Acupuncture for Bell's Palsy:A Systematic Review and Meta-analysis

Objective： To assess the clinical evidence for and against acupuncture as a treatment for Bell＇s palsy. Methods： We conducted a literature search of 15 databases from their inception to December 2010 without language restrictions. We included all randomized clinical trials （RCTs） regardless of their controls. Methodological quality was evaluated using the Cochrane risk of bias assessment tool. Results： Of the 3 474 articles, only eight RCTs met our inclusion criteria. Four RCTs tested the effects of acupuncture against drug therapy on disease response rate. The meta-analysis of these data showed significant improvements in the acupuncture group [n=463, risk ratio （RR）=1.07, 95% CI： 1.02 to 1.13; P=0.006, I^2=0%]. Six RCTs tested the effects of acupuncture plus drug therapy versus drug therapy alone. The meta-analysis of this set of RCTs also showed the favorable effects of acupuncture on disease response rate （n=512, RR=1.11, 95% CI： 1.05 to 1.17; P=0.001, I^2=13%）. Conclusions： The evidence supporting the effectiveness of acupuncture for treating Bell＇s palsy is limited. The number and quality of trials are too low to form firm conclusions. Further rigorous RCTs are warranted but need to overcome the many limitations of the current evidence.

Acupuncture and vitamin B_(12) injection for Bell's palsy:no high-quality evidence exists

OBJECTIVE： To assess the efficacy of acupuncture combined with vitamin B12 acupoint injection versus acupuncture alone to reduce incomplete recovery in patients with Bell＇s palsy. DATA RETRIEVAL： A computer-based online retrieval of Medline, Web of Science, CNKI, CBM databases until April 2014 was performed for relevant trials, using the key words ＂Bell＇s palsy or idiopathic facial palsy or facial palsy＂ and＂acupuncture or vitamin B12 or methylcobalamin＂. STUDY SELECTION： All randomized controlled trials that compared acupuncture with acupuncture combined with vitamin B12 in patients with Bell＇s palsy were included in the me- ta-analysis. The initial treatment lasted for at least 4 weeks. The outcomes of incomplete facial recovery were monitored. The scoring index varied and the definition of healing was consistent. The combined effect size was calculated by using relative risk （RR） with 95% confidence interval （C/） using the fixed effect model of Review Manager. MAIN OUTCOME MEASURES： Incomplete recovery rates were chosen as the primary outcome. RESULTS： Five studies involving 344 patients were included in the final analysis. Results showed that the incomplete recovery rate of Bell＇s palsy patients was 44.50% in the acupuncture combined with vitamin B12 group but 62.57% in the acupuncture alone group. The major acupoints were Taiyang （EX-HN5）, Jiache （ST6）, Dicang （ST4） and Sibai （ST2）. The combined effect size showed that acupuncture combined with vitamin B12 was better than acupuncture alone for the treatment of Belrs palsy （RR = 0.71, 95%CI： 0.58-0.87; P = 0.001）, this result held true when 8 patients lost to follow up in one study were included into the analyses （RR = 0.70, 95%CI： 0.58-0.86; P = 0.0005）. In the subgroup analyses, the therapeutic effect in patients of the electroacupuncture subgroup was better than in the non-electroacupuncture subgroup （P = 0.024）. There was no significant dif- ference in the incomplete recovery rate by subgroup analysis on drug types and treatment period. Most of the included studies were moderate or low quality, and bias existed. CONCLUSION： In patients with Bell＇s palsy, acupuncture combined with vitamin 812 can reduce the risk of incomplete recovery compared with acupuncture alone in our meta-analysis. Because of study bias and methodological limitations, this conclusion is uncertain and the clinical appli- cation of acupuncture combined with vitamin B12 requires further exploration.

