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JKM > Volume 43(1); 2022 > Article
Kim, Lim, Kim, and Park: Review on the effect of acupuncture on Parkinson’s disease over the last 5 years

Abstract

Objectives

The objective of this study was to summarize clinical studies conducted over the last five years that investigated the effect of acupuncture on Parkinson’s disease and to propose a better process of study.

Methods

Research Information Sharing Service (RISS), Korea Studies Information Service (KISS), Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, and China National Knowledge Infrastructure (CNKI) were systemically searched for clinical trials that had investigated the effect of acupuncture on the course of Parkinson’s disease from May 2016 to April 2021.

Results

A total of 23 studies met all the inclusion criteria. In most reports, acupuncture had significant positive effects on the course of Parkinson’s disease. Furthermore, there were no serious adverse events associated with acupuncture in any of the studies. In addition to the acupuncture methods that showed effectiveness in previous studies, various types of acupuncture have been used to treat sub-symptoms of Parkinson’s disease. The outcome measures were subdivided through individual symptom evaluation and mechanical analysis. Follow-up assessments were also performed to analyze the continuous effect.

Conclusion

In the clinical studies conducted over the last five years, many studies investigated the various types of acupuncture used to treat Parkinson’s disease and the segmentation and diversification of outcome measures focusing on individual symptoms, and a new approach for excluding placebo effects through follow-up studies has been made. Further attempts like these are needed to overcome methodological flaws in studies on the effects of acupuncture on Parkinson’s disease.

Fig. 1
Flow chart of the identification, screening, eligibility, and inclusion process of acupuncture for the treatment of Parkinson’s disease.
jkm-43-1-112f1.gif
Table 1
Characteristics of the Included Studies on Acupuncture for Treating Parkinson’s Disease
Author, year, country, study design Dx, age (y) in A/B, Dx duration (y) in A/B, H&Y A. Type of intervention B. Type of comparison Treatment frequency and period Acupoints of intervention Outcome measures Results (pre, post mean±S.D, *: p<0.05) Adverse event
Liu 20218), China, RCTs PD, 65±7/67±7, 7.50±3.27/7. 33±3.39, II~V Scalp AT+Huatuo Jiaji point (n=30) MA (n=30) 6 times/w for 4 weeks bilateral motor zone, bilateral dance tremor, Huatuo Jiaji points
  • 1) UPDRS V

  • 2) Webster scale

  • 3) total UPDRS

  • 1) A>B, p<0.05

  • 2) (A:24.83±1.51, 16.87±1.28/B:24.47±1.50, 19.20±1. 86)*

  • 3) (A:109.80±2.19, 85.17±3.27/B:109.37±2.19, 100.83 ±4.55)*

NR
Cai 20209), China, RCTs PD, 69.10±7.46/69.69±7.82, 4.24±0.60/4. 48±0.94, NR Abdominal AT + CM(tolterodi ne tartrate tablets) (n=29) CM(tolterodi ne tartrate tablets) (n=29) 5 times/w for 4 weeks CV12, CV10, CV6, CV4, CV3, KI13, CV9, ST28
  • 1) no. of nocturia

  • 2) N-QOL

  • 3) PDSS

  • 1) (A:4.06±1.42, 2.44±0.86/B:4.24±1.40, 3.06±1.24)*

  • 2) (A:20.10±8.20, 31.79±8.42/B:20.38±6. 69, 26.93±8.94)*

  • 3) (A:95.21±18.07, 116.14±3.15/B:96.86±15.59, 106.14±2.69)*

  • A: numbness of the needle area 1, temporary dizziness 1

  • B: bloating 1, dry mouth 1, palpitations 1,

  • • difference in incidence of adverse events: NS (p>0.05)

Kim 202010), USA, RCTs IPD, NR MA + Qigong meditation (n=10) Qigong meditation (n=11) 12 times/m for 1month bilateral GB20, LI4, Du14, Du16
  • 1) UPDRS I

  • 2) TSI

  • 1) pre, post M.D±S.D (A:−5.6±5.15/B:−4.8±3.80)

  • 2) pre, post M.D±S.D (A:−10.3±4.37/B:−12.6±1.77)

NR
Li 202011), China, RCTs PD, 71±5/68±7, 6.25/6.00, 2.5/2 EA + CM (keep previous medications) (n=30) CM (keep previous medications) (n=30) 3 times/w for 12 weeks bilateral GV21~GB5, frontal EX-HN1(Shencon g)~GB6, LI11, LI4, GB34, ST36, SP6, KI3, LR3
  • 1) total UPDRS

  • 2) PDQ-39

  • 3) ①20m walking time (s), ②average step length (m)

  • 1) (A:31.80±14.25, 27.20±13.51/B:30.23±13.14, 38.00±13.06)*

  • 2) (A:34.50±16.02, 30.63±13.35/B:33.10±16.00, 38.06±18.14)*

  • 3) ①pre, post median(quartile range) (A:17.44(13.95,22.21),16.24(14.46,20.11)/B:16.51(15.07,23.42),17.75(16.30,23.75))* ②pre, post mean±S.D(A:0.61±0.15, 0.67±0.12/B:0.62±0.12, 0.58±0.09)*

