Cervical Vertigo:

Vertiges cervicaux : évaluation de l'acupuncture

Articles connexes: - syndrome de Menière - troubles de l'équilibre post-AVC - conduites thérapeutiques - pathologies - qigong - acupuncture expérimentale -

1. Systematic Reviews and Meta-Analysis

1.1. Generic Acupuncture

1.1.1. Chen 2018

Chen Ji-Xin, Chen Shu-Qi, Liu Rong. [Efficacy of acupuncture in treating posterior circulation ischemic vertigo: a meta-analysis of randomized controlled trials]. Chinese Journal of Gerontology. 2018;14:3329-3333. [201770].

目的运用Meta分析的方法评价针刺治疗后循环缺血性眩晕(PCIV)的临床疗效与安全性.方法分别用计算机检索英文数据库和中文数据库,前者主要包括PubMed和Cochrane图书馆及Excerpta Medica Database(Embase),后者则以万方数据库、中国科技期刊全文数据库(简称维普,VIP)和中国期刊全文数据库(简称中国知网,CNKI)为主.并收集所有与针刺治疗PCIV有关的随机对照试验(RCT),按照既定的纳入标准进行逐一排除,对符合纳入标准的RCT进行方法学质量评价和相关资料提取后,运用RevMan5.3统计软件分析相关研究指标.结果共纳入14个RCT,合计1046例患者.Meta分析结果显示:试验组治疗PCIV总有效率的合并分析效应为〔RR=1.23,95％CI(1.17,1.29),P<0.001〕,说明试验组的总有效率高于对照组.结论针刺治疗PCIV效果比西药或中成药等治疗更具优势.
Objective	To evaluate the clinical efficacy and safety of cyclic ischemic vertigo (PCIV) after acupuncture treatment by means of meta-analysis.
Methods	The method was to use computer to search English database and Chinese database respectively. The former mainly includes PubMed and Cochrane Library and Excerpta Medica Database. (Embase), the latter is based on Wanfang database, China Science and Technology Periodical Full-text Database (VIP) and China Journal Full-text Database (CNKI), and collects all randomization related to acupuncture treatment of PCIV. The control trials (RCT) were excluded according to the established inclusion criteria. After the methodological quality evaluation and related data extraction of the RCTs meeting the inclusion criteria, RevMan5.3 statistical software was used to analyze the relevant research indicators.
Results	The results included 14 RCTs. A total of 1046 patients. The results of the meta-analysis showed that the combined effect of the total effective rate of PCIV in the experimental group was [RR=1.23, 95% CI (1.17, 1.29), P < 0.001], indicating that the total effective rate of the test group was higher than that of the control group.
Conclusion	Acupuncture treatment of PCIV is more advantageous than Western medicine or Chinese patent medicine.

1.1.2. Hou 2017 ☆

Hou Z, Xu S, Li Q, Cai L, Wu W, Yu H, Chen H. The Efficacy of Acupuncture for the Treatment of Cervical Vertigo: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2017. [195941].

Objective	This study aims to evaluate the efficacy and safety of acupuncture for the treatment of cervical vertigo (CV).
Methods	Randomized controlled trials (RCTs) regarding effectiveness of acupuncture for treating CV were searched in 7 comprehensive databases prior to April 2016. The data analysis was performed by using RevMan version 5.3.
Results	A total of 10 studies with 914 participants were included. Results showed that acupuncture was more effective than conventional medicine therapy (CMT) in effectiveness, improvement rate of vertigo and headache, and increased average blood flow velocity of vertebral-basilar artery. In the subgroup analysis, the results did not change in different acupuncture methods and drug categories substantially. Sensitivity analysis demonstrated that the results of this meta-analysis were stable. Meanwhile, the long-term safety of acupuncture for CV still remains uncertain. GRADE analysis indicated that the quality of evidence for all outcomes was from very low to low which limited the value of the meta-analysis.
Conclusion	Based on the systematic review, acupuncture appeared to be a promising therapeutic approach for CV based on low or very low quality of evidence. However, large-scale and high-quality trials are required to provide stronger evidence for the conclusion.

