Acupuncture-induced cerebral blood flow responses in dystonia

Acupuncture as Adjuvant Therapy for the Management of Cervical Dystonia

Objectives: There are no curative treatments for cervical dystonia (CD), therefore conventional management is aimed at pain relief and muscle relaxation. Many patients with CD use complementary and integrative medicine interventions to manage symptoms, yet there are limited data on the use of acupuncture for CD. The aim of the current study was to determine the feasibility, safety, and efficacy of adjuvant acupuncture. Materials and Methods: A pilot open-label study was conducted on acupuncture treatments as add-on therapy to botulinum-toxin injection sessions (3 months apart) in 5 subjects with chronic idiopathic CD. Six 1-hour acupuncture sessions were administered every other week over the 3-month period between consecutive botulinum-toxin sessions. Data from exploratory efficacy endpoints-including a visual analogue scale for pain, the Clinician Global Impression of Change, the Patient Global Impression of Change, the Toronto Western Spasmodic Torticollis Rating Scale, and the Short Form-36) Health Survey-were collected. Results: Five subjects completed the study with only 1 acupuncture session missed by 1 subject, thereby meeting the study's predetermined adherence goal. All participants reported improvement from acupuncture. Only minor adverse events were reported, with self-resolved discomfort in 1 subject and self-resolved minor bruising in 2 subjects. Conclusions: Acupuncture is feasible and safe as an adjunct treatment for chronic CD, and might be associated with subjective symptomatic benefits.

Transient tardive dystonia: overview and case presentation

Dystonia is a syndrome of involuntary, repetitive (or sustained) muscle contractions of opposing muscles, which may result in torsions and abnormal postures. Tardive dystonia is a form of the disorder that starts after longer term use of dopamine antagonists. It occurs in approximately 3% of patients receiving ongoing antipsychotic treatment and is often difficult to reverse. Dystonia can also be induced by compounds other than antipsychotics, such as antidepressants, levodopa, carbamazepine, dextroamphetamine, and diphenylhydantoin. In these cases, it is transient, generally disappearing after the dose is reduced or the causative drug is stopped. Dystonia induced by injury can also be transient. We report a case of transient oromandibular dystonia following a dental filling in a woman receiving quetiapine, a second-generation antipsychotic. The timing, localization, and transience of the dystonia suggested that the dental procedure may have played a triggering role. The dystonia symptoms responded within 8 weeks to benztropine and a dose reduction of quetiapine, and they did not return when benztropine was discontinued. This case benefited from prompt attention and has led to practical recommendations for psychiatric clinicians.

Study protocol for a pragmatic randomised controlled trial in general practice investigating the effectiveness of acupuncture against migraine

Background

Migraine is a chronic neurologic disease that can severely affect the patient's quality of life. Although in recent years many randomised studies have been carried out to investigate the effectiveness of acupuncture as a treatment for migraine, it remains a controversial issue. Our aim is to determine whether acupuncture, applied under real conditions of clinical practice in the area of primary healthcare, is more effective than conventional treatment.

Methods/Design

The design consists of a pragmatic multi-centre, three-armed randomised controlled trial, complemented with an economic evaluation of the results achieved, comparing the effectiveness of verum acupuncture with sham acupuncture, and with a control group receiving normal care only.

Patients eligible for inclusion will be those presenting in general practice with migraine and for whom their General Practitioner (GP) is considering referral for acupuncture. Sampling will be by consecutive selection, and by randomised allocation to the three branches of the study, in a centralised way following a 1:1:1 distribution (verum acupuncture; sham acupuncture; conventional treatment). Secondly, one patient in three will be randomly selected from each of the acupuncture (verum or sham) groups for a brain perfusion study (by single photon emission tomography). The treatment with verum acupuncture will consist of 8 treatment sessions, once a week, at points selected individually by the acupuncturist. The sham acupuncture group will receive 8 sessions, one per week, with treatment being applied at non-acupuncture points in the dorsal and lumbar regions, using the minimal puncture technique. The control group will be given conventional treatment, as will the other two groups.

Discussion

This trial will contribute to available evidence on acupuncture for the treatment of migraine. The primary endpoint is the difference in the number of days with migraine among the three groups, between the baseline period (the 4 weeks prior to the start of treatment) and the period from weeks 9 to 12. As a secondary aspect, we shall record the index of laterality and the percentage of change in the mean count per pixel in each region of interest measured by the brain perfusion tomography, performed on a subsample of the patients within the real and sham acupuncture groups.

Trial registration

Current Controlled Trials ISRCTN98703707.