Rédacteur : Johan Nguyen

Restless Legs Syndrome

Syndrome des jambes sans repos : 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. Harrison 2019

Harrison EG, Keating JL, Morgan PE. Non-pharmacological interventions for restless legs syndrome: a systematic review of randomised controlled trials. Disabil Rehabil. 2019;41(17):2006-14. [203373]. DOI

IntroductionRestless legs syndrome (RLS) is a sensorimotor disorder characterised by an uncomfortable urge to move the legs. Management is primarily pharmacological. Effects for non-pharmacological, non-surgical options are published but lack systematic examination.
ObjectivesTo synthesise results of non-pharmacological/non-surgical treatment compared to no-treatment controls or alternative treatment for RLS on any relevant outcome. Methods: Databases and reference lists of reviews were searched for randomised controlled trials (RCTs) comparing non-pharmacological treatment to alternative or no treatment controls for idiopathic RLS. Search results were independently screened for inclusion by two researchers; disagreements regarding eligibility were resolved with discussion. Outcomes were summarised, and pooled where possible in meta-analysis.
ResultsThe search yielded 442 articles. Eleven trials met inclusion criteria. Repetitive transcranial magnetic stimulation, exercise, compression devices, counterstrain manipulation, infrared therapy, and standard acupuncture were significantly more effective for RLS severity than control conditions. Vibration pads, cryotherapy, and transcranial direct current stimulation were ineffective in reducing RLS severity. Vibration pads, cryotherapy, yoga, compression devices, and acupuncture significantly improved some sleep-related outcomes.
ConclusionsFew studies were identified and quality of evidence was not high. Some non-pharmacological interventions may be beneficial for reducing RLS severity and enhancing sleep. Implications for Rehabilitation The current management of restless leg syndrome is primarily pharmacological, and medications can have unwanted side effects. Repetitive transcranial magnetic stimulation, exercise, compression devices, counterstrain manipulation, infrared therapy, and standard acupuncture may reduce restless leg syndrome severity. Vibration pads, cryotherapy, yoga, compression devices, and acupuncture may improve some sleep-related outcomes in restless leg syndrome. Non-pharmacological interventions for RLS may cause placebo effects and rehabilitation professionals should control for this possibility in future investigations

1.2. Huang 2019

Huang CW, Lee MJ, Wang LJ, et al. Comparative efficacy and acceptability of treatments for restless legs syndrome in end-stage renal disease: a systematic review and network meta-analysis. Nephrol Dial Transplant. 2019. [202530]. DOI

BackgroundRestless legs syndrome (RLS) is common in end-stage renal disease (ESRD) patients and impairs health and quality of life significantly. However, the optimal treatment of RLS in ESRD patients is uncertain and less studied compared with idiopathic RLS patients.
Methods We conducted a systematic review and network meta-analysis to compare the efficacy and acceptability of treatments for RLS in ESRD patients. Randomized controlled trials (RCTs) by February 2019 in the PubMed, Cochrane Library, Embase and ClinicalTrials.gov were reviewed. RLS severity reduction was treated as treatment efficacy, and adverse events were treated as acceptable. Both outcomes were appraised using a random effects model expressed as standardized mean differences and odds ratios with 95% confidence intervals (CIs), respectively, and were ranked using surface under the cumulative ranking curve (SUCRA) probabilities to obtain a hierarchy of interventions.
ResultsA total of 12 RCTs were included, comprising 9 interventions and 498 participants. All the interventions significantly improved RLS severity without critical side effects compared with placebo. Gabapentin achieved the greatest decrease of RLS severity [standardized mean difference (SMD) = 1.95, 95% CI 0.81-3.09 (SUCRA: 79.3%)], despite its frequent adverse events [SMD = 0.18, 95% CI 0.02-1.50 (19.9%)]. The combination therapy of exercise plus dopamine agonist had better efficacy [SMD = 1.60, 95% CI 0.08-3.12 (59.8%)] and acceptability [SMD = 1.41, 95% CI 0.01-142.53 (63.9%)] compared with that of vitamin C plus vitamin E [SMD = 1.50, 95% CI 0.47-2.54 (56.6%); SMD = 0.32, 95% CI 0.04-2.86 (32.5%)].
ConclusionsThis network meta-analysis supports that gabapentin is the most effective treatment for RLS in ESRD patients. Exercise plus dopamine agonist is a favorable combination therapy concerning side effects. Future large RCTs with long-term treatment outcomes are necessary.
Acupuncture Acupoint stimulation has also been applied in the treatment of idiopathic or ESRD associated RLS. Our analysis examined two RCTs evaluating the effect of two kinds of acupoint stimulation, acupuncture therapy (moxibustion) and near-infrared light therapy, on RLS treatment in ESRD patients and the results showed that acupoint stimulation could significantly reduce RLS severity and improve sleep quality compared with placebo.

