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Sommaire

Troubles cognitifs post-AVC : évaluation de l'acupuncture

1. Revues systématiques et méta-analyses

1.1. Acupuncture générique

1.1.1. Zhan 2017

Zhan J, Wang X, Cheng N, Tan F. [Electroacupuncture for post stroke cognitive impairment: a systematic review and Meta-analyses]. Chinese Acupuncture and Moxibustion. 2017;37(10):1119-25. 165857[165857].

Objective To systematically evaluate the efficacy and safety of electroacupuncture (EA) for post stroke cognitive impairment (PSCI).
Methods The randomized clinical trials (RCTs) regarding EA for PSCI published before October of 2016 were researched in China National Knowledge Infrastructure (CNKI), Chinese Biomedical Database (CBM), WanFang database, VIP medicine information system, PubMed and Cochrane Library. The literature screening and information extraction was conducted by two independent reviewers. The quality assessment was performed based on the guidance of the Cochrane Reviewers' Handbook, and Meta-analyses was performed by using RevMan 5. 3 software.
ResultsTotally 14 RCTs were included, involving 896 PSCI patients. The results of Meta-analyses showed the EA group was superior to the control group in improving the MMSE [MD =1. 78, 95% CI (0. 24, 3. 32), P =0. 02], the MoCA [MD=1. 92, 95% CI (0. 96, 2. 88), P<0. 000 1], P300 latency [MD =-11. 01, 95% CI (-18. 91, -3. 11), P =0. 000 6], P300 amplitude [MD=1. 56, 95% CI (1. 14, 1. 98), P<0. 000 01], FMA score [MD =10. 74, 95% CI (2. 67, 18. 82), P =0. 009] and the clinical effective rate [RR =1. 37, 95% CI (0. 98, 1. 91), P =0. 06]. However, the comparison of BI score in both group had no significant differences [MD =6. 38, 95% CI (-2. 41, 15. 18), P =0. 15].
Conclusion This Meta-analyses confirmed EA is effective and safe for PSCI, which could improve cognitive function and motor function. However, because of low quality of the included studies, more well-designed multicenter RCTs are needed

1.1.2. Zhang 2015

Zhang Yang, Tang Wei, Song Xiao-Ge, Wu Song, Zhang Gao-Ying, Xu Hua. [Systematical review and meta-analysis of the efficacy of acupuncture and moxibustion plus cognitive rehabilitation training in treating post-stroke cognitive disorder]. Shanghai Journal of Acupuncture & Moxibustion 2015. 34(10):1013-20. (chi). [187058]

Objective To systematically assess the efficacy of acupuncture and moxibustion plus cognitive rehabilitation training in treating post-stroke cognitive disorder.
Method A computer searched CNKI, CBM, VIP, WANFANG DATA, and Pubmed and Cochrane Library for randomized controlled trials (RCT) of acupuncture and moxibustion plus cognitive rehabilitation training for the treatment of post-stroke cognitive disorder. The reference Iiterature in the included literature was also retrieved. Retrieval time limit for both of them was from Jan. 1st 1990 to Jan. 1st 2015. Two reviewers independently selected the trials, extracted the data and assessed the quality of methodology. Meta-analysis was then performed using RevMan 5.3 software.
Result Eleven trials with a total of 789 subjects were finally included. The results of Meta-analysis showed that the following aspects were better in acupuncture plus cognitive rehabilitation training than in cognitive rehabilitation training or medication alone and there were statistically significant differences: the total efficacy rate [RR=1 .58, 95% CI(1.10,2.26), P=0.011, the MMSE sc0re [M.D=2.64, 95% CI(1.78, 3.50), P'0.00001], P300 latency [MD= - 18.46, 95% CI( - 30.51, - 6.41), P=0.003], P300 amplitude [MD=l.23, 95% CI(0.82, 1 .63), P<0.0000 1] and activities of daily living (ADL) [SMD=().52, 95% CI(0.3 1, 0.73), P=0.00001]. Based on the results of a systematical review, the quality of evidence was assessed using GRADE system recommended classification method. The results showed that the level of evidence was low and the strength of recommendations was weak.
Conclusion The results of Meta-analysis showed that the therapeutic effect was better in acupuncture and moxibustion plus cognitive rehabilitation training than in cognitive rehabilitation training or medication alone. Because of low quality of all the original literature, high-quality, multicenter and large-sample randomized blind controlled trials are still needed for validation.

1.2. Techniques particulières

1.2.1. Liu 2018 (association 20VG + 24VG)

Liu Fang, Yao Li-Qun, Chen Jin-Hui. [Therapeutic Efficacy of Acupuncture at Baihui (GV 20) and Shenting (GV 24) for Post-stroke Cognitive Impairment: A Systematic Review]. Shanghai Journal of Acupuncture and Moxibustion. 2018;37(1):104-111. [100878].

Objective To evaluate the clinical efficacy of acupuncture at Baihui (GV 20) and Shenting (GV 24) in treating post-stroke cognitive impairment (PSCI) by using the systematic review method.
Method Via computer, Chinese Journal Full-text Database, Wanfang, China Biology Medicine disc (CBMdisc),Chinese Science and Technology Periodical Database, Pub Med, Foreign Evidence-Based Medicine(FEMB), the Cochrane Library were retrieved. Chinese Acupuncture and Moxibustion and Shanghai Journal of Acupuncture-moxibustion were manually retrieved. Randomized controlled trials published before Jan 31 st of 2013 on acupuncture at Baihui (GV 20) and Shenting (GV 24) in treating PSCI, both in Chinese and English, were collected. The required data were extracted, then were evaluated according to the criteria of Cochrane systematic review and underwent meta-analysis by using Rev Man 5.0.
Results Twenty-two clinical trials were finally recruited, including 1 637 subjects. The meta-analysis showed that acupuncture at acupoints including Baihui (GV 20) and Shenting (GV 24) produced a more significant rehabilitation result compared to single rehabilitation training or medication. The comparison of Mini-Mental State Examination(MMSE) score showed: [WMD=3.37, 95%CI(1.70, 5.05), P<0.00001]; the comparison of P300 latency: [WMD=1.22, 95%CI(0.84, 1.59), P<0.00001]. Severe adverse reactions were not discovered.
Conclusion Acupuncture at Baihui (GV 20) and Shenting (GV 24) can effectively improve the cognitive function of PSCI patients. However, the diagnostic criteria and evaluation indexes are expected to be unified and standardized, and the clinical trials on acupuncture intervening PSCI are required to be further improved methodologically.