Efficacy and safety of transcutaneous electrical acupoint stimulation to treat muscle spasticity following brain injury: a double-blinded, multicenter, randomized controlled trial

Transcutaneous electrical acupoint stimulation for upper limb spasticity after stroke: effect and feasibility-a randomised pilot study

IMPORTANCE

Limb spasticity is a common issue among stroke patients. Transcutaneous electrical acupoint stimulation (TEAS) is recommended as an alternative therapy for managing upper limb spasticity after stroke; however, its potential effects and feasibility remain uncertain.

OBJECTIVE

To investigate the potential effects and feasibility of TEAS on motor function in patients with upper limb spasticity after stroke.

METHODS

This randomised controlled, double-blined pilot study was conducted in two phases. All the patients were randomly divided into two groups: the TEAS group and the sham TEAS group. The intervention period for both TEAS and sham TEAS was 6 weeks, with each session lasting 30 min and conducted thrice weekly. The outcomes measured were the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) score, the effective improvement rate, the modified Ashworth Scale (MAS), the Wolf Motor Function Test (WMFT), the visual analogue scale (VAS), the Barthel index (BI) and the surface electromyography (sEMG).

RESULTS

All participants completed the course of therapy. Baseline characteristics were comparable across the two groups. Compared with the sham TEAS group, the TEAS group showed significant increases in FMA-UE score (P value=0.013), WMFT score (P value=0.001) and BI score (P value=0.008) at week 6. For integrated electromyogram (p=0.048) and root mean square of the biceps (p=0.033), lower scores were identified in the TEAS group compared with the sham TEAS group with a significant difference at week 6.

CONCLUSION

TEAS was acceptable and feasible in participants with upper limb spasticity after stroke. A pivotal study of this therapy is justified.

Accurate diagnosis and effective treatment of abnormal meridians in erectile dysfunction patients based on infrared thermography: an electrophysiological technique study

An increasing body of research has demonstrated that appropriate stimulation of the meridians and acupoints in the human body can play a preventative and therapeutic role in diseases. This study combines the use of infrared thermography with intelligent electrophysiological diagnostic system (iEDS) to accurately diagnose and apply transdermal low-frequency electrical stimulation to treat abnormal meridians in patients with erectile dysfunction (ED). The treatment protocol included 6 treatments (each lasting 30 min and performed twice a week). The International Index of Erectile Function-5 (IIEF-5), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Erection Hardness Scale were used to assess treatment results. A total of 62 patients were included in this study, with 31 patients in the treatment group and 31 patients in the sham therapy group. After six treatments, the treatment group improved significantly in IIEF-5 (15.52 ± 2.06 vs. 18.84 ± 2.67, p < 0.001), PHQ-9 (8.32 ± 6.33 vs. 4.87 ± 4.41, p < 0.001), GAD-7 (5.32 ± 5.08 vs. 2.94 ± 3.31, p = 0.003), and EHS (2.48 (2.00, 3.00) vs. 2.90 (2.00, 3.00), p = 0.007). After six sham treatment sessions, no improvements in any of the scores were reported in the sham therapy group. Following that, this group had an additional six treatments of regular therapy, which resulted in statistically significant improvements in IIEF-5 (16.65 ± 1.96 VS. 19.16 ± 2.40, p < 0.001), PHQ-9 (8.81 ± 6.25 VS. 4.97 ± 4.36, p < 0.001), GAD-7 (5.74 ± 5.18 VS. 3.68 ± 3.42, p < 0.001), and EHS (2.61 (2.00, 3.00) VS. 3.03 (2.00, 4.00), p = 0.003). No adverse events were reported regarding penile discomfort, pain, injury, or deformity. CLINICAL TRIALS: The study protocol is registered in the Clinical Trials Registry with the identification number ChiCTR2300070262.

A Randomized Controlled Trial Assessing the Impact of Transcutaneous Electrical Acupoint Stimulation on Gastrointestinal Motility, Nutritional Status, and Immune Function in Patients Following Cerebrovascular Accident Surgery

BACKGROUND

Transcutaneous Electrical Acupoint Stimulation (TEAS) is a technique that involves stimulating specific acupoints on the body with electrical currents. It may regulate nerve excitability and improve nerve function. This study aimed to assess the impact of TEAS on gastrointestinal motility, nutrition, and immune function in patients post cerebrovascular accident surgery in the intensive care unit (ICU).

METHODS

A randomized controlled trial included 300 post-cerebrovascular surgery patients at Lishui Central Hospital (January 2021-June 2023). Patients were randomly assigned to TEAS or control groups in a 1:1 ratio. The TEAS group received TEAS at bilateral Zusanli (ST36), Shangjuxu (ST37), Tianshu (ST25), Neiguan (PC6), and Hegu (LI4) according to the International Acupuncture Point Code, plus standard care. The control group received routine enteral nutrition and sham TEAS. Nutritional, immune, and gastrointestinal motility indicators were compared.