Scalp Acupuncture for Parkinson's Disease:A Systematic Review of Randomized Controlled Trials

Objective： To evaluate the effectiveness of scalp acupuncture （SA）, a modern acupuncture technique specialized to neurological disorders, in managing motor function and symptoms for Parkinson＇s disease （PD） patients. Methods： Two independent reviewers extracted data from all of the randomized clinical trials （RCTs） that assessed the efficacy of SA for PD compared with conventional therapies （CTs）. Sixteen electronic databases were searched. The risk of bias was appraised with the Cochrane Collaboration tool, and the reporting of the included studies was evaluated by the Consolidated Standards of Reporting Trials （CONSORT） 2010 checklist and the revised Standards for Reporting Interventions in Clinical Trials of Acupuncture （STRICTA） guidelines. Results： In total, 4 RCTs met the inclusion criteria. As assessed by the Unified PD Rating Scale （UPDRS）, 2 RCTs showed that SA combined with CTs proved superior to CTs alone [60 cases; weighted mean difference, -3.94; 95% confidence interval （CI）, -6.05 to -1.64, P=0.01; 12=0%]. Based on the Webster scale, however, 3 RCTs showed no superior effect of SA when combined with CTs with high heterogeneity （154 cases; risk ratio, 1.29; 95% CI, 0.79 to 2.12, P=0.30; 12=84%）. The Cochrane risk of bias, adherence to the CONSORT and the STRICTA checklist showed that the quality of all the included RCTs was generally low. Conclusions： The result of our systematic review and meta-analysis suggested that the effectiveness of SA for PD is promising, however, the evidence is not convincing. A sham-controlled RCT design that adheres to the CONSORT and STRICTA guidelines to overcome methodological weakness and that includes a large sample size is strongly recommended to confirm the precise effect of SA on PD.

Effect of Acupuncture Combined with Blood-letting by a Three-edged Needle on 50 cases of Bell's Palsy at the Acute Stage

Objective:To observe clinical effects of acupuncture combined with blood-letting by a three-edged needle for treating Bell's palsy of wind-heat syndrome at the acute stage.Methods:One hundred patients were randomly divided into a treatment group(50 cases) treated by acupuncture plus blood-letting and a control group(50 cases) treated by simple acupuncture.Four courses of treatments were given in both groups.The main symptoms and signs were observed and clinical effects evaluated with scores after one week,2 weeks and one month of treatments respectively.Results:After treatment,the scores for symptoms and signs were significantly different from those before treatment in both groups(P<0.05 or P<0.01).After one month of treatment,the improvement of the symptoms and signs in the treatment group was more than that in the control group with a significant difference(P<0.05).Conclusion:Acupuncture plus blood-letting can produce good therapeutic effects on Bell's palsy of wind-heat syndrome at the acute stage.

Efficacy of acupuncture and moxibustion in treating Bell’s palsy: a multicenter randomized controlled trial in China

Background Bell’s palsy involves acute facial paralysis due to inflammation of the facial nerve. Acupuncture and moxibustion (acu-moxi) is beneficial in treating facial palsy. In order to verify the efficacy of acu-moxi on Bell’s palsy, a randomized single-blind, multicenter clinical trial was performed.Methods A total of 480 patients from four clinical centers were involved in this trial, of whom 439 completed the trial and 41 did not. All patients were randomly assigned to either the control group or to one of two treatment groups. The control group was treated with prednisone, vitamin B_1, vitamin B_ 12, and dibazole; the treatment groups were treated either with acu-moxi alone or in combination with prednisone, Vitamin B_1, vitamin B_ 12, and dibazole. Symptoms and signs, the House-Brackmann scale, and facial disability index (FDI) scores were assessed and determined both pre- and post-treatment to evaluate the effectiveness of the treatment methods.Results The characteristics of the control and two treatment groups were comparable without statistically significant differences before treatment. There were significant differences between the control and treatment groups after treatment (χ2=15.265, P=0.018). According to evaluations based on the House-Brackmann scale and FDI scores, the effectiveness of treatment in the two treatment groups was better than in the control group and was most effective in patients receiving acu-moxi treatment alone (Z=-2.827, P=0.005). Conclusion The efficacy of acu-moxi treatment for Bell’s palsy is verified scientifically.

