hiccups after stroke:

Hoquet post-AVC : évaluation de l'acupuncture

1. Systematic Reviews and Meta-Analysis

☆☆☆	Evidence for effectiveness and a specific effect of acupuncture
☆☆	Evidence for effectiveness of acupuncture
☆	Limited evidence for effectiveness of acupuncture
Ø	No evidence or insufficient evidence

1.1. Wang 2023

Wang J, Wu B, Li Y, Wang X, Lu Z, Wang W. Acupuncture in the treatment of post-stroke hiccup: A systematic Review and meta-analysis. Libyan J Med. 2023 Dec;18(1):2251640. https://doi.org/10.1080/19932820.2023.2251640

Aim	Central hiccups following a stroke are a frequent complication, exerting adverse effects on both the stroke condition and the patient's daily life. Existing treatments exhibit limited efficacy and pronounced side effects. Acupuncture has been explored as a supplementary intervention in clinical practice. This study aims to investigate the clinical effectiveness of acupuncture for post-stroke hiccups.
Methods	To identify published clinical randomized controlled trials addressing post-stroke hiccups treatment, comprehensive searches were conducted across PubMed, the Cochrane Library, EMBASE, Web of Science, Chinese Biological Medical (CBM), Wanfang Database, and China Science and Technology Journal (VIP). In addition, we scrutinized ClinicalTrials.gov and the Chinese Clinical Trial Registry. Employing Cochrane Handbook 5.1.0 and Review Manager 5.4 software, three authors independently reviewed literature, extracted data, and evaluated study quality. Data analysis was performed using Stata 16.0 and Review Manager 5.4.
Results	A total of 18 trials were encompassed in the analysis. In comparison to standard treatment, acupuncture exhibited a significant enhancement in treatment effectiveness (RR: 1.27, 95% CI: 1.21-1.33; P < 0.00001). Notably, Hiccup Symptom Score displayed a considerable decrease (WMD: -1.28, 95% CI: -1.64 to -0.93; P < 0.00001), concurrent with a noteworthy improvement in the quality of life (WMD: 8.470, 95% CI: 7.323-9.617; P < 0.00001). Additionally, the incidence of adverse reactions decreased (RR: 0.45, 95% CI: 0.16-1.25; P = 0.13), and there was a significant reduction in SAS (WMD: -7.23, 95% CI: -8.47 - -5.99; P < 0.00001).
Conclusions	Our investigation suggests that acupuncture could prove effective in post-stroke hiccup treatment. Nonetheless, due to concerns about the quality and size of the included studies, conducting higher-quality randomized controlled trials to validate their efficacy is imperative.

1.2. Chen 2020

Chen Jiaqi. [Meta-analysis on the treatment of refractory hiccup after stroke with external treatment of traditional Chinese medicine]. Hunan Journal of TCM. 2020. [212943].

Objective	To systematically evaluate the clinical effect of external treatment of traditional Chinese medicine on refractory hiccups after stroke.
Methods	Search China Knowledge Network (CNKI) with keywords such as “refractory hiccup after stroke” or “refractory hiccup after stroke” and “acupuncture”, “acupuncture”, “electroacupuncture”, “enema”, “ear points”, “tuina”, etc. , Wanfang Database (WANGFANG DATA), VIP Chinese Science and Technology Journal Database (VIP), China Biomedical Literature Database (CBM), Web of Science, PubMed, The Cochrane Library, to collect randomized Chinese medicine external treatment methods for intractable hiccups after stroke Controlled test. The search date is the start time of the database collection and ends on November 30, 2018. After the data is obtained, the Revman 5.3.0 software is used for Meta analysis.
Results	A total of 21 articles and 1393 cases were included. The total effective rate (RR=1.22, 95%CI[1. 12, 1.32], P <0. 00001) and cure rate (RR=1.68, 95%) of the experimental group using external treatment of traditional Chinese medicine CI[1. 50, 1.88], P <0. 00001), hiccup symptom score (SMD=-1.66, 95%CI[-2. 64, -0. 67], P=0. 001) , Mental state score (SMD=1. 02, 95%CI[0.61, 1.43], P <0.00001), diet score (SMD=1. 00, 95%CI[0. 43, 1. 58], P=0. 0006), sleep score (SMD=1. 14, 95%CI[0. 60, 1.68], P <0. 0001) and other efficacy indicators, are better than the control group, and The recurrence rate and safety have not been definitively analyzed to support its better effect.
Conclusion	The external treatment of traditional Chinese medicine can effectively improve the treatment effect of intractable hiccups after stroke, but a larger sample size and more rigorously designed clinical trials are still needed for further verification.

