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Thursday, 11 April 2019

Can acupuncture treat Parkinson’s disease?

Tiejun Tang
Today is World Parkinson's Day. This week is Parkinson’s disease awareness week of UK. Parkinson’s disease (PD) is the second most common age-related neurodegenerative disorder after Alzheimer’s disease. An estimated seven to 10 million people worldwide have PD. There are an estimated 127,000 people in the UK living with PD.

There's currently no cure for Parkinson's disease. Physiotherapy can relieve muscle stiffness and joint pain through manipulation and exercise. Language therapy can help to improve speaking. Levodopa usually used to improves movement problems, but it often causes a lot of side effects. Long-term use of levodopa is also linked to problems such as uncontrollable, jerky muscle movements (dyskinesias) and "on-off" effects, where the person rapidly switches between being able to move (on) and being immobile (off).

Acupuncture is widely used to treat PD in many countries. Many clinical trials and laboratory research reports were published in the past two decades. These reports showed us two facts: 
1. Acupuncture is effective in PD treatment:
Shulman LM [1] used acupuncture to treat 20 cases of PD. On the patient questionnaire, 85% of patients reported subjective improvement of individual symptoms including tremor, walking, handwriting, slowness, pain, sleep, depression, and anxiety; Ren XM [2] used acupuncture combined with madopar to treat 50 cases of PD. A total effective rate of 92% was achieved with obvious alleviation of motor disorder in the treatment group, which was significantly higher than that in the madopar control group. The result indicates acupuncture can enhance therapeutic effects of western medicine and lessen the dose of the medicine needed; Arankalle DV[3]  used electro-acupuncture to treat a case of PD. Assessments were based on the Berg Balance Scale (BBS) and Parkinson's Disease Questionnaire-39 items. The patient  improvement on the BBS, his quality of life showed improvement particularly on the 'activities of daily living', 'cognition' and 'communication' dimensions;  Iseki C [4] reported acupuncture can alleviate the nonmotor symptoms of PD including pain, depression, and autonomic Symptoms; Fukuda S [5] reported acupuncture have an immediately effects on tongue pressure including swallowing reflex latency in PD;  Lee SH [6] reviewed 25 randomized controlled trials (RCTs) on the topic of acupuncture treat PD. The results showed acupuncture was effective in relieving PD symptoms compared with no treatment and conventional treatment alone, and acupuncture plus conventional treatment had a more significant effect than conventional treatment alone; Yeo S [7] used electro-acupuncture to treat 10 patients in the hospital. The acupoints GB34 and LR3 were selected. After 8 weeks treatment the Unified Parkinson's Disease Rating Scale (UPDRS) sub-scores and the depression scores for the patients had statistically decreased compared to the scores before acupuncture treatment; moreover, 8 weeks later, these scores remained stable. A positive correlation was found between the UPDRS and the mean magnetic resonance signal change for the thalamus.
2.    These effects were supported by many scientific research reports:
Wang L [8] reported 29 PD patients were under the auditory evoked brain stem potential (ABP) examination, the latent period of V wave and the intermittent periods of III-V peak and I-V peak were significantly shortened after acupuncture treatment. The difference of cumulative scores in Webster's scale was also decreased in correlation analysis; My ex colleague Huang Y[9] used positron emission tomography (PET) and the 18-flourodeoxyglucose tracer to study cerebral effects of acupuncture in PD. Five patients received scalp-acupuncture and Madopa, while the other five had Madopa only. PET scans before and after acupuncture show increased glucose metabolisms in parietal, temporal, occipital lobes, the thalamus, and the cerebellum in the light-diseased hemisphere, and in parietal and occipital lobes of the severe-diseased hemisphere. No changes were observed in the Madopa-only group. This indicated acupuncture in combination with Madopa may improve cerebral glucose metabolism in PD; in the other report [10] she used single photon emission computed tomography (SPECT) measures of 99mT-ECD and 99mTc-TRODAT-4, before and after scalp acupuncture treatment. Patients who received levodopa and complementary acupuncture had increased regional cerebral blood flow (rCBF) in the frontal lobe, the occipital lobe, the basal ganglion; Yang JL[11] investigated the role of acupuncture in neurotoxin-induced PD mice. The mice were evaluated for behavioral changes, in terms of time of landing, after acupuncture treatment. The animals were sacrificed and their brains assayed for dopamine and its metabolites and tyrosine hydroxylase (TH) expression by using HPLC and immunohistochemistry/Western blotting. The results showed that the time of landing of the three groups with treatment was significant longer than normal group. Nonetheless, the acupuncture group had a shorter time of landing than sham acupuncture group. The number of TH (+) neurons and the expression of TH proteins were significantly higher in the acupuncture group than in the sham acupuncture group. These results conclude that acupuncture possibly attenuates neuronal damage in MPTP-induced PD mice, which suggests acupuncture may be useful as a complementary strategy when treating human PD; Yeo S[12] investigated the reported association between acupuncture point GB34 and PD. They use fMRI methods examined the neural responses of 12 patients with PD and 12 healthy participants before and after acupuncture stimulation. The results showed acupuncture stimulation increased neural responses in regions including the substantia nigra, caudate, thalamus, and putamen, which are impaired caused by PD; Wang S[13] investigated the effect of electro-acupuncture at Fengfu (GV16) and Taichong (LR3) acupoints in rat models of PD. Reverse transcription-PCR demonstrated that brain-derived neurotrophic factor and glial cell line-derived neurotrophic factor mRNA expression was significantly increased in the substantia nigra of rat models of PD, and that abnormal behavior of rats was significantly improved following electro-acupuncture treatment. These results indicated that electro-acupuncture treatment up-regulated brain-derived neurotrophic factor and glial cell line-derived neurotrophic factor mRNA expression in the substantia nigra of rat models of PD;  Wattanathorn J[14] aimed to determine the effect of laser acupuncture at HT7 on memory impairment, oxidative stress status, and the functions of both cholinergic and dopaminergic systems in hippocampus of animal model of PD. The results showed that laser acupuncture at HT7 enhanced memory and neuron density in CA3 and dentate gyrus. The decreased AChE, MAO-B, and MDA together with increased GSH-Px in hippocampus of a 6-OHDA lesion rats were also observed; Park JY[15] reported that p53 signalling mediates the protective effects of acupuncture treatment in a mouse model of PD. They found that the acupuncture treatment in the mouse PD model results in significant recovery to the normal in the context of behaviour and molecular signatures. The gene network associated with p53 signalling is closely involved in the protective effects of acupuncture treatment in PD. These data suggest that p53 signalling mediates the protective effects of acupuncture treatment in PD.

