Acupuncture research
Explore research showing how acupuncture can support a wide range of health conditions.
This page shares a selected list of research showing how acupuncture can help with a wide range of health conditions. It’s not an exhaustive list, but includes studies chosen for their quality, relevance, and either their recent publication or their importance as key contributions to the field. Together, they highlight the growing body of evidence that supports acupuncture as a safe and effective part of modern healthcare.
If your condition isn’t included in the list, please feel free to contact me — I’m happy to look into the research and advise whether acupuncture may be helpful for you.
Ankle osteoarthritis
- Jiang C, Xia L, Li H, et al. Effect of electroacupuncture for early ankle osteoarthritis: A randomized controlled trial using three-dimensional gait analysis. J Back Musculoskelet. Rehabil. 2025;10538127241308216. doi: 10.1177/10538127241308216
Back Pain
Vickers, A. J., Vertosick, E. A., Lewith, G., MacPherson, H., Foster, N. E., Sherman, K. J., … & Acupuncture Trialists’ Collaboration. (2018). Acupuncture for chronic pain: update of an individual patient data meta-analysis. The Journal of Pain. May;19(5):455-474.
Cancer-related conditions
Zhang X-W, Hou W-B, Pu F-L, et al. Acupuncture for cancer-related conditions: An overview of systematic reviews. Phytomedicine 2022;106:154430. doi:10.1016/j.phymed.2022.154430
Aromatase inhibitor-related joint pain
Cancer-related insomnia
Cancer-related fatigue
Cancer-related pain
Cancer treatment-related anxiety
Cancer treatment-related constipation
Cancer treatment-related dry mouth (xerostomia)
Cancer treatment-related hot flushes
Cancer treatment-related nausea and vomiting
Cancer treatment-related (chemotherapy-induced) peripheral neuropathy
Cold hypersensitivity in hands and feet
Kwon N-Y, Yu J-S, Kim D-I, et al. Effectiveness of electroacupuncture and acupuncture in alleviating cold hypersensitivity in the hands and feet: A randomized controlled trial. PloS One. 2024;19:e0313789. doi: 10.1371/journal.pone.0313789
Constipation
Gao S, Zhu L, Yao H, et al. Effect of electroacupuncture versus prucalopride for ultra-severe chronic constipation: Secondary analysis of a randomized controlled trial. Integr Med Res. 2026;15:101253. doi: 10.1016/j.imr.2025.101253
Liu Z, Yan S, Wu J, et al. Acupuncture for Chronic Severe Functional Constipation: A Randomized Trial. Ann Intern Med 2016;165:761–9. doi:10.7326/M15-3118
Wang Y, Liu Y, Zhou K, et al. The duration of acupuncture effects and its associated factors in chronic severe functional constipation: secondary analysis of a randomized controlled trial. Ther Adv Gastroenterol. 2019;12:1756284819881859. doi: 10.1177/1756284819881859
Zeng Y, Liu Y, Liu S, et al. Initial Effects of Electroacupuncture for Chronic Severe Functional Constipation and the Potential Underlying Factors: Secondary Analysis of a Randomized Controlled Trial. Evid-Based Complement Altern Med ECAM. 2019;2019:7457219. doi: 10.1155/2019/7457219
Zhou J, Liu Y, Zhou K, et al. Electroacupuncture for Women with Chronic Severe Functional Constipation: Subgroup Analysis of a Randomized Controlled Trial. BioMed Res Int. 2019;2019:7491281. doi: 10.1155/2019/7491281
Disc herniation
Albert HB, Sayari AJ, Barajas JN, et al. The impact of novel inflammation-preserving treatment towards lumbar disc herniation resorption in symptomatic patients: a prospective, multi-imaging and clinical outcomes study. Eur Spine J. Published Online First: 15 December 2023. doi: 10.1007/s00586-023-08064-x
Shi F, Wen H, Liu Y, et al. Comparative clinical efficacy of acupuncture combined with manipulation and other non-pharmacological interventions in the treatment of lumbar disc herniation: a prospective, multi-arm, randomized, open-label, blinded endpoint trial. Front Med. 2024;11:1507115. doi: 10.3389/fmed.2024.1507115
Tang S, Mo Z, Zhang R. Acupuncture for lumbar disc herniation: a systematic review and meta-analysis. Acupunct Med. 2018;36:62–70. doi: 10.1136/acupmed-2016-011332
Fibromyalgia
Di Carlo M, Beci G, Cipolletta E, et al. Predicting acupuncture efficacy in fibromyalgia: results of a pragmatic open-label study. Clin Exp Rheumatol Published Online First: 18 May 2023. doi:10.55563/clinexprheumatol/1xr38b
Zhang XC, Chen H, Xu WT, Song YY, Gu YH, Ni GX. Acupuncture therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials. J Pain Res. 2019 Jan 30;12:527-542. doi: 10.2147/JPR.S186227. PMID: 30787631; PMCID: PMC6365227.