NR
Liang 202012), China, RCTs PD, 51.0±2.5/53. 0±2.5, 6.02±2.54/5. 98±2.46, I~III TTNcVLFES + RRT (n=25) MA + RRT(n=25) 1 time/d for 30 days CV23, its left and right sides to make a 1-inch straight puncture.
  • 1) Kubota’s scale of swallowing ability (water swallowing test)

  • 2) SSA

  • 3) SWAL-QOL

  • 4) total effective rate by water swallowing test (%)

  • 1) A>B, p<0.05,

  • 2) (A:3.49±1.02, 8.12±1.23/B:3.51±1.18, 5.79±1.65)*

  • 3) (A:102.52±17.95,197.91±18.75/B:102.79±16.85,181.32±17.88)*

  • 4) (A:88/B:68)*

NR
Liu 202013), China, RCTs PD, 61±8/62 ±9, 6.10±4.43/5. 93±4.83, NR MA + Sling exercise + CM(n=24) Sling exercise + CM (n=23) 5 times/w for 4 weeks GV15, bilateral BL10, GB20, GB12 LOS by NeuroCom Balance Master (NeuroCom® International, Inc. Oregon,USA)
  • 1) RT (s)

  • 2) MVL (°/s)

  • 3) EPE (%)

  • 4) MXE (%)

  • 5) DCL(%)

  • 1) (A:1.03±0.23, 0.55±0.26/B:1.09±0.22, 0.88±0.08)*

  • 2) (A:2.42±1.56, 3.48±0.94/B:2.31±1.14, 2.63±0.98)*

  • 3) (A:50.88±17.20, 68.29±6.77/B:50.43±14.22, 57.17±11.36)*

  • 4) (A:60.62±18.52, 83.17±6.48/B:62.52±15.27, 68.78±12.00)*

  • 5) (A:62.50±15.61, 82.00±5.44*/B:66.00±11.34, 79.70±6.02*),

NR
Wanga 202014), China, RCTs PD, 63/64, 234±140 d/228±136d, NR PTNTCEN + SRT(n=20) SRT(n=20) 2~3 courses (depends on condition, 1 course =10 times) PTN(tip of the tongue, EX-HN12, EX-HN13, posterior pharyngeal wall) + TCEN (GV20,GV23, LI4,LI11,TE5, LR3,ST36,SP6)
  • 1) total effective rate by water swallowing test (%)

  • 2) dysphagia score

  • 3) SF-36

  • 1) (A:85/B:70)*

  • 2) (A:3.65±1.28,6.70±1.60/B:3.90±1.30, 5.05±0.92)*

  • 3) (A:42.3±3.2, 88.4±4.2/B:42.0±1.6, 78.7±4.9)*

NR
Wangb 202015), China, RCTs PD, 54.0±9.2/52. 0±11.3, 1~2/1~2, NR Nape AT + SRT (n=60) SRT(n=60) 6 times/w for 4 weeks bilateral GB20, Ex-HN14, Gongxue, GV23, lateral Ex-HN13, lateral Ex-HN12
  • 1) SSA

  • 2) VFSS

  • 3) SWAL-QOL

  • 1) (A:35.71±5.66, 21.67±3.34/B:35.35±5.94, 25.16±3.82)*

  • 2) (A:3.83±1.56, 7.68±1.03/B:4.10±1.31, 5.94±1.72)*

  • 3) (A:112.58±10.54, 137.24±12.97/B:113.95±9.84, 121.98±9.32)*

NR
Xu 202016), China, RCTs PD, 61.73±10.28/61.95±9.77, 3.52±2.78/3. 26±2.32, I~IV MA + CM(Madopa r) (n=33) CM(Madopar ) (n=37) 4times/w for 8 weeks GV17, GB19, Ex-HN1, temporal three-needle (located 2 cun to the hairline straight up from the tip of ear; the other two are 1 cun next to the first point bilaterally)
  • 1) modified Webster scale

  • 2) UPDRS I

  • 3) UPDRS II

  • 4) UPDRS III

  • 5) UPDRS IV

  • 6) PDSS

  • 7) SDS

  • 1) (A:13.18±3.41, 6.36±1.69/B:14.35±4.08, 9.08±2.69)*

  • 2) (A:12.09±2.28, 5.52±1.44/B:12.57±2.39, 9.08±3.44)*

  • 3) (A: 33.30±6.00, 23.06±7.25/B:32.68±9.81, 27.19±10.30)

  • 4) (A:35.61±10.02, 23.88±13.73/B:36.89±9.40, 28.84±11.68)

  • 5) (A:5.24±2.02, 3.06±1.97/B:4.84±2.14, 5.03±1.88)*

  • 6) (A:113.39±23.16, 125.36±17.73/B:112.78±19.72, 109.95±18.10)*

  • 7) (A:49.91±7.78, 44.12±7.81/B:51.24±6.62, 51.35±6.74)*

  • A: fell down and had difficulty moving 1, received surgery 2, hospitalized with acute cerebral infarction 2,

  • B: combined with other drugs according to the condition 1 (no drug- or acupuncture-related AEs)

Yu 202017), China, RCTs PD, 68.1±14.7/58.2±13.4, 7.2±2.6/8.3 ±2.7, NR Superficial needling + CM (depends on condition) (n=20) Conventional AT (head, body) + CM (depends on condition) (n=20) 1time/2d for 2weeks pain region
  • 1) SF-MPQ

