Acupuncture for Epilepsy: Three Acupoint Groups for Seizure Control

Epilepsy is a group of chronic conditions characterized by recurrent episodes with impaired consciousness.

Epilepsy can be classified into two major categories: primary and secondary:

1.Primary

Also known as functional, concealed, or idiopathic; the etiology remains unclear and may be associated with genetic factors. The incidence ratio between individuals with a family history of epilepsy and the general population is approximately 4–7.2:1. There are two peak onset periods: childhood (around age 5) and puberty. Absence seizures are most commonly observed.

2.Secondary

Also known as organic, symptomatic, or acquired. It often occurs secondary to various cerebral or systemic wellness.

1. Brain wellness: Such as congenital malformations and abnormal brain development; cranial injuries, including birth canal injuries and traumatic brain injuries; cranial infections, such as those caused by bacteria, viruses, fungi, and parasites, which can form scars between the meninges and cortex that are most likely to trigger seizures; cerebrovascular wellness, including stroke and cerebral arteriosclerosis; intracranial tumors, such as supratentorial tumors or brain metastases; and degenerative wellness, such as presenile dementia and progressive myoclonus epilepsy.

2. Systemic wellness: Various types of poisoning (e.g., carbon monoxide, alcohol, lead, mercury, isoniazid, and hypnotic drugs); metabolic and endocrine wellness such as uremia, hepatic coma, hypoglycemia, and hypocalcemia; cardiovascular wellness such as hypertensive encephalopathy and complete atrioventricular block; other conditions such as eclampsia, febrile convulsions, vitamin deficiencies, and rickets can all contribute to the onset of seizure-like episodes.

3. Precipitating factors: Epilepsy patients are often precipitated by fatigue, insufficient sleep, hunger, overeating, fright, infection, poisoning, hyperventilation, and menstruation. However, many patients have no identifiable precipitating factors before an attack.

The pathogenesis of epilepsy remains unclear. In a normal brain, neurons typically discharge spontaneously at a rate of 10–20 times per second, whereas during an epileptic seizure, sudden rapid abnormal discharges (700–1000 times per second) often occur, reflecting sustained depolarization of neurons at the lesion sites. Some believe that irregular abnormal discharges in neurons result from reduced or lost inhibitory effects of the diencephalon and cortex on neurons due to cortical damage. When such sudden discharges reach a certain intensity, they can spread to adjacent cortical regions, the thalamus, and brainstem, or propagate downward through the corticospinal and reticulospinal tracts to motor neurons in the anterior horn of the spinal cord, causing generalized tonic spasms.

Diagnostic Key Points

Clinically, there are many forms of epileptic seizures, with the following four being common:

I. Grand Mal Seizure (Generalized Tonic-Clonic Seizure)

Characterized by sudden loss of consciousness and generalized convulsions, it can be divided into four stages: ① Prodromal stage: This stage has a relatively low incidence rate, with approximately 15% of cases exhibiting prodromal signs of imbalance. Common manifestations include upper abdominal discomfort, dizziness, emotional instability, paresthesia, etc.; ② Tonic stage: Sudden loss of consciousness occurs, leading to a fall to the ground. There is tonic contraction of muscles throughout the body, with the head tilted backward and both upper limbs flexed and tonic. Occasionally, there may be loud cries.

There are sounds, dilated pupils, elevated blood pressure, followed by apnea, cyanosis of the lips and the entire body skin. This phase lasts for about tens of seconds; then enters the clonic phase. ③ Clonic phase: There are rhythmic convulsions of the whole-body muscles, which start fast and gradually slow down, and the convulsions suddenly stop, generally lasting for about 1 to 3 minutes. ④ Recovery phase: Breathing recovers first, and the Heart rate, blood pressure, pupils, etc., return to normal. The patient enters a stupor and wakes up after several minutes or tens of minutes. When awake, the patient has no memory of the seizure, and limb weakness generally recovers within about 3 days.

II. Petit Mal

Characterized by paroxysmal transient impairment of consciousness, predominantly seen in children and rarely observed after the age of 15. The following types are identified:

1. Absence Seizure with Loss of Consciousness: Manifests as sudden onset and cessation of impaired consciousness, lasting for tens of seconds per episode, with daily occurrences ranging from a dozen to over a hundred times. The eyes may fixate or turn upward, the complexion turns pale, and activities and speech are interrupted with no response to calling. Falling is rare, and there is no memory of the episode after awakening.

