A Systematic Review and Meta-analysis of Acupuncture in Parkinson's Disease with Dysphagia

Overview

Journal Front Neurol

Specialty Neurology

Date 2023 Jun 12

PMID 37305760

Authors

Jing Wu

Yi Wang

Xueyan Wang

Yujia Xie

Weihong Li

Affiliations

Soon will be listed here.

Abstract

Objective: The systematic review and meta-analysis aimed to comprehensively evaluate acupuncture's efficacy and safety in treating dysphagia in Parkinson's disease (PD).

Methods: We searched PubMed, Cochrane Library, Embase, Web of Science, China Knowledge Infrastructure (CNKI), China Science Journal Database (VIP), Wan-fang Database, and the China Biomedical Literature Service System (CBM) for randomized controlled trials (RCTs) comparing the efficacy of acupuncture alone or in combination with control treatment in improving dysphagia by October 2022. The degree of dysphagia was the primary outcome indicator, with secondary outcomes including serum albumin (ALB) and hemoglobin (Hb) levels, the incidence of pneumonia, and adverse events. Two investigators independently extracted information according to the inclusion and exclusion criteria. Data synthesis was calculated by RevMan (V.5.4.1) software.

Results: This study included ten randomized controlled trials with 724 patients. Most RCTs have a high or uncertain risk of bias due to the lack of a blinded design. Meta-analysis showed that acupuncture combined with control treatment was superior to control treatment alone in improving Videofluoroscopic Swallowing Study (VFSS) scores (MD: 1.48; 95% CI: 1.16, 1.81; < 0.00001) and reducing Standardized Swallowing Assessment (SSA) scores (MD: -3.08; 95% CI: -4.01, -2.15; < 0.00001). Acupuncture combined with control therapy has a more significant benefit in improving the clinical efficiency of dysphagia in PD (RR: 1.40; 95%CI: 1.25, 1.58; < 0.00001). Compared to the control group without acupuncture, acupuncture improved the nutritional status of patients and increased their serum ALB (MD: 3.38, 95%CI: 1.83, 4.92, < 0.00001) and Hb levels (MD: 7.66; 95%CI: 5.57, 9.75; < 0.00001). Three RCTs reported that the rate of pulmonary infections in the acupuncture group was lower than without acupuncture intervention (RR: 0.29, 95% CI: 0.14, 0.63; = 0.001).

Conclusion: Acupuncture could be recommended as an adjunctive treatment for dysphagia in PD. However, due to the high risk of bias in the included studies, more high-quality evidence is needed to confirm the efficacy and safety of acupuncture for dysphagia in PD.

Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022370221.

Citing Articles

Acupuncture Effect on Reaction-Time Changes in Parkinson's Disease Patients-Case Study Series.

Pereira C, Greten H, Santos R, Reis A, Ramos B, Santos M J Clin Med. 2024; 13(18).

PMID: 39337127 PMC: 11433072. DOI: 10.3390/jcm13185642.

Acupuncture Therapy on Dysphagia in Patients with Parkinson's Disease: A Randomized Controlled Study.

Zeng H, Zhao W, Luo P, Zhang X, Luo S, Li Y Chin J Integr Med. 2024; 31(3):261-269.

PMID: 39305459 DOI: 10.1007/s11655-024-3668-x.

An overview of systematic reviews of acupuncture for Parkinson's disease.

Xue H, He H, Wu D, Fan W, Li Y Front Neurosci. 2024; 18:1415008.

PMID: 39280262 PMC: 11392918. DOI: 10.3389/fnins.2024.1415008.

Meta-analysis of the therapeutic effect of acupuncture on dysphagia in patients with Parkinson disease.

Jiayu L, Minmin W, Zhu L Medicine (Baltimore). 2023; 102(51):e36698.

PMID: 38134058 PMC: 10735101. DOI: 10.1097/MD.0000000000036698.

References

Zhu W, Ye Y, Liu Y, Wang X, Shi G, Zhang S . Mechanisms of Acupuncture Therapy for Cerebral Ischemia: an Evidence-Based Review of Clinical and Animal Studies on Cerebral Ischemia. J Neuroimmune Pharmacol. 2017; 12(4):575-592. DOI: 10.1007/s11481-017-9747-4. View

Takizawa C, Gemmell E, Kenworthy J, Speyer R . A Systematic Review of the Prevalence of Oropharyngeal Dysphagia in Stroke, Parkinson's Disease, Alzheimer's Disease, Head Injury, and Pneumonia. Dysphagia. 2016; 31(3):434-41. DOI: 10.1007/s00455-016-9695-9. View

Han M, Ohnishi H, Nonaka M, Yamauchi R, Hozuki T, Hayashi T . Relationship between dysphagia and depressive states in patients with Parkinson's disease. Parkinsonism Relat Disord. 2011; 17(6):437-9. DOI: 10.1016/j.parkreldis.2011.03.006. View