RESULTS

A randomized controlled trial involving 300 post-surgery patients compared TEAS to sham TEAS, demonstrating significant enhancements (p < 0.05) in immune function and gastrointestinal motility. Compared to the control group, the TEAS group showed significant improvements in the patient's serum nutritional levels (prealbumin, albumin, hemoglobin, and total protein), immune status (IgG, IgA, IgM, and CD4+/CD8+), gastrointestinal motility (daily gastric residual volume, time to achieve target feeding volume, time for nutritional fluid to meet standards, time to first bowel movement, time to first passage of activated charcoal stool, time to reach the defecation volume), and overall condition (the scores of clinical scales and ICU stay duration) (p < 0.05). The TEAS group also experienced a significantly lower incidence of adverse events (p < 0.05).

CONCLUSIONS

Early TEAS intervention positively impacted recovery, shortened ICU stay, and improved outcomes in patients post cerebrovascular accident surgery.

Effect of transcutaneous electrical acupoint stimulation at different frequencies on mild hypertension: A randomized controlled trial

BACKGROUND

Transcutaneous electrical acupoint stimulation (TEAS) may contribute to blood pressure (BP) control, but the evidence remains insufficient. Our objectives were to evaluate the impact of TEAS on hypertension and determine the optimal frequency.

METHODS

A total of 120 hypertensive patients were randomly allocated to the TEAS-2Hz group, TEAS-10Hz group, or usual care control group in a 1:1:1 ratio. All patients were advised to continue their usual antihypertensive regimen. Additionally, patients in the TEAS groups received TEAS therapy 3 times per week for 4 weeks, with a 4-week follow-up.

RESULTS

The primary outcome was the change in systolic BP (SBP) from baseline to week 4. Secondary outcomes included changes in diastolic BP (DBP), mean arterial pressure (MAP), heart rate (HR), heart rate variability (HRV), and 12-item health survey (SF-12) at different time points. Both TEAS groups showed reductions in SBP relative to control (TEAS-2Hz group vs. control, -4.70 mmHg [95 % CI, -7.00 to -2.40 mmHg]; P < 0.001; TEAS-10Hz group vs. control, -8.66 mmHg [95 % CI, -10.97 to -6.36 mmHg]; P < 0.001). TEAS-10Hz provided a significant decrease in SBP than TEAS-2Hz (-3.96 mmHg [95 % CI, -1.66 to -6.26 mmHg]; P< 0.001). TEAS groups also exhibited reductions in DBP, MAP, HR, LF/HF ratio（LF/HF）, very low frequency (VLF), and normalized low frequency (LF norm), and an increase in normalized high frequency (HF norm) than control. No differences were observed among groups in low frequency (LF), high frequency (HF), total power (TP), very low frequency (VLF), and SF-12.

CONCLUSION

TEAS might be a promising adjunctive therapy for hypertension, and the recommended frequency is 10 Hz, which should be confirmed in larger trials.

Transcutaneous electrical acupoint stimulation for upper limb motor recovery after stroke: a systematic review and meta-analysis

Background

Transcutaneous electrical acupoint stimulation (TEAS) is an innovative, non-invasive therapy that stimulates the contraction of paralyzed muscles in the upper limbs, promoting functional recovery. Several studies have demonstrated the efficacy of TEAS in restoring upper limb function. This study aims to evaluate the impact of TEAS on upper limb motor recovery after stroke.

Objectives

This study aims to evaluate the influence of TEAS on upper limb motor recovery after stroke and improve the quality of life in such patients.

Methods

Eight databases were systematically searched from inception to 1st October 2024. Two independent reviewers conducted the screening and data extraction of the study. The primary outcome measure was the Fugl Meyer Assessment of the Upper Extremity (FMA-UE), which evaluates upper extremity motor function in stroke patients. Secondary outcomes included the Modified Ashworth Scale (MAS) for assessing spasticity and the Modified Barthel Index (MBI) to evaluate patients' abilities to perform activities of daily living. Data synthesis was conducted using RevMan 5.4 and Stata 14.0. The GRADE method was employed to assess the quality of evidence.

Results

A total of 16 trials involving 1,218 stroke patients were included in this meta-analysis. Meta-analysis showed that the TEAS significantly improved upper limb function (SMD = 1.70, 95CI% = 1.09 to 2.31, p < 0.00001, I 2 = 93%; low certainty of evidence), reduced spasticity (SMD = -1.18, 95CI% = -1.79 to -0.58, p < 0.00001, I 2 = 90%; very low certainty of evidence), and enhanced the ability to perform daily activities (SMD = 1.53, 95CI% = 0.85 to 2.20, p < 0.00001, I 2 = 95%; low certainty of evidence).

Conclusion

Our results indicated that TEAS improved motor function and functional activities and reduced muscle tone in the upper limbs after stroke. However, these results should be interpreted with caution due to the limited strength of the evidence. High-quality, larger sample, multi-center studies are needed to validate these preliminary findings.