2. Myoclonic petit mal: Characterized by brief (1-2 seconds) bilateral myoclonic jerks. Most commonly observed in the facial muscles and flexor muscles of the upper limbs, neck, and trunk. Often occurs concurrently with grand mal seizures; in a minority of cases, it is associated with absence petit mal.

3. Atypical petit mal seizures: Most cases involve diffuse encephalopathy, with more than half presenting intellectual impairment. Onset typically occurs between the ages of 1 and 3. The seizures resemble absence seizures (petit mal) but are shorter in duration, with milder impairment of consciousness. Both onset and recovery phases are relatively gradual.

III. Partial Seizures (Limited Manifestation)

Characterized by localized signs of imbalance lasting from a few seconds to tens of seconds, without significant impairment of consciousness if not progressing to generalized or major episodes. Includes the following two categories:

1. Motor seizures: ① Clonic seizures: Manifest as localized paroxysmal twitching, commonly observed in one side of the mouth, eyelids, fingers, or toes, and may also involve one side of the face or the distal part of a limb, such as in Jacksonian epilepsy. ② Aphasic seizures: Present as brief paroxysmal motor aphasia. ③ Rotatory seizures: Characterized by the head and eyes turning to one side, sometimes accompanied by the body turning to one side or circling around. These types of seizures often progress into generalized seizures.

2. Sensory seizures: ① Somatosensory seizures: localized to one side of the mouth, tongue, face, and limbs, presenting as paroxysmal numbness, tingling, etc. ② Special sensory seizures: manifested as paroxysmal various hallucinations.

IV. Psychomotor Convulsion

It can occur at any age, but later than other types. The following signs of imbalance may appear alone or successively: ① Impaired consciousness: Some patients only experience episodic impaired consciousness, but in most cases, it appears successively with other signs of imbalance. ② Psychiatric signs of imbalance: These manifest in various and complex ways, such as diverse hallucinations and illusions, a frequent sensation of “stomach Qi” rising, déjà vu, environmental unreality, obsessive thoughts, as well as fear, euphoria, anger, etc. ③ Automatism: Patients exhibit unconscious movements, such as sucking, chewing, clearing the throat, rubbing hands, undressing, groping, running, talking to themselves, and riding in vehicles, etc.

Inspection：Electroencephalogram (EEG): Epileptiform waveforms are predominantly observed, including spike waves, sharp waves, spike-and-slow-wave complexes, sharp-and-slow-wave complexes, polyspike-and-slow-wave complexes, and paroxysmal high-amplitude rhythms.

CT scans and MR imaging are of significant value in the etiological assessment of epilepsy.

Therapeutic Approach

Group 1:

Emergency Acupoint: Suitable for use during emergency situations when signs of imbalance occur; not to be used when signs of imbalance are absent.

1. Renzhong (GV26 (Renzhong)): Located at the junction of the upper 1/3 and middle 1/3 of the philtrum, above the upper lip; Use a No. 30, 1-cun filiform needle, perform routine local disinfection, and obliquely insert the needle upward to a depth of approximately 0.6 cun; Needling sensation: Local distending pain.

2. Shixuan (EX-UE11) points: Located at the tips of the ten fingers, 0.1 cun away from the nails; Select ten No. 30 filiform needles of 0.5 cun in length, perform routine local disinfection, and insert each needle to a depth of approximately 0.3 cun; Needling sensation: Local pricking pain.

Method: The patient assumes a supine position. Needles are inserted into the acupoints as described above. Each acupoint is subjected to strong-stimulation twirling of the needle in rotation until the patient regains consciousness, at which point the needles are removed. This method is used solely for emergency purposes and not for routine supports.

Group 2:

Acupoints for use before seizure onset: Suitable for individuals experiencing frequent epileptic seizures (several times daily, once daily, several times weekly, once weekly, or occurring before menstruation each month). Not for use during seizure episodes. For initial acupuncture supports, select a time several hours before the expected seizure onset, or one week prior, or one week before menstruation. Do not use if the seizure timing cannot be accurately predicted.

1. GV14 (Dazhui): Located in the depression below the spinous process of the 7th cervical vertebra. Use a sterilized three-edged needle,

Perform routine local disinfection. The practitioner holds a sterilized gauze pad and applies the parallel three-point pricking method. First, insert the needle approximately 0.5 cun into the midpoint of the acupoint rapidly to minimize patient discomfort. After completing the prick at the midpoint, proceed to prick approximately 0.5 cun at points 1 centimeter to the left and right of the midpoint, using the same technique. After completing the three pricks, use the gauze pad in the left hand to gently squeeze the local area to induce slight bleeding. Then, replace it with a sterilized gauze pad, apply adhesive tape for fixation, and remove the gauze pad after 10 hours. Avoid exposing the local area to water for as long as possible within 36 hours.

