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      Efficacy of acupuncture combined with traditional Chinese herbal for primary epilepsy patients with cognitive impairment: A protocol for systematic review and meta-analysis

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      Author(s): 1 , * , , 2 , 1 , 1
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      Publication date (Electronic):
      Journal: PLOS ONE
      Publisher: Public Library of Science

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          Abstract

          Background

          Epilepsy is a common and serious chronic neurological disorder, and some patients suffer from cognitive dysfunction. We aim to assess the efficacy and safety of acupuncture combined with traditional Chinese herbal for primary epilepsy patients with cognitive impairment.

          Methods

          To search the randomized control trials (RCTs) published before April 20, 2023 from PubMed, Embase, Cochrane Library, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Web of science, and Wanfang Database. The risk of bias within each individual trial was evaluated using the Cochrane Collaboration tool. RevMan5.3 software was used for statistical analysis. The odds ratio (OR) or weighted mean difference (WMD) with a 95% confidence interval (CI) was calculated for each RCT before data pooling.

          Results

          The primary outcomes involve changes in cognitive function and behavioral disturbances. The secondary outcomes focused on quality of life and adverse effects.

          Conclusion

          The results of this review are expected to provide new guidelines for the treatment of primary epilepsy patients with cognitive impairment.

          Trial registration

          This systematic review protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) (Registration number: CRD42023415355).

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          Most cited references21

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          Epilepsy in adults

          Roland Thijs, Rainer Surges, Terence J O'Brien … (2019)
          Epilepsy is one of the most common serious brain conditions, affecting over 70 million people worldwide. Its incidence has a bimodal distribution with the highest risk in infants and older age groups. Progress in genomic technology is exposing the complex genetic architecture of the common types of epilepsy, and is driving a paradigm shift. Epilepsy is a symptom complex with multiple risk factors and a strong genetic predisposition rather than a condition with a single expression and cause. These advances have resulted in the new classification of epileptic seizures and epilepsies. A detailed clinical history and a reliable eyewitness account of a seizure are the cornerstones of the diagnosis. Ancillary investigations can help to determine cause and prognosis. Advances in brain imaging are helping to identify the structural and functional causes and consequences of the epilepsies. Comorbidities are increasingly recognised as important aetiological and prognostic markers. Antiseizure medication might suppress seizures in up to two-thirds of all individuals but do not alter long-term prognosis. Epilepsy surgery is the most effective way to achieve long-term seizure freedom in selected individuals with drug-resistant focal epilepsy, but it is probably not used enough. With improved understanding of the gradual development of epilepsy, epigenetic determinants, and pharmacogenomics comes the hope for better, disease-modifying, or even curative, pharmacological and non-pharmacological treatment strategies. Other developments are clinical implementation of seizure detection devices and new neuromodulation techniques, including responsive neural stimulation.
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            Effects and mechanisms of acupuncture based on the principle of meridians.

            Wei-Wei Zhou, Peyman Benharash (2014)
            Acupuncture has been practiced in China for over 2000 years to treat a variety of diseases based on the "meridian theory" as described in the Yellow Emperor's Classic of Internal Medicine. To this date, the meridian theory continues to be an important guide for traditional Chinese medicine practitioners to diagnose and treat patients. Although the meridians have not been identified reliably as actual anatomical structures, they appear to serve as a road map to identify the location of various acupoints. Research has shown that acupoints overlie major neuronal bundles. The meridians extensively studied in the cardiovascular realm are the pericardial meridians (P) 5, 6, which overlie the deep median nerve. Meridians involved with gastrointestinal processes are (St) 36, 37, which overlie the deep peroneal nerve. Acupuncture needles, either manipulated manually or stimulated using a low current and frequency, have been documented to be a neurophysiological basis for modulating the activity of peripheral and central neural pathways. This review describes our current understanding of acupoints and meridians from a physiological aspect.
            Article 0 comments Cited 62 times – based on 0 reviews     Review now
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              Age-related cognitive impairment is associated with long-term neuroinflammation and oxidative stress in a mouse model of episodic systemic inflammation

