Observation on therapeutic effect of half puncture plus transcutaneous acupoint electric stimulation for infantile facial paralysis

Yang Hang (杨杭)

Heilongjiang University of Chinese Medicine, Harbin 150040, China

Observation on therapeutic effect of half puncture plus transcutaneous acupoint electric stimulation for infantile facial paralysis

Yang Hang (杨杭)

Heilongjiang University of Chinese Medicine, Harbin 150040, China

Objective:To observe the clinical effects of half puncture plus transcutaneous acupoint electric stimulation in the treatment of infantile facial paralysis.

Acupuncture Therapy; Acupoint Therapy; Transcutaneous Electric Nerve Stimulation; Facial Paralysis; Child

Peripheral facial paralysis is a common clinical disease. Its etiology and pathogenesis are still unknown in modern medicine. It is termed ‘deviation of mouth and eye’ in traditional Chinese medicine (TCM). The children are of ‘immature yin and immature yang’, and weak in anti-pathogenic ability, hence easy to develop this condition. The routine acupuncture therapy is very satisfactory in the therapeutic effects for infantile facial paralysis. But, children are afraid of the needles and poor in obedience, which will influence the clinical effect. Therefore, I treated infantile peripheral facial paralysis by half puncture plus transcutaneous acupoint electric stimulation and observed its effect.

1 Clinical Materials

1.1 Diagnostic criteria

All the patients were in conformity with the diagnostic criteria of peripheral facial paralysis[1]: sudden disappearance of frontal crease on one side of the face, incomplete closure of the palpebral fissure, flat nasolabial groove, deviation of the mouth in smiling and showing the teeth.

1.2 Inclusion criteria

In conformity with the above diagnostic criteria; age ranged between 0 and 14 years old; without cardiac, cerebral, renal and other serious internal diseases; and with grade II-IV scores of the nerve functions by House-Brackmann (H-B); the guardians of the patientswere willing to participate in this study and signed the informed consent.

1.3 Exclusion criteria

Those with central facial paralysis caused by other diseases; those allergic to the electrode film or direct current; those with acute suppurative inflammation or bleeding tendency; those implanted with cardiac pacemaker.

1.4 Statistical methods

All the data were processed by SPSS 17.0 version statistical software. The measurement data were processed by pairedt-test in the comparison within the group. The groupt-test was used in the comparison between the two groups after treatment. The grading data were processed by non-parametric rank sum test.

1.5 General data

All the patients came from the Acupuncture Outpatient or Inpatient of the Second Hospital Affiliated to Heilongjiang University of Chinese Medicine. By the central randomization, the random digit table was yielded by computer to divide 60 cases into a treatment group and a control group. In 30 cases of the treatment group, the age ranged from 12 months to 10 years old, and the duration ranged from 5 d to 30 d. In 30 cases of the control group, the age ranged from 2 years old to 7 years old, and the duration ranged from 4 d to 30 d. By statistical management, the general information of gender, age and duration was statistically insignificant between the two groups (P＞0.05), indicating that the two groups were comparable.

Table 1. Comparison of general data between the two groups

2 Therapeutic Methods

2.1 Treatment group

2.1.1 Transcutaneous acupoint electric stimulation

Acupoints: Yangbai (GB 14), Sizhukong (TE 23), Quanliao (SI 18), Sibai (ST 2), Dicang (ST 4), Jiache (ST 6), Qianzheng (Extra, 0.5-1.0 cun in front of the ear lobe) and Yifeng (TE 17) on the affected side.

Method: After the skin of the acupoints was routinely disinfected, the square electrode films in side length of 10-15 mm were selected and glued on the above eight acupoints of the affected side, and then the negative electrodes and positive electrodes wires from KWD-808-I low frequency pulse acupuncture apparatus (Great Wall Brand) were respectively linked with Sizhukong (TE 23) and Yangbai (GB 14), Quanliao (SI 18) and Sibai (ST 2), Jiache (ST 6) and Dicang (ST 4), Yifeng (TE 17) and Qianzheng (Extra). The frequency was 50 Hz and the wave form was intermittent wave. The intensity of stimulation was within the patient’s tolerance. It would be the best if muscular uplifting action appeared in the face. This method was given 30 min before half puncture.

