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| Les deux révisions précédentes Révision précédente Prochaine révision | Révision précédente | ||
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acupuncture:evaluation:neuro-psychiatrie:07. troubles cognitifs post-avc [28 Dec 2023 15:09] Nguyen Johan [1.1.1. Liu 2023] |
acupuncture:evaluation:neuro-psychiatrie:07. troubles cognitifs post-avc [13 Aug 2025 17:38] (Version actuelle) Nguyen Johan [3. Clinical Practice Guidelines] |
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| ===== Systematic Reviews and Meta-Analysis===== | ===== Systematic Reviews and Meta-Analysis===== | ||
| - | | ☆☆☆ | Evidence for effectiveness and a specific effect of acupuncture | | + | |
| - | | ☆☆ | Evidence for effectiveness of acupuncture | | + | |
| - | | ☆ | Limited evidence for effectiveness of acupuncture | | + | |
| - | | Ø | No evidence or insufficient evidence | | + | |
| Ligne 19: | Ligne 16: | ||
| + | === Kreiger 2025 === | ||
| + | |||
| + | Kreiger K, Weiss E, Fluri F. Novel therapies for post-stroke cognitive impairment: a systematic review. Front Neurol. 2025 May 27;16:1569329. https://doi.org/10.3389/fneur.2025.1569329 | ||
| + | ^Backgound| Stroke impacts 15 million people annually, ranking as the second-leading cause of mortality and the third-leading cause of disability globally. Despite advances in acute care, long-term cognitive impairments persist in 30-70% of survivors, impeding rehabilitation and increasing dependency. The existing treatments for post-stroke cognitive impairment (PSCI) show limited efficacy, underscoring the need for more comprehensive approaches. The objective of this systematic review is to evaluate the effectiveness of novel therapeutic interventions for PSCI.| | ||
| + | ^Methods| The present systematic review was conducted in accordance with the PRISMA guidelines and has been registered in PROSPERO (CRD42024621445). A comprehensive search in PubMed and EMBASE identified randomized controlled trials (RCTs) from the past 5 years examining PSCI interventions, with the selection criterion being an assessment of the trials using the Montreal Cognitive Assessment (MoCA). Statistical analyses included pooled mean differences (MD) with 95% confidence intervals (CI), heterogeneity assessment, and subgroup analyses.| | ||
| + | ^Results| Of 755 identified articles, 22 RCTs involving 5,100 participants met the inclusion criteria. The results demonstrated that brain stimulation therapies, particularly transcranial direct current stimulation (tDCS; MD 4.56, 95% CI: 3.19-5.93) and pharmacological interventions (MD 4.00, 95% CI: 3.48-4.52) exhibited significant benefits. **Acupuncture** showed potential benefits (MD 2.65, 95% CI: 1.07-4.23), albeit with considerable variability. Training approaches yielded mixed outcomes (MD 1.53, 95% CI: -0.09-3.15). Early interventions (within 3 months post-stroke) were the most effective.| | ||
| + | ^Discussion|Brain stimulation, especially tDCS, resulted in consistent cognitive benefits, with early initiation enhancing outcomes. Pharmacotherapy demonstrated robust, generalizable results, while cognitive training showed small but reliable effects. **Acupuncture** and physical training hold potential but require further standardization.| | ||
| + | ^Conclusion| Effective stroke rehabilitation requires a multimodal, personalized approach integrating brain stimulation, pharmacotherapy, and cognitive training. Early intervention is critical for maximizing neuroplasticity, the effect of later interventions needs further evaluation. Standardization is needed to optimize physical training and alternative medicine.| | ||
| + | |||
| + | === Luo 2024 === | ||
| + | |||
| + | Luo Z, Li W, Jiang J, Sun J, Zhang M, Zhang Y, Dong L, Li K, Wu C. Effect of Acupuncture on Cognitive Function in Patients With Post-Stroke Cognitive Impairment: A Systematic Review and Meta-Analysis. Brain Behav. 2024 Oct;14(10):e70075. https://doi.org/10.1002/brb3.70075 | ||
| + | ^Aims and objective|To investigate the impact of acupuncture on post-stroke cognitive impairment (PSCI).| | ||
| + | ^Backgound| PSCI is a major barrier to stroke patients' rehabilitation, and acupuncture is one of the treatments. However, the benefit of acupuncture on PSCI is unclear.| | ||