1.3. Xu 2018

Xu XM, Liu Y, Jia SY, Dong MX, Cao D, Wei YD. Complementary and alternative therapies for restless legs syndrome: An evidence-based systematic review. Sleep Med Rev. 2018;:158-167. [181972].

BackgroungRestless legs syndrome (RLS) is defined as an irresistible urge to move the legs, which is usually accompanied by paresthesias or dysesthesias at least twice weekly and affects 2%-4% of adults in Europe and North America.
ObjectivesThis systematic review assesses the current complementary and alternative options for RLS and the potential benefits of those treatments on sleep quality, mood disorder, and quality of life.
Methods A systematic search of the PubMed, Embase, Cochrane, and Web of Science databases was conducted. Eighteen studies met the inclusion criterion, which included the use of the international RLS study group criteria.
Results and conclusionsComplementary and alternative therapies have been found to be effective in both primary and secondary RLS. The severity of primary RLS symptoms can be significantly ameliorated by exercise training, transcutaneous spinal direct current stimulation, pneumatic compression devices, light therapy, repetitive transcranial magnetic stimulation, and acupuncture. Pneumatic compression devices and yoga also improve RLS-related disorders. Exercise training is highly efficacious in the reduction of symptom severity in uremic RLS and related effects such as poor quality of life. Endovenous laser ablation may be a good choice for patients with concurrent RLS and superficial venous insufficiency.

1.4. Xie 2011 ☆

Xie Yi-Nan, Wang Shu, Zhao Ran, Yu Qi-Lin. [Acupuncture for restless legs syndrome : a systematic review]. Journal of Clinical Acupuncture and Moxibustion. 2011;27(6):7. (chi). [174455].

ObjectiveTo assess the therapeutic effect of acupuiicture for restless legs syndrome.
MethodsThe paper searched EMbase , MEDLINE, CNKI CBM, WANFANG,VIP, Database, and handsearched relevant journals and conference proceedings. It included all randomized controlled trials ( RCTs) and quasi-RCTs of acupuncture treatment for patients with restless legs syndrome. Datawere extracted and evaluated by two reviewers independently with a specially designed extraction form. The Cochrane Collaborations RevMan4. 2. 10 software was used for data analysis. At the same time, we do Fail - safe number analysis and use Funnel plot for the possible existence of publication bias.
ResultsA total of 8 trials involving 581 patients were included. Meta - analysis showed that the total effective rate in the treatment group was better than that in the control group: Acupuncture group versus western medicine group (OR = 13. 87,95% CI [8. 03,23. 96]). Fail - safe number analysis revealed a relatively stable result. Furinelplot is asymmetrica, which showed the possible existence of publication bias.
ConclusionAcupuncture is better, but further large - scale trials are required to define the role of acupuncture in the treatment of restless legs syndrome.

1.5. Cui 2008 ∅

Cui Y, Wang Y, Liu Z. Acupuncture for restless legs syndrome. Cochrane Database Syst Rev. 2008. 8(4):cd006457. [151006].

