Scalp Acupuncture Throughout History

Scalp acupuncture therapy has been used to treat many conditions in China since 5 BC, (Liu et al., 2012). Scalp acupuncture needles are penetrated into the specific areas of the scalp or lines on the scalp, and it differs significantly from classic acupuncture in that it has its own theoretical basis and its acupoints are quite different from traditional acupoints (Hao et al., 2013). There are three basic features of scalp acupuncture that differentiate it from body acupuncture. Firstly, treatment zones (14 lines or zones) that have been mapped onto the scalp are associated with body functions and broad body regions, and are based on the ideas of different schools of scalp acupuncture (Lu, 1991; Liu et al., 2012). Secondly, scalp acupuncture is characterized by inserting needle into a thin layer of loose tissue beneath the scalp surface, at a low angle of about 15-30 degrees, with an insertion distance of about 1 cum (approximately one inch for adult) (Liu et al., 2012). Thirdly, the needles in scalp acupuncture are subjected to rapid stimulation, which may be performed a variety of ways including twirling, pulling/thrusting and electro-stimulation (Lu, 1991).

Despite its relatively short history, scalp acupuncture has been now used to treat a wide range of conditions in many countries (Liu et al., 2012; Lu, 1991). Scalp acupuncture has been proven effective for the treatment of brain-related conditions such as cerebrovascular diseases and neurodegenerative disorders (Wang et al., 2009a,b; Hao et al., 2013; Li et al., 2014; Chen et al., 2014). In this review article, recent development of scalp acupuncture application on Parkinson’s disease was summarized.

Parkinson’s Disease

 

Parkinson’s disease (PD) is the second most common progressive neurodegenerative disease and is characterized by the loss of dopaminergic neurons in the substantia nigra of middle brain and subsequent depletion of dopamine in the striatum (Hornykiewicz, 2001; Obeso et al., 2008). The clinical manifestation of PD motor symptoms includes bradykinesia, resting tremor, rigidity of muscles and joints, gait and posture imbalance. Although the general intervention for PD involves pharmacological, physical, or deep brain stimulation therapies (Salat & Tolosa, 2013; Connolly & Lang, 2014), treatment is accompanied by a number of adverse effects such as dyskinesia and motor fluctuations in 50% of patients after 5 years’ treatment and in nearly 100% of patients after 10 years’ treatment (Olanow & Schapira, 2013).

Scap Acupuncture to Treat Parkinson’s Disease

 

Scalp acupuncture was used to PD for some time. Two clinical studies were conducted to assess effectiveness of manual scalp acupuncture on PD (Zhang et al., 2002; Yang et al., 2004). In the study by Zhang et al., (2002), 64 patients with PD were recruited and randomly divided into scalp acupuncture plus medication group (n=32) and medication only group (n=32), and scalp acupuncture treatment was applied daily for 30 days. While the study by Yang et al., (2004), 60 patients were allocated into scalp acupuncture plus medication group (n=30) and medication alone group (n=30), and scalp acupuncture treatment was given on one day interval for 90 days. The Webster scale was used in both studies to monitor the outcome. It was reported that scalp acupuncture for 30 days improved many aspects of the conditions but it was not statistically significant compared with medication control group (Zhang et al., 2002); However, 3-moth of scalp acupuncture treatment markedly improved many perimeters of measurements in patients with PD compared with medication only group (Yang et al., 2004).

When scalp acupuncture with electrical stimulation was applied to patients with PD for 30 days, it statistical significantly improved many aspects of the conditions judged by the unified Parkinson’s disease rating scale compared with control groups (Huang et al., 2009). In another study (Jiang et al., 2006), patients with PD were given scalp electro-acupuncture for 6 weeks and single photon emission computer tomography (SPECT) measuring 99mTc-TRODAT-1 was used to examine the activities of dopamine transporter (DAT) before and after scalp acupuncture. Results showed that DAT activities were increased within the striatum on the affected side of brain compared with intact side (Jiang et al., 2006). A later study (Huang et al., 2010) showed that PD patients who received levodopa and scalp acupuncture, examined by SPECT measuring of 99mTc-ECD and99mTc-TRODAT-4, had increased regional cerebral blood flow (rCBF) in the frontal lobe, the occipital lobe, the basal ganglion, and the cerebellum in the most affected hemisphere as compared to baseline, but there were no change in basal ganglia DAT levels. On the other hand, treatment with levodopa alone did not change rCBF, whereas it increased basal ganglion DAT activity in the most affected hemisphere. This indicated that complementary acupuncture treatment in Parkinson’s disease may affect rCBF but not basal ganglion DAT.

The protective mechanism of scalp acupuncture was studied with experimental model of PD (Wang et al., 2009a,b; Qi & Wang, 2011). Scalp electro-acupuncture was applied on acupoints GV 20 and EX-HN 5, once a day, 6 days a course, for total 2 courses on PD models. Immunohistochemistry of tyrosine hydroxylase (TH), the rate-limiting enzyme responsible for catalyzing the conversion of the amino acid L-tyrosine to L-3,4-dihydroxyphenylalanine, TUNEL method was used to observe the apoptotic amount, and in situ hybridization detecting the mRNA expression of brain-derived neurotrophic factor (BDNF) and DAT were used to assess the outcome of the scalp electro-acupuncture. It was found that scalp electro-acupuncture treatment significantly increased the area density (AD), numerical density (ND) and integrating optic density (IOD) of the positive neurons of TH in the substantia nigra of PD model, compared with control groups (Jiang et al., 2006; Qi & Wang, 2011). Further, scalp acupuncture markedly elevated the levels of the mRNA expression of BDNF and DAT in substantia nigra of PD model (Wang et al., 2009a), markedly decreased the amount of apoptosis (Wang et al., 2009b), and compared with control groups. This suggested that scalp acupuncture may increase TH+ cells by elevating the synthesis GDNF mRNA, decrease apoptosis and promote the reuptake of dopamine, leading to alleviate parkinsonian symptoms.

Although the studied cited above showed a certain effect of scalp acupuncture on PD, the quality of studies were variable. Because many of the studies did not follow the Consolidated Standards of Reporting Trials (CONSORT) 2010 checklist and the revised Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) guidelines (MacPherson et al., 2010; Moher et al., 2010).  For example, there were no sham acupuncture controls in majority studies. None of the included studies adopted assessor blinding.  STRICTA checklist items i.e. “depth of insertion,” “description of participating acupuncturists” and “the optimal dosage for the scalp acupuncture treatment” were not mentioned. So following CONSORT and STRICTA recommendation are strongly recommended, and well-designed studies with rigorous methodologies are required to confirm the effectiveness of scalp acupuncture for neurological disorders.

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