1.3. Yue 2017 ☆

Yue J, Liu M, Li J, Wang Y, Hung ES, Tong X, Sun Z, Zhang Q, Golianu B. Acupuncture for the treatment of hiccups following stroke: a systematic review and meta-analysis. Acupunct Med. 2017;35(1):2-8. [186084].

OBJECTIVES	To assess the effectiveness and safety of acupuncture for hiccups following stroke.
METHODS	Medline, Embase, CENTRAL, CINAHL, and four Chinese medical databases were searched from their inception to 1 June 2015. The dataset included randomised controlled trials (RCTs) with no language restrictions that compared acupuncture as an adjunct to medical treatment (effectiveness) or acupuncture versus medical treatment (comparative effectiveness) in stroke patients with hiccups. The Cochrane risk of bias tool was used to assess the methodological quality of the trials.
RESULTS	Out of 436 potentially relevant studies, five met the inclusion criteria. When acupuncture was compared with other interventions (as sole or adjunctive treatment), meta-analysis revealed a significant difference in favour of cessation of hiccups within a specified time period (CHWST) following intervention when used as an adjunct (risk ratio (RR) 1.59, 95% CI 1.16 to 2.19, I2=0%), but not when used alone (RR 1.40, 95% CI 0.79 to 2.47, I2=65%, ie, high heterogeneity). No safety information was reported in these studies.
CONCLUSIONS	Our systematic review and meta-analysis suggests that acupuncture may be an effective treatment for patients suffering from hiccups following stroke when used as an adjunct to medical treatment. However, due to the limited number of RCTs and poor methodology quality, we cannot reach a definitive conclusion, hence further large, rigorously designed trials are needed.

1.4. Zhu 2011 Ø

Zhu Li-Ling, Wang Wei-Xing, Guo Xiao-Gang. [Acupuncture for hiccups after stroke: a systematic review]. Chinese Journal of Evidence-Based Medicine. 2011; 11(3):325-28. [166487].

Objective	To assess the efficacy and safety of acupuncture for patients with hiccups after stroke.
Methods	The randomized controlled trials (RCTs) of acupuncture for patients with hiccups after stroke were collected by searching PubMed, The Cochrane Library, CNKI, VIP, and WangFang databases. The quality of the included studies was evaluated and the data were retrieved according to the methods recommended by the Cochrane Collaboration. Metaanalyses were conducted by using RevMan software.
Results	Three trials involving 143 patients were included. All of them were open-label controlled without observing the effective rate and mortality rate (or dependence rate) at the end of follow-up visit lasting for at least three months. The result of meta-analyses showed that the group of acupuncture plus drug was more effective for hiccup after stroke than the drug group at the end of the treatment, and the difference was significant (OR=9.05, 95%CI 3.17 to 25.82, P<0.000 01). The three studies did not report any adverse reactions.
Conclusion	Although the acupuncture has the short-term improvement trend without adverse events for hiccups after stroke, the confirmed conclusion of long-term effectiveness has not yet been reached because both the methodological quality and the quantity of all included studies are poor, and especially the long-term outcome measures are insufficient. There is no enough evidence to recommend acupuncture as a routine treatment for hiccups after stroke. So more high-quality multicenter RCTs in large scale are required.

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