  • 1.1) PRI

  • 1.2) VAS

  • 1.3) PPI

  • 2) McGill total score

  • 3) PDQ-39

  • 4) total effective rate of pain (%)

  • 1.1) (A:10.54±1.57, 4.07±1.35/B:10.45±0.25, 5.13±0.52)*

  • 1.2) (A:7.44±0.83, 1.32±0.31/B:7.31±0.61,1.78±0.15)*

  • 1.3) (A:3.32±0.56, 1.23±0.32/B:3.29±0.68, 1.65±0.12)*

  • 2) (A:27.45±2.32, 12.56±0.80/B:27.55±3.55, 14.04±0.58)*

  • 3) (A:47.68±11.53, 35.15±10.12/B:46.66±7.4, 40.53±7.87)*

  • 4) (A:95/B:70)*

NR
Wu 201918), China, RCTs PD, 67.32±10.03/66.82±9.67, 7.32±5.13/7. 68±4.97, NR Gongshi cerebral needle + CM (dopaserazid e) (n=30) CM (dopaserazide ) (n=30) 2courses (1 course=1 time/d for 10d+1time/2d for 10d+rest for 10d) midline of the top of the head, from the highest point of the occipital tuberosity to the front hair, set a point every 1.5 ~ 2cm, generally take 1 to 2 points each time
  • 1) UPDRS I+II+III

  • 2) total effective rate by UPDRS I+II+III (%)

  • 1) (A:44.30±6.76, 24.21±7.03/B.43.16±6.69, 32.15±7.25)*

  • 2) (A:93.33/B:66.67)*

NR
Jiang 201819), China, RCTs PD, 71.84±7.22/71.93±8.12, NR, I~III Eye AT + CM (Madopar) (n=30) Conventional AT(scalp, body) + CM(Madopar) (n=30) 5times/w for 4 weeks on the outer area of both eyes, acupoints for lower-energizer, liver, kidney, spleen, lung, and large intestine
  • 1) total effective rate by geriatric tremor dysfunction score (%)

  • 2) total effective rate by total UPDRS (%)

  • 1) (A:96.6/B:80.0)*

  • 2) (A:96.7/B:76.7)*

NR
Li 201820), China, RCTs PD, 65.79±6.07/62.85 ±5.00/62.17 ±7.66, 5.14±3.32/5. 03±4.73/7.33±4.62, I~III A. MA + CM(levodop a) (n=14) B. Sham AT+ CM(levodopa) (n=14) C. CM(levodopa) (n=13) 2times/w for 12 weeks DU20, GB20, the Chorea-Tremor Controlled Zone
  • 1) UPDRS II

  • 2) UPDRS III

  • 3) UPDRS III-tremor score

  • 4) UPDRS III-rigidity score

  • 5) UPDRS III-hypokinesia score

  • 6) UPDRS III-PIGD score

  • 7) DC, ReHo, ALFF by fMRI brain scan

  • 1) (A:12.64±5.98, 9.00±4.40*/B:11.25±4.58, 10.33±5.28/C:11.09±6.58, 12.27±7.90)

  • 2) (A:26.00±15.07, 21.64±13.68*/B:19.50±8.49, 19.25±9.21/C:24.36±14.07, 26.73±14.03)

  • 3) (A:1.17±0.52, 0.85±0.43*/B:0.92±0.49, 0.90±0.47/C:1.12±0.62, 1.31±0.69*)

  • 4) (A:0.89±0.82, 0.76±0.79/B:0.52±0.54, 0.50±0.53/C:0.71±0.72, 0.80±0.64)

  • 5) (A:0.84±0.75, 0.71±0.77/B:0.56±0.32,0.58±0.30/C:0.85±0.53, 0.91±0.52)

  • 6) (A:0.88±0.45, 0.82±0.36/B:0.79±0.58, 0.75±0.62/C: 0.82±0.66, 0.82±0.63)

  • 7) ① specific activating effect on cerebrocerebellum (DC ↓, ReHo ↓, ALFF↑)

    ② nonspecific effect on the spinocerebellum (ReHo ↑, ALFF↑)
    ③ ReHo ↑ in the thalamus and motor cortex
    ④ DMN, visual areas, insula activation [DC ↑, ReHo ↑, and/or ALFF↑] vs ReHo ↓, ALFF↓in PFC
NR (No serious AEs)
Cho 201721), Korea, RCTs, IPD, 64.42±8.24/61.33±8.20/64.07±6.33, 5.08±3.68/5. 92±4.18/4.53±3.25, I~IV A. BVA + MA+ CM(keep previous medications) (n=24) B. NS +Sham AT +CM(keep previous medications) (n=24) C. CM(keep previous medications) (n=15) 2 times/w for 12 weeks bilateral GB20, LI11, GB34, ST36, LR3
  • 1) UPDRS II +III

  • 2) UPDRS II

  • 3) UPDRS III

  • 4) PIGD

  • 5) 20m gait number(steps)

  • 6) 20m gait speed (s)

  • 7) PDQL

  • 8) BDI

  • 9) postural stability by NeuroCom Balance Master (NeuroCom® International, Inc. Oregon,USA)

  • 9.1) MXE (%)

  • 9.2) DCL (%)

pre, post M.D±S.D
  • 1) (A:−4.52±4.98/B:−3.83±6.55/C: +0.40±3.83), A,B:NS, A>C, p<0.05