Systematic review registration

This study was registered on PROSPERO with registration number CRD42024592509. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024592509.

Cortical functional networks of transcutaneous electrical stimulation at acupoints on the pericardial meridian

To explore the relationship between pericardial meridian acupoints and brain, the electroencephalogram (EEG) signals were collected synchronously during transcutaneous electrical stimulation at PC3, PC5, PC7, and PC8 on the pericardial meridian in 21 healthy subjects. The cerebral cortex functional networks were constructed by standard low-resolution electromagnetic tomography (sLORETA), phase-locking value (PLV) and complex network methods. The prefrontal cortex (BA10), the orbitofrontal cortex (BA11), the middle temporal gyrus (BA21), the temporal gyrus (BA22), the temporal pole (BA38), the triangular part (BA44), the dorsolateral prefrontal cortex (BA46), and the inferior frontal cortex (BA47) were activated by electrical stimulation at PC3, PC5, PC7, and PC8 on the pericardium meridian. These activated brain regions are able to modulate both local and remote emotion and cognitive networks. Acupoint stimulation of pericardium meridian mainly activated the frontal and the temporal lobes. Compared with non-acupoint stimulation, the node degree in the frontal lobe of electrical stimulation at PC3 (p < 0.05), PC5 (p < 0.05), PC7 (p < 0.01), PC8 (p < 0.05) and the temporal lobe of PC3 (p < 0.05), PC5 (p < 0.05), PC7 (p < 0.05), PC8 (p < 0.01) were significantly increased. The clustering coefficient in the frontal lobe of the stimulation at PC3 (p < 0.05), PC5 (p < 0.05), PC7 (p < 0.01), PC8 (p < 0.05) and the temporal lobe of PC3 (p < 0.05), PC5 (p < 0.05), PC7 (p < 0.01), PC8 (p < 0.05) were significantly increased. The characteristic path length decreased and the global efficiency increased during acupoint stimulation. The changes of functional network of stimulated pericardium meridian through cerebral cortex may provide theoretical support for the specificity of meridian and acupoints.

Effects of transcutaneous electrical acupoint stimulation on upper-limb impairment after stroke: A randomized, controlled, single-blind trial

OBJECTIVE

To evaluate the effects of transcutaneous electrical acupoint stimulation (TEAS) on upper limb motor recovery during post-stroke rehabilitation.

DESIGN

Single-blind, randomized controlled trial.

SETTING

Four inpatient rehabilitation facilities.

SUBJECTS

A total of 204 stroke patients with unilateral upper limb motor impairment were randomly 1:1 allocated to TEAS or sham TEAS group. Baseline demographic and clinical characteristics were comparable between the two groups.

INTERVENTIONS

Both groups received conventional physical and occupational therapies. TEAS and sham TEAS therapy were administered to two acupoints (LI10 and TE5) with a pulse duration of 300 µs at 2 Hz on the affected forearm for 30 times over 6 weeks.

OUTCOME MEASURES

The upper-extremity Fugl-Meyer score (primary outcome), manual muscle testing, modified Ashworth scale, Lindmark hand function score, and Barthel index were evaluated by blinded assessors at baseline, 2, 4, 6, 10, and 18 weeks.

RESULTS

The number of patients who completed the treatment was 99 and 97 in the TEAS and the sham group. No significant between-group difference was found in the Upper-Extremity Fugl-Meyer score, Modified Ashworth Scale, Lindmark hand function score, and Barthel Index after intervention and during follow-up. However, the TEAS group exhibited 0.29 (95% CI 0.02 to 0.55) greater improvements in Manual Muscle Testing of wrist extension than the sham group (p  =  0.037) at 18 weeks.

CONCLUSIONS

Administration of TEAS therapy to hemiplegic forearm could not improve the upper extremity motor recovery. However, TEAS on the forearm might provide potential benefits for strength improvement of the wrist.

The Impact of Complementary and Integrative Medicine Following Traumatic Brain Injury: A Scoping Review

OBJECTIVE

To examine the evidence levels, study characteristics, and outcomes of nonpharmacologic complementary and integrative medicine (CIM) interventions in rehabilitation for individuals with traumatic brain injury (TBI).

DATA SOURCES

MEDLINE (OvidSP), PubMed (NLM), EMBASE ( Embase.com ), CINAHL (EBSCO), PsycINFO (OvidSP), Cochrane Library (Wiley), and National Guidelines Clearinghouse databases were evaluated using PRISMA guidelines. The protocol was registered in INPLASY (protocol registration: INPLASY202160071).

DATA EXTRACTION

Quantitative studies published between 1992 and 2020 investigating the efficacy of CIM for individuals with TBI of any severity, age, and outcome were included. Special diets, herbal and dietary supplements, and counseling/psychological interventions were excluded, as were studies with mixed samples if TBI data could not be extracted. A 2-level review comprised title/abstract screening, followed by full-text assessment by 2 independent reviewers.

