Clinical Effects of Scalp Electrical Acupuncture in Stroke: A Sham-Controlled Randomized Clinical Trial

Stroke is one of the leading causes of disability worldwide, accounting for a significant number of patients who are left with permanent sequelae. Although some spontaneous recovery may occur in the first months after stroke, especially during the first six to twelve months, about one-third to one-half of patients are left with moderate to severe functional limitations that persist into the chronic phase of the disease. During this late period, conventional treatment options are limited, creating an important need to seek complementary therapies that can offer additional benefits to patients.

Scalp acupuncture has emerged as a promising therapeutic approach in this context. This technique involves the insertion of needles into the subcutaneous tissue of the scalp at points corresponding to the functional areas of the cerebral cortex, based on the concept that stimulation of these specific regions can increase activity in the corresponding brain areas and consequently promote local neuroplasticity in the injured regions. Although prior studies have investigated the effects of conventional acupuncture in stroke patients, the results have remained inconsistent, and there has been limited evidence specifically on the efficacy of scalp electroacupuncture in the chronic phase of stroke.

To address these questions, the researchers conducted a randomized controlled study of 62 patients who had suffered ischemic stroke at least 18 months earlier. The participants, aged 24 to 65 years, were randomly divided into two groups to receive ten treatment sessions. The active group received low-frequency electrical stimulation delivered through acupuncture needles inserted into the scalp, while the control group received sham treatment using disconnected leads but with all other aspects of the protocol kept identical. Each session lasted 30 minutes and was performed twice a week for five weeks.

The needles were positioned over projections of motor, sensory, and association areas of the brain, based on established neuroanatomical mapping. To assess outcomes, the researchers used three validated scales: the National Institutes of Health Stroke Scale (NIHSS), which evaluates neurological function; the Barthel Index, which measures functional independence; and the modified Rankin Scale, which assesses the degree of functional disability.

The results showed that the group receiving active treatment had significant improvement on the NIHSS compared with the sham group. This scale, which evaluates specific neurological aspects such as level of consciousness, motor strength, and other neurological functions, detected clinically relevant changes in patients treated with verum scalp electroacupuncture. Importantly, the active group showed statistically significant improvement after the ten treatment sessions, while the control group showed no substantial change. However, the other two functional scales used in the study did not show significant differences between groups.

All patients tolerated treatment well, with no reports of major adverse events or dropouts during the study period.

Clinically, these findings suggest that scalp electroacupuncture may offer detectable neurological benefits for patients with chronic stroke, even when applied over a relatively short period. For health professionals, this represents an additional therapeutic option that may be considered as part of a comprehensive rehabilitation plan. For patients, especially those in the chronic phase of stroke who have few available treatment alternatives, this technique may represent hope for functional improvement. The results also indicate that the electrical component of the stimulation may be crucial to the observed benefits, suggesting that electrostimulation through acupuncture needles may be more effective than traditional manual acupuncture in this specific context.

It is important to acknowledge the limitations of this study. The difference in results between scales may indicate that the NIHSS is more sensitive for detecting short-term neurological changes, while the functional scales may require more time or more substantial changes to show improvement. In addition, assessments were performed only immediately after the end of treatment, precluding analysis of whether the benefits are sustained over the long term or whether they may translate into broader functional improvements over time. The study population was heterogeneous in terms of time since stroke and lesion location, which, while increasing the generalizability of the results, may have influenced the detection of effects across all scales used.

Future research should include longer follow-up periods to assess the durability of benefits and to investigate whether the initial neurological improvements eventually translate into measurable functional gains in activities of daily living. It would also be valuable to explore the underlying neurobiological mechanisms of these effects and to compare traditional acupuncture directly with electrostimulation to determine which component is more responsible for the observed benefits.