Athukorala R, Jones R, Sella O, Huckabee M . Skill training for swallowing rehabilitation in patients with Parkinson's disease. Arch Phys Med Rehabil. 2014; 95(7):1374-82. DOI: 10.1016/j.apmr.2014.03.001. View

Guo X, Ma T . Effects of Acupuncture on Neurological Disease in Clinical- and Animal-Based Research. Front Integr Neurosci. 2019; 13:47. PMC: 6729102. DOI: 10.3389/fnint.2019.00047. View

Troche M, Okun M, Rosenbek J, Musson N, Fernandez H, Rodriguez R . Aspiration and swallowing in Parkinson disease and rehabilitation with EMST: a randomized trial. Neurology. 2010; 75(21):1912-9. PMC: 2995389. DOI: 10.1212/WNL.0b013e3181fef115. View

Lin C, Chang Y, Chen W, Chang K, Chang H, Wang T . Prolonged swallowing time in dysphagic Parkinsonism patients with aspiration pneumonia. Arch Phys Med Rehabil. 2012; 93(11):2080-4. DOI: 10.1016/j.apmr.2012.07.010. View

Simons J . Swallowing Dysfunctions in Parkinson's Disease. Int Rev Neurobiol. 2017; 134:1207-1238. DOI: 10.1016/bs.irn.2017.05.026. View

Lim A, Leow L, Huckabee M, Frampton C, Anderson T . A pilot study of respiration and swallowing integration in Parkinson's disease: "on" and "off" levodopa. Dysphagia. 2007; 23(1):76-81. DOI: 10.1007/s00455-007-9100-9. View

10.

Wu M, Wang L, Li H, Zeng X . [Acupuncture adjuvant treatment for dysphagia in patients with Parkinson's disease: a randomized controlled trial]. Zhongguo Zhen Jiu. 2021; 41(5):485-8. DOI: 10.13703/j.0255-2930.20200724-0002. View

11.

Monteiro L, Souza-Machado A, Pinho P, Sampaio M, Nobrega A, Melo A . Swallowing impairment and pulmonary dysfunction in Parkinson's disease: the silent threats. J Neurol Sci. 2014; 339(1-2):149-52. DOI: 10.1016/j.jns.2014.02.004. View

12.

LeWitt P . Levodopa therapy for Parkinson's disease: Pharmacokinetics and pharmacodynamics. Mov Disord. 2014; 30(1):64-72. DOI: 10.1002/mds.26082. View

13.

Sung H, Kim J, Lee K, Kim Y, Song I, Chung S . The prevalence and patterns of pharyngoesophageal dysmotility in patients with early stage Parkinson's disease. Mov Disord. 2010; 25(14):2361-8. DOI: 10.1002/mds.23290. View

14.

Herer B, Arnulf I, Housset B . Effects of levodopa on pulmonary function in Parkinson's disease. Chest. 2001; 119(2):387-93. DOI: 10.1378/chest.119.2.387. View

15.

Edmiaston J, Connor L, Steger-May K, Ford A . A simple bedside stroke dysphagia screen, validated against videofluoroscopy, detects dysphagia and aspiration with high sensitivity. J Stroke Cerebrovasc Dis. 2013; 23(4):712-6. PMC: 4019433. DOI: 10.1016/j.jstrokecerebrovasdis.2013.06.030. View

16.

Mu L, Sobotka S, Chen J, Su H, Sanders I, Nyirenda T . Parkinson disease affects peripheral sensory nerves in the pharynx. J Neuropathol Exp Neurol. 2013; 72(7):614-23. PMC: 3695629. DOI: 10.1097/NEN.0b013e3182965886. View

17.

Lindor K, Fleming C, Ilstrup D . Preoperative nutritional status and other factors that influence surgical outcome in patients with Crohn's disease. Mayo Clin Proc. 1985; 60(6):393-6. DOI: 10.1016/s0025-6196(12)60849-0. View

18.

Schindler A, Pizzorni N, Cereda E, Cosentino G, Avenali M, Montomoli C . Consensus on the treatment of dysphagia in Parkinson's disease. J Neurol Sci. 2021; 430:120008. DOI: 10.1016/j.jns.2021.120008. View

19.

Kwon M, Lee J . Oro-Pharyngeal Dysphagia in Parkinson's Disease and Related Movement Disorders. J Mov Disord. 2019; 12(3):152-160. PMC: 6763715. DOI: 10.14802/jmd.19048. View

20.

Chang Q, Lin Y, Hsieh C . Acupuncture and neuroregeneration in ischemic stroke. Neural Regen Res. 2018; 13(4):573-583. PMC: 5950656. DOI: 10.4103/1673-5374.230272. View