Headache
Fogleman C, McKenna K. Integrative Health Strategies to Manage Chronic Pain. Prim Care 2022;49:469–83. doi:10.1016/j.pop.2022.01.001
Linde, K., Allais, G., Brinkhaus, B., Fei, Y., Mehring, M., Shin, B. C., … & White, A. R. (2016). Acupuncture for the prevention of tension‐type headache. The Cochrane Library
See also
Tension headache
Migraine
Indigestion (dyspepsia)
Dickman R, Schiff E, Holland A, et al. Clinical trial: acupuncture vs. doubling the proton pump inhibitor dose in refractory heartburn. Aliment Pharmacol Ther 2007;26:1333–44. doi:10.1111/j.1365-2036.2007.03520.x
Dong S, Zhao L, Liu J, et al. Neuroanatomical organization of electroacupuncture in modulating gastric function in mice and humans. Neuron. 2025;S0896-6273(25)00504-5. doi: 10.1016/j.neuron.2025.06.023
Inflammatory bowel disease (IBD)
Chen Y, Cheng J, Zhang Y, et al. Electroacupuncture at ST36 Relieves Visceral Hypersensitivity via the NGF/TrkA/TRPV1 Peripheral Afferent Pathway in a Rodent Model of Post-Inflammation Rectal Hypersensitivity. J Inflamm Res 2021;14:325–39. doi:10.2147/JIR.S285146
Irritable bowel syndrome (IBS)
Liu S, Huang Q, Huang Q, et al. The protective effects of electroacupuncture on intestinal barrier lesions in IBS and UC model. Sci Rep 2023;13:7276. doi:10.1038/s41598-023-34182-z
Pei L, Geng H, Guo J, et al. Effect of Acupuncture in Patients With Irritable Bowel Syndrome: A Randomized Controlled Trial. Mayo Clin Proc 2020;:1–13. doi:10.1016/j.mayocp.2020.01.042
Yang J-W, Qi L-Y, Yan S-Y, et al. Efficacy of ACupuncTure in Irritable bOwel syNdrome (ACTION): a multi-centre randomized controlled trial. Gastroenterology. 2025;S0016-5085(25)00826-1. doi: 10.1053/j.gastro.2025.05.016
Zhao J, Zheng H, Wang X, et al. Efficacy of acupuncture in refractory irritable bowel syndrome patients: a randomized controlled trial. Front Med. Published Online First: 3 July 2024. doi: 10.1007/s11684-024-1073-7
Knee osteoarthritis
Corbett, M. S., Rice, S. J. C., Madurasinghe, V., Slack, R., Fayter, D. A., Harden, M., … & Woolacott, N. F. (2013). Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis. Osteoarthritis and Cartilage, 21(9), 1290-1298.
