Ask an expert - neuro and psycho logical

208 questions

Restless leg syndrome is awful, as this 'expert' knows from personal experience back in the 80s when nothing, but nothing, would make the problem relent. It is nowgaining recognition as a diagnosable problem, with a new name(!), and there are a number of treatment options which are being explored. A review article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101885/ cites several of these, and the one acupuncture review this in turn cites

http://www.ncbi.nlm.nih.gov/pubmed/18843716

mentions two to three studies which are interesting but generally concludes that the majority of studies are too small and not methodologically sound enough to draw firm conclusions.

From a Chinese medicine perspective, however, there are entirely different ways of looking at the balance of energies within the body which can sometimes make sense of problems such as these within a theoretical structure which is quite different from western medicine. Problems like restless legs syndrome, where the leg feels as though it is 'over-energised' can sometimes make sense in a system of thought which looks at the free flow of energy within the system, and tries to understand the pathologies which arise in terms of excesses and deficiencies, and especially blockages. A skilled practitioner should very quickly be able to make sense of the energy flows within the system, and be able to offer you some sense of whether there is something which is treatable.

Even where this is not the case it is important to mention that the older theories of Chinese medicine were primarily aimed at balancing the whole system, seeing symptoms only as alarm bells, not the problem itself. Working in this kind of way our members very often have an effect on problems without necessarily being able to give a highly specific audit trail of what is causing something to go wrong.

We have not come across much in the way of new research, although another small study published early this year (2015)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339862/

repeats the general pattern of significant effects but small study sizes which means that we cannot give a more unqualified recommendation.

As far as motor axonal neuropathy is concerned, there is very little focused research on this specific presentation of peripheral neuropathy. There is a systematic review published earlier this year

https://www.ncbi.nlm.nih.gov/pubmed/28112552

which embraces a number of papers about neuropathies very similar to axonal neuropathy, but nothing specifically about it. Most studies of this kind tend to be very small, and inevitably the conclusion is that more studies on a larger scale would be necessary. The main question which is left unanswered is 'who will pay for them?'

If you are considering acupuncture treatment for the problem the best advice we can give is that you visit a local BAcC member to ask for a brief face to face chat about what may be possible. It follows from what we have said before that each case is unique and different, and a face to face assessment is the only way to get a specific answer about what you might expect. Many practitioners are happy to give up a small amount of time without charge to prospective patients to make this kind of assessment.

File under neuro - neuralgia

We have been asked several times about TN, the most recent answer we gave to this question was:

Trigeminal neuralgia is a very painful and quite often intractable condition. We have been asked about it a number of times, and  we have factsheets about both facial pain and neuropathic pain

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/facial-pain.html

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/neuropathic-pain.html

The evidence underpinning a recommendation for acupuncture treatment is limited, but as you can see from the evidence button on the neuropathic pain sheet acupuncture has on several occasions been shown to be superior to the standard drug treatment, which suggests that it is worth trying. 

In a previous response on the same question we said that if you look through these various responses, however, you will see much the same advice in each one. The evidence is encouraging but far from conclusive, although it would be fair to say that the gold standard of research in western medicine, the randomised double blind control trial, is not the most appropriate tool for assessing traditional acupuncture. However, there are a number of treatment possibilities within the paradigm of Chinese medicine, to do with blockages or deficiencies in the flow of energy, or 'qi' as it is called, which a practitioner might be able to identify and correct. Your best bet here is to contact a BAcC member local to you and seek a brief face to face assessment of whether they think acupuncture may be of benefit.

We have to say, however, that trigeminal neuralgia or neuropathy does appear to be a rather intractable condition, and we are usually relatively cautious about the prognosis when we take on patients in whom this is their main complaint. You will note that in one or two replies we have suggested that cranial osteopathy may offer another treatment option. The pathway of the trigeminal nerve is easily compromised by some of the physical structures around the tempero-mandibular joint, and subtle manipulation may offer possibilities.

We think that this remains the best advice that we can give. We have no doubt that acupuncture treatment can deliver temporary pain relief, and the amount of research which has been done to investigate this aspect of acupuncture's effects has been very considerable. However, as with all forms of pain relief, it is relief, not removal altogether, which is what the treatment delivers, and even when treatment works the extent of the relief it can give and its sustainability do not seem to us to be sufficient to warrant making a recommendation to try to use acupuncture as a long-term pain relief option.