              Joana d’Avila, Luciana Domett Siqueira, Aurélien Mazeraud … (2018)
              Background Microglia function is essential to maintain the brain homeostasis. Evidence shows that aged microglia are primed and show exaggerated response to acute inflammatory challenge. Systemic inflammation signals to the brain inducing changes that impact cognitive function. However, the mechanisms involved in age-related cognitive decline associated to episodic systemic inflammation are not completely understood. The aim of this study was to identify neuropathological features associated to age-related cognitive decline in a mouse model of episodic systemic inflammation. Methods Young and aged Swiss mice were injected with low doses of LPS once a week for 6 weeks to induce episodic systemic inflammation. Sickness behavior, inflammatory markers, and neuroinflammation were assessed in different phases of systemic inflammation in young and aged mice. Behavior was evaluated long term after episodic systemic inflammation by open field, forced swimming, object recognition, and water maze tests. Results Episodic systemic inflammation induced systemic inflammation and sickness behavior mainly in aged mice. Systemic inflammation induced depressive-like behavior in both young and aged mice. Memory and learning were significantly affected in aged mice that presented lower exploratory activity and deficits in episodic and spatial memories, compared to aged controls and to young after episodic systemic inflammation. Systemic inflammation induced acute microglia activation in young mice that returned to base levels long term after episodic systemic inflammation. Aged mice presented dystrophic microglia in the hippocampus and entorhinal cortex at basal level and did not change morphology in the acute response to SI. Regardless of their dystrophic microglia, aged mice produced higher levels of pro-inflammatory (IL-1β and IL-6) as well as pro-resolution (IL-10 and IL-4) cytokines in the brain. Also, higher levels of Nox2 expression, oxidized proteins and lower antioxidant defenses were found in the aged brains compared to the young after episodic systemic inflammation. Conclusions Our data show that aged mice have increased susceptibility to episodic systemic inflammation. Aged mice that showed cognitive impairments also presented higher oxidative stress and abnormal production of cytokines in their brains. These results indicate that a neuroinflammation and oxidative stress are pathophysiological mechanisms of age-related cognitive impairments. Electronic supplementary material The online version of this article (10.1186/s12974-018-1059-y) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                Hua Xue:
                ORCID: https://orcid.org/0009-0002-8366-6977
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Project administrationRole: SoftwareRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Li Zeng: Role: ConceptualizationRole: Writing – review & editing
                Hongxian He: Role: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Dongxun Xu: Role: Writing – review & editing
                Muhammad Junaid Farrukh: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS One
                Journal ID (publisher-id): plos
                Title: PLOS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 1 July 2024
                Publication date Collection: 2024
                Volume: 19
                Issue: 7
                Electronic Location Identifier: e0297410
                Affiliations
                [1 ] Department of Neurology, Sichuan Taikang Hospital, Chengdu, Sichuan, China
                [2 ] Department of Rehabilitation, Affiliated Hospital of Yunnan University, Kunming, Yunnan, China
                UCSI University, MALAYSIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0009-0002-8366-6977
                Article
                Publisher ID: PONE-D-23-12455
                DOI: 10.1371/journal.pone.0297410
                PMC ID: 11216577
                PubMed ID: 38950015
                SO-VID: 8415d56b-e0f9-42ea-a1db-de1f2f21cba1
                Copyright © © 2024 Xue et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 17 May 2023
                Date accepted : 20 December 2023
                Page count
                Figures: 1, Tables: 1, Pages: 8
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Subject: Study Protocol
                Subject: Medicine and Health Sciences
                Subject: Neurology
                Subject: Epilepsy
                Subject: Medicine and Health Sciences
                Subject: Complementary and Alternative Medicine
                Subject: Acupuncture
                Subject: Biology and Life Sciences
                Subject: Neuroscience
                Subject: Cognitive Science
                Subject: Cognitive Neuroscience
                Subject: Cognitive Neurology
                Subject: Cognitive Impairment
                Subject: Biology and Life Sciences
                Subject: Neuroscience
                Subject: Cognitive Neuroscience
                Subject: Cognitive Neurology
                Subject: Cognitive Impairment
                Subject: Medicine and Health Sciences
                Subject: Neurology
                Subject: Cognitive Neurology
                Subject: Cognitive Impairment
                Subject: Medicine and Health Sciences
                Subject: Clinical Medicine
                Subject: Clinical Trials
                Subject: Randomized Controlled Trials
                Subject: Medicine and Health Sciences
                Subject: Pharmacology
                Subject: Drug Research and Development
                Subject: Clinical Trials
                Subject: Randomized Controlled Trials
                Subject: Research and Analysis Methods
                Subject: Clinical Trials
                Subject: Randomized Controlled Trials
                Subject: Research and Analysis Methods
                Subject: Research Assessment
                Subject: Systematic Reviews
                Subject: Medicine and Health Sciences
                Subject: Mental Health and Psychiatry
                Subject: Mental Health Therapies
                Subject: Medicine and health sciences
                Subject: Complementary and alternative medicine
                Subject: Traditional medicine
                Subject: Traditional Chinese medicine
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Quality of Life
                Custom metadata
                Data Availability No datasets were generated or analysed during the current study. All relevant data from this study will be made available upon study completion.

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                ScienceOpen disciplines: Uncategorized

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