Liu C-Y, Duan Y-S, Zhou H, et al. Clinical effect and contributing factors of acupuncture for knee osteoarthritis: a systematic review and pairwise and exploratory network meta-analysis. BMJ Evid-Based Med. Published Online First: 1 November 2024. doi: 10.1136/bmjebm-2023-112626
Liu J, Li Y, Li L, et al. Effects of acupuncture at acupoints with lower versus higher pain threshold for knee osteoarthritis: a multicenter randomized controlled trial. Chin Med 2022;17:67. doi:10.1186/s13020-022-00626-3
Reinhold T, Witt CM, Jena S, et al. Quality of life and cost-effectiveness of acupuncture treatment in patients with osteoarthritis pain. Eur J Health Econ 2008;9:209–19. doi:10.1007/s10198-007-0062-5
Scharf H-P, Mansmann U, Streitberger K, et al. Acupuncture and knee osteoarthritis: a three-armed randomized trial. Ann Intern Med 2006;145:12–20. doi:10.7326/0003-4819-145-1-200607040-00005
Tu J-F, Yang J-W, Shi G-X, et al. Efficacy of Intensive Acupuncture Versus Sham Acupuncture in Knee Osteoarthritis: A Randomized Controlled Trial. Arthritis Rheumatol2021;73:448–58. doi:10.1002/art.41584
Vas J, Méndez C, Perea-Milla E, et al. Acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee: randomised controlled trial. BMJ 2004;329:1216. doi:10.1136/bmj.38238.601447.3A
Wang T-Q, Li L-R, Tan C-X, et al. Effect of Electroacupuncture on Gut Microbiota in Participants With Knee Osteoarthritis. Front Cell Infect Microbiol 2021;11:597431. doi:10.3389/fcimb.2021.597431
White A, Foster NE, Cummings M, et al. Acupuncture treatment for chronic knee pain: a systematic review. Rheumatology. 2007;46:384–90. doi: 10.1093/rheumatology/kel413
Myofascial pain syndrome
Steen JP, Jaiswal KS, Kumbhare D. Myofascial Pain Syndrome: An Update on Clinical Characteristics, Etiopathogenesis, Diagnosis, and Treatment. Muscle Nerve. Published Online First: 20 March 2025. doi: 10.1002/mus.28377
Neck pain
Chen L, Li M, Fan L, et al. Optimized acupuncture treatment (acupuncture and intradermal needling) for cervical spondylosis-related neck pain: a multicenter randomized controlled trial. Pain. 2021;162:728–39. doi: 10.1097/j.pain.0000000000002071
Li W, Liu X, Lin J, et al. Clinical Efficacy of Electroacupuncture in the Treatment of Chronic Neck Pain: A Randomized Clinical Trial. J Pain Res. 2025;18:2909–22. doi: 10.2147/JPR.S515679
Trinh K, Graham N, Irnich D, Cameron ID, Forget M. Acupuncture for neck disorders. Cochrane Database of Systematic Reviews 2016, Issue 5. Art. No.: CD004870.
Vas J, Perea-Milla E, Méndez C, et al. Efficacy and safety of acupuncture for chronic uncomplicated neck pain: a randomised controlled study. Pain 2006;126:245–55. doi:10.1016/j.pain.2006.07.002
Zhao L, Sun M, Yin Z, et al. Long-Term Effects of Individualized Acupuncture for Chronic Neck Pain : A Randomized Controlled Trial. Ann Intern Med. Published Online First: 3 September 2024. doi: 10.7326/M23-2425
Parkinson’s Disease
Hwang Y-C, Lee J, Kang D, et al. A nationwide retrospective cohort study of the association between acupuncture exposure and clinical outcomes of idiopathic Parkinson’s disease using health insurance claim data in South Korea. Integr Med Res. 2025;14:101146. doi: 10.1016/j.imr.2025.101146
Period pain
Post-operative pain
Cho Y-H, Kim C-K, Heo K-H, et al. Acupuncture for acute postoperative pain after back surgery: a systematic review and meta-analysis of randomized controlled trials. Pain Pract Off J World Inst Pain 2015;15:279–91. doi:10.1111/papr.12208
Heo I, Shin B-C, Cho J-H, et al. Multicentre randomised controlled clinical trial of electroacupuncture with usual care for patients with non-acute pain after back surgery. Br J Anaesth Published Online First: 16 December 2020. doi:10.1016/j.bja.2020.10.038
Pregnancy-related dyspepsia (indigestion)
