Effects of Laser Acupuncture Therapy for Patients With Inadequate Recovery From Bell’s Palsy: Preliminary Results From Randomized, DoubleBlind, Sham-Controlled Study Effects of Laser Acupuncture for Chronic Bell’s Palsy
Journal of Lasers in Medical Sciences,
Vol. 12 (2021),
13 February 2021
,
Page e70
Abstract
Introduction: Inadequate recovery from Bell’s palsy exists in a third of patients and results in physical and social impairments. The controversial nature of existing medical treatment options means that novel, alternative approaches are needed. In basic and clinical studies, low-level laser therapy (LLLT) has proven successful in regenerating peripheral nerves. Laser acupuncture therapy (LAT) is a rapidly growing treatment modality; however, its effectiveness for treating chronic Bell’s palsy is unknown. The feasibility of this innovative approach is the focus of this pilot study.
Methods: A two-armed, parallel, randomized, investigator-subject-assessor-blinded, shamcontrolled pilot study was conducted, and 17 eligible subjects were randomly allocated to either LAT (n=8) or sham LAT (n=9). The LAT group received three treatments each week for six weeks (18 sessions), while the sham LAT group received the same procedure but with a sham laser device. The change from baseline to week 6 in the social subscale of the Facial Disability Index (FDI) was the primary outcome. Secondary outcomes were changes in the House-Brackmann facial paralysis scale (HB), the Sunnybrook facial grading system (SB) and a stiffness scale at weeks 3 and 6.
Results: A significant difference was shown in the HB score (P=0.0438) between baseline and week 3 and borderline significance was observed in both SB and stiffness scores from baseline to week 6 (P=0.0598 and P=0.0980 respectively). There was no significant difference in the FDI score between baseline and week 6.
Conclusion: To the best of our knowledge, this clinical trial is the first such investigation on this topic. Our findings suggest that using LAT may have clinical effects on long-term complications of Bell’s palsy and justify further large-scale studies.
- Bell’s palsy sequelae; Randomized controlled trial; Laser acupuncture; Low-level laser therapy
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References
Gilden DH. Clinical practice, Bell's Palsy. N Engl J Med. 2004;351(13):1323-31. doi:10.1056/NEJMcp041120
Peitersen E. Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl. 2002;549:4-30
Baugh RF, Basura GJ, Ishii LE, Schwartz SR, Drumheller CM, Burkholder R, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013;149(3 Suppl):S1-27. doi:10.1177/0194599813505967
Berg T, Bylund N, Marsk E, Jonsson L, Kanerva M, Hultcrantz M, et al. The effect of prednisolone on sequelae in Bell's palsy. Arch Otolaryngol Head Neck Surg. 2012;138(5):445-9. doi:10.1001/archoto.2012.513
Chen N, Zhou M, He L, Zhou D, Li N. Acupuncture for Bell's palsy. Cochrane Database Syst Rev. 2010;2010(8):CD002914. doi:10.1002/14651858.CD002914.pub5
Wu M-Y LY-C, Lin C-L, Huang M-C, Sun M-F, Yen H-R. Trends in use of acupuncture among adults in Taiwan from 2002 to 2011: A nationwide population-based study. PLoS ONE. 2018;13(4):e0195490. doi:10.1371/journal.pone.0195490
Gökçe Kütük S, Özkan Y, Topuz MF, Kütük M. The Efficacy of Electro-Acupuncture Added to Standard Therapy in the Management of Bell Palsy. J Craniofac Surg. 2020; 31(7):1967-1970. doi: 10.1097/SCS.0000000000006537.
Kwon HJ, Choi JY, Lee MS, Kim YS, Shin BC, Kim JI. Acupuncture for the sequelae of Bell's palsy: a randomized controlled trial. Trials. 2015; 16:246. doi: 10.1186/s13063-015-0777-z.
Goo B, Jeong SM, Kim JU, Park YC, Seo BK, Baek YH, et al. Clinical efficacy and safety of thread-embedding acupuncture for treatment of the sequelae of Bell's palsy: A protocol for a patient-assessor blinded, randomized, controlled, parallel clinical trial. Medicine (Baltimore). 2019;98(7):e14508. doi: 10.1097/MD.0000000000014508.