Clinical Practice Guideline of Acupuncture for Bell's Palsy

Backgroud: Acupuncture is common used for Bell's palsy in clinic, however, recent systematic reviews all shows that there is no sufficient evidence to support the effectiveness of acupuncture for Bell's palsy because ofthe poor quality and heterogeneity. It's urgently necessary to develop a guideline of acupuncture for Bell's palsy based on principles of evidence-based medicine to optimize acupuncture treating,standardize outcomes evaluating and to improve the quality of acupuncture for patients with Bell's palsy under general circumstances.Objective: To improve the accuracy of diagnosing and managing Bell's palsy, optimize acupuncture treating and outcomes evaluating for patients with Bell's palsy, and to improve the quality of acupuncture for patients with Bell's palsy in most instances.Methods: This guideline was developed using an explicit and transparent a priori protocol based on supporting evidences and experts' consensus. The guideline developing Group followed the protocol through all stages of the development process: proposed clinical questions,searched clinical evidences, evaluated levels of evidences, developed recommendations, peer reviewed and consummated, and finally formed the draft of this guideline.Results:(1)The guideline development group made a Grade A recommendation that ①With a course of Bell's palsy within 3 months, the patients with mild facial palsy may be treated with any one of acupuncture, western drugs, or acupuncture combing with western drugs,whereas the patients with severe facial palsy may be treated with acupuncture or acupuncture combing with western drugs. With a course of more than 3 months, acupuncture is more suitable.②Acupuncture should be applied as early as possible for Bell's palsy.③The principle of selecting acupoints for Bell's palsy is to select local points, points of corresponding meridians and those according to differentiation. Generally,the points of yangming meridians are the main ones. ④The various methods of acupuncture and moxibustion are adopted for Bell's palsy,including filiform needling, moxibustion, electro-acupuncture, etc. Two or more methods are usually used together in clinical practice.(2) The development group formed expert consensus on the principles of acupuncture treatment for Bell' palsy. Bell's palsy is suitably treated according to the stages, differentiation and symptoms.

Metaphysical Energy Therapy in the Treatment of Cranial Nerve Palsies with Special Reference to Bell’s Palsy

Neuropathy, or nerve injury, is a severe and common impediment of diabetes. Studies evaluate that 50% of people with diabetes will develop neuropathy. Diabetic nerve injury is impairment of a single solitary nerve (also named mononeuropathy). Com- monly 2 cranial nerves Viz., cranial nerve VII and cranial nerve VI are involved in facial nerve palsies. The former one is called Bell’s palsy and is acute Lower Motor Neuron facial nerve paralysis (>80%) causing an inability to control facial muscles on the affected side. The later one is sixth nerve palsy, (the abducens nerve), which is responsible for triggering contraction of the lateral rectus muscle to abduct (i.e., turn out) the eye resulting in double vision on the affected side. In recent times, we have found to our amazement, rapid restoration of normalcy within a few hours to a few days, of Cranial Nerve palsies in diabetic subjects at our centre. We are presenting a group of cases having Type2DM over different time periods from 6 to 20 years and those who suddenly suffered facial nerve palsy and they came to VHSDRC for treatment. They were started on the new modality called the Dynamic Acupuncture Mediated Meta-physical Energy Therapy (DAMM Therapy), to recover from the facial palsy. The DAMM therapy is a unique novel way of infusing and transferring healing energy from the therapist to the patient. Within 2 - 7 sittings of DAMM therapy patients showed 75% - 100% improvement in their clinical condition.

PROF.ZHANG ANLI'S EXPERIENCE OF TREATING STUBBORN CASES OF FACIAL PALSY

Based on her own experience of many years＇ clinical practice, Prof. Zhang Anli summarized and created the method in which the shallow insertion at the upper eyelid, acupuncture at the Back-shu points and balanced selection of points together with the modified Setting Mountain on Fire and application of Fire Needle were applied for the treatment of stubborn cases of facial palsy. The therapeutic effect is good.