  • 2) (A:−2.84±3.17/B:−2.17±3.60/C:−0.07±2.05) A,B:NS, A>C, p<0.05

  • 3) (A:−1.68±2.48/B:−1.67±3.17/C:+0.40±2.85) A,B:NS, A>C, p<0.05

  • 4) (A:−0.96±1.74/B:−0.63±1.53/C:+0.20±1.70), A,B:NS, A>C, p<0.05

  • 5) (A:−1.40±3.39/B:−2.67±5.21/C:−0.13±3.76)

  • 6) (A:−2.72±8.53/B:−1.13±2.97/C:+0.53±2.95)

  • 7) (A:12.24±11.22/B:10.04±18.32/C:15.27±13.48)

  • 8) (A:−0.60±7.82/B:−2.71±8.57/C:−2.47±5.69)

  • 9.1) (A:0.68±10.22/B:0.12±12.37/C:4.03±9.00)

  • 9.2) (A:1.56±6.18/B:−1.79±11.84/C:−1.32±9.04)

AT: mild pain, slight bleeding, BVA: mild itchiness, mild swelling
Aroxa 201722), Brazil, RCTs, IPD, 60(10)/56(12) median (interquartile range), NR, I~III MA (n=11) No treat (n=11) 1time/w for 8weeks LR3, SP6, LI4, TE5, HT7, PC6, LI11, GB20 PDSS pre, post median (interquartile range) (A: 97(58), 124(57)*/B: 87(33), 126(25)) NR
Lia 201723), China, RCTs PD, 59.18±3.15/58.51± 2.82, NR, II~IV MA + CM (Madopar) (n=64) CM (Madopar) (n=64) NR for 3months HT5, PC3, SP6, ST36, LR3, KI3, LI4, GV4, CV4, GV20, Ex-HN1, GB20, GB34, SP9, etc. acupoints were selected according to clinically validated points total effective rate by total UPDRS (%) (A: 89.06/B:75.00)*
  • A: constipation 30, insomnia 18, nausea 11, switching phenomenon 4, end-of-dose phenomenon 4,

  • B: constipation 46, insomnia 31, nausea 24, switching phenomenon 15, end-of-dose phenomenon 14,

  • • difference in incidence of adverse events: A<B (p<0.05)

Lib 201724), China, RCTs PD, 76.77±11.30/76.77±11.50, 4.60±1.54/4.67±1.7, NR AT (press-needle-method) (n=30) CM (mosapride) (n=30) 2times/w for 30days CV12, CV10, CV6, CV4, BL20, BL21, BL25, BL27
  • 1) PAC-QOL

  • 2) anorectal dynamic exam

  • 2.1) resting rectal pressure(kPa)

  • 2.2) anal canal resting pressure(kPa)

  • 2.3) anal systolic pressure(kPa)

  • 2.4) initial rectal sensory volume(ml)

  • 2.5) maximum tolerable volume(ml)

  • 3) total effective rate by Cleveland scale and Bristol scale (%)

  • 1) (A:79.17±4.74, 55.77±6.18/B:78.83±4.90, 54.13±4.07),

  • 2.1) (A:4.43±1.59, 6.60±1.63/B:3.77±1.19, 6.20±1.00)

  • 2.2) (A:5.90±1.30, 6.83±1.42/B:6.20±1.86, 6.97±1.50)

  • 2.3) (A:13.90±2.56, 15.30±1.99/B:14.10±2.73, 14.90±2.02)

  • 2.4) (A:65.27±5.14, 38.93±8.48/B:64.30±6.01, 39.90±5.38)

  • 2.5) (A:194.70±16.73, 132.23±23.06/B:199.23±17.07, 134.47±21.35)

  • 3) (A:81.7/B:70)*

NR
Liu 201625), China, RCTs PD, 65±7/65±6, 4.3±1.4/4.1±1.3, III Tung’s AT + CM(levodop a) (n=46) CM(levodopa) (n=46) 1time/d for 20 days shang san huang (tian huang, ming huang, qi huang), xia san huang (ren huang, de huang, shen guan), ling gu, dabai Walk and balance function by NeuroCom Balance Master(NeuroCom® International, Inc. Oregon,USA)
  • 1) WLK

  • 1.1) step length(cm)

  • 1.2) gait speed(m/min)

  • 2) SNT

  • 2.1) turning sway angle(°)

  • 2.2) turning time(s)

  • 3) TUGT (s)

pre, post M.D±S.D
  • 1.1) (A:15.2±3.9/B: 8.8±4.6)*,

  • 1.2) (A:22.6±7.42/B:14.5±5.0)*,

  • 2) L: left, R: right

  • 2.1) (A:L−18.4±10.3, R−21.1±11.6/B:L−13.1±7.9, R−15.6±11.0)*,

  • 2.2) (A:L−1.3±1.0, R−1.1±0.9/B:L−0.8±0.8, R−0.9±0.8)*,

  • 3)(A:19.6±9.2/B:7.9±1.6)*

NR
Jang 202026), Korea, RCT pilot PD, 65.38±7.81/61.46±8.33, 6.92±4.83/8. 38±3.88, 1.92±0.64/1. 85±0.69 MA + CM(NR) (n=13) CM(NR) (n=13) 2 times/w for 4 weeks acupoints were selected according to clinically validated points
  • 1) GAITRite parameters by GAITRite (CIR Systems Inc, New Jersey, USA)

