Acupuncture has been widely used for a range of neurologic disorders, mainly in Asian countries, and recently in the West. In spite of popular clinical applications, evidence to support the use of acupuncture needs to be established. A brief and moderate evaluation on the available evidence of acupuncture accumulated during the last 10 years for some neurologic disorders including Bell's palsy, spinal-cord injury, spasticity, whiplash, and trigeminal neuralgia was presented. Clinical studies of acupuncture for the aforementioned neurologic disorders published between 1997 and October 2007 were identified from PubMed and personal files, and were reviewed using the U.S. Preventive Services Task Force Ratings.20
These grade the Task Force's recommendations according to one of five classifications (A strongly recommends; B recommends; C makes no recommendation for or against; D recommends against; and I concludes insufficient evidence) reflecting the strength of evidence and magnitude of net benefit (benefits minus harms), and the quality of the overall evidence for a service on a 3-point scale (good, fair, poor).
For Bell's palsy, 7 studies that were asserted to be randomized (total n
1017) were carried out in China and published in Chinese. While no harmful adverse events were reported, four studies that tested acupuncture additionally to or comparatively against steroid
vitamin B reported positive results,21–25
another study reported superiority of electroacupuncture (EA) to surface-electrode,26
and yet another study reported nonsignificance between acupuncture and manipulation.27
In summary, other than in clear viral infection, for which antiviral agents and steroids are proven to be effective, acupuncture may have served clinical purposes with the recommendation rating between B and C, though methodologically rigorous study is required.
Regarding acupuncture studies for spinal-cord injury, one randomized controlled trial (RCT) on neurologic and functional recovery, two RCTs, one controlled study, and an observational study on pain in patients with spinal-cord injury were identified from a PubMed search; none reported any adverse events. By far, the largest study concluded that the use of concomitant auricular and electrical acupuncture therapies, when implemented early in acute spinal-cord injury, can contribute to significant neurologic and functional recoveries.28
Meanwhile, two other good-quality RCTs, although underpowered, reported nonsignificant results,29,30
while two relatively inferior-quality studies reported significance.31,32
Meanwhile, most acupuncture studies for bladder control in patients with spinal-cord injury, including two RCTs33,34
and two case series,35,36
indicated favorable outcomes despite limited quality. All in all, the recommendation rating for pain and bladder control in patients with spinal-cord injury is close to C with potential toward B.
Spasticity is a complex indication for acupuncture, and several studies measure effects on spasticity as a secondary outcome.37,38
Very few studies exist on acupuncture for treating spasticity. Mukherjee et al. reported that a combination of EA and muscle-strengthening exercise for 6 weeks significantly reduced spasticity from a crossover study involving 7 patients with chronic stroke.39
However, the placebo-controlled RCT of Fink et al.40
concluded that acupuncture has not shown significant effects on leg spasticity and reported neurophysiologic evidence of needle acupuncture causing spastic effects. Overall, acupuncture has not yet been shown to be beneficial in managing spasticity resulting from a variety of neurologic conditions. Research in this area has been limited (current evidence ratings range between C and D, and is close to D).
Whiplash is broadly defined as acute/chronic neck or cervical myofascial pain. Trinh et al. concluded in their review that, for chronic mechanical neck disorders, there is moderate evidence that acupuncture is more effective than sham when measured immediately post-treatment, and that this effect is maintained at short-term follow-up.41
Therefore, only six acupuncture studies for acute neck pain/whiplash were reviewed. Harmful adverse events were rarely reported, and four studies testing electroauricular acupuncture,42
and distant acupuncture44,45
reported a significant effect compared to SA, while in the other studies, the results of laser,46
and auricular acupuncture47
were reported to be negative. After weighing the benefits and risks, a rating between B and C was suggested.
In the treatment of trigeminal neuralgia, included studies used diverse applications of acupuncture including injection on acupoints, cupping, bloodletting, and deep needling. Five (5) of the studies were methodologically poor in comparative controls (n
5) and the other study was a case series. All reported favorable outcomes48–52
except the study for acupoint injection.53
Clinicians who seek nonpharmaceutical and non-neurosurgical approaches for this condition may provide benefit for patients by first trying acupuncture (suggested rating of C).
In summary, based on the available literature, for Bell's palsy, spinal-cord injury, whiplash or neck pain, and trigeminal neuralgia,54
clinicians' recommendations for acupuncture may vary between “clinicians should discuss the service of acupuncture when benefit outweighs risks, or do so if individual patient considers when the benefits are close to risks.” However, for spasticity, more studies are necessary to make clinical recommendations. The most promising research data on acupuncture for a selected group of neurologic conditions is in the treatment of Bell's palsy and whiplash/neck pain; however, evidence-based recommendations are not yet conclusive.