Needle acupuncture in chronic poststroke leg spasticity

Fink M, Rollnik JD, Bijak M, Borstädt C, Däuper J, Guergueltcheva V, Dengler R, Karst M. Needle acupuncture in chronic poststroke leg spasticity. Arch Phys Med Rehabil 2004;85:667–672. Objective To determine whether needle acupuncture may be useful in the reduction of leg spasticity in a chronic state. Design Single-blind, randomized, placebo-controlled trial. Setting Neurologic outpatient department of a medical school in Germany. Participants Twenty-five patients (14 women) suffering from chronic poststroke leg spasticity with pes equinovarus deformity (Modified Ashworth Scale [MAS] score, ≥1), aged 38 to 77 years (mean ± standard deviation, 58.5±10.4y), were enrolled in the study. The mean time from stroke to inclusion in the study was approximately 5 years (mean, 65.4±48.3mo; range, 7–180mo). Interventions Participants were randomly assigned to placebo treatment (n=12) by using a specially designed placebo needling procedure, or verum treatment (n=13). Main outcome measures MAS score of the affected ankle, pain (visual analog scale), and walking speed. Results There was no demonstrated beneficial clinical effects from verum acupuncture. After 4 weeks of treatment, mean MAS score was 3.3±0.9 in the placebo group versus 3.3±1.1 in the verum group. The neurophysiologic measure of H-reflex indicated a significant increase of spinal motoneuron excitability after verum acupuncture (H-response/M-response ratio: placebo, .39±.19; verum, .68±.41; P<.05). Conclusions This effect might be explained by afferent input of A delta and C fibers to the spinal motoneuron. The results from our study indicate that needle acupuncture may not be helpful to patients with chronic poststroke spasticity. However, there was neurophysiologic evidence for specific acupuncture effects on a spinal (segmental) level involving nociceptive reflex mechanisms.