针灸治疗Bell's面瘫疗效的系统评价

目的 系统评价针灸促进Bell s面瘫康复和减少其远期发病率的效果。方法 计算机检索MED LINE、EMBASE、LILAS、中国生物医学文献数据库和Cochrane肌肉疾病组注册组资料库 ,检索时间截止至 2 0 0 2年 12月 ;同时检索其它相关灰色文献 ,获取所有涉及针灸治疗Bell s面瘫的随机和半随机对照试验。而后选择符合纳入标准的临床试验 ,评价其方法学质量 ,并从中提取患者基本情况、干预措施、终点指标和结果等相关资料进行系统评价。结果 共有 3个小规模的临床随机对照试验 ,合计 2 88例患者符合纳入标准 ,但因其在试验设计、报道上存在明显缺陷 ,以及试验之间存在较大差异 ,不符合Meta分析条件 ,因而只进行了定性分析。结果显示 ,针灸治疗Bell s面瘫有一定疗效 (P均 <0.0 1)。结论 针灸治疗Bell s面瘫有效 ,但入选的 3个随机对照试验规模小 ,质量不高 ,降低了这一结论的可靠性。开展高质量、内在真实性好的相关随机对照试验非常必要。

药物联合电针同步应用治疗早期Bell’s面瘫随机平行对照研究

[目的]观察药物联合电针同步应用治疗早期Bell’s面瘫疗效。[方法]使用随机平行对照方法,将80例门诊患者按就诊顺序编号法分为两组。对照组40例强的松30mg/d,早晨顿服,6d后,改为15mg/d顿服,再服3d后改为5mg/d顿服,继服2d后停用;神经营养剂维生素B1等常规量使用;治疗10d后,加用电针治疗;选取患侧风池、地仓、颊车、下关、迎香、阳白、四白、人中、合谷等穴;直刺或横刺入皮肤,以患者疼痛或有酸胀感为度,用电针仪分别连接阳白、四白;地仓、颊车组穴,连续波,强度以患者耐受为度,留针30min。治疗组40例药物与电针同时进行。均连续治疗10d为1疗程。观测临床症状、面神经功能评价分级、不良反应。[结果]治疗组治愈39例,显效0例,有效1例,无效0例,总有效率100.00%。对照组治愈38例,显效0例,有效0例,无效0例,总有效率100.00%。临床疗效两组间无明显差异(P>0.05),痊愈时间治疗组改善优于对照组(P<0.05)。[结论]药物联合电针同步应用治疗早期Bell’s面瘫可明显缩短治疗时间,效果显著,值得深入研究。

针刺配合按摩、TDP治疗Bell麻痹与Hunt综合征的疗效对比研究

目的:比较针刺配合按摩、TDP治疗Bell麻痹与Hunt综合征的临床疗效及疗程。方法:选取周围性面瘫患者328例,Bell麻痹(治疗1组)236例,Hunt综合征(治疗2组)92例。两组均采用相同的针刺配合按摩、TDP治疗,5次/周,1周为1疗程,4个疗程后进行评价。结果:治疗1组愈显率91.53%;治疗2组愈显率96.74%。组间比较差异有显著性(P<0.01),临床痊愈患者平均疗程分别为2.21、3.16个,组间比较差异有显著性(P<0.01)。结论:针刺配合按摩、TDP治疗Hunt综合征与Bell麻痹二者疗效确切,但Bell麻痹恢复的时间明显较Hunt综合征短。

针灸治疗Bell氏面瘫的研究

Bell氏面瘫，是面神经疾患中最为普遍的疾病之一，又称贝尔麻痹，是指病因阐释不肯定、急性起病的单侧或双侧周围性面神经水肿、感觉麻木。临床研究表明，针灸已作为治疗周围性面瘫的首选治疗，有着显著的临床疗效。史籍记载华夏医学在针灸治疗面瘫方面己有数千年历史，积累丰硕的临床经验，其具备疗效准确、便于掌握和运用、反作用和毒副作用小、医疗风险小等优势和特点。下面就近5年来针灸治疗Bell氏面瘫研究概况综述如下。

