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Motor task activation map. Stroke patients and healthy subjects revealed significant higher activations in a series of brain regions following left hand motor task. Results from two-tailed, p < 0.05, corrected by Monte Carlo Simulations, iterated 1000 times, and cluster size >94 voxels.
Source publication
Increasing neuroimaging researches in stroke rehabilitation had revealed the neural mechanisms of rehabilitation therapy. However, little was known about the neural mechanisms of acupuncture therapy in subcortical stroke patients. The aim of this study was to investigate the changes of functional connectivity (FC) between the bilateral primary moto...
Similar publications
A number of studies have suggested that motor imagery training (MIT) has a positive influence on the upper extremity motor recovery in stroke patients, but little is known about its neural basis. To investigate the cortical motor network plasticity after MIT, 34 chronic hemiplegic subjects with subcortical stroke were recruited and randomly allocat...
Citations
... Past studies of cerebral mechanisms in patients with cerebral infarction, were focused on single acupoint such as Zusanli (ST36) and Yanglingquan (GB34). Zou et al. (22)(23)(24) studied GB34 and found that this acupoint can activate multiple sensory and motor imagery areas in patients. The FC between bilateral M1 was decreased in patients with cerebral infarction and increased after acupuncture on GB34. ...
Introduction
Limb motor dysfunction is one of the challenges in rehabilitation after cerebral ischemic stroke (CIS) and greatly affects the quality of life of patients. This study aims to investigate the central mechanisms of the curative effect with multimodal magnetic resonance imaging (MRI), which will provide additional evidence to support the application of Xingnao Kaiqiao (XNKQ) acupuncture.
Methods and analysis
This trial is a randomized controlled trial. Patients who meet the criteria will be recruited and randomly divided into 2 groups. One group will receive acupuncture treatment and another group will not receive acupuncture treatment. Both groups will receive conventional treatment. In addition, 20 healthy individuals will be recruited who will not receive any treatment. The total course of treatment is 14 days. The primary outcome is multimodal MRI analysis. For safety assessment, adverse events will be observed and recorded.
Ethics and dissemination
The study involving human subjects was reviewed and approved by the Ethics Committee of IRB of The First Teaching Hospital of Tianjin University of TCM (TYLL2023[K]031). This study complied with the Declaration of Helsinki. Written informed consent about this study was provided by the participants. The results of this study will be published in a peer-reviewed journal.
Clinical trial registration
Chinese Clinical Trial Registration Center (ChiCTR2300078315) https://www.chictr.org.cn/.
... Wu et al [47] found through research that acupuncture at acupoints can cause changes in the BOLD signal in the relevant areas of the brain indicating that the local cerebral blood flow has changed that is, the local brain function has changed. It has been reported that acupuncture GB34 can enhance the FC decline between bilateral M1 in right hemisphere subcortical stroke patients, which may reflect the neural plasticity mechanism of acupuncture treatment of stroke in the brain center [48]. Acupuncture can improve the clinical manifestations of ischemic stroke, promote recovery from the disease, rebuild neuroplasticity of brain function under the mechanism of damaged brain function, and enhance the recovery of neurological function. ...
Background
The probability of motor deficits after stroke is relatively high. At the same time many studies have reported that acupuncture and rehabilitation therapy have a significant effect on the treatment of stroke.
Objective
This systematic review and meta-analysis aimed to evaluate the clinical value of acupuncture and rehabilitation therapy on brain eloquent areas and neurological function in ischemic stroke.
Methods
Seven databases were electronically searched to screen randomized controlled trials (RCTs) of different intervention methods (acupuncture, rehabilitation) in the treatment of ischemic stroke. The search time is from January 1, 2000 to April 20, 2023, and the search languages are limited to Chinese and English. Two researchers independently screened literature and extracted data. The methodological quality of the studies was assessed using the Cochrane Handbook for Systematic Reviews of Interventions.
Results
A total of 17 randomized controlled studies were included, including 699 patients, with a maximum sample size of 144 cases and a minimum sample size of 11 cases. Among them, 3 studies reported the brain function in SM1 area. The effective rate of the experimental group was higher than that of the control group [relative risk (OR) = 3.24, 95%CI: 1.49 to 7.05, P < 0.05]. The FMA score of patients in the experimental group was higher than that in the control group [mean difference (MD) = 4.79, 95% CI: 3.86 to 5.71, P < 0.00001]. The NIHSS score of patients in the experimental group was lower than that in the control group [mean difference (MD) = -4.12, 95% CI: -6.99 to -1.26, P < 0.05].None of studies reported adverse events.
Conclusions
Acupuncture rehabilitation for ischemic stroke can activate corresponding brain functional areas and improve neurological deficits. The therapeutic effect of acupuncture rehabilitation treatment is better than that of basic western medicine treatment, and it is more effective in improving neurological deficits. At the same time, clinical research needs to use high-quality randomized double-blind controlled trials with more detailed and larger sample designs, long-term efficacy evaluation and evidence-based research methods.
... Resting-State fMRI before and after acupuncture in stroke patients was found to increase the intrinsically reduced functional connectivity between bilateral primary motor cortices. Thus, further understanding the neuroplasticity mechanism of acupuncture on motor function recovery in stroke is crucial [44]. ...