  • 1.1) velocity(cm/s)

  • 1.2) cadence (steps/min)

  • 1.3) stride length(cm)

  • 1.4) stride time(s)

  • 1.5) single support time(s)

  • 1.6) double support time(s)

  • 1.7) swing time(s)

  • 1.8) swing %cycle

  • 2) hemodynamic responses of oxyhemoglobin in the cerebral cortices by fNIRS

  • 3) UPDRSA by MDS-UPDRS

  • 4) UPDRSM by MDS-UPDRS

  • (0,4,8w) 1.1) (A:118.34±24.86, 116.73±22.02, 120.71±19.73/B:115.88±14.50, 118.90±16.46, 123.54±17.61)

  • 1.2) (A:120.24±10.41, 115.76±9.59, 116.84±7.83/B:120.37±8.94, 121.76±10.04, 124.07±8.74)*

  • 1.3) (A:117.75±19.40, 120.90±18.50, 123.98±17.49/B: 115.66±10.50, 117.57±12.90, 119.87±15.19)

  • 1.4) (A:1.01±0.09, 1.04±0.09, 1.03±0.07/1.00±0.08, 0.99±0.09,0.97±0.07)*

  • 1.5) (A:0.38±0.03, 0.40±0.03, 0.40±0.03/B:0.38±0.02, 0.38±0.03, 0.38±0.03)*

  • 1.6) (A:0.24±0.04, 0.24±0.05, 0.23±0.04/B:0.24±0.04, 0.23±0.04, 0.21±0.04)

  • 1.7) (A:0.38±0.03, 0.40±0.03, 0.40±0.03/B:0.38±0.02, 0.38±0.03, 0.38±0.03)*

  • 1.8) (A:38.30±1.58, 38.57±1.85, 38.83±1.73/B:38.42±1.26, 38.42±1.23, 39.22±1.86)

  • 2) ①supplementary motor area: Channels 11(A>B. P=0.037), Channels 15 (A>B. P=0.022)

    ②prefrontal cortex: Channels 35(A>B. P=0.035), Channels 39(A>B. P=0.023), Channels 40 (A>B. P=0.006)
  • 3) (A:1.92±1.55, 0.77±0.83, 0.85±0.80/B:1.83±1.03, 1.83±1.70, 1.50±1.31)*

  • 4) (A:4.85±2.03, 2.85±1.68, 3.54±1.61/B:5.08±2.78, 4.00±2.89, 4.15±2.76)

NR (No serious AEs)
Kong 201727), Singapore, RCT pilot PD, 66.4±6.5/62. 9±9.7, 87.2±53.2/50.1±26.4 (months), NR MA (n=20) Sham AT (Park Sham needle) (n=20) 2 times/w for 5 weeks CV6, bilateral PC6, LI4, ST36, SP6, KI3
  • 1) UPDRS III

  • 2) MFI-GF

  • 3) MFI-Total score

  • 4) PDQ 39

  • 5) GDS

  • 6) ESS

  • 1) (A:27.1±13.7, 22.5±12.1*/B:23.8±10.6, 23.7±10.9)

  • 2) (A:13.4±2.9, 10.4±3.3*/B:14.0±2.7, 9.3±2.9*)

  • 3) (A:61.6±15.1, 52.5±15.5*/B:56.6±9.2, 47.2±10.6*)

  • 4) (A:38.4±25.1, 30.3±25.5/B:23.7±17.5, 19.5±15.2)

  • 5) (A:7.5±3.8, 5.8±4.3/B:6.7±4.4, 5.2±4.6)

  • 6) (A 4.0±3.3, 3.2±2.7/B:3.3±2.5, 2.8±2.3)

fracture after a fall 2 (not related to AT), exacerbation of anxiety 1
Lei 201628), USA, RCT pilot PD, 69.8±4.5/71. 0±11.7, 6.2±5.9/5.2 ±4.7, 3.0±1.0/2.9 ±0.7 EA + CM(levodop a) (n=10) Sham EA +CM(levodop a) (n=5) 1 time/w for 3weeks foot motor sensory area, balance area, GV20, GV14, LI4, ST36, GB34, BL40, SP6, KI3, LR3
  • 1) Gait parameters: speed(m/s), stride(m), cadence(steps/min), double support(%), midswing(º/s) by LEGSys™ (BioSensics LLC, Boston, MA)

  • 1.1) STHW

  • 1.2) DTHW

  • 1.3) STFW

  • 1.4) DTFW

  • 2) UPDRS I

  • 3) UPDRS II

  • 4) UPDRS III

  • 5) SF-12 (PCS)

  • 6) SF-12 (MCS)

  • 7) FES-I

  • 8) VAS

  • 1.1) % change in speed(A:9%*/B:3%), stride(A:13%*/B:3%)

  • 1.2) NS

  • 1.3) % change in speed(A:9%*/B:1%), midswing(A:6%*/B:5%)

  • 1.4) % change in speed(A:19%*/B:3%), stride(A:9%*/B:−0.2%)

  • 2) pre, post M.D±S.D(A:−2.6±2.10/B:1.8±2.7)*

  • 3) pre, post M.D±S.D(A:−7.2±5.50/B:−0.4±3.4)*

  • 4) pre, post M.D±S.D(A:−16.0±6.20/B:3.0±5.2)*

  • 5) pre, post M.D±S.D(A:0.6±6.40/B:−1.0±7.5)