DATA SYNTHESIS

In total, 90 studies were included, with 57 001 patients in total. This total includes 2 retrospective studies with 17 475 and 37 045 patients. Of the 90 studies, 18 (20%) were randomized controlled trials (RCTs). The remainder included 20 quasi-experimental studies (2-group or 1-group pre/posttreatment comparison), 9 retrospective studies, 1 single-subject study design, 2 mixed-methods designs, and 40 case study/case reports. Guided by the American Academy of Neurology evidence levels, class II criteria were met by 61% of the RCTs. Included studies examined biofeedback/neurofeedback (40%), acupuncture (22%), yoga/tai chi (11%), meditation/mindfulness/relaxation (11%), and chiropractic/osteopathic manipulation (11%). The clinical outcomes evaluated across studies included physical impairments (62%), mental health (49%), cognitive impairments (39%), pain (31%), and activities of daily living/quality of life (28%). Additional descriptive statistics were summarized using narrative synthesis. Of the studies included for analyses, 97% reported overall positive benefits of CIM.

CONCLUSION

Rigorous and well experimentally designed studies (including RCTs) are needed to confirm the initial evidence supporting the use of CIM found in the existing literature.

Characterising the Features of 381 Clinical Studies Evaluating Transcutaneous Electrical Nerve Stimulation (TENS) for Pain Relief: A Secondary Analysis of the Meta-TENS Study to Improve Future Research

Background and Objectives: Characterising the features of methodologies, clinical attributes and intervention protocols, of studies is valuable to advise directions for research and practice. This article reports the findings of a secondary analysis of the features from studies screened as part of a large systematic review of TENS (the meta-TENS study). Materials and Methods: A descriptive analysis was performed on information associated with methodology, sample populations and intervention protocols from 381 randomised controlled trials (24,532 participants) evaluating TENS delivered at a strong comfortable intensity at the painful site in adults with pain, irrespective of diagnosis. Results: Studies were conducted in 43 countries commonly using parallel group design (n = 334) and one comparator group (n = 231). Mean ± standard deviation (SD) study sample size (64.05 ± 58.29 participants) and TENS group size (27.67 ± 21.90 participants) were small, with only 13 of 381 studies having 100 participants or more in the TENS group. Most TENS interventions were ‘high frequency’ (>10 pps, n = 276) and using 100 Hz (109/353 reports that stated a pulse frequency value). Of 476 comparator groups, 54.2% were active treatments (i.e., analgesic medication(s), exercise, manual therapies and electrophysical agents). Of 202 placebo comparator groups, 155 used a TENS device that did not deliver currents. At least 216 of 383 study groups were able to access other treatments whilst receiving TENS. Only 136 out of 381 reports included a statement about adverse events. Conclusions: Clinical studies on TENS are dominated by small parallel group evaluations of high frequency TENS that are often contaminated by concurrent treatment(s). Study reports tended focus on physiological and clinical implications rather than the veracity of methodology and findings. Previously published criteria for designing and reporting TENS studies were neglected and this should be corrected in future research using insights gleaned from this analysis.

Involvement of Opioid Peptides in the Analgesic Effect of Spinal Cord Stimulation in a Rat Model of Neuropathic Pain

Spinal cord stimulation (SCS)-induced analgesia was characterized, and its underlying mechanisms were examined in a spared nerve injury model of neuropathic pain in rats. The analgesic effect of SCS with moderate mechanical hypersensitivity was increased with increasing stimulation intensity between the 20% and 80% motor thresholds. Various frequencies (2, 15, 50, 100, 10000 Hz, and 2/100 Hz dense-dispersed) of SCS were similarly effective. SCS-induced analgesia was maintained without tolerance within 24 h of continuous stimulation. SCS at 2 Hz significantly increased methionine enkephalin content in the cerebrospinal fluid. The analgesic effect of 2 Hz was abolished by μ or κ opioid receptor antagonist. The effect of 100 Hz was prevented by a κ antagonist, and that of 10 kHz was blocked by any of the μ, δ, or κ receptor antagonists, suggesting that the analgesic effect of SCS at different frequencies is mediated by different endorphins and opioid receptors.

[Physical factors in the rehabilitation of patients after brain injury: a scientometric analysis of evidence-based studies]

OBJECTIVE

Scientometric analysis of evidence-based studies of the physical and rehabilitation medicine (PRM) technologies' effectiveness in the rehabilitation of patients with traumatic brain injury (TBI).

MATERIAL AND METHODS

The search for the material was carried out in electronic databases (PEDro, eLIBRARY, PubMed), as well as databases of systematic reviews (SR) (Cochrane Library) using the keywords: «brain injury», «brain», «physical therapy». RCTs were assessed on the PEDro scale from 1 to 10 points. For the final analysis the results of foreign SRs and RCTs published in the period from January 2014 to December 2019 were selected.