da Silva JBG, Nakamura MU, Cordeiro JA, et al. Acupuncture for Dyspepsia in Pregnancy: A Prospective, Randomised, Controlled Study. Acupunct Med 2009;27:50–3. doi:10.1136/aim.2009.000497
Prostatitis pain
Sun Y, Liu Y, Liu B, et al. Efficacy of Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome : A Randomized Trial. Ann Intern Med: 17 August 2021. doi:10.7326/M21-1814
TMJ (temporomandibular joint) pain
Trigger points
Yehoshua I, Rimon O, Mizrahi Reuveni M, et al. Dry needling for the treatment of acute myofascial pain syndrome in general practitioners’ clinics: a cohort study. BMC Prim Care 2022;23:339. doi:10.1186/s12875-022-01951-0
Urinary tract infection (UTI) (recurrent)
Ots T, Gold D, Ziller P, et al. Segmental Acupuncture for Prevention of Recurrent Urinary Tract Infections. A Randomised Clinical Trial. Int Urogynecology J. Published Online First: 25 July 2024. doi: 10.1007/s00192-024-05872-7
Qin X, Coyle M, Yang L, et al. Acupuncture for recurrent urinary tract infection in women: a systematic review and meta‐analysis. BJOG Int J Obstet Gynaecol. 2020;1471-0528.16315. doi: 10.1111/1471-0528.16315
Aromatase inhibitor-related joint pain
- Hershman, D, Unger JM, Greenlee, H, et al. Comparison of Acupuncture vs Sham Acupuncture or Waiting List Control in the Treatment of Aromatase Inhibitor-Related Joint Pain: A Randomized Clinical Trial. JAMA Netw. Open 2022;5:e2241720. doi:10.1001/jamanetworkopen.2022.41720
- Mao JJ Ismaila, N, Bao T, et al. Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-ASCO Guideline. J Clin Oncol 2022;JCO2201357. doi:10.1200/JCO.22.01357
Bell’s palsy
Choi Y, Lee S, Yang C, et al. The Impact of Early Acupuncture on Bell’s Palsy Recurrence: Real-World Evidence from Korea. Healthcare. 2023;11:3143.
Li T, Wang S, Yin X, Zhang S, Yang Z, Wu J, Huang Z. Electroacupuncture with intermittent wave stimulation as rehabilitation approach for chronic Bell’s palsy: a randomized controlled trial. Postgrad Med J. 2024 Feb 15;100(1181):151-158. doi: 10.1093/postmj/qgad126. PMID: 38134327.
Yang L-S, Zhou D-F, Zheng S-Z, et al. Early intervention with acupuncture improves the outcome of patients with Bell’s palsy: A propensity score-matching analysis. Front Neurol 2022;13:943453. doi:10.3389/fneur.2022.943453
Chronic Pain
Fogleman C, McKenna K. Integrative Health Strategies to Manage Chronic Pain. Prim Care 2022;49:469–83. doi:10.1016/j.pop.2022.01.001
MacPherson, H., Vertosick, E. A., Foster, N. E., Lewith, G., Linde, K., Sherman, K. J., … & Vickers, A. J. (2017). The persistence of the effects of acupuncture after a course of treatment: A meta-analysis of patients with chronic pain. Pain, 158(5), 784-793.
Liao H-Y, Kumaran Satyanarayanan S, Lin Y-W, et al. Clinical Efficacy and Immune Effects of Acupuncture in Patients with Comorbid Chronic Pain and Major Depression Disorder: A Double-Blinded, Randomized Controlled Crossover Study. Brain Behav Immun2023;:S0889-1591(23)00073-9. doi:10.1016/j.bbi.2023.03.016
Pham T, Ma Q, Agiro A, et al. Do acupuncture services reduce subsequent utilization of opioids and surgical interventions compared to noninvasive therapies among patients with pain conditions? Pain Med Published Online First: 15 June 2021. doi:10.1093/pm/pnab187
Vickers, A. J., Vertosick, E. A., Lewith, G., MacPherson, H., Foster, N. E., Sherman, K. J., … & Acupuncture Trialists’ Collaboration. (2018). Acupuncture for chronic pain: update of an individual patient data meta-analysis. The Journal of Pain. May;19(5):455-474.
See also
Ankle osteoarthritis
Hip osteoarthritis
Crohn’s Disease
Bae JH, Kang SY, You SE, Jeong HI, Jang S, Kim KH. The Effects of Acupuncture on Crohn’s Disease: a systematic review and meta-analysis. J Pharmacopuncture. 2023 Sep 30;26(3):211-226. doi: 10.3831/KPI.2023.26.3.211. PMID: 37799620; PMCID: PMC10547815.
