Zhang 2006b.

Methods	Randomised controlled trial, parallel groups
Participants	Setting: hospital inpatients and outpatients Treatment group 1 (catgut implantation at acupoints) (males): 50 (27) Treatment group 2 (needle acupuncture) (males): 50 (25) Control group (males): 50 (24) Age: Treatment group 1: 15 to 30 years (28), 30 to 45 years (19), 45 to 60 years (3); Treatment roup 2: 15 to 30 years (30), 30 to 45 years (13), 45 to 60 years (7); Control group: 15 to 30 years (26), 30 to 45 years (20), 45 to 60 years (4) Inclusion: aged 15 to 60 years, generalized tonic‐clonic epilepsy, informed consent signed Exclusion: no seizure within past 6 months, received treatment that may affect current study, concomitant diseases of heart, liver, spleen, lung, or kidney, or brain tumour or psychiatric diseases, or bleeding disorders, cannot comply with study treatment Seizure type: generalized tonic‐clonic epilepsy Duration of epilepsy Treatment group 1: < 5years (24), 5 to 10 years (20), > 10 years (6); Treatment group 2: < 5years (28), 5 to 10 years (13), > 10 years (9) Control group: < 5years (25), 5 to 10 years (19), > 10 years (6) Aetiology of epilepsy: not available Baseline seizure frequency: not available Number of AEDs taken: not available
Interventions	Treatment group 1: catgut implantation in 9 acupoints (9 points were divided into 3 groups, each group was used in alternate cycle), plus 1 additional acupoints according to Traditional Chinese Medicine diagnosis. Implantation once every 15 days Treatment group 2: needle acupuncture at same acupoints, needle left in place for 20 minutes. Treatment applied once daily on alternate days Control group: Sodium valproate 200 mg tds Duration of treatment: 3 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 70% or greater reduction in epilepsy score 40% or greater reduction in epilepsy score 20% or greater reduction in epilepsy score Post‐treatment epilepsy score Post‐treatment quality of life score (QOLIE‐31 score) Post‐treatment EEG abnormality: severe, moderate, mild Frequency of adverse effects: dizziness, malaise, nausea, anorexia, impaired concentration, sleepiness
Notes	Duration of follow‐up: 3 months
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Randomization was done by computer‐generated random number
Allocation concealment (selection bias)	Low risk	Allocation was concealed by sealed opaque envelopes
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 and outcome assessors 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	The comparability of the groups at baseline was questionable since there were no data on aetiology of epilepsy, current AED treatments, and frequency of seizures at baseline. 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