Traditional Chinese medicine believes PD is mostly due to liver & kidney yin deficiency this lead to liver yang excess. In some conditions it might combined with blood stasis and/or phlegm heat. Bases on these TCM philosophy acupuncturists select different acupoints in different conditions. Body acupuncture, scalp acupuncture and electro- acupuncture can be selected. If Chinese herbal medicine were added it will obtained a better treatment effect.
World Parkinson’s Day, be aware of PD !

 Reference:
  1. Shulman LM. Acupuncture therapy for the symptoms of Parkinson's disease. Mov  Disord. 2002; 17(4):799-802.
  2. Ren XM. Fifty cases of Parkinson's disease treated by acupuncture combined with madopar. J Tradit Chin Med. 2008; 28(4):255-7.
  3. Arankalle DV. Effect of electroacupuncture on function and quality of life in Parkinson's disease: a case report. Acupunct Med. 2013; 31(2):235-8.
  4. Iseki C. Acupuncture Alleviated the Nonmotor Symptoms of Parkinson's Disease including Pain, Depression, and Autonomic Symptoms. Case Rep Neurol Med. 2014;2014:953109.
  5. Fukuda S. Immediate effects of acupuncture on tongue pressure including swallowing reflex latency in Parkinson's disease. Acupunct Med. 2016; 34(1):59-61.
  6. Lee SH. Clinical effectiveness of acupuncture on Parkinson disease: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore). 2017; 96(3):e5836.
  7. Yeo S. A study of the effects of 8-week acupuncture treatment on patients with Parkinson's disease. Medicine (Baltimore). 2018; 97 (50):e13434.
  8. Wang L. Effect of acupuncture on the auditory evoked brain stem potential in Parkinson's disease. J Tradit Chin Med. 2002
  9. Huang Y. Complementary acupuncture treatment increases cerebral metabolism in patients with Parkinson's disease. Int J Neurosci. 2009; 119(8):1190-7.
  10. Huang Y.  Complementary acupuncture in Parkinson's disease: a spect study. Int J Neurosci. 2010; 120(2):150-4.
  11. Yang JL. Neuroprotection effects of retained acupuncture in neurotoxin-induced Parkinson's disease mice. Brain Behav Immun. 2011; 25(7):1452-9.
  12. Yeo S. Acupuncture stimulation on GB34 activates neural responses associated with Parkinson's disease. CNS Neurosci Ther. 2012; 18(9):781-90.
  13. Wang S. Electroacupuncture-regulated neurotrophic factor mRNA expression in the substantia nigra of Parkinson's disease rats. Neural Regen Res. 2013; 25; 8(6):540-9.
  14. Wattanathorn J. Laser Acupuncture at HT7 Acupoint Improves Cognitive Deficit, Neuronal Loss, Oxidative Stress, and Functions of Cholinergic and Dopaminergic Systems in Animal Model of Parkinson's Disease. Evid Based Complement Alternat Med. 2014:937601. doi: 10.1155/2014/937601.
  15. Park JY. p53 signalling mediates acupuncture-induced neuroprotection in Parkinson's disease. Biochem Biophys Res Commun. 2015; 460(3):772-9.


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