2.1.2 Half puncture treatment

Half puncture treatment was given 30 min after the transcutaneous acupoint electric stimulation.

Acupoints: Cuanzhu (BL 2), Yangbai (GB 14), Sizhukong (TE 23), Sibai (ST 2), Quanliao (SI 18), Yingxiang (LI 20), Jiache (ST 6), Dicang (ST 4), Qianzheng (Extra), Yifeng (TE 17) on the affected side, and Hegu (LI 4) on the normal side[2].

Operation: After the head of the sick child was held by the parents, the above acupoints were selected. After routine disinfection, disposable sterile filiform needles were inserted quickly by half puncture, for 0.5-1.0 cun, without manipulating and retaining, and without pressing the hole after needle withdrawal. Yifeng (TE 17) and Qianzheng (Extra) were manipulated in small amplitude by lifting-thrusting and twisting.

The treatment lasted for 30 min, twice per day (4 hour-interval between the two sessions). Totally 20 sessions (10 d) constituted one course, and 6 courses were given. Additionally, the parents were asked to apply wet warm compress on the affected side, behind the ear in particular, at proper temperature and humidity, and to massage the face of the affected side properly.

2.2 Control group

The children in the control group were punctured by routine manual techniques. The needles and acupoints were as same as those for the treatment group. The needles were retained for 20 min. The treatment was given twice per day, and 20 sessions (10 d) constituted one course. Totally, 6 courses were given.

3 Therapeutic Effects

3.1 Observed measurements

The scores were assessed by the grading criteria of H-B for facial paralysis[3].

Grade Ⅰ: Normal symmetrical function of the facial movement (100 points).

Grade Ⅱ: Mild dysfunction (slight weakness, symmetrical two sides and muscular tension at rest) (76-99 points).

Grade Ⅲ: Moderate dysfunction (obvious but not disfiguring weakness and synkinesis, symmetrical muscular tension), complete eye closure by efforts, and good forehead movement (52-75 points).

Grade Ⅳ: Moderate or severe dysfunction (obvious and disfiguring asymmetry, significant synkinesis), incomplete eye closure, decreased forehead movement.

Grade Ⅴ: Severe dysfunction (barely perceptible motion).

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Grade Ⅵ: Total paralysis (no facial movement).

The patients in the two groups were respectively scored before treatment and after 6-course treatment.

3.2 Criteria of therapeutic effects[4]

Basic cure: After treatment, H-B grade reached to gradeⅠ, or the score was elevated by ＞50 points.

Remarkable effect: H-B grade reached to grade Ⅱ, or the scores were elevated by ＞25 points, but ≤50 points.

Effect: H-B grade reached grade Ⅲ, or the score was elevated by ＞10 points, but ≤25 points.

Failure: After treatment, the symptoms were not alleviated, and H-B grade was still IV-VI, or the score was elevated by ＜10 points.

3.3 Therapeutic results

3.3.1 Comparison of H-B scores between the two groups

The comparison of H-B scores before and after treatment between the two groups were not statistically significant (P＞ 0.05). After 6-course treatments, H-B scores were obviously elevated than those before treatment in the two groups (P＜0.05), and the difference between the two groups was statistically significant (P＜0.05), indicating that the patients’ situations were improved more significantly in the treatment group than those in the control group (Table 2).

Table 2. Comparison of H-B scores before and after treatment

3.3.2 Comparison of total effective rates between the two groups

After 6-course treatments, the total effective rate was 96.5% in the treatment group versus 80.0% in the control group. There was a statistically significant difference in the total effective rate between the two groups (P＜0.05), indicating that the curative effect was better in the treatment group than that in the control group (Table 3).

