ratio of dopamine. Hence, we hypothesized that combining L-dopa with acupuncture would have a behavioural benefit for those with PD. We performed unilateral injections of 6-OHDA into the striatum of C57Bl/6 mice to model hemi-Parkinsonian attributes. To test motor function and dyskinetic anomalies, we examined cylinder behaviour and abnormal involuntary movement (AIM), respectively. We found that (1) a 50% reduced dose of L-dopa (7.5mg/kg) combined with acupuncture showed an improvement in motor function that was comparable to mice given the standard dose of L-dopa treatment (15mg/kg) only, and that (2) the combination treatment (L-dopa+acupuncture) was significantly superior in reducing AIM scores when equivalent doses of L-dopa were used. The combination treatment also significantly reduces the abnormal increase of GABA contents in the substantia nigra compared to the standard L-dopa treatment. Furthermore, abnormal expression of FosB, the immediate early gene of L-dopa induced dyskinesia (LID), was mitigated in the striatum by the combination treatment. All of these results indicate that acupuncture enhances the benefits of L-dopa on motor function with reduced dose of L-dopa and alleviating LID by normalising neurochemical imbalance within the basal ganglia.
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Occidental medicine has a given definition for Parkinson's disease and knowledge of Parkinson's disease pathophysiology has led to development of its therapeutic management. Parkinson's disease, however, is likely to have always existed in different parts of the world. Description and management of this neurodegenerative condition could be found in ancient medical systems. Here, we introduce the philosophical concepts of traditional Chinese medicine and the description, classification and understanding of parkinsonian symptoms in traditional Chinese medicine. We have conducted an in-depth review of Chinese literature reporting anti-parkinsonian and anti-dyskinetic efficacy of more than 60 traditional medicines in Parkinson's disease patients. A number of issues, however, plague the relevance of these reports and call for a scientific re-evaluation of these therapies in preclinical models of Parkinson's disease before proposing traditional Chinese medicine-based symptomatic treatment of Parkinson's disease.
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Parkinson's disease (PD) is a common and debilitating neurodegenerative disorder without a known neuroprotective cure. Currently, an increasing number of patients with PD resort to complementary and alternative medicine (CAM). This study aimed to determine the epidemiology of CAM use for PD worldwide. Methodological issues included the definition of CAM, running a search strategy using five databases, and citation tracking. Six studies estimated the prevalence of CAM use for PD to be between 25.7% and 76%. The response rates in these surveys varied from 81% to 100%. Frequently utilized forms of therapy were acupuncture, massage, herbs, and vitamins/health supplements, and these therapies were mainly used to improve the associated motor symptoms of PD. However, only 11% to 20% of these patients were referred to use CAM by a healthcare professional. Of the sociodemographic and disease-specific factors, CAM use was correlated with female sex, age, age at onset of PD, longer duration of PD, degree of education, higher income, rural location, comorbidity for indications, levodopa load, and severe motor symptoms. These results suggested that CAM use is widespread among patients with PD worldwide, but the largely unexamined use of CAM requires more attention. Moreover, there is a lack of communication between physicians and patients, increasing the risks associated with CAM use and the potential for adverse events.