Abstract
Background
Acupuncture is 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 2008.
Objectives
To determine the effectiveness and safety of acupuncture in people with epilepsy.
Search methods
We searched the Cochrane Epilepsy Group Specialised Register (June 2013) and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2013, Issue 5), MEDLINE, EMBASE, CINAHL, AMED and other databases (from inception to June 2013). We reviewed reference lists from relevant trials. We did not impose any language restrictions.
Selection criteria
Randomised controlled trials (RCTs) 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
We used standard methodological procedures expected by The Cochrane Collaboration.
Main results
We included 17 RCTs with 1538 participants that had a wide age range and were suffering mainly from generalized epilepsy. The duration of treatment varied from 7.5 weeks to 1 year. All included trials had a high risk of bias with short follow-up. Compared with Chinese herbs, needle acupuncture plus Chinese herbs was not effective in achieving at least 50% reduction in seizure frequency (80% in control group versus 90% in intervention group, RR 1.13, 95% CI 0.97 to 1.31, 2 trials; assumed risk 500 per 1000, corresponding risk 485 to 655 per 1000). Compared with valproate, needle acupuncture plus valproate was not effective in achieving freedom from seizures (44% in control group versus 42.7% in intervention group, RR 0.97, 95% CI 0.72 to 1.30, 2 trials; assumed risk 136 per 1000, corresponding risk 97 to 177 per 1000) or at least 50% reduction in seizure frequency (69.3% in control group versus 81.3% in intervention group, RR 1.34, 95% CI 0.52 to 3.48, 2 trials; assumed risk 556 per 1000, corresponding risk 289 to 1000 per 1000) but may have achieved better quality of life (QOL) after treatment (QOLIE-31 score (higher score indicated better QOL) mean 170.22 points in the control group versus 180.32 points in the intervention group, MD 10.10 points, 95% CI 2.51 to 17.69 points, 1 trial). Compared with phenytoin, needle acupuncture was not effective in achieving at least 50% reduction in seizure frequency (70% in control group versus 94.4% in intervention group, RR 1.43, 95% CI 0.46 to 4.44, 2 trials; assumed risk 700 per 1000, corresponding risk 322 to 1000 per 1000). Compared with valproate, needle acupuncture was not effective in achieving seizure freedom (14.1% in control group versus 25.2% in intervention group, RR 1.75, 95% CI 0.93 to 3.27, 2 trials; assumed risk 136 per 1000, corresponding risk 126 to 445 per 1000) but may be effective in achieving at least 50% reduction in seizure frequency (55.3% in control group versus 73.7% in intervention group, RR 1.32, 95% CI 1.05 to 1.66, 2 trials; assumed risk 556 per 1000, corresponding risk 583 to 923 per 1000) and better QOL after treatment (QOLIE-31 score mean 172.6 points in the control group versus 184.64 points in the intervention group, MD 12.04 points, 95% CI 4.05 to 20.03 points, 1 trial). Compared with antiepileptic drugs, catgut implantation at acupoints plus antiepileptic drugs was not effective in achieving seizure freedom (13% in control group versus 19.6% in intervention group, RR 1.51, 95% CI 0.93 to 2.43, 4 trials; assumed risk 127 per 1000, corresponding risk 118 to 309 per 1000) but may be effective in achieving at least 50% reduction in seizure frequency (63.1% in control group versus 82% in intervention group, RR 1.42, 95% CI 1.07 to 1.89, 5 trials; assumed risk 444 per 1000, corresponding risk 475 to 840 per 1000) and better QOL after treatment (QOLIE-31 score (higher score indicated worse quality of life) mean 53.21 points in the control group versus 45.67 points in the intervention group, MD -7.54 points, 95% CI -14.47 to -0.61 points, 1 trial). Compared with valproate, catgut implantation may be effective in achieving seizure freedom (8% in control group versus 19.7% in intervention group, RR 2.82, 95% CI 1.61 to 4.94, 4 trials; assumed risk 82 per 1000, corresponding risk 132 to 406 per 1000) and better QOL after treatment (QOLIE-31 score (higher score indicated better quality of life) mean 172.6 points in the control group versus 191.33 points in the intervention group, MD 18.73 points, 95% CI 11.10 to 26.36 points, 1 trial) but not at least 50% reduction in seizure frequency (65.6% in control group versus 91.7% in intervention group, RR 1.31, 95% CI 0.94 to 1.84, 4 trials; assumed risk 721 per 1000, corresponding risk 677 to 1000 per 1000). Acupuncture did not have excess adverse events compared to control treatment in the included trials.