Table 3. Comparison of total effective rates between the two groups (case)

4 Discussion

It is believed in TCM that the pathogenesis of facial paralysis is insufficient healthy qi, deficient meridian qi, plus invasion of exogenous pathogens into Yangming and Shaoyang Meridians, leading to obstruction of qi and blood in the facial region, and malnutrition of the meridians, and hence disorder and flaccidity of the facial muscles. Therefore, Sibai (ST 2) and Yifeng (TE 17) are mostly selected from Yangming and Shaoyang meridians in acupuncture. Acupuncture has the effects to dredge qi and blood of the meridians, regulate Zang-fu organs, strengthen the healthy qi to eliminate pathogenic factors, and is effective for facial paralysis caused by obstruction of qi and blood in the meridians[5-6]. The needling techniques are very important for therapeutic effects[7].

Half puncture belongs to the five puncturing techniques in Ling Shu (Spiritual Pivot)[8], and is characterized by quick insertion and quick withdrawal, inserting into the shallow region, like pulling out a soft hair, without damaging the muscles. It is also termed ’quick puncture’, and the practitioners are requested to be nimble in the manual techniques. Zang-fu organs are weak in the sick children, but the functions of Zang-fu organs are pure and precise, so the sick children are easy to recover[9]. Moreover, half puncture is in correspondence to the lung. The children are mostly deficient in the lung qi and easy to be susceptible to the exogenous pathogens. Therefore, half puncture is an effective needling technique for infantile peripheral facial paralysis[10]. It has been proven in acupuncture clinic that half puncture is most appropriate for the children in terms of the intensity of stimulation and also easy to operate[11].

Children are young in age and poor in obedience. Painful sensation of acupuncture and local sore and distension sensation induced by acupuncture are not beneficial to the persistent treatment of children, impacting their recovery[12]. Transcutaneous acupoint electric stimulation greatly reduces the painful sensation of the sick children during the treatment, andcan promote the restoration of the facial nerve functions, and shorten the course. Low frequency pulse current below 1 000 Hz can excite the muscular and nervous tissues, inhibit the muscular fibrosis, prevent muscular spasm and effectively promote blood circulation and absorption of exudates[13]. In this study, 50 Hz direct current intermittent wave was selected to function on human body for producing the physiological effect, physical effect and chemical effect[14], and can effectively induce the muscular contraction and tremor, prevent muscular fatigue, and has better therapeutic effect. Moreover, it has been proven clinically that low frequency electric stimulation is safe and reliable[15].

It has been shown in the results of this study that half puncture plus transcutaneous acupoint electric stimulation is better than ordinary acupuncture in the therapeutic effect for children with facial paralysis and needs to be clinically popularized.

Conflict of Interest

The authors declared that there was no conflict of interest in this article.

Statement of Informed Consent

All of the children’s guardians in the study signed the informed consent.

Received: 5 December 2014/Accepted: 10 January 2015

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[2] Wang QC. Acupuncture and Moxibustion Therapeutics. 2nd Edition. Beijing: China Press of Traditional Chinese Medicine, 2003: 70.

[3] Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery, Academic Board of Chinese otorhinolaryngology Society of Chinese Medical Association. Facial nerve grading system (draft). Zhonghua Er Bi Yanhou Tou Jing Waike Zazhi, 2006, 41(1): 22-24.

[4] Sun CX. Clinical Diagnostic Basis and Criteria for Cure and Improvement of Disease. 2nd Edition. Beijing: People’s Military Medicine Press, 1999: 198.

[5] Li SP, Huo GM, Li JD, Sun D. Therapeutic effect analysis on combined acupuncture and medication for peripheral facial paralysis. J Acupunct Tuina Sci, 2011, 9(3): 185-187.

[6]Liu YZ. Clinical observations of mind-regulating acupuncture in treating 100 cases of peripheral facial paralysis. J Acupunct Tuina Sci, 2007, 5(5): 307-310.