BackgroundRestless legs syndrome (RLS) is a common movement disorder for which patients may seek treatment with acupuncture. However, the benefits of acupuncture in the treatment of RLS are unclear and have not been evaluated in a systematic review until now.
Objectives To evaluate the efficacy and safety of acupuncture therapy in patients with RLS.
Methods Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2007), MEDLINE (January 1950 to February 2007), EMBASE (January 1980 to 2007 Week 8), Chinese Biomedical Database (CBM) (1978 to February 2007), China National Knowledge Infrastructure (CNKI) (1979 to February 2007), VIP Database (1989 to February 2007), Japana Centra Revuo Medicina (1983 to 2007) and Korean Medical Database (1986 to 2007). Four Chinese journals, relevant academic conference proceedings and reference lists of articles were handsearched. Selection criteria: Randomized controlled trials and quasi-randomized trials comparing acupuncture with no intervention, placebo acupuncture, sham acupuncture, pharmacological treatments, or other non-acupuncture interventions for primary RLS were included. Trials comparing acupuncture plus non-acupuncture treatment with the same non-acupuncture treatment were also included. Trials that only compared different forms of acupuncture or different acupoints were excluded. DATA collection and analysis: Two authors independently identified potential articles, assessed methodological quality and extracted data. Relative risk (RR) was used for binary outcomes and weighted mean difference for continuous variables. Results were combined only in the absence of clinical heterogeneity.
Main Results Fourteen potentially relevant trials were identified initially, but twelve of them did not meet the selection criteria and were excluded. Only two trials with 170 patients met the inclusion criteria. No data could be combined due to clinical heterogeneity between trials. Both trials had methodological and/or reporting shortcomings. No significant difference was detected in remission of overall symptoms between acupuncture and medications in one trial (RR 0.97, 95% CI 0.76 to 1.24). Another trial found that dermal needle therapy used in combination with medications and massage was more effective than medications and massage alone, in terms of remission of unpleasant sensations in the legs (RR 1.36, 95% CI 1.06 to 1.75; WMD -0.61, 95% CI -0.96 to -0.26) and reduction of RLS frequency (WMD -3.44, 95% CI -5.15 to -1.73). However, there was no significant difference for the reduction in either the longest or the shortest duration of RLS (WMD -2.58, 95% CI -5.92 to 0.76; WMD -0.38, 95% CI -1.08 to 0.32).
Authors' conclusionsThere is insufficient evidence to determine whether acupuncture is an efficacious and safe treatment for RLS. Further well-designed, large-scale clinical trials are needed.

2. Clinical Practice Guidelines

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

2.1. American Academy of Neurology (AAN, USA) 2016 Ø

Winkelman JW, Armstrong MJ, Allen RP, Chaudhuri KR, Ondo W, Trenkwalder C, Zee PC, Gronseth GS, Gloss D, Zesiewicz T. Practice guideline summary: Treatment of restless legs syndrome in adults. Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology Neurology. 2016;87(24):2585-93. [175863].

There is insufficient evidence to support or refute use of acupuncture in RLS (Level U).

3. Randomized Controlled Trials

3.1. Sources

  1. Acudoc2: Base de données du Centre de documentation du GERA. ECR non inclus dans les autres sources
  2. Harrison 2019: Harrison EG, Keating JL, Morgan PE. Non-pharmacological interventions for restless legs syndrome: a systematic review of randomised controlled trials. Disabil Rehabil. 2019;41(17):2006-14. [203373].
  3. Huang 2019 : Huang CW, Lee MJ, Wang LJ, et al. Comparative efficacy and acceptability of treatments for restless legs syndrome in end-stage renal disease: a systematic review and network meta-analysis. Nephrol Dial Transplant. 2019. [202530].
  4. Xu 2018: Xu XM, Liu Y, Jia SY, Dong MX, Cao D, Wei YD. Complementary and alternative therapies for restless legs syndrome: An evidence-based systematic review. Sleep Med Rev. 2018;:158-167. [181972].
  5. Xie 2011: Xie Yi-Nan, Wang Shu, Zhao Ran, Yu Qi-Lin. [Acupuncture for restless legs syndrome : a systematic review]. Journal of Clinical Acupuncture and Moxibustion. 2011;27(6):7. [174455].
  6. Cui 2008: Cui Y, Wang Y, Liu Z. Acupuncture for restless legs syndrome. Cochrane Database Syst Rev. 2008. 8(4):cd006457. [151006].

