Table 1.

Reported clinical trials of acupuncture for patients with Parkinson disease

Study	Size	Design	Duration	Intervention	Controls	Outcomes	AEs
Eng et al. (2006) [17]
USA	25	Open-label	6 months	24 sessions of acupuncture with Tui Na massage and Qi Gong	–	Motor: 2.4 points worsening on mUPDRS from baseline Non-motor: 16% improvement on PDQ-39 (p = 0.044) and 29% improvement on BDI (p = 0.006) Qualitative: 3 reported no change, 4 mild, 9 moderate, and 7 marked improvement	Safe and well tolerated
Doo et al. (2015) [16]
Korea	11	Open-label	12 weeks	24 acupuncture + BVA sessions	–	Motor: UPDRS parts II and III improved significantly from baseline (5-point improvement) Improved gait speed (2-s improvement) Non-motor: PDQL improved significantly from baseline (122 to 147)	Some reported slight bleeding or pain; some redness or itchiness with BVA. No serious adverse effects
Fukuda et al. (2015) [19]
Japan	27	Open-label	1 visit	1 acupuncture session	–	Motor: improvement in gait speed (60.4 to 66.2 m/min, p = < 0.001), step length (53.7 to 57.7 cm, p = < 0.001), floor reaction force (0.26 to 0.29 m/s2, p = < 0.001), and cadence (112.7 to 114.8 steps/min, p = 0.007)	Did not report
Shulman et al. (2002) [18]
USA	20	Open-label	5 weeks or 8 weeks	Twice weekly acupuncture sessions	–	Motor: no improvement in mUPDRS or other quantitative motor assessments Non-motor: on SIP, only significant improvement in sleep and rest category (p = 0.03); no change in total score; no improvement in BDI or BAI Qualitative: 85% of patients reported subjective improvement of symptoms including tremor, walking, handwriting, slowness, pain, sleep, depression, and anxiety	Safe and well tolerated
Yu et al. (2019) [20]
Taiwan	15	Controlled trial, groups assigned based on patient preference	8 weeks	Twice weekly acupuncture sessions (n = 9)	Usual care, with oral pain medications only (n = 7)	Motor: improvement in total UPDRS (− 21.6%, p = 0.005), but not motor subscale Non-motor: KPPS improved from baseline (− 46.2%, p = 0.023); no change in BDI, PDSS-2, and PDQ-39
Ren (2008) [21]
China	80	Randomized, controlled	Unspecified	2 courses of 10 sessions of acupuncture (n = 50) given every 3–5 days	Levodopa (Madopar) only (n = 30)	Motor: significantly lower dose of Madopar in the treatment group after intervention (752 mg vs 504 mg, p < 0.05)	Did not report
Aroxa et al. (2017) [22]
Brazil	22	Randomized, controlled	8 weeks	Weekly acupuncture sessions (n = 11)	Usual care (n = 11)	Non-motor: PDSS showed significant improvement from baseline in sleep quality, nocturnal psychosis, and nocturnal motor symptoms compared to baseline; no difference between groups	Did not report
Cristian et al. (2005) [23]
USA	14	Randomized, controlled, double-blind	2 weeks	5 EA sessions (n = 7)	EA in non-acupuncture sites (n = 7)	Motor: non-significant trend toward improvement in mUPDRS Non-motor: non-significant trend toward improvement on PDQ-39 ADL subscale and summary index; no change in GDS Qualitative: subjective improvements in nausea and sleep	Did not report
Cho et al. (2012) [24]
Korea	43	Randomized, controlled, double-blind	8 weeks	Twice weekly BVA (n = 14) or regular acupuncture sessions (n = 15)	Usual care (n = 14)	Motor: Both interventions had improvement in mUPDRS from baseline; BBS and 30-m walking time improved in BVA from baseline; total UPDRS and mUPDRS improved relative to controls in BVA Non-motor: BDI improved from baseline in the regular acupuncture group	One patient reported itchiness with BVA. No serious adverse events
Toosizadeh et al. (2015) [25]; Lei et al. (2016) [26]
USA	15	Randomized, sham-controlled, double-blind	3 weeks	Weekly EA sessions (n = 10)	Sham acupuncture at placebo sites (n = 5)	Motor: Compared to baseline, the EA group had improved balance based on measures of sway and significant improvement in mUPDRS, specifically falls and rigidity (67% and 48%, respectively; p = 0.02); significant improvement in UPDRS II and III and rigidity subscale compared to controls (p < 0.05) In specific measures of gait and balance, significant improvement from baseline in speed, stride length, and mid-swing speed; improvement compared to controls in most measures of gait, especially speed (effect size 0.32–1.16, p = 0.001)	One patient with transient lightheadedness during procedure No serious adverse events
Kluger et al. (2016) [27]
USA	94	Randomized, sham-controlled, double-blind	6 weeks	Twice weekly acupuncture sessions (n = 47)	Sham acupuncture with toothpicks at placebo sites (n = 47)	Motor: no improvement in mUPDRS in either group after 6 weeks Non-motor: no between-group differences on the MFIS, though both groups improved significantly from baseline at 6 weeks and 12 weeks	One patient reported constipation that resolved after stopping acupuncture
Cho et al. (2018) [28]
Korea	73	Randomized, sham-controlled, double-blind	12 weeks	Twice weekly BVA sessions (n = 29)	Sham acupuncture with normal saline (n = 29), usual care (n = 15)	Motor: Compared to usual care, the BVA group had improvement in UPDRS II and III and PIGD, but not compared to sham acupuncture; both BVA and sham improved significantly from baseline on mUPDRS, 20-m step at 12 weeks, but only BVA had sustained improvements at 20 weeks Non-motor: PDQL improved in both groups at 12 weeks, sustained only in the BVA group at 20 weeks, BDI was improved in the BVA group at 20 weeks	Some patients reported mild pain or slight bleeding after acupuncture and mild itchiness or swelling after BVA No serious adverse events
Kong et al. (2018) [29]
Singapore	40	Randomized, sham-controlled, double-blind	5 weeks	Twice weekly acupuncture sessions (n = 20)	Sham acupuncture with retractable needles (n = 20)	Motor: significant improvement from baseline on mUPDRS in the acupuncture group, but not compared to controls Non-motor: Both groups had significant improvement from baseline on the MFI, but no between-group differences; no improvement from baseline on PDQ-39, GDS, and ESS	2 serious adverse events from falls, not felt to be related to acupuncture; 1 worsening of anxiety

AEs = adverse events; BAI = Beck Anxiety Inventory; BBS = Berg Balance Scale; BDI = Beck Depression Inventory; BVA = Bee Venom Acupuncture; EA = electroacupuncture; ESS = Epworth Sleepiness Scale; GDS = Geriatric Depression Scale; KPPS = King’s Parkinson’s Disease Pain Scale; MFI = Multidimensional Fatigue Inventory; MFIS = Modified Fatigue Impact Scale; mUPDRS = Unified Parkinson’s Disease Rating Scale, motor subscale; PDQ-39 = 39-item Parkinson’s Disease Questionnaire; PDQL = Parkinson’s Disease Quality of Life Questionnaire; PDSS = Parkinson’s Disease Sleep Scale; PDSS-2 = Parkinson’s Disease Sleep Scale 2; PIGD = Postural Instability and Gait Disturbance score; SIP = Sickness Impact Profile; UPDRS = Unified Parkinson’s Disease Rating Scale