Novel efficacy evidence and mechanistic explorations of motion-style scalp acupuncture in post-stroke muscle spasticity management: Systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE

Motion-style scalp acupuncture (MSSA), integrating concurrent scalp acupuncture (SA) and motor rehabilitation (MR), has emerged as a promising intervention for post-stroke spasticity (PSS). This systematic review and meta-analysis was designed to evaluate its efficacy, safety, and potential antispastic mechanisms.

METHODS

Adhering to PRISMA guidelines, we systematically searched eight databases for relevant RCTs up to August 2025. The primary outcome was spasticity severity (modified Ashworth scale). Risk of bias were assessed using Cochrane RoB 2.0. Meta-analyses were performed using Stata, RevMan, and R software.

RESULTS

Nineteen RCTs (n = 1648 participants) were included. Meta-analysis revealed that MSSA significantly reduced spasticity versus standalone SA/MR (95 % CI [-0.71, -0.47]), with concurrent improvements in motor function [0.54, 1.05], balance function [6.17, 12.35], and activities of daily living [0.85, 1.68]. Furthermore, MSSA was superior to sequential SA + MR for motor function recovery [0.48, 1.0] and daily living improvement [0.30, 0.90], underscoring the significance of concurrent application. Subgroup analysis preliminarily identified 30-minute needle retention [-1.55, -0.81] and 24-week duration [-1.55, -0.81] as potential determinants of optimal anti-spasticity outcomes. Mechanistic synthesis suggests MSSA may alleviate spasticity through enhanced cerebral perfusion, suppressed neuroinflammatory responses, and reduced spinal hyperexcitability, thereby promoting motor coordination.

CONCLUSIONS

MSSA demonstrates superior efficacy in improving PSS and associated motor dysfunction compared to standard therapies, with a favorable safety profile. Future high-quality RCTs are needed to confirm long-term benefits. The employment of advanced assessments (e.g., fMRI-based functional brain connectivity, muscle ultrasound) illuminates MSSA's antispastic mechanisms across central-peripheral perspectives, furnishing robust evidence for protocol optimization.