Bao C, Wang D, Liu P, et al. Effect of Electro-Acupuncture and Moxibustion on Brain Connectivity in Patients with Crohn’s Disease: A Resting-State fMRI Study. Front Hum Neurosci 2017;11:559. doi:10.3389/fnhum.2017.00559
Bao C, Wu L, Wang D, et al. Acupuncture improves the symptoms, intestinal microbiota, and inflammation of patients with mild to moderate Crohn’s disease: A randomized controlled trial. EClinicalMedicine 2022;45:101300. doi:10.1016/j.eclinm.2022.101300
Shang H-X, Wang A-Q, Bao C-H, et al. Moxibustion combined with acupuncture increases tight junction protein expression in Crohn’s disease patients. World J Gastroenterol 2015;21:4986–96. doi:10.3748/wjg.v21.i16.4986
Dry mouth (xerostomia)
Hayfever (allergic rhinitis)
Brinkhaus B, Witt CM, Jena S, et al. Acupuncture in patients with allergic rhinitis: a pragmatic randomized trial. Ann Allergy Asthma Immunol Off Publ Am Coll Allergy Asthma Immunol 2008;101:535–43. doi:10.1016/S1081-1206(10)60294-3
Gellrich D, Pfab F, Ortiz M, et al. Acupuncture and its effect on cytokine and chemokine profiles in seasonal allergic rhinitis: a preliminary three-armed, randomized, controlled trial. Eur Arch Oto-Rhino-Laryngol Off J Eur Fed Oto-Rhino-Laryngol Soc EUFOS Affil Ger Soc Oto-Rhino-Laryngol – Head Neck Surg Published Online First: 17 March 2022. doi:10.1007/s00405-022-07335-5
Taw, M. B., Reddy, W. D., Omole, F. S., & Seidman, M. D. (2015). Acupuncture and allergic rhinitis. Current Opinion in Otolaryngology & Head and Neck Surgery, 23(3), 216-220.
Witt CM, Reinhold T, Jena S, et al. Cost-effectiveness of acupuncture in women and men with allergic rhinitis: a randomized controlled study in usual care. Am J Epidemiol2009;169:562–71. doi:10.1093/aje/kwn370
Incontinence
Infertility
Gao R, Guo B, Bai J, et al. Acupuncture and clomiphene citrate for anovulatory infertility: a systematic review and meta-analysis. Acupunct Med Published Online First: 3 October 2019. doi:10.1136/acupmed-2017-011629
See also
Polycystic Ovarian Syndrome (PCOS)
Insomnia
Knee replacement (arthroplasty) pain
Huang H, Tang K, Song X, et al. Effects of contralateral versus ipsilateral electroacupuncture for analgesia and rehabilitation after unilateral total knee arthroplasty: a randomized controlled trial. Acupunct Med. 2023;9645284231211601.
Liu N, Liu G, Chang X, Xu Y, Hou Y, Zhang D, Wang L, Chen S. Combining various acupuncture therapies with multimodal analgesia to enhance postoperative pain management following total knee arthroplasty: a network meta-analysis of randomized controlled trials. Front Neurol. 2024 Mar 18;15:1361037. doi: 10.3389/fneur.2024.1361037. PMID: 38562427; PMCID: PMC10984270.
Low back pain
DeBar LL, Wellman RD, Justice M, et al. Acupuncture for Chronic Low Back Pain in Older Adults: A Randomized Clinical Trial. JAMA Netw Open. 2025;8:e2531348. doi: 10.1001/jamanetworkopen.2025.31348
Fuentes RC, Organ B, Creech J, et al. Acupuncture for low back pain. Can Fam Physician | Le Médecin Fam Can 2020;66:186–7.
Haake M, Müller H-H, Schade-Brittinger C, et al. German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups. Arch Intern Med 2007;167:1892–8. doi:10.1001/archinte.167.17.1892
Harwood KJ, Pines JM, Andrilla CHA, et al. Where to start? A two stage residual inclusion approach to estimating influence of the initial provider on health care utilization and costs for low back pain in the US. BMC Health Serv Res 2022;22:694. doi:10.1186/s12913-022-08092-1
Liu, L., Skinner, M., McDonough, S., Mabire, L., & Baxter, G. D. (2015). Acupuncture for low back pain: an overview of systematic reviews.Evidence-Based Complementary and Alternative Medicine.