  • 6) pre, post M.D±S.D(A:3.7±11.20/B:0.5±3.4)

  • 7) pre, post M.D±S.D(A:−2.2+3.90/B:1.8±3.8)

  • 8) pre, post M.D±S.D(A:−1.1±3.00/B:−1.2±2.8)

  • A: transient light headedness

Ye 202029), China, CTs PD, 60.10±8.44, NR, 1~2.5 Scalp AT (n=10) none 1 time for 30min the tip of the coronal sagittal point (the junction of the frontal bone and the nape bone, the intersection of the coronal suture and the sagittal suture), 5cm below the occipital tuberosity and 4cm outward. images of brain local area by fMRI Increased local consistency in brain areas such as bilateral hippocampus, left amygdala, left insula, bilateral superior temporal gyrus, left middle temporal gyrus, left inferior frontal gyrus, bilateral putamen, left caudate nucleus, bilateral lateral globus pallidus, corpus callosum NR
Wang 201830), China, CTs PD, 54.5±4.9/53. 7±4.6, NR, NR MA + CM(Carbido pa) (n=58) CM (Carbidopa) (n=58) 1time/d for 1 month HT7, ST36, LI20, Shenmen, heart and lung points in the ear acupoints
  • 1) total UPDRS

  • 2) HAMD

  • 1) (A:28.4±9.4, 17.8±5.9/B:27.6±9.1, 22.6±7.5)*

  • 2) (A:17.9±5.9, 7.5±2.4/B:17.6±5.8, 9.8±3.2)*

NR

AEs: Adverse Events; ALFF: Amplitudes of Low-Frequency Fluctuation; BDI: Beck Depression Inventory; BVA: Bee Venom Acupuncture; CM: Conventional Medicine; CT: Controlled Trial; DC: Degree Centrality; DCL: Directional Control; DMN: the Default Mode Network; DTFW: Dual-Task Fast Walking; DTHW: Dual-Task Habitual Walking; EA: Electroacupuncture; EPE: Endpoint Excursion; ESS: Epworth Sleepiness Scale; FES-I: Falls Efficacy Scale-International, fNIRS: functional Near-Infrared Spectroscopy; GDS: Geriatrics Depression Scale; HAMD: Hamilton Depression Scale; H&Y: Hoehn and Yahr scale; LOS: Limits of Stability; MA: Manual Acupuncture; M.D: Mean Difference; MDS-UPDRS: The Movement Disorder Society-Unified Parkinson’s Disease Rating Scale; MFI-GF: General Fatigue score of the Multidimensional Fatigue Inventory; MVL: Movement Velocity ; MXE: Maximum Excursion; N-QOL: Nocturia related Quality of Life scale; NR: Not Reported; NS: Not Significant; PAC-QOL: Patient Assessment of Constipation Quality of Life; PDQ-39: Parkinson’s Disease Questionnaire-39; PDQL: Parkinson’s Disease Quality of Life Questionnaire; PDSS: Parkinson Disease Sleep Scale; PFC: Prefrontal Cortex; PIGD: Postural Instability and Gait Disturbance; PPI: Present Pain Intensity; PRI: Pain Rating Index; PTNTCEN: Pharynx Three-Needle and Tremor-Ceasing Eight-Needle; RCT: Randomized Controlled Trial; ReHo: Regional Homogeneity; RRT: Routine Rehabilitation Training; RT: Reaction Time; SDS: Self-rating Depression Scale; SF-12 (MCS) : Short Form-12 Health Survey (mental component summary); SF-12 (PCS): Short Form-12 Health Survey (physical component summary); SF-36: 36-Item Short Form Health Survey; SF-MPQ: Short-Form McGill Pain Questionnairel; SNT: Step/Quick Turn; SRT: Swallowing Rehabilitation Training; SSA: Standardized Swallowing Assessment; STFW: Single-Task Fast Walking; STHW: Single-Task Habitual Walking; SWAL-QOL: Swallowing related Quality of Life; TSI: Test of Smell Identification; TTNcVLFES: Tongue Triple Needles combined with Vitalstim Low-Frequency Electrical Stimulation; TUGT: Timed Up & Go Test; UPDRS: Unified Parkinson’s Disease Rating Scale; UPDRSA: UPDRS score that includes the “walking and balance” and “freezing” parts of the UPDRS II assessment for activities of daily living”; UPDRSM: UPDRS score that includes the “gait,” “postural stability,” “posture,” and “body bradykinesia” parts of the UPDRS III motor assessment; VFSS: Video Fluoroscopic Swallowing Study; WLK: Walk Across

Table 2
Types of Acupuncture Treatment for Parkinson’s Disease
Previous studies Last 5-year studies
MA k=15, 39.47% k=9, 39.13%
EA K=13, 34.21% k=2, 8.70%
Scalp AT k=6, 15.80% k=2, 8.70%
Pharmaco-Acupuncture k=2, 5.26% k=1, 4.34%
Abdominal AT k=1, 2.63% k=1, 4.34%
Sasang-constitution AT k=1, 2.63%
Other various type AT k=8, 34.78%
 ① PTNTCEN
 ② Nape AT
 ③ TTNcVLFES
 ④ Superficial needling
 ⑤ Gongshi Cerebral needle
 ⑥ Eye AT
 ⑦ Press-needle-method
 ⑧ Tung’s AT