3.2. List

2018 Mohammadi MM, Raygani AAV, Ghobadi A, Samadzadeh S, Salari N. Effect of Near-Infrared Light Therapy Based on Acupoints on the Severity of Restless Legs Syndrome in Patients Undergoing Hemodialysis: A Single-Blind, Randomized Controlled Trial. Clin Med Res. 2018;16(1-2):1-8. [198671]. Huang 2019
Wang Yu-lin, Li Wei, Ruan Zhen-xu, et al. Therapeutic Observation of Acupuncture plus Auricular Point Sticking for Sleep Disorders in Restless Leg Syndrome Shanghai Journal of Acupuncture and Moxibustion. 2018;37(4):422. [181902]. Acudoc2
2017 Raissi GR, Forogh B, Ahadi T, Ghahramanpoori S, Ghaboussi P, Sajadi S. Evaluation of Acupuncture in the Treatment of Restless Legs Syndrome: A Randomized Controlled Trial. Journal of Acupuncture and Meridian Studies. 2017;10(5):346-350. [52126]. Acudoc2
Wang Liu-Yun, Yuan Wen-Li, Tian Tong-Liang, Yu Feng-Ping. [Observations on the Efficacy of Penetrating Moxibustion plus Short Joint Needling in Treating Restless Leg Syndrome]. Shanghai Journal of Acupuncture and Moxibustion. 2017;36(11): 1307-1310. [113407]. Acudoc2
2016 Fang Xiang-jun. [Therapeutic Observation of Acupoint Thread Embedding plus Ultrashort Waves for Sleep Disorders Due to Restless Legs Syndrome]. Shanghai Journal of Acupuncture and Moxibustion. 2016;35(1):25-26. [191560] Acudoc2
Gao Y, Zhao J, Guo C. [Effect of governor moxibustion for restless legs syndrome of maintenance hemodialysis: a randomized controlled trial]. Chinese Acupuncture and Moxibustion. 2016;36(6):597-600. [192117]. Acudoc2
2015 Pan W, Wang M, Li M, Wang Q, Kwak S, Jiang W, Yamamoto Y. Actigraph evaluation of acupuncture for treating restless legs syndrome. Evid Based Complement Alternat Med. 2015. [178965]. Harrison 2019, Xu 2018
2012 Ma Bi-Wei, Wang De-Wei, Lin Hao, Pan Qin-Guan. [Observations on the efficacy of acupuncture plus warm pedicure in treating restless leg syndrome]. Shanghai Journal of Acupuncture and Moxibustion. 2012;31(6):419. [175573]. Acudoc2
2011 Wang Jian-Xiong, Zhang Jun-Feng. [Observation on acupuncture plus moving cupping for restless legs syndrome]. Shanghai Journal of Acupuncture and Moxibustion. 2011;30(12):836. [177207]. Acudoc2
2010 Zhang Weiguo, Wang Huidong. [Clinical observation of acupuncture combined with Levodopa in treatment of restless leg syndrome], Zhejiang Journal of Integrated Traditional Chinese and Western Medicine. 2010;20(8):480-1. [143358]. Xie 2011
2009 Lu Qinmei. [Head-body acupuncture combined with restless legs syndrome in 58 cases], Hebei Journal of TCM. 2009;31(12):1844-45. [142244]. Xie 2011
2008 Wu YH, Sun CL, Wu D, Huang YY, Chi CM. [Observation on therapeutic effect of acupuncture on restless legs syndrome]. Chinese Acupuncture and Moxibustion. 2008;28(1):27. [148105]. Xie 2011
2007 Li Lixia, Wang Guoming, Wen Fengyun, et al. [Observation on the therapeutic effect of acupuncture on restless leg syndrome]. Chinese Archives of TCM. 2007;25(3):621-2. [202372] Xie 2011
2006 Dai Xiao-Yu, Li Yan , Song Qiu-Zhen, et al. Clinical observation of warm acupuncture at biguan (St 31) in treating post-apoplectic restless legs syndrome. Journal of Acupuncture and Tuina Science. 2006;4(3):174. [143376].
Dai XY, Li Y, Song QZ, AL. [Observations on the efficacy of biguan warming acupuncture for treating post-apoplectic restless legs syndrome]. Shanghai Journal of Acupuncture and Moxibustion. 2006;25(1):23. [142647].
Xie 2011, exclu de Cui 2008 (All subjects had experienced cerebrovascular diseases)
2005 Zhou W, Wang DH, Yang RK, Zhou H. [Comparison of therapeutic effects of acupoints selected along different meridians on restless legs syndrome]. Chinese Acupuncture and Moxibustion. 2005;25(9):616-8. [123916]. Acudoc2
2003 Shi Yili, Wang Yuemin. [Observation on therapeutic effect of acupuncture plus steaming-washing with chinese herbs for treatment of 40 cases of restless legs syndrome]. Chinese Acupuncture and Moxibustion. 2003;23(11):651. [122765]. Cui 2008, Xie 2011
2001 Zhang Zhiyong. [Acupuncture for 32 Cases of Restless Leg Syndrome]. Journal of Fujian College of TCM. 2001;11(2):32-3. [202369]. Xie 2011, exclu de Cui 2008 (The four essential diagnostic criteria defined by IRLSSG were only partly met).
1993 He Yan, Shao Jihong. [Observation on the therapeutic effect of acupuncture on holographic acupoints for restless leg syndrome] Journal of Ningxia Medical College. 1993;15(4):397-8. [202481] Xie 2011