Li P, Qiu T, Qin C. Efficacy of Acupuncture for Bell's Palsy: A Systematic Review and Meta- Analysis of Randomized Controlled Trials. PLoS One. 2015;10(5):e0121880.doi:10.1371/journal.pone.0121880
Zhang R, Wu T, Wang R, Wang D, Liu Q. Compare the efficacy of acupuncture with drugs in the treatment of Bell's palsy: A systematic review and meta-analysis of RCTs. Medicine (Baltimore). 2019; 98(19):e15566. doi: 10.1097/MD.0000000000015566
White A, Hayhoe S, Hart A, Ernst E. Adverse events following acupuncture: prospective survey of 32 000 consultations with doctors and physiotherapists. BMJ. 2001;323(7311):485-486. doi:10.1136/bmj.323.7311.485
Su D, Li L. Trends in the use of complementary and alternative medicine in the United States: 2002-2007. J Health Care Poor Underserved. 2011; 22(1):296-310. doi: 10.1353/hpu.2011.0002.
Whittaker P. Laser acupuncture: past, present, and future. Lasers Med Sci. 2004;19(2):69-80. doi: 10.1007/s10103-004-0296-8.
Barbosa RI, Marcolino AM, de Jesus Guirro RR, Mazzer N, Barbieri CH, de Cassia Registro Fonseca M. Comparative effects of wavelengths of low-power laser in the regeneration of sciatic nerve in rats following crushing lesion. Lasers Med Sci. 2010; 25(3):423-30. doi: 10.1007/s10103-009-0750-8.
Fontana CR, Bagnato VS. Low-level laser therapy in pediatric Bell's palsy: case report in a three- year-old child. J Altern Complement Med. 2013; 9(4):376-82. doi: 10.1089/acm.2011.0531
Ordahan B, Karahan Ay. Role of low-level laser therapy added to facial expression exercises in patients with idiopathic facial (Bell’s) palsy. Lasers Med Sci. 2017 32(4):931-936. doi: 10.1007/s10103-017-2195-9.
Alayat MS, Elsodany AM, El Fiky AA. Efficacy of high and low level laser therapy in the treatment of Bell's palsy: a randomized double blind placebo-controlled trial. Lasers Med Sci. 2014;29(1):335-42. doi: 10.1007/s10103-013-1352-z.
Ladalardo TCCGP, Brugnera Jr A, Takamoto M, Pinheiro A LB, Campos R AC, Garrini A E C, et al. Functional and electrophysiological evaluation of the effect of laser therapy in the treatment of peripheral facial paralysis. Paper presented at: Procceding SPIE 4249, Lasers in Dentistry VII; April 27, 2001; San Jose, CA, United States. doi:10.1117/12.424489
Litscher G, Opitz G. Technical Parameters for Laser Acupuncture to Elicit Peripheral and Central Effects: State-of-the-Art and Short Guidelines Based on Results from the Medical University of Graz, the German Academy of Acupuncture, and the Scientific Literature. Evid Based Complement Alternat Med. 2012;2012:697096. doi: 10.1155/2012/697096.
Ton G, Lee LW, Ng HP, Liao HY, Chen YH, Tu CH, et al. Efficacy of laser acupuncture for patients with chronic Bell's palsy: A study protocol for a randomized, double-blind, sham-controlled pilot trial. Medicine (Baltimore). 2019;98(15):e15120. doi: 10.1097/MD.0000000000015120.
Irnich D, Salih N, Offenbächer M, Fleckenstein J. Is Sham Laser a Valid Control for Acupuncture Trials?. Evid Based Complement Alternat Med. 2011;2011:485945. doi: 10.1093/ecam/neq009
Schulz KF, Altman DG, Moher D. Factors that limit the quality, number and progress of randomised controlled trials. BMC Med. 2010 Oct;8(18):7015-8. doi:10.1186/1741-7015-8-18
MacPherson H AD, Hammerschlag R, Youping L, Taixiang W, White A, Moher D. Revised Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): Extending the CONSORT Statement. PLoS Med. 2010;7(6): 1-11. doi:10.1371/journal.pmed.1000261
VanSwearingen JM, Brach JS. The Facial Disability Index: reliability and validity of a disability assessment instrument for disorders of the facial neuromuscular system. Phys Ther. 1996;76(12):1288-98. doi: 10.1093/ptj/76.12.1288.
Evans RA, Harries ML, Baguley DM, Moffat DA. Reliability of the House and Brackmann grading system for facial palsy. J Laryngol Otol. 1989;103(11):1045-6. doi: 10.1017/s002221510011093x.
Beurskens CH, Heymans PG. Positive effects of mime therapy on sequelae of facial paralysis: stiffness, lip mobility, and social and physical aspects of facial disability. Otol Neurotol. 2003;24(4):677-81. doi: 10.1097/00129492-200307000-00024.