If you did decide to visit a practitioner local to you, we would recommend that you are very clear about the review periods at which you can assess how successful the treatment has been, and also that you try to establish very clear outcome measures, i.e. changes which you can actually measure rather than simply soundings based on how you feel on the day. With conditions like this there are good days and bad days, or more accurately bad days and worse days, and it helps to try to bring a measure of objectivity where possible to the proceedings.

In your own case the backdrop of MS would appear to make the situation a little more complex, but it is important to recognise that the diagnostic categories of Chinese medicine are entirely different from the conventional medicine paradigm. From this perspective how a patient presents is far more important than the disease labels which they carry. That is not to say that Chinese medicine offers a chance of change where conventional medicine doesn't; in the modern parlance of sales, once it's gone it's gone. If a nerve is demyelinated there is no evidence to suggest that acupuncture treatment can reverse the damage. 

However, MS, as you know very well, can sometimes plateau and often have periods of remission, and our general sense is that treatments like acupuncture which are aimed at maintaining balance in the system may well be a contributory factor in staying well. This was, after all, the basis of ancient Chinese medicine,, helping people to stay well rather trying to get them better after they got ill, which was said to b e 'like forging a spear after the battle had started or digging a well when you were already thirsty.'

Trigeminal neuraligia is a very painful and quite often intractable condition. We have been asked about it a number of times, and  we have factsheets about both facial pain and neuropathic pain

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/facial-pain.html

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/neuropathic-pain.html

There evidence underpinning a recommendation for acupuncture treatment is limited, but as you can see from the evidence button on the neuropathic pain sheet acupuncture has on several occasions been shown to be superior to the standard drug treatment, which suggests that it is worth trying. 

In a previous response on the same question we said:

If you look through these various responses, however, you will see much the same advice in each one. The evidence is encouraging but far from conclusive, although it would be fair to say that the gold standard of research in western medicine, the randomised double blind control trial is not the most appropriate tool for assessing traditional acupuncture. However, there are a number of treatment possibilities within the paradigm of Chinese medicine, to do with blockages or deficiencies in the flow of energy, or 'qi' as it is called, which a practitioner might be able to identify and correct. Your best bet here is to contact a BAcC member local to you and seek a brief face to face assessment of whether they think acupuncture may be of benefit.

We have to say, however, that trigeminal neuralgia or neuropathy does appear to be a rather intractable condition, and we are usually relatively cautious about the prognosis when we take on patients in whom this is their main complaint. You will note that in one or two replies we have suggested that cranial osteopathy may offer another treatment option. The pathway of the trigeminal nerve is easily compromised by some of the physical structures around the tempero-mandibular joint, and subtle manipulation may offer possibilities.

We think that this remains the best advice that we can give. We have no doubt that acupuncture treatment can deliver temporary pain relief, and the amount of research which has been done to investigate this aspect of acupuncture's effects has been very considerable. However, as with all forms of pain relief, it is relief, not removal altogether which is what the treatment delivers, and even when treatment works the extent of the relief it can give and its sustainability do not seem to us to be sufficient to warrant making a recommendation to try to use acupuncture as a long-term pain relief option.

If you did decide to visit a practitioner local to you, we would recommend that you are very clear about the review periods at which you can assess how successful the treatment has been, and also that you try to establish very clear outcome measures, i.e. changes which you can actually measure rather than simply soundings based on how you feel on the day. With conditions like this there are good days and bad days, or more accurately bad days and worse days, and it helps to try to bring a measure of objectivity where possible to the proceedings.

We are really sorry to hear of your wife's problems. It must be extremely hard for all of you.

First, let us say that acupuncture and herbal medicine are two distinct and separate disciplines, although in China they are usually learned together. For historical reasons in the UK there were already existing traditions of acupuncture and western herbal medicine, and the two eastern modalities developed separately. So, if you go to an acupuncturist the chances are that they will not be using Chinese herbs as well. If they are you can be assured that they are very well trained, and are particularly careful when someone is already taking medications which have a serious impact on their functioning. Herbalists will know what the potential interactions of the medications are, and will make sure that nothing they do will interfere with your wife's treatment.

Acupuncture itself is extremely unlikely to cause any problems for your wife. The main source of adverse effects from treatment, other than minor transient ones, is from insertion of the needles themselves, not from the energetics of what is going on. There are no case reports of which we are aware which suggest that acupuncture treatment can do anything other than good when treating people with serious mental health issues.