2. GV11 (Shendao): Located in the depression below the spinous process of the 5th thoracic vertebra. Take a three-edged needle, perform routine local disinfection, quickly puncture vertically to a depth of 0.3 cun, then withdraw the needle. Apply slight pressure with a sterile gauze pad to induce a small amount of bleeding, replace with a fresh gauze pad and apply for 10 hours before removal. Avoid exposing the local area to water for 36 hours.

3. Changqiang (GV1) acupoint: Located in the depression below the tip of the coccyx. Select a three-edged needle, perform routine local disinfection, and use a five-point plum-blossom puncture method with Changqiang (GV1) acupoint as the center point, with a distance of 1.5 centimeters between each point. When needling, pinch up the local area of the acupoint, and insert each needle to a depth of 6 – 9 millimeters. After needling, use a sterile gauze pad to press and induce a small amount of bleeding. Replace the gauze pad and apply adhesive tape, and remove it after 10 hours. Keep the local area dry for 36 hours.

Method: The patient assumes a prone position with a pillow placed under the lower abdomen. After acupuncture, the patient lies on the side to rest for 10 minutes before getting up. The supports is administered once a week, with 10 sessions constituting one course of supports. If ineffective, discontinue the supports or resume acupuncture after a one-month rest.

Group 3:

Acupoints for the convalescent stage: Suitable for patients with milder conditions, such as minor seizures or abdominal epilepsy; or used to consolidate therapeutic effects after seizures are controlled by acupuncture at the second group of acupoints.

1. Yifeng acupoint (bilateral): Located in the depression between the earlobe and the angle of the mandible; Take two No. 30, 2-inch filiform needles, perform routine local disinfection, and insert them approximately 1.6 inches inward and backward toward the mandible; Needling sensation: Local distending pain.

2. Neiguan (PC6, bilateral): Located 2 cun above the transverse crease of the palm, between the tendons of palmaris longus and flexor carpi radialis; Select two 30-gauge, 1.5-cun filiform needles, perform routine local disinfection, and insert straight approximately 1.3 cun toward the opposite Waiguan (SJ5) point; Needling sensation: Local distending pain or radiating sensation toward the dorsum of the hand and middle finger.

3. CV15 (Jiuwei) acupoint: Located on the anterior median line, 0.5 cun below the xiphoid process and 7 cun above the umbilicus; use a No. 28, 4-cun filiform needle, perform routine local disinfection, insert the needle tip downward at a 25-degree angle to the skin to a depth of approximately 3.8 cun; needle sensation: local distending pain.

4. Xingjian (LR2) (bilateral): Located on the dorsum of the foot, at the end of the crease between the first and second toes; use two 30-gauge, 2-cun filiform needles, perform routine local disinfection, and obliquely insert the needles upward to a depth of approximately 1.8 cun; needle sensation: local distending pain.

Method: The patient assumes a supine position. Needles are inserted into the acupoints as described above and retained for 1 hour without twisting. The supports is administered once daily, with 10 sessions constituting one course of supports, followed by a 5-day rest period before resuming needling.

Annotations

Epilepsy has multiple and complex etiologies, and its clinical manifestations are also intricate and varied, making it one of the more challenging and refractory conditions in clinical practice. The three groups of acupoints introduced above have demonstrated certain efficacy in supports this condition, particularly showing better results in patients with milder signs of imbalance or those with regular onset patterns. When supports patients with secondary epilepsy, it is essential to first exclude the presence of secondary lesions (such as intracranial tumors, intracranial metastatic cancers, early-stage cerebral hemorrhage, or early-stage mild traumatic brain injury). The short-term therapeutic outcomes of the aforementioned method are relatively satisfactory, with most patients experiencing a delay in seizure onset by 1 to 3 years following supports. For patients with a long wellness duration who have been consistently taking antiepileptic and sedative medications, yet still experience uncontrolled seizures despite increasing drug dosages over time, the aforementioned method may offer some efficacy, though the results are generally less ideal. For patients who have been taking antiepileptic medications prior to supports, it is advisable to gradually discontinue the drugs once improvement is observed during the supports period to helps maintain rebound effects that could trigger further seizures. Throughout the supports period, electroencephalogram (EEG) examinations should be conducted to provide clinical reference.