MA: Manual Acupuncture; EA: Electroacupuncture; PTNTCEN: Pharynx Three-Needle and Tremor-Ceasing Eight-Needle; TTNcVLFES: Tongue Triple Needles combined with Vitalstim Low- Frequency Electrical Stimulation

Table 3
Outcome Measures in the Treatment of Parkinson’s Disease
Symptoms of Parkinson’ disease Outcome measures in previous studies Outcome measures in last 5-year studies
Integrated symptoms Total UPDRS, Webster scale Total UPDRS8,11,30), Webster scale8), MDS-UPDRS26), modified Webster scale16)
Motor symptoms Integrated motor symptoms UPDRS II, UPDRS III, MDRSPD UPDRS II16,20,21,28), UPDRS III16,20,21,28)
Rigidity Rigidity score-UPDRS III, TAS Rigidity score-UPDRS III20)
Tremor Tremor score-UPDRS III20), total effective rate by geriatric tremor dysfunction score19)
Hypokinesia Hypokinesia score-UPDRS III20)
Postural instability, balance Balance outcome measures by BalanSens TM (BioSensics LLC, Boston, Mass., USA): COGAP sway, COGML sway, COGML/AP sway, ankle sway, hip sway, ankle/hip sway, Short FES-1, BBS LOS by NeuroCom Balance Master (NeuroCom® International, Inc. Oregon, USA): RT (s), MVL (°/s), EPE (%), MXE (%), DCL (%)13), PIGD score-UPDRS III20,21), FES-I28)
Gait disturbance 30m walking time(s) and steps, FOGQ 20m walking time (s)11), 20m average step length (m)11), GAITRite parameters by GAITRite (CIR Systems Inc, New Jersey, USA) : velocity (cm/s), cadence (steps/min), stride length (cm), stride time (s), single support time (s), double support time (s), swing time (s), swing %cycle26), Gait parameters by LEGSys™ (BioSensics LLC, Boston, MA) : speed (m/s), stride (m), cadence (steps/min), double support (%), midswing (º/s) during STHW, DTHW, STFW, DTFW28), Walk and balance function by NeuroCom Balance Master (NeuroCom® International, Inc. Oregon,USA): WLK (step length (cm), gait speed (m/min)), SNT (turning sway angle (°), turning time (s)), TUGT (s)25), PIGD score-UPDRS III20,21)
Non-motor symptoms Disturbances in autonomic function constipation PAC-QOL24), anorectal dynamic exam: resting rectal pressure (kPa), anal canal resting pressure (kPa), anal systolic pressure (kPa), initial rectal sensory volume (ml), maximum tolerable volume (ml)24), total effective rate by Cleveland scale and Bristol scale24)
urinary disorders Changes in urination frequency over 24 h, frequency of incontinence over 24 h, average urine volume at a time
nocturia No. of nocturia9), N-QOL9)
Sensory symptoms pain VAS SF-MPQ: PRI, VAS, PPI17), McGill total score17), total effective rate of pain17)
olfactory disorder TSI10)
Neuropsychiatric symptoms mental disorder CGI-I
cognitive dysfunction MMSE, MoCA
depression HAMD, GDS, HADS, BDI HAMD30), GDS27), SDS16)
apathy AES
Other symptoms dysphagia Dysphagia score14), total effective rate by water swallowing test14), SSA12,15), VFSS15), SWAL-QOL12, 15), Kubota’s scale of swallowing ability (water swallowing test)12)
fatigue MFIS MFI-GF27), MFI-total score27)
sleep disturbances PDSS, ESS, PSQI PDSS9,16,22), ESS,27)
QOL PDQ-39, PDQ-18, PDQL, SF-12 (PCS), SF-12 (MCS), QOL PDQ-3927), PDQL21), SF-12 (PCS)28), SF-12 (MCS)28), SF-3614)
Images of brain local area Brain local area scanning by fMRI20,29), hemodynamic responses of oxyhemoglobin in the cerebral cortices by fNIRS26)