 As far as the treatment itself is concerned, we were asked a question about schizophrenia a while ago, and although this is a very different problem the response we gave captures some of what we would like to say. We responded:

We have to say that although the World Health Organisation's list of treatable conditions does include schizophrenia as a condition for which some evidence of efficacy exists, the overall position is that there is nowhere enough evidence to suggest that acupuncture would be able to deliver a solution to this problem.

However, when we talk about evidence in this context, we are talking about the kind of randomised control trials beloved of drug testing regimes, which are not the most suitable way of testing a complex multivariate process like traditional acupuncture. Is there a history of acupuncture and herbal medicine for serious mental disorder? Well, the answer would be a qualified yes. There are a number of presentations for groups of symptoms which could well be characterised as psychosis which are recognised syndromes in Chinese medicine with clear treatment protocols. This is even more the case with Tibetan medicine which uniquely in Far Eastern medicine has a very complex and enduring tradition of using herbal medicines to treat a number of what we regard as sectionable mental disorders. However, this tradition has barely travelled to the West, and few practitioners have the necessary skills to offer solutions.

The major issue would be to locate someone with the requisite skills and experience. Although we have few recognised specialisms in traditional acupuncture we have been developing areas like paediatrics, obstetrics and mental health issues where we believe the special nature of the client group may require additional skills which we would recognise as expert practice. Although in theory, as generalists we should all be able to help any patient we take the view that serious mental disease needs some familiarity with the field and some experience of how to work with people in extremely distressed states. Not everyone has this experience or skill, and it would not help your wife is someone is out of their depth. With that caveat it may be possible to locate someone through our searchable database who is skilled in this area and willing to have a try. The chances are that anyone working in an area will know which of their colleagues is most likely to be able to help,

We think that there is still some wisdom in these words, and our advice is pretty much always to visit a local BAcC member for a brief informal assessment of what might be possible. These situations are so very complex that it is nigh on impossible to give a definitive view at arm's length. We always feel confident that we can help everyone to a degree, but when a situation is quite fraught it is always best to make sure that a patient gets the help they need, even if that means referring them to other forms of treatment.

 

 

The use of acupuncture treatment to help after stroke is now becoming more greatly accepted, and as you can see from our review paper

https://www.acupuncture.org.uk/arrc/public-review-papers/stroke-and-acupuncture-the-evidence-for-effectiveness.html There has been considerable interest because in China it is not uncommon for people to begin  a course of acupuncture treatment within hours of a stroke in order to remobilise the energy of the body as quickly as possible.

The paper doesn't make much mention of dysphagia, though, and for that we have had to look at wider evidence sources. The best summary is here

https://www.ncbi.nlm.nih.gov/pubmed/23000511.

A systematic review is a means of aggregating the results of many different trials and is seen as a very effective way of building up a wider picture than a small trial can offer. The results are encouraging, although as always there is criticism of the design studies and methodological rigour of many of the tests. This is usually to do with the fact that most studies are performed in China and are less concerned with whether acupuncture works - 2500 years of history says it does - than with what works better. We are still held to account for whether it works at all, which requires a very strict and not entirely appropriate trial design.

There was one rather interesting study published in  2016 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4810993/ which looks really encouraging but the technique describes pharyngeal acupuncture, and we doubt that you will find many UK practitioners either trained in this technique or willing to do it. There are also a growing number of practitioners using scalp acupuncture, for which there are two or three main systems, and great claims are made for their success in treating neurological problems, but here the research is very thin. If you can find someone who works with this method near where you live it may be worth having a chat with them.

We always advise prospective patients to visit a BAcC member local to them for a chat. Everyone is unique and different, and with cases like stroke recovery there are so many confounding factors that it is always best to find a way of getting a face to face assessment. There are no magic formulae to apply, but there are often signs which a practitioner can use to assess how well someone is likely to respond. This is invaluable for offering a prognosis.

From a Chinese medicine perspective there are many ways of regarding functional disturbances, and given the general agreement about what causes a stroke in energetic terms it is sometimes possible to track the functional disturbances which flow from this to the problems with swallowing in a way which offers direct treatment possibilities.

We are always cautious, however; the longer a symptom has been in place the more difficult it can be to move, a view shared with conventional medicine in looking at post-stroke recovery. If the problem arises from a head injury rather than an infarct, though, there may be good reasons to believe that acupuncture treatment may be able to help, however long after the injury a person is treated.

 

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