Mao 2011.

Methods	Randomised controlled trial, parallel groups Study period: March 2004 to March 2009
Participants	Setting: hospital outpatients Treatment group (males): 30 (16) Control group (males): 22 (12) Age: Treatment group : mean 29.93.56 (SD 14.31) years; Control group: mean 33.62 (SD 16.17) years Inclusion: generalized tonic‐clonic epilepsy Exclusion: partial epilepsy, pseudoseizure, syncope, migraine, transient ischemic attack, hyperventilation, hepatic or renal dysfunction Seizure type: generalized tonic‐clonic epilepsy Duration of epilepsy: Treatment group: mean 16.45 (SD 11.05) years; Control group: mean 15.89 (SD 9.62) years Aetiology of epilepsy: not available Baseline seizure frequency: Treatment group: mean 5.17 (SD 1.91) times/year; Control group: mean 5.27 (SD 1.96) times/year Number of AEDs taken: not available
Interventions	Treatment group: catgut implantation in 4 acupoints, plus 1‐3 additional acupoints according to Traditional Chinese Medicine diagnosis. Implantation once every month for 6 months. Valproate 2 g/day divided into 2 doses for adults, 50mg/kg/day divided into 3 doses for children, for 1 year Control group: Valproate 2 g/day divided into 2 doses for adults, 50mg/kg/day divided into 3 doses for children, for 1 year Duration of treatment: 12 months
Outcomes	Seizure freedom 75% or greater reduction in seizure frequency 50% or greater reduction in seizure frequency 25% or greater reduction in seizure frequency Post‐treatment seizure frequency (times/year)
Notes	Duration of follow‐up: 12 months
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Allocation to treatment groups according to random number
Allocation concealment (selection bias)	Unclear risk	Allocation concealment was not described
Blinding (performance bias and detection bias) All outcomes	High risk	The participants and personnel and outcome assessors were not blinded
Blinding of participants and personnel (performance bias) All outcomes	High risk	The participants and personnel were not blinded
Blinding of outcome assessment (detection bias) All outcomes	High risk	The outcome assessors were not blinded
Incomplete outcome data (attrition bias) All outcomes	Low risk	There were no dropouts
Selective reporting (reporting bias)	Low risk	All outcomes were reported
Other bias	High risk	Comparability of groups at baseline was uncertain since there were no data on aetiology of epilepsy and current AED treatments. There was no sham or placebo control and hence there might be placebo effect which causes bias. Treatment was variable within the treatment group and might introduce bias