Menopause
Perimenopause
Mental health
Lu M, Sharmin S, Tao Y, et al. Effectiveness of acupuncture in treating patients with pain and mental health concerns: the results of the Alberta Complementary Health Integration Project. Front Neurol. 2024;15:1366685. doi: 10.3389/fneur.2024.1366685
Nausea and vomiting (postoperative)
Lee A, Zhang JZ, Xie J, et al. Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting: a network meta-analysis. Cochrane Database Syst Rev. 2025;9:CD003281. doi: 10.1002/14651858.CD003281.pub5
Overactive bladder
Forde, J. C., Jaffe, E., Stone, B. V., Te, A. E., Espinosa, G., & Chughtai, B. (2016). The role of acupuncture in managing overactive bladder; a review of the literature. International Urogynecology Journal, 27(11), 1645-1651.
Huang J, Fan Y, Zhao K, et al. Comparative Efficacy of Neuromodulation Technologies for Overactive Bladder in Adults: A Network Meta-Analysis of Randomized Controlled Trials. Neuromodulation. 2023;26:1535–48. doi: 10.1016/j.neurom.2022.06.004
Lv T, Fang W, Si J, et al. Effectiveness of simultaneous electroacupuncture stimulation on the tibial and ilioinguinal-iliohypogastric nerves in the treatment of refractory overactive bladder syndrome in women. Curr Urol. 2025;19:110–6. doi: 10.1097/CU9.0000000000000266
Sonmez R, Yildiz N, Alkan H. Efficacy of percutaneous and transcutaneous tibial nerve stimulation in women with idiopathic overactive bladder: A prospective randomised controlled trial. Ann Phys Rehabil Med. 2022;65:101486. doi: 10.1016/j.rehab.2021.101486
Peripheral neuropathy
Dimitrova, A., Murchison, C., & Oken, B. (2017). Acupuncture for the Treatment of Peripheral Neuropathy: A Systematic Review and Meta-Analysis. The Journal of Alternative and Complementary Medicine, 23(3), 164-179.
Post-stroke dysphagia
Ma Y, Guo H, Geng L, et al. Effect of quick acupuncture combined with rehabilitation therapy on improving motor and swallowing function in patients with stroke. Clin Rehabil. 2024;2692155241228694.
Xu F, Zhang Y, Su X, et al. Effects of Acupuncture Combined with Conventional Rehabilitation Training for Patients with Post-Stroke Dysphagia: A Randomized Controlled Trial. J Multidiscip Healthc. 2025;18:3139–52. doi: 10.2147/JMDH.S526827
Zhang W, Jin H-T, Wang F, et al. A randomized controlled study investigating the efficacy of electro-acupuncture and exercise-based swallowing rehabilitation for post-stroke dysphagia: Impacts on brainstem auditory evoked potentials and cerebral blood flow. Medicine (Baltimore). 2024;103:e37464.
Prostate cancer-related nocturia
Liou KT, Carlsson S, Ajay D, et al. Acupuncture for Nocturia in Survivors of Prostate Cancer: The NOCTURNAL Randomized Clinical Trial. JAMA Oncol. Published Online First: 29 May 2025. doi: 10.1001/jamaoncol.2025.1199
Shoulder pain
Cox, J., Varatharajan, S., Côté, P., & Optima Collaboration. (2016). Effectiveness of Acupuncture Therapies to Manage Musculoskeletal Disorders of the Extremities: A Systematic Review. Journal of Orthopaedic and Sports Physical Therapy, 46(6), 409-429.
Vas J, Ortega C, Olmo V, et al. Single-point acupuncture and physiotherapy for the treatment of painful shoulder: a multicentre randomized controlled trial. Rheumatology2008;47:887–93. doi:10.1093/rheumatology/ken040Tendinopathy
Rotator cuff problems
Trigeminal neuralgia
Li R, Sun J, Luo K, et al. Electroacupuncture and carbamazepine for patients with trigeminal neuralgia: a randomized, controlled, 2 × 2 factorial trial. J Neurol. Published Online First: 31 May 2024. doi: 10.1007/s00415-024-12433-x