AES: Apathy Evaluation Scale; BBS: Berg Balance Scale; BDI: Beck Depression Inventory; CGI-I: Clinical Global Impression of Improvement scale; COGML/AP sway: the ratio of Medial-Lateral Center-Of-Gravity sway to Anterior-Posterior sway; DCL: Directional Control; DTFW: Dual-Task Fast Walking; DTHW: Dual-Task Habitual Walking; EPE: Endpoint Excursion; ESS: Epworth Sleepiness Scale; FES-I: Falls Efficacy Scale-International, fNIRS: functional Near-Infrared Spectroscopy; FOGQ: Freezing of Gait Questionnaire; GDS: Geriatrics Depression Scale; HADS: Hospital Anxiety and Depression Scale; HAMD: Hamilton Depression Scale; LOS: Limits Of Stability; MDRSPD: Motor-Dysfunction Rating Scale for Parkinson’s Disease; MDS-UPDRS: the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale; MFI-GF: General Fatigue score of the Multidimensional Fatigue Inventory; MFIS: Modified Fatigue Impact Scale; MMSE: Mini-Mental State Examination; MoCA: Montreal Cognitive Assessment; MVL: Movement Velocity ; MXE: Maximum Excursion; N-QOL: Nocturia related Quality of Life scale; PAC-QOL: Patient Assessment of Constipation Quality of Life; PDQ-39: Parkinson’s Disease Questionnaire-39; PDQL: Parkinson’s Disease Quality of Life questionnaire; PDSS: Parkinson’s Disease Sleep Scale; PIGD: Postural Instability and Gait Disturbance; PPI: Present Pain Intensity; PRI: Pain Rating Index; PSQI: Pittsburgh Sleep Quality Index; RT: Reaction Time; SDS: Self-rating Depression Scale; SF-12 (MCS) : Short Form-12 Health Survey (Mental Component Summary); SF-12 (PCS): Short Form-12 Health Survey (Physical Component Summary); SF-36: 36-Item Short Form Health Survey; SF-MPQ: Short-Form McGill Pain Questionnaire; SNT: Step/Quick Turn; SSA: Standardized Swallowing Assessment; STFW: Single-Task Fast Walking; STHW: Single-Task Habitual Walking; SWAL-QOL: Swallowing related Quality Of Life; TAS: Tone Assessment Scale; TSI: Test of Smell Identification; TUGT: Timed Up & Go Test; UPDRS: Unified Parkinson’s Disease Rating Scale; VFSS: Video Fluoroscopic Swallowing Study; WLK: Walk Across

Table 4
Comparison of the Effects of True Acupuncture and Sham Acupuncture for Treating Parkinson’s Disease
Author, Year Type of intervention Outcome measures Results

Baseline Right after treatment Follow-up
Cho 201721) A. BVA+ MA + CM, B. NS+ Sham AT + CM 0week (mean±S.D) 12week (pre, post M.D±S.D) 20week (between-group adjusted difference in mean change from baseline of A,B)
UPDRS II +III A.29.29±11.00, B.32.42±9.86 A.−4.52±4.98*, B.−3.83±6.55* −4.895, (p<0.05)
UPDRS II A.13.50±6.21, B.15.75±5.69 A.−2.84±3.17*, B.−2.17±3.60* −2.507, (p<0.05)
UPDRS III A.15.79±5.51, B.16.75±5.10 A.−1.68±2.48*, B.−1.67±3.17* −2.26, (p<0.05)
PIGD A.5.67±2.68, B.6.33±3.28 A.−0.96±1.74*, B.−0.63±1.53 −0.785, (p>0.05)
20m gait number(steps) A.39.79±5.67, B.43.50±10.68 A.−1.40±3.39*, B.−2.67±5.21* −0.662, (p>0.05)
20m gait speed (s) A.22.92±11.52, B.21.75±5.305 A.−2.72±8.53, B.−1.13±2.97 −1.726, (p<0.05)
PDQL A.133.92±25.38, B.130.08±16.98 A.12.24±11.22*, B.10.04±18.32* 7.048, (p>0.05)
BDI A.15.04±8.41, B.16.79±6.83 A.−0.60±7.82, B.−2.71±8.57 −1.554, (p>0.05)
MXE A.61.87±17.54, B.62.60±13.86 A.0.68±10.22, B.0.12±12.37 1.585 (p>0.05)
DCL A.76.32±12.23, B.74.47±11.52 A.1.56±6.18, B.−1.79±11.84 1.992 (p>0.05)

Kong 201727) A. MA, B. Sham AT 0week (mean±S.D) 5week (mean±S.D) 9week (mean±S.D)
UPDRS III A.27.1±13.7, B.23.8±10.6 A.22.5±12.1*, B.23.7±10.9 A.24.8±16.3*, B.23.8±10.6, (p>0.05)
MFI-GF A.13.4±2.9, B.14.0±2.7 A.10.4±3.3*, B.9.3±2.9* A.10.6±3.37*, B.10.5±3.2*, (p>0.05)
MFI-Total score A.61.6±15.1, B.56.6±9.2 A.52.5±15.5*, B.47.2±10.6* A.52.7±15.1*, B.48.5±8.0*, (p>0.05)
PDQ-39 A.38.4±25.1, B.23.7±17.5 A.30.3±25.5, B.19.5±15.2 A.34.3±25.8, B.18.6±16.0, (p>0.05)
GDS A.7.5±3.8, B.6.7±4.4 A. 5.8±4.3, B.5.2±4.6 A.5.5±3.6, B.5.2±3.6, (p>0.05)
ESS A. 4.0±3.3, B.3.3±2.5 A.3.2±2.7, B.2.8±2.3 A.3.8±2.8, B.2.3±2.3, (p>0.05)

* Indicates a significant difference of pre, post treatment (p<0.05)

BVA: Bee Venom Acupuncture; BDI: Beck Depression Inventory; CM: Conventional Medicine; MA: Manual Acupuncture; PIGD: Postural Instability and Gait Disturbance; PDQL: Parkinson’s Disease Quality of Life Questionnaire; UPDRS: Unified Parkinson’s Disease Rating Scale; MXE: Maximum Excursion in postural stability by NeuroCom Balance Master (NeuroComR International, Inc. Oregon,USA); DCL: Directional Control in postural stability by NeuroCom Balance Master; MFI-GF: General Fatigue score of the Multidimensional Fatigue Inventory; NS: Normal Saline; PDQ-39: Parkinson’s Disease Questionnaire-39; GDS: Geriatrics Depression Scale; ESS: Epworth Sleepiness Scale

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