1.2. Special Acupuncture Techniques

1.2.1. Mai 2023 (Moxibustion at Baihui combined with acupuncture)

Mai W, Bu XZ, Miao FR, Rui JL, Huang LL, Zhao XJ, Fan YS. [Moxibustion at Baihui combined with acupuncture for cervical vertigo: a Meta-analysis and trial sequential analysis]. Zhen Ci Yan Jiu. 2023 Jan 25;48(1):95-101. Chinese. https://doi.org/10.13702/j.1000-0607.20211054

Objective	To evaluate the efficacy and safety of moxibustion at Baihui (CV20) combined with acupuncture in treatment of cervical vertigo.
Methods	From the databases, such as CNKI, VIP, WanFang, CBM, PubMed, Cochrane Library and Embase, the studies of randomized controlled trials (RCTs) on moxibustion at CV20 combined with acupuncture for cervical vertigo were searched from inception to September 15th, 2021. The Cochrane risk of bias assessment tool was utilized to evaluate the quality of the included literature. Using RevMan5.3, Stata12.0 and TSA0.9.5.0 10 Beta software, the Meta-analysis and trial sequential analysis (TSA) were performed.
Results	Seventeen RCTs with 1 232 patients were included. Meta-analysis showed that in the trial group (moxibustion at CV20 combined with acupuncture), the total effective rate (RR=1.17, 95%CI［1.12, 1.22］, P<0.000 1), the curative and remarkably-effective rate (RR＝1.28，95%CI［1.20，1.36］，P<0.000 1) and the score of cervical vertigo (WMD=2.88, 95%CI［1.87, 3.89］, P<0.000 1) were all better when compared with the control group (simple acupuncture or electroacupuncture group). The results of trial sequential analysis indicated that for the cumulative Z-score of each RCT, the Z-curve crossed the conventional test boundary and TSA boundary, which further confirmed the clinical efficacy of moxibustion at CV20 combined with acupuncture on cervical vertigo.
Conclusion	The clinical efficacy of moxibustion at CV20 combined with acupuncture is determined in treatment of cervical vertigo.

1.2.2. Guo 2017 (combined with bone-setting)

Guo Rusong, Huang Fan, Zhao Siyi, Fan Zhiyong, Lu Xiaobo, Wu Shan. [Efficacy and safety of bone-setting combined with acupuncture in the treatment of cervical vertigo: a meta-analysis]. Chinese Journal of Evidence-Based Medicine. 2017;17(12):1428. [175855].

Objectives	To systematically review the efficacy and safety of bone-setting combined acupuncture in the treatment of cervical vertigo.
Methods	PubMed, CNKI, VIP, CBM and WanFang Data databases were searched to collect randomized controlled trials (RCTs) on bone-setting combined acupuncture in the treatment of cervical vertigo from inception to February 15th, 2017. Two reviewers independently screened literature extracted data and assessed the risk of bias of the included studies. Meta-analysis was performed by RevMan 5.3 software.
Results	Eighteenth RCTs involving 1 915 patients were included. The results of meta-analysis showed that, compared with acupuncture or bone-setting alone group, the effective rate in bone-setting combining acupuncture group was higher (RR acupuncture=1.17, 95%CI 1.12 to 1.23, P<0.000 01; RR bone-setting=1.16, 95%CI 1.10 to 1.23, P<0.000 01). Improvement of the cervical vertigo symptom and function in the combined group was better than that in the acupuncture group or bone-setting group (MD acupuncture=3.42, 95%CI 2.29 to 4.56, P<0.000 01; MD bone-setting=6.45, 95%CI 5.56 to 7.33, P<0.000 01). Average flow velocity of cervical vertigo basilar artery (BA) in the combined group was superior to the bone-setting group (MD=7.54, 95%CI P=0.02). 1.08 to 13.99,
Conclusions	Bone-setting combining acupuncture treatment of cervical vertigo in terms of effectiveness and function improvement are better than those of acupuncture alone or pure bone-setting. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions

2. Clinical Practice Guidelines

⊕ positive recommendation (regardless of the level of evidence reported)
Ø negative recommendation (or lack of evidence)

2.1. Duodecim EBM Guidelines (Finland) 2019 ⊕

Version française (EBMFrance.net). Vertiges. Duodecim 2019. [220457]. https://www.ebmfrance.net/fr/Pages/ebm/ebm00745.aspx

Origine cervicale : étirement, augmentation de l'activité physique, physiothérapie, acupuncture ; éventuellement un antidépresseur tricyclique comme traitement médicamenteux.

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