RESULTS

The analysis of studies devoted to the use of therapeutic physical factors in the rehabilitation of patients with TBI from the standpoint of evidence-based medicine is carried out. The basic trends in evidence-based studies on the use of various forms of physical exercise, neuromuscular stimulation, and robot-assisted training in the rehabilitation of patients with TBI are highlighted. PRM technologies have been identified which usage led to positive results in patients with TBI for a number of physiological indicators but the number of evidence-based studies on this topic was insufficient. Based on the scientometric analysis of benign studies the promising directions in the study of the influence of therapeutic physical factors in the rehabilitation of patients with TBI have been identified.

CONCLUSION

The presented data demonstrate the studies' results conducted over the past 5 years on the use of PRM technologies in patients with previous TBI. A significant part of the methods considered in the article is actively used in domestic rehabilitation that reflects the ubiquitous process of integrating information obtained in the course of evidence-based research. In order to improve the quality of rehabilitation care for patients with TBI the practice of analyzing and conducting evidence-based studies on this nosology should be continued.

Zakaria H, M. Ragab W, Al Awaji NN, Y. Elzanaty M, R. Elserougy H. Therapeutic Efficacy of Transcutaneous Electrical Nerve Stimulation Acupoints on Motor and Neural Recovery of the Affected Upper Extremity in Chronic Stroke: A Sham-Controlled Randomized Clinical Trial

Inability to use the affected upper extremity (UE) in daily activities is a common complaint in stroke patients. The somatosensory system (central and peripheral) is essential for brain reorganization and plasticity. Neuromuscular electrical stimulation is considered an effective modality for improving UE function in stroke patients. The aim of the current study was to determine the therapeutic effects of transcutaneous electrical nerve stimulation (TENS) acupoints on cortical activity and the motor function of the affected UE in chronic stroke patients. Forty male and female patients diagnosed with stroke agreed to join the study. They were randomly assigned to group 1 (G1) and group 2 (G2). G1 received task-specific training (TST) and sham electrical stimulation while G2 received TST in addition to TENS acupoints. Session duration was 80 min. Both groups received 18 sessions for 6 successive weeks, 3 sessions per week. Evaluation was carried out before and after completion of the treatment program. Outcome measures used were the Fugl-Meyer Assessment of the upper extremity (FMA-UE) and the box and block test (BBT) as measures of the motor function of the affected UE. Brain activity of the motor area (C3) in the ipsilesional hemisphere was measured using a quantitative electroencephalogram (QEEG). The measured parameter was peak frequency. It was noted that the motor function of the affected UE improved significantly post-treatment in both groups, while no significant change was reported in the FMA-UE and BBT scores post-treatment in either G1 or G2. On the other hand, the activity of the motor area C3 improved significantly in G2 only, post-treatment, while G1 showed no significant improvement. There was also significant improvement in the activity of the motor area (C3) in G2 compared to G1 post-treatment. The results of the current study indicate that TST only or combined with TENS acupoints can be considered an effective method for improving motor function of the affected UE in chronic stroke patients, both being equally effective. However, TST combined with TENS acupoints proved better in improving brain plasticity in chronic stroke patients.

Efficacy of transcutaneous electrical acupoint stimulation combined with diazepam for acute alcohol withdrawal syndrome: A double-blind randomized sham-controlled trial

Objective

To compare the efficacy of transcutaneous electrical acupoint stimulation (TEAS) combined with diazepam against diazepam alone for treatment of acute alcohol withdrawal syndrome (AWS).

Methods

In this double-blind randomized sham-controlled trial, men with acute AWS were randomly allocated to either a group treated with TEAS combined with diazepam (n = 57) or a control group treated with sham TEAS combined with diazepam (n = 60). Treatment was performed at four acupoints twice a day for 14 days. The Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar), visual analogue scale (VAS), Pittsburgh Sleep Quality Index (PSQI) and modified Epworth Sleepiness Scale (mESS) were used to evaluate treatment efficacy.

Results

All scores improved significantly in both groups during the trial. CIWA-Ar scores were lower in the TEAS group than in the control group from day 3 until the end of observation. VAS and mESS scores were also lower in the TEAS group than in the control group on day 7. VAS and PSQI scores were lower in the TEAS group on day 14.

Conclusion

Combining diazepam with TEAS may result in milder AWS symptoms than diazepam alone, improve sleep quality and reduce sleepiness.

Pain management of surgical abortion using transcutaneous acupoint electrical stimulation: An orthogonal prospective study

Aim

This study aimed to evaluate the optimal combination of parameters for the management of pain during surgical abortion using transcutaneous acupoint electrical stimulation (TEAS).

Methods

This study recruited patients scheduled for surgical abortion between October 2014 and August 2015. The treatment protocol was created using three levels for each factor (stimulating time, acupoints, age, and parity). The primary outcomes were intraoperative visual analog scale (VAS), postoperative VAS, cervical relaxation degree and intraoperative blood loss. The secondary outcomes were the vital signs.

