Acupuncture for Bell's palsy: Cochrane systematic review

Abstract

Assessed as up to date: 2010/05/23

Background

Bell's palsy or idiopathic facial palsy is an acute facial paralysis due to inflammation of the facial nerve. A number of studies published in China have suggested acupuncture is beneficial for facial palsy.

Objectives

The objective of this review was to examine the efficacy of acupuncture in hastening recovery and reducing long-term morbidity from Bell's palsy.

Search strategy

We updated the searches of the Cochrane Neuromuscular Disease Group Trials Specialized Register (24 May 2010), The Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 2, 2010), MEDLINE (January 1966 to May 2010), EMBASE (January 1980 to May 2010), AMED (January 1985 to May 2010), LILACS (from January 1982 to May 2010) and the Chinese Biomedical Retrieval System (January 1978 to May 2010) for randomised controlled trials using 'Bell's palsy' and its synonyms, 'idiopathic facial paralysis' or 'facial palsy' as well as search terms including 'acupuncture'. Chinese journals in which we thought we might find randomised controlled trials relevant to our study were handsearched. We reviewed the bibliographies of the randomised trials and contacted the authors and known experts in the field to identify additional published or unpublished data.

Selection criteria

We included all randomised controlled trials involving acupuncture by needle insertion in the treatment of Bell's palsy irrespective of any language restrictions.

Data collection and analysis

Two review authors identified potential articles from the literature search, extracted data and assessed quality of each trial independently. All disagreements were resolved by discussion between the review authors.

Main results

The literature search and handsearching identified 49 potentially relevant articles. Of these, six RCTs were included involving 537 participants with Bell's palsy. Two more possible trials were identified in the update than the previous version of this systematic review, but both were excluded because they were not real RCTs. Of the six included trials, five used acupuncture while the other one used acupuncture combined with drugs. No trial reported on the outcomes specified for this review. Harmful side effects were not reported in any of the trials. Poor quality caused by flaws in study design or reporting (including uncertain method of randomisation, allocation concealment and blinding) and clinical differences between trials prevented reliable conclusions about the efficacy of acupuncture.

Authors' conclusions

The quality of the included trials was inadequate to allow any conclusion about the efficacy of acupuncture. More research with high quality trials is needed.

Author(s)

Chen Ning, Zhou Muke, He Li, Zhou Dong, Li N

Summary

Acupuncture for Bell's palsy

Bell's palsy or idiopathic facial palsy is the most common disorder affecting the facial nerves and results in weakness or paralysis on one side of the face. The paralysis causes distortion of the face and interferes with normal functions, such as closing the eye and eating. It is thought to be caused by inflammation of the facial nerve.

According to Traditional Chinese Medicine, facial paralysis is known as 'deviated mouth'. It was attributed to 'wind' by past dynasties. 'Qi' refers to the vital substances comprising the human body and the physiological functions of viscera and bowels, channels and collaterals. It maintains life activities and reflects the resistance of the human body. Deficiency of 'qi' allows the invasion of exogenous pathogenic wind. Acupuncture is part of Traditional Chinese Medicine and dates back thousands of years. It involves inserting fine needles into specific points on the skin or applying various other techniques to the acupuncture points to bring about healing. In Bell's palsy, acupuncture treatment might have numerous beneficial effects. This review aimed to review systematically all randomised controlled trials and controlled clinical trials, which examined the effectiveness of acupuncture by needle insertion for Bell's palsy. Six studies including a total of 537 participants met the inclusion criteria. Five studies used acupuncture while the other used acupuncture combined with drugs. No trials reported on the outcomes specified for this review. Harmful side effects were not reported in any of the trials. Poor quality caused by flaws in study design or reporting (including uncertain method of randomisation, allocation concealment and blinding) and clinical differences between trials prevented reliable conclusions about the efficacy of acupuncture. More research with high quality trials is needed.

Reviewer's Conclusions

Implications for practice

Six small RCTs in this review suggested a beneficial effect of acupuncture in treating Bell's palsy, but the poor quality of these trials precluded reliable conclusions.

Implications for research

There is a need for high quality RCTs using a study design which assures high internal validity. These studies should be conducted as randomised controlled trials with valid random sequence generation, adequate allocation concealment, blinding of outcome assessors and adequate handling of any attrition (by means of reporting any losses to follow-up and by performing intention-to-treat analyses).

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