Suresh K. An overview of randomization techniques: An unbiased assessment of outcome in clinical research. J Hum Reprod Sci. 2011;4(1):8-11. doi:10.4103/0974-1208.82352 29. Rochkind S, Drory V, Alon M, Nissan M, Ouaknine GE. Laser phototherapy (780 nm), a new modality in treatment of long-term incomplete peripheral nerve injury: a randomized double- blind placebo-controlled study. Photomed Laser Surg. 2007;25(5):436-42. doi:
1089/pho.2007.2093.
Baxter GD, Bleakley C, McDonough S. Clinical effectiveness of laser acupuncture: a systematic review. J Acupunct Meridian Stud. 2008;1(2):65-82. doi: 10.1016/S2005-2901(09)60026-1.
Bjordal JM. Low level laser therapy (LLLT) and World Association for Laser Therapy (WALT) dosage recommendations. Photomed Laser Surg. 2012 ;30(2):61-2. doi: 10.1089/pho.2012.9893.
Fu L, Bundy C, Sadiq SA. Psychological distress in people with disfigurement from facial palsy. Eye (Lond). 2011;25(10):1322-6. doi: 10.1038/eye.2011.158.
Lin JG, Chen CH, Huang YC, Chen YH. How to design the control group in randomized controlled trials of acupuncture?. Evid Based Complement Alternat Med. 2012;2012:875284. doi:10.1155/2012/875284
Andreo L, Soldera CB, Ribeiro BG, de Matos PRV, Bussadori SK, Fernandes KPS, et al. Effects of photobiomodulation on experimental models of peripheral nerve injury. Lasers Med Sci. 2017; 32(9):2155-2165. doi: 10.1007/s10103-017-2359-7.
Moskvin S, Pritiko D, Sergeenko E, Lukash E, Gusev L. A brief literature review and own clinical experience in prophylaxis of oral mucositis in children using low level laser therapy. Biomedicine (Taipei). 2019;9(1):1. doi: 10.1051/bmdcn/2019090101.
Javaherian M, Attarbashi Moghaddam B, Bashardoust Tajali S, Dabbaghipour N. Efficacy of low-level laser therapy on management of Bell's palsy: a systematic review. Lasers Med Sci. 2020;35(6):1245-1252. doi: 10.1007/s10103-020-02996-2.
Kim JI, Lee MS, Choi TY, Lee H, Kwon HJ. Acupuncture for Bell's palsy: a systematic review and meta-analysis. Chin J Integr Med. 2012;18(1):48-55. doi: 10.1007/s11655-011-0861-5.
Passarella S, Karu T. Absorption of monochromatic and narrow band radiation in the visible and near IR by both mitochondrial and non-mitochondrial photoacceptors results in photobiomodulation. J Photochem Photobiol B. 2014;140:344-58. doi: 10.1016/j.jphotobiol.2014.07.021.
He S, Zhang H, Liu R. Review on acupuncture treatment of peripheral facial paralysis during the past decade. J Tradit Chin Med. 1995;15(1):63-7.
Hu WL, Chang CH, Hung YC, Tseng YJ, Hung IL, Hsu SF. Laser acupuncture therapy in patients with treatment-resistant temporomandibular disorders. PLoS One. 2014;9(10):e110528. doi: 10.1371/journal.pone.0110528.
on G, Lee LW, Chen YH, Tu CH, Lee YC. Effects of laser acupuncture in a patient with a 12-year history of facial paralysis: A case report. Complement Ther Med. 2019;43:306-310. doi: 10.1016/j.ctim.2019.02.015.
Cooper L, Lui M, Nduka C. Botulinum toxin treatment for facial palsy: A systematic review. J Plast Reconstr Aesthet Surg. 2017;70(6):833-841. doi: 10.1016/j.bjps.2017.01.009.
Engström M, Berg T, Stjernquist-Desatnik A, Axelsson S, Pitkäranta A, Hultcrantz M, et al. Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet Neurol. 2008;7(11):993-1000. doi: 10.1016/S1474-4422(08)70221-7.
Sassi FC, Toledo PN, Mangilli LD, Alonso N, Andrade CRFd. Correlation between electromyographic data and facial disability index in patients with long-term facial paralysis: implications for treatment outcomes. Rev Bras Cir Plást. 2011; 26(4):596-601. doi:10.1590/S1983-51752011000400010
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