Results

Stimulation time was associated with intraoperative VAS scores (P < 0.001), acupoints were associated with postoperative VAS scores (P = 0.037), and age was associated with postoperative VAS scores (P < 0.043). Parity (P = 0.025) was associated with heart rate. A comprehensive analysis of the parameters revealed the best levels for each (stimulation time: from 15 min before operation to immediate postoperative; acupoints: SP 6 and LR 3; patient age 25.1–30.0 years; and parity: G_≥2P₀A_≥1). Seven patients did not complete follow‐up. The remaining 135 subjects did not show continuous vaginal bleeding, abdominal pain, fever or any other adverse effect.

Conclusion

During surgical abortion, TEAS stimulation from 15 min before operation to immediate postoperative, SP 6 and LR 3, age 25.1–30.0 years and G_≥2P₀A_≥1 were associated with the best analgesic effect.

Xuefu Zhuyu decoction improves neurological dysfunction by increasing synapsin expression after traumatic brain injury

Xuefu Zhuyu decoction has been used for treating traumatic brain injury and improving post-traumatic dysfunction, but its mechanism of action needs further investigation. This study established rat models of traumatic brain injury by controlled cortical impact. Rat models were intragastrically administered 9 and 18 g/kg Xuefu Zhuyu decoction once a day for 14 or 21 days. Changes in neurological function were assessed by modified neurological severity scores and the Morris water maze. Immunohistochemistry, western blot assay, and reverse-transcription polymerase chain reaction were used to analyze synapsin protein and mRNA expression at the injury site of rats. Our results showed that Xuefu Zhuyu decoction visibly improved neurological function of rats with traumatic brain injury. These changes were accompanied by increased expression of synaptophysin, synapsin I, and postsynaptic density protein-95 protein and mRNA in a dose-dependent manner. These findings indicate that Xuefu Zhuyu decoction increases synapsin expression and improves neurological deficits after traumatic brain injury.

Efficacy and safety of the "Xingnao Kaiqiao" acupuncture technique via intradermal needling to treat postoperative gastrointestinal dysfunction of laparoscopic surgery: study protocol for a randomized controlled trial

Background

Xingnao Kaiqiao acupuncture involves needling of the Neiguan (PC6), Renzhong (DU26), and Sanyinjiao (SP6) acupoints. The technique has a significant clinical effect in many neurological diseases. In the present report, we have developed a protocol for a scientific trial to analyze whether Xingnao Kaiqiao can be used to treat gastrointestinal dysfunction after laparoscopic surgery. In this context, we intend to execute a double-blind, randomized controlled trial to assess the efficacy and safety of Xingnao Kaiqiao acupuncture via intradermal needling.

Methods/design

This will be a single-center, double-blind, randomized controlled clinical trial. It has been designed on the basis of the Consolidated Standards of Reporting Trials (CONSORT 2010) guidelines and the Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA). The subjects will be recruited from among inpatients scheduled for laparoscopic surgery at the Department of Minimally Invasive Surgery, Tianjin Nankai Hospital, Tianjin, China. Using random numbers generated in SPSS 19.0, the recruited subjects will be allocated to either the “Xingnao Kaiqiao” group or the sham stimulation group. A specially appointed investigator will be in charge of the randomization. Xingnao Kaiqiao via intradermal needling (or sham needling) will be administered 6 h after laparoscopic surgery, and then every 12 h for a total of six sessions, each of which will last 3 min. The subjects will undergo their first evaluation shortly before the first treatment (6 h after laparoscopic surgery); evaluations will be repeated every 12 h until a total of seven evaluations have been completed. The primary outcome will be the time until the first postoperative flatus. The secondary outcomes will be: the time until the first postoperative defecation; levels of abdominal pain, abdominal distension, and nausea; blood ghrelin level; occurrence of vomiting; psychological status; and quality of life.

Discussion

This upcoming randomized clinical trial was designed as a standardized method to assess the efficacy and safety of Xingnao Kaiqiao acupuncture using intradermal needles on PC6, DU26, and SP6 in the treatment of gastrointestinal dysfunction after laparoscopic surgery. We aim to provide evidence and thus improve the clinical application of this technique.

Trial registration

Chinese Clinical Trial Registry, ChiCTR-IOR-17010763. Registered on 2 March 2017.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-2319-3) contains supplementary material, which is available to authorized users.

Interventions for managing skeletal muscle spasticity following traumatic brain injury

BACKGROUND

Skeletal muscle spasticity is a major physical complication resulting from traumatic brain injury (TBI), which can lead to muscle contracture, joint stiffness, reduced range of movement, broken skin and pain. Treatments for spasticity include a range of pharmacological and non-pharmacological interventions, often used in combination. Management of spasticity following TBI varies from other clinical populations because of the added complexity of behavioural and cognitive issues associated with TBI.

OBJECTIVES

To assess the effects of interventions for managing skeletal muscle spasticity in people with TBI.

