Ask the MAB- Samuel Zinner, M.D.

Samuel Winner, M.D. is an Assistant Professor of Pediatrics at the University of Washington School of Medicine in Seattle, Washington and a member of the TAA Medical Advisory Board.

Q: There are reports that acupuncture has worked for a number of human disorders. Is it an effective therapy for Tourette Syndrome?

A: So far, there has been very little research looking at acupuncture in the treatment of tics in Tourette syndrome. Of the few available published studies, most have been published in Chinese (Dr. Zinner completed an extensive search using several online catalog databases, identifying 8 studies in total, only one of which was published in English). However, most of these studies do provide an English abstract that briefly describes the respective study and findings. All published abstracts reported a successful outcome using acupuncture, although the target outcomes were not always clearly defined.

Acupuncture is an ancient treatment that began in China and has extended across the world. The word “acu-puncture” means to pierce using a needle, although there are several different varieties of acupuncture. Its aim is to stimulate very precise points along the body through which practitioners believe important energies flow. Acupuncturists believe that imbalances in these energies result in illness, loss of well-being, or other undesirable effects, and the acupuncture treatment is directed to restore the balance in energy.

As noted in a 2003 published review by the World Health Organization (WHO), it is very difficult to evaluate acupuncture practice when relying on the usual accepted research measures. The WHO suggests that a practical way to design research using acupuncture is to compare this treatment with a conventional treatment. This is an important step to ensure that “gold standard” good-quality research is performed. Usual “gold standard” measures are built into research in an effort to make sure that research results can be believed. Importantly, not all published research follows such methods.

“Gold standard” high-quality research using acupuncture has been conducted for a variety of conditions and ailments. Acupuncture is now very popular across the world to treat, maintain or prevent a wide range of health issues. Overviews of high-quality research have found acupuncture to be effective for the treatment and prevention of some types of pain and nausea. However, most diseases, symptoms or conditions that have been tested using acupuncture have yet to be proved. Because available high-quality research that examines acupuncture for Tourette syndrome is so limited, it’s not yet possible to determine whether acupuncture may be an effective therapy for Tourette syndrome.

It’s very difficult to design gold standard research many reasons, but it’s necessary to do so if we are to believe research results. But it’s not enough to perform research in gold standard ways. Researchers must also clearly describe their approach so that anyone who reads their published research can understand how the research was performed and how the researchers came to their conclusion. Indeed, in the one available acupuncture-Tourette syndrome study published in English, the researchers provide no description of how their research participants were diagnosed or selected to participate, if there was a comparison group who did not undergo the treatment or who underwent another treatment, the duration of treatment for each participant, or which and how symptoms were being measured. The report includes only one reference citation. The study reports nearly a 90% success rate. Based on the remarkable limitations discovered in reviewing the article, it is impossible to determine whether this study was designed and carried out using high-quality research approaches, and therefore the reader can not come to a meaningful understanding of the reported results.

To help to address this and related limitations, a planned research review was reported by scientists in China in 2009 who aim to look at published and future research that explores acupuncture use in Tourette syndrome. The protocol is available online at the Cochrane Library. The reviewers report that they will look only at studies that are of good quality, and that use any form of acupuncture therapy if compared with non-acupuncture treatments (e.g., no intervention, sham acupuncture, western medicine, herbal medicine, or psychological treatment, among other possible comparisons). The reviewers plan to focus on clearly defined research outcome measures, such as tic severity using accepted tic-measurement scales, and they will search several databases across the world and in all published languages. Last, the researchers plan to contact authors of unpublished and ongoing studies so that all good-quality research available is considered. To date, these investigators have not published any findings.

More information about acupuncture is available through the National Institutes of Health.

Q: Many people with TS have reported that exercise and other physical activities have reduced their tics. Are there studies that support this and how does it work?

A: The benefits of aerobic exercise are increasingly apparent in medicine, emotional health and wellbeing, and preventive health. There are many anecdotal reports of tic reduction benefits (and even some of tic worsening) resulting from exercise, but there are no published scientific studies examining exercise and impact on tics to determine “if” it works, much less “how”. There have been several research studies looking at exercise among people with other developmental and behavioral challenges, such as with reading disabilities or attention deficit disorders. Results about possible benefits are not clear. The website for the TAA provides a useful discussion entitled “Exercise, Sports and Tourette Syndrome.”

As a precaution, this and any related information should not be taken as medical advice. Anyone considering beginning an exercise program should consult with a qualified professional. Also, consider combining play and exercise into the family or individual lifestyle.