| + | ^Design| A meta-analysis and systematic review of randomized controlled trials (RCTs).| | ||
| + | ^Methods| Up to February 1, 2024, databases in PubMed, MEDLINE, Scopus, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, VIP, and Wanfang Data were searched. The risk of bias was investigated using the Cochrane Handbook for systematic reviews of treatments. Random-effect and fix-effect models were used to report the effects.| | ||
| + | ^Results| There were **29 randomized clinical trials with 2477 participants** included. The findings demonstrated that the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) scores were higher in the acupuncture group than medicine group (mean difference [MD] = 1.74, 95% confidence interval (CI) CI [1.26, 2.23], I2 = 59%, p < 0.01). Compared to medicine group, the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) score exhibited a significant decrease and demonstrated improvement in the acupuncture group. Statistically significant outcomes were observed in the Barthel Index scores and P300 event-related potential (ERP). According to subgroup analysis, acupuncture was superior to conventional therapy for improving cognitive function in PSCI patients at 4 weeks after treatment.| | ||
| + | ^Conclusion| Acupuncture therapy has shown promise in ameliorating cognitive deficits and enhancing daily functional abilities in individuals diagnosed with PSCI. But future research should focus on the duration and implement large sample, high-quality RCTs.| | ||
| + | ^Relevance to clinical practice|Clinical workers in practical clinical work can select appropriate acupoints according to the actual conditions of patients, as well as confirm the treatment course of PSCI patients, while paying attention to observing and evaluating the therapeutic efficacy of acupuncture, to improve the health outcomes of patients in a patient-centered way.| | ||
| + | |||
| + | === Wu 2024 === | ||
| + | |||
| + | Wu W, Song C, Yang Y, Hu Y, Lin H. Acupuncture for cognitive impairment after stroke: A systematic review and meta-analysis. Heliyon. 2024 May 1;10(9):e30522. https://doi.org/10.1016/j.heliyon.2024.e30522 | ||
| + | | | ||
| + | ^Objective| Acupuncture as an alternative therapy for post-stroke cognitive impairment (PSCI) has emerged as a research focus. The inclusion of additional external treatments in many previous studies prevents a clear, direct assessment of acupuncture's impact on PSCI. In order to prevent patients from developing hypersensitivity to other treatments and misinterpreting acupuncture's true therapeutic value, this study establish stricter intervention criteria and exclude therapies beyond acupuncture. The review aimed to offering a clearer evaluation of acupuncture's efficacy and safety in PSCI treatment.| | ||
| + | ^Methods| This research involved a comprehensive search for randomized controlled trials (RCTs) across eight databases, adhering to the Cochrane Systematic Reviewer's Handbook 5.1.0 for risk-of-bias and quality assessments. A meta-analysis was conducted using RevMan 5.3 software.| | ||
| + | ^Results| The inclusion of **18 publications, totaling 1361 patients**, was achieved. The meta-analysis demonstrated a significantly higher overall efficacy of acupuncture for PSCI compared to controls (OR = 4.06, 95 % CI 2.86-5.76, Z = 7.82). Notable statistical differences were observed in the Montreal Cognitive Assessment scores (MD = 2.32, 95 % CI 1.68-2.97, Z = 7.10) and the Mini-Mental State Examination scores (MD = 2.02, 95 % CI 1.06-2.98, Z = 4.13) between the groups. Improvements in the Barthel Index scores were noted for the experimental group (MD = 5.70, 95 % CI 4.68-6.72, Z = 10.92).| | ||
| + | ^Conclusion| Integrating acupuncture with Western medications offers significant benefits for treating PSCI over Western medications alone. However, the long-term efficacy of acupuncture in PSCI treatment and its potential in reducing recurrence rates remain undetermined. Further high-standard RCTs are essential to explore acupuncture's effectiveness in PSCI treatment more thoroughly. | | ||
| + | |||
| + | === Yang 2024 === | ||
| + | |||
