Efficacy and safety of acupuncture combined with herbal medicine for children and adolescents with Tourette syndrome: A Systematic Review and Meta-Analysis

Background: With the increasing prevalence of Tourette syndrome (TS), the search for alternative therapy for TS is a growing public concern. In recent years, a growing number of randomized controlled trials have revealed the value of acupuncture combined with herbal medicine for the treatment of TS; however, its holistic efficacy and safety remains unclear. This study aimed to evaluate the efficacy and safety of acupuncture combined with herbal medicine and to provide preliminary evidence for clinical practice. Methods: Eight databases were searched from their establishment to November 27, 2022 to collect randomized controlled trials (RCTs) of acupuncture combined with herbal medicine for TS treatment. Two researchers independently completed the study screening, data extraction and risk of bias assessment by using NoteExpress, Excel and Cochrane Risk of Bias Tool 2.0 (RoB 2.0). Stata 15.0 software was applied to conduct meta-analysis. Results: A total of 1400 participants in 18 RCTs were included. Compared with the Western medicine (WM) , acupuncture combined with herbal medicine had better curative effect in the field of effective rate (RR = 1.18, 95% CI [1.12, 1.23], P < 0.05, I-2= 0%), Yale Global Tic Severity Scale (YGTSS) total score (MD = -3.91, 95% CI [-5.49, -2.33], P < 0.05, I-2 = 96.4%), TCM syndrome total score (MD = -2.42, 95% CI [-3.71,-1.13], P < 0.05, I-2 = 87.1%) and serum IgE negative rate (RR = 3.41, 95% CI [1.69, 6.87], P < 0.05, I-2 = 0%). Furthermore, acupuncture combined with herbal medicine reduced the adverse reaction rate (RR = 0.20, 95% CI [0.14,0.30], P < 0.05, I-2 = 0%) and the recurrence rate (RR = 0.27, 95% CI [0.13,0.52], P < 0.05, I-2 = 0%). Conclusion: This study demonstrated the efficacy and safety of acupuncture combined with herbal medicine, which is probably a better alternative therapy for TS. However, the small number, low quality and potential bias of the included studies caused the limitations of our results. More high-quality RCTs are required to provide supplementary evidence in the future.