高压氧治疗Bell麻痹的系统评价

目的了解是否有足够的证据表明高压氧治疗Bell麻痹有效。方法电子检索PubMed、Ovid、TheCochrane central Register of Controlled Trails、EMbase、Science Citation Index Expanded、HighWire Press、中国生物医学文献数据库(CBMDisc)、中国知网(CNKI)、维普数据库(VIP),文献检索起止时间均为从建库到2010年2月,同时检索纳入文献的参考文献,纳入高压氧治疗Bell麻痹的的随机对照试验,进行质量评价及资料提取。统计学分析采用RevMan5.0.22.0软件。结果共检索到随机对照试验10个,病例823例。所有研究认为高压氧可以提高面神经麻痹的治愈率和有效率。结论现有证据提示高压氧治疗面神经麻痹很有前途,但是严格设计的RCT证据数量太少,质量有待改进,结果说服力不强,还需要更多高质量的RCT证实其疗效,以便在国内外推广。

分期针刺配合分期运动疗法治疗Bell麻痹临床观察

目的:观察分期针刺配合分期运动疗法治疗Bell麻痹临床疗效。方法:将100例Bell麻痹患者随机分为治疗组与对照组,治疗组采用分期针刺配合分期运动疗法,对照组采用针刺疗法,10 d为一疗程,休息2 d后行下一个疗程,连续治疗4个疗程,采用H-B分级法进行疗效对比,治疗后6个月对治疗患者进行随访,进行后遗症及并发症对比。结果:两组在总体疗效上无显著差异(P>0.05),但在治愈、显效、缩短病程及减少后遗症和并发症方面治疗组优于对照组(P<0.05)。结论:分期针刺配合分期运动治疗Bell麻痹可以缩短病程、提高疗效、减少后遗症及并发症。

Electrical response grading versus House-Brackmannscale for evaluation of facial nerve injury after Bell's palsy: a comparative study

OBJECTIVE： There are no convenient techniques to evaluate the degree of facial nerve injury during a course of acupuncture treatment for Bell＇s palsy. Our previous studies found that observing the electrical response of specific facial muscles provided reasonable correlation with the prognosis of electroacupuncture treatment. Hence, we used the new method to evaluate the degree of facial nerve injury in patients with Bell＇s palsy in comparison with the House-Brackmann scale. The relationship between therapeutic effects and prognosis was analyzed to explore an objective method for evaluating Bell＇s palsy. METHODS： The facial nerve function of 68 patients with Bell＇s palsy was assessed with both electrical response grading and the House-Brackmann scale before treatment. Then differences in evaluation results of the two methods were compared. All enrolled patients received electroacupuncture treatment with disperse-dense wave at 1/100 Hz for 4 weeks. After treatment, correlation analysis was conducted to find the relationship between electrical response and therapeutic effects or prognosis. RESULTS： Checking consistency between electrical response grading and House-Brackmann scale： Kappa value 0.028 （P = 0.578）. Correlation analysis： the two methods were correlated with the prognosis, and electrical response grading （rER = 0.789） was better than the House-Brackmann scale （rHB = 0.423）. CONCLUSION： Electrical response grading is superior to the House-Brackmann scale in efficacy and reliability, and can conveniently assess the degree of facial nerve injury. The House-Brackmann scale is suitable for the patients with mild facial nerve injury, but its evaluation quality for severe facial nerve injury is poor.