| + | Yang G, Guo L, Zhang Y, Li S. Network meta-analysis of non-pharmacological interventions for cognitive impairment after an ischemic stroke. Front Neurol. 2024 Jun 4;15:1327065. https://doi.org/10.3389/fneur.2024.1327065 | ||
| + | ^Objective| This study aims to evaluate the effectiveness of non-pharmacological interventions in improving cognitive function in patients with ischemic stroke through network meta-analysis.| | ||
| + | ^Methods| We searched databases including the Cochrane Library, PubMed, EmBase, and Web of Science for randomized controlled trials (RCTs) on non-pharmacological treatments to improve cognitive impairment following ischemic stroke. The publication date was up to 15 March 2023. Due to the insufficiency of included studies, supplementary searches for high-quality Chinese literature were performed in databases such as CNKI, WanFang Data, and VIP Chinese Science Journals Database. Two reviewers independently went through the literature, extracted data, and assessed the risk of bias in the included studies using the risk of bias assessment tool recommended by the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. By utilizing R 4.2.3 RStudio software and the GeMTC package, a Bayesian network meta-analysis was conducted to assess the improvement in Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores under a variety of non-pharmacological interventions.| | ||
| + | ^Results| A total of **22 RCTs involving 2,111 patients** and 14 different non-pharmacological treatments were included. These interventions were transcranial direct current stimulation (tDCS), reminiscence therapy (RT), remote ischemic conditioning (RIC), physical fitness training (PFT), intensive patient care program (IPCP), moderate-intensity continuous training + high-intensity interval training (MICT + HIIT), medium intensity continuous training (MICT), grip training (GT), acupuncture, cognitive behavioral therapy (CBT), cognitive rehabilitation training (CRT), high pressure oxygen (HPO), moxibustion, and repetitive transcranial magnetic stimulation (rTMS). The results of the network meta-analysis indicated that rTMS had the highest likelihood of being the most effective intervention for improving MMSE and MoCA scores.| | ||
| + | ^Conclusion| The evidence from this study suggests that rTMS holds promise for improving MMSE and MoCA scores in patients with cognitive impairment following ischemic stroke. However, further high-quality research is needed to confirm and validate this finding.| | ||
| === Liu 2023 === | === Liu 2023 === | ||
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| ==== Special Acupuncture Techniques ==== | ==== Special Acupuncture Techniques ==== | ||
| + | |||
| + | === Comparison of Acupuncture techniques === | ||
| + | |||
| + | == Huo 2024 == | ||
| + | |||
| + | |||
| + | Huo L, Zhao M, Wang Z, Zhang L, Fu K, Zhang X. A network meta-analysis of different acupuncture therapy in the treatment of poststroke cognitive impairment and dementia. Medicine (Baltimore). 2024 Oct 25;103(43):e40233. https://doi.org/10.1097/MD.0000000000040233 | ||
| + | ^Backgound| Poststroke cognitive impairment and dementia (PSCID) is a major cause of stroke-related morbidities and mortalities. Over the last few years, there has been growing evidence supporting the effectiveness of needle-related treatments in PSCID. Our goal was to rate the included therapies and assess the clinical effectiveness of various needle-related treatments in patients with PSCID.| | ||
| + | ^Methods| We searched PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Chinese Biomedical Literature Service System (SinoMed), Wanfang, FDA.gov, and ClinicalTrials.gov. A mix of subject terms and free words was used to search the databases. The retrieval period was from the inception date of the database to February, 2023. We included SRs and MAs from acupuncture RCTs of patients with PSCID. The Cochrane Risk Assessment Scale was used to evaluate the risk of bias in the included studies. State 17.0 was used for network meta-analysis in accordance with the Bayesian framework.| | ||
| + | ^Results| There were **34 studies total of 2690 patients**. The cumulative ranking curve (SUCRA) revealed that CT + CFT + EA was the most efficient intervention to improve (Mini-Mental State Examination, MMSE) efficiency, followed by CT + CFT + AP to improve (Montreal Cognitive Assessment, MoCA) efficiency, CT + CFT + ACU for improving (Activities of Daily Living scale, ADL) scores, and CT + CFT + EA to improve clinical efficiency.| | ||
