Parkinson’s disease is the second most prevalent neurodegenerative disease in the world, affecting approximately 10 million people globally — and with incidence that doubles every decade of life after age 60. The cardinal motor symptoms — resting tremor, bradykinesia, rigidity, and postural instability — are mediated by progressive degeneration of dopaminergic neurons of the substantia nigra, with consequent dopamine depletion in the striatum. Treatment with levodopa remains the reference standard, but prolonged use generates significant motor complications — “on/off” fluctuations, dyskinesias — and does not control non-motor symptoms (depression, sleep disturbances, autonomic dysfunction, cognitive decline) that profoundly compromise quality of life. A network meta-analysis published in Behavioural Brain Research in January 2026 offers the broadest synthesis ever conducted on the use of acupuncture modalities for Parkinson’s disease: 57 randomized clinical trials, 4,262 patients, and simultaneous comparison of five acupuncture modalities, alone or combined with conventional treatment.
The study — published online in September 2025 and in the print volume in January 2026 — was conducted by the team of corresponding researcher Yibin Zhao, with systematic search in Chinese and international databases covering trials published between 2002 and 2024. The methodology employed frequentist network meta-analysis (Stata SE 15.1 software), with random-effects models to handle heterogeneity across studies and SUCRA (Surface Under the Cumulative Ranking Curve) values to rank the interventions. Study quality was assessed with the Cochrane Risk of Bias 2.0 tool, and certainty of evidence with the CINeMA framework — resulting in classification “low to moderate” for most comparisons, reflecting the current state of the literature in this área.
NETWORK META-ANALYSIS OF ACUPUNCTURE FOR PARKINSON’S DISEASE (BEHAVIOURAL BRAIN RESEARCH, JANUARY 2026)
The Five Modalities Evaluated and Their Profiles
The network meta-analysis compared five distinct acupuncture modalities — alone or combined with conventional medication (CM) or Chinese herbal medicines (CHM): manual acupuncture (MA), which uses needling with manual techniques to elicit de qi; electroacupuncture (EA), which adds low- or high-frequency electrical stimulation to the needles; warm acupuncture (WA), which heats the needles by combustion of Artemisia on them (a form of integration between needling and moxibustion); fire acupuncture (FA), a brief needling technique with a needle heated to red-hot at specific points; and moxibustion alone (MOX), without needling. The combined use with CM (levodopa, dopamine agonists, MÃO-B inhibitors) was the most prevalent approach — only 3 of the 57 trials evaluated acupuncture without conventional medication.
Results by Outcome: Effectiveness, Motor, Depression, and Webster
For the total effectiveness rate — a binary outcome that aggregates clinically significant improvement in any dimension of the disease, evaluated in 41 trials with 3,086 patients — the combination of electroacupuncture + warm acupuncture + conventional medication (EA+WA+CM) reached first rank (RR=3.00; 95% CI 1.20–7.48; SUCRA=97%), followed by moxibustion+CM (RR=1.33; SUCRA=68.8%) and manual acupuncture+CM (RR=1.20; SUCRA=51.7%). The high magnitude of RR for EA+WA+CM should be interpreted with caution given the wide confidence interval — reflecting the smaller number of trials that specifically tested this combination.
For motor symptoms — assessed by the UPDRS part III (motor) scale in 36 trials with 2,655 patients — manual acupuncture + CM led (MD=−0.89; 95% CI −1.58 to −0.20; SUCRA=61.6%), with moderate confidence. For depression (HAMD, 11 trials, 802 patients), the rank was led by MA+CM (MD=−2.41; 95% CI −3.48 to −1.34; SUCRA=91.9%) followed by EA+CM (MD=−2.16; SUCRA=62.8%) — a clinically relevant datum, since depression affects 40–50% of Parkinson’s patients and responds inadequately to levodopa. For the Webster Score — overall disability assessment scale for Parkinson’s — EA+CM led (MD=−3.65; 95% CI −5.01 to −2.28; SUCRA=91.1%), followed by MA+CM.
Frequently Asked Questions
This is still an open question. Experimental studies in animal models (MPTP) show that electroacupuncture protects dopaminergic neurons of the substantia nigra — a potentially neuroprotective effect. However, clinical trials in humans have not yet conclusively demonstrated that acupuncture modifies the rate of disease progression. This network meta-analysis evaluated short- and medium-term clinical outcomes (motor symptoms, overall effectiveness, depression) — not long-term outcomes such as rate of neurologic progression. Specific longitudinal studies are needed to answer this question. At present, the position most supported by the evidence is that acupuncture improves symptoms — not that it is demonstrably neuroprotective in humans.
There is no evidence of adverse pharmacologic interactions between acupuncture and the medications used in Parkinson’s (levodopa/carbidopa, dopamine agonists such as pramipexole and ropinirole, MÃO-B inhibitors such as selegiline and rasagiline, COMT inhibitors). All 57 trials in this meta-analysis were conducted with acupuncture in addition to conventional medication — not in substitution. The medical acupuncturist should know the patient’s current medication regimen to plan the protocol and communicate with the neurologist about possible dose adjustments based on the observed clinical improvement.
Resting tremor is the symptom that most concerns patients, but paradoxically it is the one that responds most variably to acupuncture in the literature. The studies in this meta-analysis did not analyze tremor as an isolated outcome — they evaluated the UPDRS motor as a whole. Clinically, it is observed that acupuncture may reduce tremor intensity in some patients, especially when associated with low-frequency electrostimulation. The proposed mechanisms include modulation of the subthalamic nucleus and of thalamic-cortical circuits. However, for severe and disabling tremor, deep brain stimulation (DBS) remains the treatment of greatest proven efficacy — acupuncture may be adjuvant, but not a substitute for that specific indication.
Founded in 1989 by physicians trained at the University of São Paulo (USP) and specialized in China, CEIMEC is a Brazilian national reference in the teaching and practice of medical acupuncture. With more than 3,000 physicians trained over 35 years, it collaborates with HC-FMUSP and is recognized by the Brazilian Medical College of Acupuncture (CMBA/AMB).