针灸从阳明论治老年周围性面神经麻痹的研究

目的观察针灸从阳明论治老年周围性面神经麻痹的临床疗效。方法将84例老年周围性面神经麻痹患者随机分为治疗组和对照组各42例。治疗组从阳明论治,分别从经筋、经络、脏腑指导临床选穴组方,并强调下针顺序和出针留针时间,选用四白、颧髎、地仓、迎香、中脘、天枢、足三里、健侧合谷腧穴进行治疗;对照组则用常规针刺,不取中脘、天枢、足三里,不讲究下针顺序。2组均每天治疗1次,每周连续治疗6 d,休息1 d,共治疗8周。观察2组治疗前后House-Brackmann(H-B)面神经功能分级变化情况及临床疗效。结果 2组治疗后H-B面神经功能分级均较治疗前明显改善(P均<0.05),且治疗组改善情况明显优于对照组(P<0.05)。治疗组的愈显率、总有效率均明显高于对照组(P均<0.05)。结论针灸从阳明论治老年周围性面神经麻痹疗效确切。

浮刺配合雷火灸治疗贝氏面瘫的临床观察

目的:观察浮刺配合雷火灸治疗贝氏面瘫的临床疗效。方法:将120例贝氏面瘫患者,随机分成治疗组62例和对照组58例,治疗组采用浮刺配合雷火灸治疗,对照组采用普通针刺治疗,2周为1个疗程,2个疗程后对临床效果进行判断对比。结果:治疗组总有效率为98.39%,对照组为84.48%,两组比较差异无统计学意义(P>0.05);两组治疗后较治疗前症状体征总积分上升,差异有统计学意义(P<0.01);两组不同病情患者治疗前后评分比较差异也有统计学意义(P<0.01)。结论:浮刺配合雷火灸治疗贝氏面瘫疗效显著,能较好缩短病程。

针刺治疗中风后假球麻痹的文献系统评价

目的:评价针刺治疗中风后假球麻痹的有效性。方法:按照循证医学的要求,以针刺、针灸、假球麻痹、假性延髓麻痹等为主题词,检索了国内相关医学数据库,以随机临床对照试验为纳入标准,治疗组以针刺治疗为主,对照组以药物治疗为主,以假球麻痹痊愈率及总有效率为测量指标,共纳入52篇文献,并对其中7篇文献采用RevMan 4.2进行Meta分析。结果:7个研究总有效率的合并RR=1.73,95%CI[1.37,2.20];7个研究痊愈率合并RR=3.30,95%CI[2.07,5.25],针刺组对假球麻痹的疗效均优于药物组(P<0.01),差异具有显著性意义。结论:从纳入的国内文献来看,针刺治疗假球麻痹有效,但是需要更多的高质量文章来证实。

红外面部图像的贝尔面瘫针灸穴位定位算法

将红外图像处理应用于中医诊疗,提出一种面部穴位自动定位算法,为贝尔面瘫的针灸选穴提供了客观化和标准化的依据.首先利用头部阈值区分前景(即头部图像)和背景,在前景中根据"三庭五眼"规则对面部特征进行分区;采用Mini-mumEigenvalue算子检测面部特征的角点,Log算子检测面部特征的边缘,综合应用角点和边缘信息,定位各面部特征的位置;最后,以面部特征的位置作为参考坐标,完成面部穴位的定位.经过大量面部红外图像验证,本方法定位平均准确率达94%,其中人中穴的定位准确率接近100%.

贝尔麻痹的病因学说和治疗方法回顾

贝尔麻痹(简称BP)是临床上不能肯定病因的、不伴有其他症状或体征的单纯性面神经麻痹。由此引起的面神经病变直接导致患侧面瘫。除了引起面瘫的主要症状(如失去眼闭合功能以外),还可引起面部表情障碍和心理障碍,给患者带来巨大的痛苦。贝尔麻痹的发病率为15-40/100,000/年。虽然比较常见,而且贝尔先生早在1821年就详细地描述了本病的临床表现,但至今为止本病的病因仍未查明。文献上最常提到的病因学说主要包括:血管痉挛学说、压迫学说、遗传学说、病毒感染和自身免疫学说。贝尔麻痹的常见治疗方法很多,包括:药物(如:可的松、阿昔洛韦等)治疗、物理疗法、面肌功能训练、手术及某些特殊疗法。本文回顾性的研究了学者们报道的贝尔麻痹的病因学说和治疗方法,希望将来更深入的研究能明确本病的病因并提高疗效。