| + | ^Conclusion| The results show that Different acupuncture methods can improve cognitive function and daily living ability in patients with PSCID. Network meta-analysis revealed that both CT + CFT + ACU and CT + CFT + EA appeared to be more beneficial for daily living activities, while CT + CFT + EA and CT + CFT + AP appeared to be more helpful for cognitive performance in patients with PSCID. Treatments including acupuncture are safer and have a reduced incidence of negative side effects.| | ||
| + | |||
| + | |||
| + | == Liu 2023 == | ||
| + | |||
| + | Liu Y, Zhao L, Chen F, Li X, Han J, Sun X, Bian M. Comparative efficacy and safety of multiple acupuncture therapies for post stroke cognitive impairment: a network meta-analysis of randomized controlled trials. Front Neurol. 2023 Aug 10;14:1218095. https://doi.org/10.3389/fneur.2023.1218095 | ||
| + | ^Background| Acupuncture therapy has been widely used to treat post-stroke cognitive impairment (PSCI). However, acupuncture therapy includes multiple forms. Which acupuncture therapy provides the best treatment outcome for patients with PSCI remains controversial.| | ||
| + | ^Objective| We aimed to compare and evaluate the efficacy and safety of different acupuncture-related therapies for PSCI in an attempt to identify the best acupuncture therapies that can improve cognitive function and self-care in daily life for patients with PSCI, and bring new insights to clinical practice.| | ||
| + | ^Method| We searched eight databases including PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, China Biomedical Literature Database (CBM), China Science and Technology Journal (VIP) database, China National Knowledge Infrastructure (CNKI) database, and Wan fang database to find randomized controlled trials (RCTs) of acupuncture-related therapies for PSCI from the inception of the database to January 2023. Two researchers independently assessed the risk of bias in the included studies and extracted the study data. Pairwise meta-analyzes for direct comparisons were performed using Rev. Man 5.4 software. Bayesian network meta-analysis (NMA) was performed using STATA 17.0 and R4.2.4 software. The quality of evidence from the included studies was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Adverse effects (AEs) associated with acupuncture therapy were collected by reading the full text of the included studies to assess the safety of acupuncture therapy.| | ||
| + | ^Results| A total of **62 RCTs** (3 three-arm trials and 59 two-arm trials) involving **5,073 participants** were included in this study. In the paired meta-analysis, most acupuncture-related therapies had a positive effect on cognitive function and self-care of daily living in patients with PSCI compared with cognitive training. Bayesian NMA results suggested that ophthalmic acupuncture plus cognitive training (79.7%) was the best acupuncture therapy for improving MMSE scores, with scalp acupuncture plus cognitive training ranking as the second (73.7%). The MoCA results suggested that warm acupuncture plus cognitive training (86.5%) was the best acupuncture therapy. In terms of improvement in daily living self-care, scalp acupuncture plus body acupuncture (87.5%) was the best acupuncture therapy for improving MBI scores. The most common minor AEs included subcutaneous hematoma, dizziness, sleepiness, and pallor.| | ||
| + | ^Conclusion| According to our Bayesian NMA results, ophthalmic acupuncture plus cognitive training and warm acupuncture plus cognitive training were the most effective acupuncture treatments for improving cognitive function, while scalp acupuncture plus body acupuncture was the best acupuncture treatment for improving the performance of self-care in daily life in patients with PSCI. No serious adverse effects were found in the included studies, and acupuncture treatment appears to be safe and reliable. However, due to the low methodological quality of the included studies, our findings need to be treated with caution. High-quality studies are urgently needed to validate our findings.| | ||