[7] Niu MM, Zou W. Children facial neuritis treated by shallow needling. Zhenjiu Linchuang Zazhi, 2002, 28(11): 43-45.

[8] Guo AC. Annotation and Translation of Spiritual Pivot of Yellow Emperor’s Inner Canon. Tianjin: Tianjin Science and Technology Publishers, 1989: 78.

[9] Wang SC. Pediatrics of Chinese Medicine. 2nd Edition. Beijing: China Press of Traditional Chinese Medicine, 2007: 16.

[10]Geng W, Lü ZH, Lü N. Treatment of 60 cases of infantile facial paralysis by half puncture. Shaanxi Zhongyi, 2007, 28(1): 92-93.

[11]Tang T, Wang JL, Gao JX. Observation on therapeutic effects of half puncture plus cupping method in treatment of 20 cases with insomnia. Shanghai Zhenjiu Zazhi, 2006, 25(11): 10-11.

[12]Wang DY, Zhao HJ, Dong X, Zhang R, He PY. Treatment of 20 cases of infantile facial paralysis by transcutaneous acupoint electric stimulation. Shanghai Zhenjiu Zazhi, 2014, 33(10): 946.

[13]Wang DY, Wang YL, Xing JJ, Wang B. Study on acupuncture combined with transcutaneous acupoint electrical stimulation in treating facial paralysis. Shanghai Zhenjiu Zazhi, 2011, 30(7): 455-457.

[14]Yuan GX. Study and application on human body effect of low frequency current. Wuhan: Master Thesis of Central China Normal University, 2006.

[15]Ni JX. Preliminary exploration on collateral puncture, warm middle and low frequency for chronic pharyngitis. Zhongyi Erbihou Kexue Yanjiu Zazhi, 2010, 9(1): 12-13.

Translator: Huang Guo-qi (黄国琪)

半刺配合经皮穴位电刺激治疗小儿面瘫疗效观察

目的：观察半刺法配合经皮穴位电刺激治疗小儿周围性面瘫的临床疗效, 探索治疗小儿周围性面瘫的新方法。方法：将60例小儿周围性面瘫患者根据随机数字表分为治疗组和对照组, 每组30例。治疗组采用半刺法配合经皮穴位电刺激治疗, 对照组采用常规针刺。治疗前后分别采用House-Brackmann (H-B)分级法对患儿进行评分，并比较两组临床总有效率。结果：治疗6个周期后, 治疗组总有效率96.5%, 对照组总有效率为80.0%, 两组比较差异具有统计学意义(P＜0.05)。治疗6个周期后, 两组H-B评分均较治疗前明显升高(P＜0.05), 两组间差异亦有统计学意义(P＜0.05)。结论：半刺法结合经皮穴位电刺激治疗小儿面瘫疗效优于常规针刺。

针刺疗法; 穴位疗法; 经皮神经电刺激; 面瘫; 儿童

R246.6 【

】A

Author: Yang Hang, 2013 master degree candidate.

E-mail: yanghangchangzhou@126.com

Methods:A total of 60 patients with infantile facial paralysis were divided into a treatment group and a control group by the random digital table, 30 cases in each group. The treatment group was treated with half puncture plus transcutaneous acupoint electric stimulation. The control group was treated with routine acupuncture. Before and after treatment, House-Brackmann (H-B) grading was used to evaluate the sick children respectively. The total effective rates were compared between the two groups after treatment.

Results:After 6-course treatments, the total effective rate was 96.5% in the treatment group and 80.0% in the control group, there was a statistical difference between the two groups (P＜0.05) in comparison of the total effective rate. After 6-course treatments, H-B scores were all elevated than those before treatment in the two groups (P＜0.05); there was a statistical difference between the two groups (P＜0.05).

Conclusion:Half puncture plus transcutaneous acupoint electric stimulation is better than routine acupuncture in curative effect for infantile facial paralysis.