Acupuncture for epilepsy

 

Abstract

Background

Acupuncture in increasingly used in people with epilepsy. It remains unclear whether existing evidence is rigorous enough to support its use. 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 methods

We searched the Cochrane Epilepsy Group's Specialised Register (June 2011) and the Cochrane Central Register of Controlled Trials (CENTRAL issue 2 of 4, The Cochrane Library 2011), MEDLINE, EMBASE, and other databases from inception to June 2011. We reviewed reference lists from relevant trials. We did not impose any language restrictions.

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

Sixteen trials (15 in China and 1 in Norway) with 1486 participants met the inclusion criteria. Compared with control treatment, needle acupuncture was not effective in reducing seizure frequency (five trials). Compared with phenytoin (two trials), needle acupuncture may be better in achieving at least 75% or at least 25% reduction in seizure frequency. Compared with valproate (two trials), needle acupuncture may be better in achieving at least 50% or at least 75% reduction in seizure frequency, better quality of life (QOL), lower frequency of impaired concentration, and higher likelihood of at least 70% improvement in epilepsy score.

Compared with antiepileptic drugs (four trials), catgut implantation at acupoints may be better in achieving at least 50% reduction in seizure frequency. However, there was significant heterogeneity in this outcome. Catgut implantation may be better in achieving at least 75% or at least 25% reduction in seizure frequency, at least 70% or at least 40% improvement in epilepsy score, better quality of life and lower frequency of dizziness or impaired concentration. Compared with valproate alone (five trials), catgut implantation may be better in achieving seizure freedom or at least 75% reduction in seizure frequency. However, there was significant heterogeneity in the latter outcome. Catgut implantation may be better in achieving at least 25% reduction in seizure frequency and improvement in epilepsy score, QOL, and lower frequency of anorexia. All included trials had high risk of bias with short follow-up.

Authors' conclusions

The current evidence does not support acupuncture for treating epilepsy.

 

Plain language summary

Acupuncture for epilepsy

Patients with epilepsy are currently treated with antiepileptic drugs, but a significant number of people continue to have seizures and many experience adverse effects to the drugs. As a result there is increasing interest in alternative therapies and acupuncture is one of those. Sixteen randomised controlled trials were included in the current systematic review. However all included trials had high risk of bias and it remains uncertain whether acupuncture is effective and safe for treating people with epilepsy.

 

摘要

背景

採用針灸治療癲癇

儘管目前抗癲癇藥物足以治療癲癇，但是許多癲癇病人發作時，卻不能控制。 人們對其他治療方法越來越有興趣，例如針灸治療。可是目前對於是否有足夠的證據支持針灸治療，還不太清楚。本文將對Cochrane首次於2006年發佈的回顧進行更新。

目標

確認針灸治療對癲癇病人的有效性和安全性。

搜尋策略

我搜尋了Cochrane Epilepsy Group's Specialized Register(2008年3月)以及Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane 圖書館，2008年第1期)、MEDLINE、EMBASE以及到2008年3月之前收錄的其他資料庫。我們回顧了相關對照試驗的參考文獻清單。沒有任何語言限制。

選擇標準

採用隨機對照試驗，進行針灸與安慰劑或假治療、抗癲癇藥物或無治療之比較、或進行針灸加上其他治療與同一個其他治療的比較。參與者的年齡及癲癇種類不拘。

資料收集與分析

兩位回顧作者獨立摘錄了試驗數據，評估試驗品質。

主要結論

一共包括11項小規模試驗，有914位受試者參加。與納入的相比，整體方法學品質較差，而追蹤時間過短。10次試驗在中國進行，1次試驗在挪威進行。 2次試驗發現，比起單獨使用中草藥治療的兒童，使用針刺針灸療法加中草藥治療的兒童在發作頻率方面，達到減少75%或以上的結果(RR 1.52, 95% CI 1.12 – 2.05) ，發作持續時間減少50%或以上(合併後RR 1.29, 95% CI 1.03− 1.62) 。但是，結合4次試驗的結果，通過比較治療組和可能產生針刺針灸治療網式效果的控制組，我們發現，治療組和控制組在降低發作頻率方面沒有任何差異(合併後RR 1.05, 95% CI 0.97 −1.17)。 和Phenytoin 相比，兩次試驗合併後的結果顯示接受針刺針灸治療的病人更有可能在發作頻率方面，達到減少75%或以上的結果 (合併後RR 2.14, 95% CI 1.47 −3.1)。 和valproate相比，3次試驗合併後的結果顯示，在穴位處接受腸線培植的病人更有可能在發病頻率方面，達到減少75%或以上的結果 (合併後RR 2.33, 95% CI 1.01 – 5.36).

作者結論

目前證據不足以證明針灸治療可作為癲癇病的一種治療方法。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

雖然目前癲癇病人一般使用抗癲癇藥物包括治療，但是許多人們的癲癇持續復發，經常會遭遇藥物的不良反應。因此人們對於於替代療法越來越感興趣，針灸治療則是其中之一。本文包括了11項研究，但是，還不足以證明針灸治療對治療癲癇病人的有效性和安全性。