SEARCH METHODS

In June 2017, we searched key databases including the Cochrane Injuries Group Specialised Register, CENTRAL, MEDLINE (Ovid), Embase (Ovid) and others, in addition to clinical trials registries and the reference lists of included studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and cross-over RCTs evaluating any intervention for the management of spasticity in TBI. Only studies where at least 50% of participants had a TBI (or for whom separate data for participants with TBI were available) were included. The primary outcomes were spasticity and adverse effects. Secondary outcome measures were classified according to the World Health Organization International Classification of Functioning, Disability and Health including body functions (sensory, pain, neuromusculoskeletal and movement-related functions) and activities and participation (general tasks and demands; mobility; self-care; domestic life; major life areas; community, social and civic life).

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. Data were synthesised narratively; meta-analysis was precluded due to the paucity and heterogeneity of data.

MAIN RESULTS

We included nine studies in this review which involved 134 participants with TBI. Only five studies reported between-group differences, yielding outcome data for 105 participants with TBI. These five studies assessed the effects of a range of pharmacological (baclofen, botulinum toxin A) and non-pharmacological (casting, physiotherapy, splints, tilt table standing and electrical stimulation) interventions, often in combination. The studies which tested the effect of baclofen and tizanidine did not report their results adequately. Where outcome data were available, spasticity and adverse events were reported, in addition to some secondary outcome measures.Of the five studies with results, three were funded by governments, charities or health services and two were funded by a pharmaceutical or medical technology company. The four studies without useable results were funded by pharmaceutical or medical technology companies.It was difficult to draw conclusions about the effectiveness of these interventions due to poor reporting, small study size and the fact that participants with TBI were usually only a proportion of the overall total. Meta-analysis was not feasible due to the paucity of data and heterogeneity of interventions and comparator groups. Some studies concluded that the intervention they tested had beneficial effects on spasticity, and others found no difference between certain treatments. The most common adverse event was minor skin damage in people who received casting. We believe it would be misleading to provide any further description of study results given the quality of the evidence was very low for all outcomes.

AUTHORS' CONCLUSIONS

The very low quality and limited amount of evidence about the management of spasticity in people with TBI means that we are uncertain about the effectiveness or harms of these interventions. Well-designed and adequately powered studies using functional outcome measures to test the interventions used in clinical practice are needed.

Effects of Transcutaneous Electrical Acupoint Stimulation on Motor Functions and Self-Care Ability in Children with Cerebral Palsy

OBJECTIVES

To observe the effects of transcutaneous electrical acupoint stimulation (TEAS) in improving motor functions and self-care abilities in children with cerebral palsy in their early childhood.

DESIGN

A preliminary, prospective, cohort study.

SETTINGS/LOCATION

Multicenter.

SUBJECTS

Children aged 2-6 years old.

INTERVENTIONS

Twenty-three children were included in the study and randomly assigned to a control group ([CG] N = 11) or a therapeutic group ([TG] N = 12). In the TG, children were treated with TEAS (Shousanli [LI10] and Waiguan [SJ5]) plus the exercise therapy, while in the control group, they were treated with sham TEAS plus exercise therapy. Therapies were performed five days per week for eight weeks.

OUTCOME MEASURES

The Gross Motor Function Measure (GMFM) and the Functional Independent Measurement for children (WeeFIM) were used to evaluate motor functions and self-care abilities before and after the therapies.

RESULTS

Greater improvements were observed in the TG concerning all the measurements, although without statistical differences. The increments of the GMFM score and the WeeFIM motor, self-care and total scores were 36.08 ± 18.34 (26%), 16.17 ± 8.21 (33%), 7.67 ± 3.42 (40%) and 20.33 ± 10.08 (28%) in the TG, while 22.73 ± 16.54 (17%), 9.09 ± 9.43 (19%), 5.64 ± 6.73 (29%) and 12.82 ± 11.77 (18%) in the CG, respectively. No statistically significant correlations were shown between functional improvements and the demographics in the TG or the CG. The GMFM improvement was not statistically correlated with the improvements of the WeeFIM motor, self-care or total scores. However, the WeeFIM motor, self-care and total score were significantly positively correlated with one another in both groups (P < 0.01). No adverse effect was recorded during the study.

CONCLUSION

TEAS may be effective in improving motor functions and self-care abilities in children with cerebral palsy, in addition to conventional exercise therapy. Larger samples are required to confirm the efficacies.

Effect of transcutaneous electrical acupoint stimulation combined with palonosetron on chemotherapy-induced nausea and vomiting: a single-blind, randomized, controlled trial

BACKGROUND

Chemotherapy-induced nausea and vomiting adversely affects the quality of life of patients who receive chemotherapy via intravenous infusion or transcatheter arterial chemoembolization (TACE). This study aimed to investigate the clinical effects of transcutaneous electrical acupoint stimulation (TEAS) on nausea and vomiting after TACE.