Authors’ conclusions
Available RCTs are small, heterogeneous and have high risk of bias. The current evidence does not support acupuncture for treating epilepsy.
Plain language summary
Acupuncture for epilepsy
People 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. Seventeen randomised controlled trials with 1538 participants were included in the current systematic review (literature search conducted on 3rd June 2013).
Compared with Chinese herbs, needle acupuncture plus Chinese herbs was not effective in achieving satisfactory seizure control (at least 50% reduction in seizure frequency). If we assumed that 500 out of 1000 patients treated with Chinese herbs alone normally achieved satisfactory seizure control, we estimated that 485 to 655 out of 1000 patients treated with needle acupuncture plus Chinese herbs would achieve satisfactory seizure control. Compared with valproate, needle acupuncture plus valproate was not effective in achieving freedom from seizures or satisfactory seizure control. If we assumed that 136 out of 1000 patients treated with valproate alone normally achieved seizure freedom, we estimated that about 97 to 177 out of 1000 patients treated with acupuncture plus valproate would achieve seizure freedom; if we assumed that 556 out of 1000 patients treated with valproate alone normally achieved satisfactory seizure control, we estimated that about 289 to 1000 out of 1000 patients treated with acupuncture plus valproate would achieve satisfactory seizure control. Compared with phenytoin, needle acupuncture was not effective in achieving satisfactory seizure control. If we assumed that 700 out of 1000 patients treated with phenytoin alone normally achieved satisfactory seizure control, we estimated that about 322 to 1000 out of 1000 patients treated with acupuncture alone would achieve satisfactory seizure control. Compared with valproate, needle acupuncture was not effective in achieving seizure freedom but it may have been better in achieving satisfactory seizure control. If we assumed that 136 out of 1000 patients treated with valproate alone normally achieved seizure freedom, we estimated that about 126 to 445 out of 1000 patients treated with acupuncture alone would achieve seizure freedom; if we assumed that 556 out of 1000 patients treated with valproate alone normally achieved satisfactory seizure control, we estimated that about 583 to 923 out of 1000 patients treated with acupuncture alone would achieve satisfactory seizure control. Compared with antiepileptic drugs, catgut implantation at acupoints plus antiepileptic drugs was not effective in achieving seizure freedom, but it may have been better in achieving satisfactory seizure control. If we assumed that 127 out of 1000 patients treated with antiepileptic drugs alone normally achieved seizure freedom, we estimated that about 118 to 309 out of 1000 patients treated with catgut implantation at acupoints plus antiepileptic drugs would achieve seizure freedom; If we assumed that 444 out of 1000 patients treated with antiepileptic drugs alone normally achieved satisfactory seizure control, we estimated that about 475 to 840 out of 1000 patients treated with catgut implantation at acupoints plus antiepileptic drugs would achieve satisfactory seizure control. Compared with valproate, catgut implantation may have been better in achieving seizure freedom but not satisfactory seizure control. If we assumed that 82 out of 1000 patients treated with valproate alone normally achieved seizure freedom, we estimated that about 132 to 406 out of 1000 patients treated with catgut implantation at acupoints alone would achieve seizure freedom; if we assumed that 721 out of 1000 patients treated with valproate alone normally achieved satisfactory seizure control, we estimated that about 677 to 1000 out of 1000 patients treated with catgut implantation at acupoints alone would achieve satisfactory seizure control.
Acupuncture did not have excess adverse events compared to control treatment in the included trials. However, the included trials were small, heterogeneous and had a high risk of bias. It remains uncertain whether acupuncture is effective and safe for treating people with epilepsy.
