Effectiveness and safety of acupuncture for children with cerebral palsy: An overview of systematic reviews

Cerebral palsy is one of the leading causes of childhood disability, bringing significant impacts not only to the affected children but also to their families and the healthcare system as a whole. This permanent neurological condition primarily affects movement and posture, often accompanied by intellectual and cognitive difficulties, epilepsy, and speech problems. With an estimated prevalence of 1.5 to 3 cases per 1,000 live births, cerebral palsy represents a complex clinical challenge that demands innovative and effective therapeutic approaches. Current conventional treatments include medications, physical therapy, surgery, and rehabilitation training, but many of these have significant adverse effects or limited efficacy, creating the need to explore complementary therapies such as acupuncture.

This study aimed to systematically evaluate the efficacy and safety of acupuncture in the treatment of children with cerebral palsy by critically analyzing previously published systematic reviews and meta-analyses. The researchers conducted a comprehensive search of 11 scientific databases, including PubMed, Embase, Cochrane Library, and Chinese databases, looking for systematic reviews and meta-analyses on acupuncture for cerebral palsy published through April 2022. To ensure methodological quality of the analysis, they used specific assessment tools such as AMSTAR-2 to evaluate the methodological quality of reviews, PRISMA-A to evaluate the quality of reports, GRADE to classify the quality of evidence, and ROBIS to evaluate risk of bias. In addition, they conducted a network meta-analysis to compare different types of acupuncture interventions.

The study included 9 systematic reviews and meta-analyses published between 2011 and 2020, encompassing a total of 107 randomized clinical trials with 9,744 patients between 6 months and 14 years of age. The evidence analyzed suggests that acupuncture may benefit children with cerebral palsy in several important ways. Regarding overall treatment efficacy, six reviews demonstrated that acupuncture, whether alone or combined with rehabilitation therapies, showed better results compared with isolated conventional treatments. Specifically, acupuncture combined with rehabilitation proved superior to rehabilitation alone, with statistically significant improvements in clinical efficacy rates.

As for motor function, which is often compromised in cerebral palsy, three reviews confirmed that acupuncture combined with rehabilitation training significantly improved gross motor function in children, measured by the Gross Motor Function Measure. Acupuncture also demonstrated efficacy in reducing muscle spasticity, a common problem in cerebral palsy that causes stiffness and movement difficulties. In addition, improvements were observed in children's functional independence and activities of daily living, aspects crucial to quality of life.

For patients and families, these results suggest that acupuncture may be a valuable therapeutic option as a complement to conventional treatments for cerebral palsy. The therapy proved particularly promising when combined with traditional rehabilitation programs, potentially offering additional benefits without completely replacing other interventions. For healthcare professionals, the evidence indicates that different acupuncture modalities may be considered in therapeutic planning, including conventional acupuncture, scalp acupuncture, and electroacupuncture. The network meta-analysis suggested that conventional acupuncture may have a slight statistical advantage, although clinical differences between different types of acupuncture are not dramatically significant.

It is important to note that, in terms of safety, the reviews analyzed reported only minor adverse events such as pain at the application site and, rarely, small injuries due to inadequate needle positioning, with no serious adverse events reported when acupuncture is performed by qualified professionals.

However, this study has important limitations that should be considered when interpreting the results. The methodological quality of the included reviews was rated as "very low" according to AMSTAR-2 criteria, mainly due to lack of prior protocol registration, incomplete search strategies, and absence of adequate risk-of-bias assessment in the original studies. The quality of evidence was classified as moderate to very low by the GRADE scale, with problems related to the design of the original clinical trials, including issues with randomization, blinding, and allocation concealment. In addition, all 107 clinical trials analyzed were conducted in China, which may limit the generalizability of the results to other populations and cultural contexts.

There is also minor overlap between studies included in different reviews, and most studies did not adequately assess the safety of acupuncture or perform long-term follow-up to evaluate lasting treatment effects.

In conclusion, although current evidence suggests that acupuncture is a promising and safe therapy for children with cerebral palsy, especially when combined with conventional rehabilitation programs, the limited methodological quality of the available studies requires caution when interpreting these results. Higher-quality randomized clinical trials are needed, with larger samples, more rigorous methodological designs, and long-term follow-up to definitively confirm the efficacy of acupuncture. Future research should also be conducted in different countries and cultures to assess the generalizability of the benefits observed. Until higher-quality evidence is available, acupuncture may be considered as a safe complementary therapeutic option for cerebral palsy, always under the supervision of qualified professionals and as part of a comprehensive treatment plan that includes other established therapeutic modalities.