METHODS

A total of 142 patients who received TACE with cisplatin for primary or metastatic liver cancer were assigned to the active-acupuncture (n = 72) or placebo-acupuncture (n = 70) groups using a covariate-adaptive randomization at a ratio of 1:1. The acupoints Hegu (LI4), Neiguan (P6), and Zusanli (ST36) were stimulated twice daily for 6 days. The effects of TEAS on nausea and vomiting were assessed by using occurrence rate and severity of these symptoms. Anorexia scale and M. D. Anderson Symptom Inventory (MDASI) scores were secondary endpoints and were used to assess the effect of TEAS on patient appetite and quality of life. The safety of the treatments was also monitored.

RESULTS

Between the two groups, the differences in occurrence rates and severities of nausea and vomiting after TACE were not significant (all P > 0.05). From the second day after TACE, anorexia scores were significantly lower in the active-acupuncture group than in the placebo-acupuncture group and continued to decrease over time with treatment (all P values less than 0.01). On days 0, 1, and 2, the mean MDASI scores for the active-acupuncture group were slightly lower than those for the placebo-acupuncture group, but the differences were not statistically significant (all P > 0.05). No significant differences were found between the two groups in the occurrence rate of any adverse event (P > 0.05).

CONCLUSION

TEAS appears to be a safe and effective therapy to relieve patients' gastrointestinal discomfort after chemotherapy. Trial registration NCT01895010. Registered 21 June 2013.

Acupuncture Reduces Excitability of Spinal Motor Neurons in Patients with Spastic Muscle Overactivity and Chronic Disorder of Consciousness Following Traumatic Brain Injury

BACKGROUND AND OBJECTIVE

Spastic hypertonia usually occurs in patients with chronic disorders of consciousness (DOC) following severe traumatic brain injury (TBI). Spinal motor neuron excitability has been reported to increase in patients with brain damage. The aim of this study was to evaluate the immediate effects of acupuncture on spinal motor neuron excitability in patients with DOC following TBI by using evoked electromyography.

SETTING AND PARTICIPANTS

Eleven male patients (mean age, 33 ± 14 years) with refractory muscle spasticity of the upper extremity accompanying chronic DOC following TBI and admitted to Chubu Medical Center for Prolonged Traumatic Brain Dysfunction were included.

DESIGN

A crossover study design was used. Changes in variables in the acupuncture session were compared with those in the control session in the same patients.

INTERVENTION

Acupuncture treatment was performed at GV 26, Ex-HN 3, bilateral LI 4, and ST 36 for 10 minutes.

OUTCOME MEASURES

F-wave was recorded from the abductor pollicis brevis muscle. The main outcome measure was F/M amplitude ratio (F-wave amplitude/M-wave amplitude), calculated as an index for spinal motor neuron excitability. F-waves were recorded before treatment (baseline), 10 minutes after needle insertion (phase 1), and 10 minutes after needle removal (phase 2). The same procedure was followed in the control session without acupuncture on a separate day.

RESULTS

F/M ratio was significantly reduced from baseline to phase 1 (p < 0.001) and phase 2 (p < 0.001) in the acupuncture session, whereas no significant changes were observed in the control session. Changes in F/M ratio from baseline to phase 1 and phase 2 were greater in the acupuncture session than the control session (p = 0.001 and <0.001, respectively).

CONCLUSION

The excitability of the spinal motor neurons in patients with DOC following TBI was reduced after acupuncture treatment, suggesting that it is beneficial for reducing spastic muscle hypertonia in these patients.

Evidence-based review of oral traditional Chinese medicine compound recipe administration for treating weight drop-induced experimental traumatic brain injury

BACKGROUND

Recently, a number of studies conducted and published in China have suggested that traditional Chinese medicine compound recipe (TCMCR) may be beneficial in the treatment of experimental traumatic brain injury (TBI). In this study, we conducted a systematic review and meta-analysis of the efficacy of TCMCR in TBI model with weight drop method to provide robust evidence on the effects of TCMCR and to determine whether TCMCR can be recommended for routine treatment or considered as a standard treatment for TBI.

METHODS

We identified eligible studies by searching five electronic databases on April 1, 2014, and pooled the data using the random-effects model. Results were reported in terms of standardized mean difference (SMD). We also calculated statistical heterogeneity, evaluated the studies' methodological quality and investigated the presence of publication bias.

RESULTS

Totally, 187 relevant publications were searched from databases, 25 of which met our inclusion criteria. The overall methodological quality of the most studies was poor, and there was evidence of statistical heterogeneity among studies along with small-study effects. Meta-analysis showed statistically significant effects indicating that TCMCR has a beneficial effect on TBI.

CONCLUSIONS

Despite the limitations, we concluded that TCMCR may reduce brain water content, improve BBB permeability, and decrease TNF-α/NO expression after experimental TBI in terms of overall efficacy. However, our review also indicates that more well-designed and well-reported animal studies are needed.