Acupuncture and other traditional Chinese medicine therapies in the treatment of children's tic syndrome: A network meta-analysis

Childhood tic syndrome is a neuropsychiatric disorder that primarily affects preschool- and school-age children, manifesting through rapid involuntary muscle movements, which can be motor or vocal. This condition has shown a gradual increase in incidence in recent years, reaching up to 6.1% of preschool children, with male predominance in a ratio of approximately 4:1. Tic syndrome can cause significant impacts on children's development, learning, and emotional state, and approximately one-third of cases may persist into adulthood. Conventional treatment with Western medications, although effective, often presents adverse effects such as drowsiness and nausea, leading parents and children to seek less invasive therapeutic alternatives.

This study aimed to evaluate the efficacy and safety of acupuncture and other traditional Chinese medicine therapies in the treatment of tic syndrome in children, through a network meta-analysis. The researchers performed a comprehensive search of eight scientific databases, from the inception of each database through November 2022, including Chinese and international literature. Only randomized controlled clinical trials comparing different acupuncture modalities (simple acupuncture, acupuncture combined with Chinese herbal medicine, or acupuncture combined with tuina) with conventional Western medications such as haloperidol, tiapride, and risperidone were selected. Study quality was assessed using standardized tools from the Cochrane Collaboration, and results were analyzed using specialized statistical software for network meta-analysis.

Thirty-nine studies involving 3,038 patients were included, all conducted in China. The analysis demonstrated that acupuncture combined with Chinese herbal medicine produced the best results across multiple assessment parameters. On the Yale Global Tic Severity Scale, which is the main measurement instrument for this condition, the acupuncture-herbal medicine combination showed superiority for both motor and vocal tics, as well as on the total scale score. Similarly, on the traditional Chinese medicine syndrome scale, which assesses specific symptoms such as head shaking and shoulder shrugging, laryngeal vocalization, and agitation, the combination with Chinese herbal medicine consistently maintained the best results.

The clinical efficacy rate was also superior in the group that received acupuncture combined with Chinese medications. Both simple acupuncture and acupuncture combined with tuina massage also demonstrated efficacy superior to conventional medications, although to a lesser degree than the combination with herbal medicine.

From a clinical standpoint, these results suggest that acupuncture, especially when combined with traditional Chinese herbal medicine, can represent a valuable therapeutic alternative for children with tic syndrome. The main advantage observed was the significant reduction of adverse effects compared with conventional medications. While the Western medications group had 191 cases of adverse effects such as dizziness, nausea, drowsiness, fatigue, and dry mouth, the acupuncture groups had only 33 cases of adverse reactions. This represents an important improvement in treatment safety and greater acceptance by patients and families.

For health professionals, these findings indicate that the integration of traditional Chinese medicine techniques may complement or, in some cases, replace conventional therapies, offering a more holistic approach with a lower adverse-effect profile. The combination of acupuncture with herbal medicine appears particularly promising, possibly due to the synergistic effect between the two modalities.

However, it is important to recognize the limitations of this research. Most of the included studies presented variable methodologic quality, with problems in describing randomization methods and difficulties in applying blinding procedures, which are inherent to the characteristics of acupuncture and massage therapies. In addition, all studies were conducted in China, which may limit generalization of the results to other populations and health systems. Heterogeneity among studies in terms of inclusion criteria and definitions of clinical efficacy may also have influenced the results.

Another aspect to consider is that the number of studies evaluating acupuncture combined with tuina was smaller compared with the other modalities, which may not provide sufficient evidence for definitive conclusions about this approach. Future studies with greater methodologic rigor, including multicenter trials with larger samples and more robust methodology, are needed to confirm these promising findings and establish standardized protocols for the clinical use of these therapies in the treatment of childhood tic syndrome.