| === Acupuncture combined with other therapies === | === Acupuncture combined with other therapies === | ||
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| === Acupoints combination === | === Acupoints combination === | ||
| - | == Comparison of multiple acupoints combination == | + | == Han 2024 (Governor vessel acupuncture) == |
| + | |||
| + | Han JZ, Yang Y, Wang YF, Feng JH, Song CN, Wu WJ, Lin HB. Effectiveness and safety of Governor vessel acupuncture therapy for post-stroke cognitive impairment: A meta-analysis of randomized controlled trials. Ageing Res Rev. 2024 Aug;99:102355. https://doi.org/10.1016/j.arr.2024.102355 | ||
| + | ^Objective| The purpose of this study was to evaluate the effectiveness of Governor vessel acupuncture (GV Ac) in treating post-stroke cognitive impairment (PSCI).| | ||
| + | ^Methods| There was a total of seven databases examined. Four English databases (Cochrane Library, PubMed, Embase, and Medline) and three Chinese databases (Chinese National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Databases (VIP), and Wan Fang Database) contain all randomized controlled trials (RCTs) comparing Governor vessel acupuncture to other treatments or none acupuncture for PSCI. The exact dates for the search period are from January 1, 2000, to January 1, 2023.Two researchers independently reviewed the literature, gathered RCT data, and performed statistical analysis. All data were analyzed using Review Manager software (Rev Man) 5.3.| | ||
| + | ^Results| This meta-analysis includes a total of **39 trials with 2044 patients**. There were 1022 participants in each of the test and control groups. Following 12-120 days of acupuncture treatment, a meta-analysis revealed that the treatment groups (GV Ac combined with conventional treatment groups) significantly increased their scores on the Curative ratio (OR = 3.00, 95 %CI = 2.37-3.79, P = 0.98, I² = 0 %), Montreal Cognitive Assessment (MoCA)(MD = 1.82, 95 %CI = 1.60-2.03, P = 0.11, I² = 25 %), Mini-Mental State Examination (MMSE)(MD = 2.18, 95 %CI = 1.64-2.72, P<0.005, I² = 92 %), and Activity of Daily Living (ADL)(MD = 5.99, 95 %CI = 5.33-6.64, P = 0.19, I² = 26 %).| | ||
| + | ^Conclusion| The results suggested that acupuncture on points of the Governor vessel enhanced cognitive function in stroke survivors. | | ||
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| === Scalp acupuncture === | === Scalp acupuncture === | ||
| + | == Li 2024 == | ||
| + | |||
| + | Li S, Dai A, Zhou Y, Chen X, Chen Y, Zhou L, Yang X, Yue M, Shi J, Qiu Y. Efficacy of combination scalp acupuncture for post-stroke cognitive impairment: a systematic review and meta-analysis. Front Neurosci. 2024 Nov 29;18:1468331. https://doi.org/10.3389/fnins.2024.1468331 | ||
| + | ^Objective| This systematic review and meta-analysis aimed to evaluate the efficacy of combination scalp acupuncture in treating post-stroke cognitive impairment.| | ||
| + | ^Methods| A comprehensive search was conducted across eight databases: PubMed, Web of Science, Cochrane Database, Embase, CBM, CNKI, WanFang, and VIP, targeting randomized controlled trials (RCTs) published from the inception of these databases until October 24, 2024. The inclusion criteria focused on RCTs that compared scalp acupuncture with conventional treatments as therapeutic interventions for patients suffering from post-stroke cognitive impairment (PSCI). The effectiveness of these treatments was evaluated using various outcome measures, including the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), as well as P300 latency and amplitude, which collectively assess cognitive function. Two independent reviewers conducted a risk of bias (ROB2) assessment, and data analysis was performed using Review Manager (RevMan) version 5.4.| | ||
| + | ^Results| This analysis included a total of **28 studies involving 1,995 patients**. However, according to the standards of the ROB2 tool, most of these studies exhibited various methodological issues. The comprehensive analysis indicates that the efficacy of combined scalp acupuncture in treating post-stroke cognitive impairment (PSCI) is superior to that of single treatments, as evidenced by improvements across multiple scales, including the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), P300 latency, and amplitude. Specifically, the overall effective rate was reported as (RR = 1.28, 95% CI: 1.14-1.45, p < 0.0001; I 2 = 51%, random effects model). The mean differences for the various scales were as follows: MoCA (MD = 3.55, 95% CI: 2.68-4.41, I 2 = 93%, random effects model), MMSE (MD = 3.78, 95% CI: 2.83-4.73, I 2 = 94%, random effects model), LOTCA (MD = 9.70, 95% CI: 7.72-11.69, I 2 = 57%, random effects model), P300 latency (MD = -21.83, 95% CI: -26.31 to -17.35, I 2 = 55%, random effects model), and amplitude (MD = 1.05, 95% CI: 0.76-1.34, I 2 = 0%, fixed effects model), demonstrating low, medium, and high levels of heterogeneity, respectively. Notably, one study reported an adverse event related to participant withdrawal during the study.| | ||
| + | ^Conclusion| Combination scalp acupuncture exhibits superior efficacy compared to single-treatment modalities in patients with post-stroke cognitive impairment (PSCI). However, the higher risk of bias (ROB) in the included trials suggests that the quality of evidence about these assessment results may be compromised. Therefore, there is an urgent need for additional high-quality clinical trials to further validate the efficacy and effectiveness of combined scalp acupuncture in treating PSCI, ultimately enhancing the overall level of evidence.| | ||
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| ===== Overviews of Systematic Reviews ===== | ===== Overviews of Systematic Reviews ===== | ||
| + | |||
| + | |||
| + | ==== Li 2023 ==== | ||
| + | |||
| + | Li Y, Cui R, Liu S, Qin Z, Sun W, Cheng Y, Liu Q. The efficacy and safety of post-stroke cognitive impairment therapies: an umbrella review. Front Pharmacol. 2023 Aug 24;14:1207075. https://doi.org/10.3389/fphar.2023.1207075 | ||
| + | ^Background| Stroke survivors are at significantly increased risk of cognitive impairment, which affects patients' independence of activities of daily living (ADLs), social engagement, and neurological function deficit. Many studies have been done to evaluate the efficacy and safety of post-stroke cognitive impairment (PSCI) treatment, and due to the largely inconsistent clinical data, there is a need to summarize and analyze the published clinical research data in this area.| | ||
| + | ^ Objective| An umbrella review was performed to evaluate the efficacy and safety of PSCI therapies.| | ||
| + | ^Methods| Three independent authors searched for meta-analyses and systematic reviews on PubMed, the Cochrane Library, and the Web of Science to address this issue. We examined ADL and Barthel index (BI), Montreal Cognitive Assessment (MoCA), neurological function deficit as efficacy endpoints, and the incidence of adverse events as safety profiles. | | ||
| + | ^Results|In all, 312 studies from 19 eligible publications were included in the umbrella review. The results showed that angiotensin-converting enzyme inhibitors (ACEI) and N-methyl-D-aspartate (NMDA) antagonists, cell therapies, **acupuncture**, and EGB76 can improve the MoCA and ADL, and the adverse effects were mild for the treatment of PSCI. Moreover, Vinpocetine, Oxiracetam, Citicoline, thrombolytic therapy, Actovegin, DL-3-n-Butylphthalide, and Nimodipine showed adverse events or low article quality in patients with PSCI. However, the research evidence is not exact and further research is needed. | | ||
| + | ^Conclusion| Our study demonstrated that ACEI inhibitors (Donepezil) and NMDA antagonists (Memantine), EGB761, and **acupuncture** are the ADL and BI, MoCA, and neurological function deficit medication/therapy, respectively, for patients with PSCI. | | ||
| ==== Choi 2022 ==== | ==== Choi 2022 ==== | ||
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| - | |||
| - | |||
| - | |||
| - | |||
| - | |||
| - | |||
| - | | ☆☆☆ | Evidence for effectiveness and a specific effect of acupuncture | | ||
| - | | ☆☆ | Evidence for effectiveness of acupuncture | | ||
| - | | ☆ |Limited evidence for effectiveness of acupuncture | | ||
| - | | Ø |No evidence or insufficient evidence | | ||
| ==== Brazilian Academy of Neurology (BAN, Brazil) 2022 ⊕ ==== | ==== Brazilian Academy of Neurology (BAN, Brazil) 2022 ⊕ ==== | ||