Acupuncture has been widely used in stroke and post-stroke rehabilitation (PSR), but there is no literature on the bibliometric analysis of acupuncture for stroke. This study aimed to characterize the global publications and analyze the trends of acupuncture for stroke in the past 40 years. We identified 1157 publications from the Web of Science Core Collection. The number of publications grew slowly in the first three decades from 1980 until it started to grow after 2010, with significant growth in 2011–2012 and 2019–2020. China, the USA, and South Korea are the top three countries in this field, and China has formed good internal cooperative relations. Early studies focused on the clinical efficacy of acupuncture for stroke. In the last five years, more emphasis has been placed on the effectiveness of acupuncture in treating sequelae and complications, combined with neuroimaging studies to explore the mechanisms of brain injury repair and neurological recovery. Acupuncture for stroke has a vast research potential, and researchers from different countries/regions and organizations still need to remove academic barriers to enhance communication and collaboration.
Supplementary Information
The online version contains supplementary material available at 10.1186/s40001-023-01253-w.
... 21,22 Previous studies showed that needling Yanglingquan (GB34) could improve the vasodilatory potential of the cerebral vasculature, 23 and for stroke patients it could also increase motor-cognition connectivity and enhance the functional connectivity between motor cortices. 24,25 So Yanglingquan (GB34) was chosen as the stimulation acupoint in this study. Based on this, we applied laser speckle imaging (LSI) to monitor dynamic CBF in the infarct region in poststroke SP rats. ...
Objective:
To evaluate the therapeutic efficacy and the influence on cerebral blood supply of waggle needling Yanglingquan (GB34) on spastic paresis (SP) rats after middle cerebral artery occlusion (MCAO) induced and investigate its mechanism of relieving neurobehavior deficiency.
Methods:
SP rat model was produced by permanent MCAO. Rats were divided into five groups: blank control group (Control), sham operation group (Sham), model group (Model), waggle needling group (WN) and perpendicular needling group (PN). SP rats were treated with acupuncture from day 3 after MCAO, once a day for 6 d. The modified neurological severity score (mNSS) and modified Ashworth scale (MAS) were conducted on days 0, 1, 3, 5, 7 and 9. Cerebral blood flow (CBF) in ischemic cortex was measured by laser speckle imaging 5 min pre ischemia, 5 min post ischemia, and after intervention on day 9. All rats were sacrificed at day 9 and the protein and mRNA expressions of γ2 subunit of the γ-aminobutyric acid receptor A (GABAAγ2) and K+-Cl?cotransporter 2 (KCC2) in the ischemic cortex and lumber enlargement was measured by Western blotting and real-time quantitative polymerase chain reaction.
Results:
Both Control and Sham groups showed no changes in mNSS and MAS scores and in the regional CBF. Compared with Model group, both WN and PN treatments significantly ameliorated neurological deficit ( 0.01), decreased muscle tone ( 0.05), and enhanced CBF ( 0.001) in SP rats; moreover, WN showed superior effects than PN ( 0.001). In line with the improvement in neurobehavior, acupuncture interventions up-regulated the expressions of GABAAγ2 and KCC2 in the ischemic cortex as well as lumber enlargement ( 0.01) in SP rats, and those changes were more obvious in WN ( 0.05).
Conclusions:
Acupuncture at Yanglingquan (GB34) enhanced cerebral blood flow and ameliorated SP in permanent MCAO rats, while waggle needling was superior to regular perpendicular needling. Waggle needling Yanglingquan (GB34) would be a potential complementary therapy for SP.
... Furthermore, numbers of studies have emphasized the impact of acupuncture on the enhancement of functional connectivity in different parts of the brain. 37 Cycling has also shown to improve functional mobility by improving the coordination of reciprocal flexion and extension movements and alternating antagonist muscle activation. 38 Kim et al 38 also suggested that cycling might have an effect on the activation of motor regions in the central nervous system. ...
Objective:
To evaluate the effectiveness of cycling in combination with electroacupuncture in treatment of post-stroke hemiplegia patients at National Hospital of Acupuncture, Vietnam.
Methods:
The study was designed as a single-centre, outcome-assessor-blinded parallel randomised controlled trial with 120 post-stroke hemiplegia patients randomly assigned into two groups: electroacupuncture plus cycling (CT group) and electroacupuncture (AT group). Patients were assessed before and after the treatment (using muscle grading, modified Rankin, Barthel, Orgorozo scores and electromyography). Statistical Man-Whitney U test, and Fisher's exact tests were used to compare between CT and AT groups.
Results:
The results reported statistically significant improvement in motor function in patients suffering from hemiplegia following ischemic stroke in both CT and AT groups. Patients in CT group experienced a greater improvement compared to those in AT group including better muscle contraction (increased frequency and amplitude of electromyography and increased muscle grading scale); increased recovery (Orgogozo scale), increased independency (Barthel scale) and decreased disability (Modified Rankin scale) (< 0.01).
Conclusions:
Combination with cycling training significantly improves the recovery of post-stroke patients treated with electroacupuncture.
... A meta-analysis of acupuncture for migraines showed that acupuncture had more significant advantages in improving the head frequency of migraine, Visual Analog Scale (VAS), and response rates compared with sham acupuncture (13). Although the application of acupuncture has shown promising efficacy in the clinic, the mechanism of acupuncture still needs to be explored (14). ...
Background
Acupuncture, a traditional Chinese medicine therapy, is an effective migraine treatment, especially in improving pain. In recent years, many acupuncture brain imaging studies have found significant changes in brain function following acupuncture treatment of migraine, providing a new perspective to elucidate the mechanism of action of acupuncture.
Objective
To analyse and summarize the effects of acupuncture on the modulation of specific patterns of brain region activity changes in migraine patients, thus providing a mechanism for treating migraine by acupuncture.
Methods
Chinese and English articles published up to May 2022 were searched in three English databases (PubMed, Embase and Cochrane) and four Chinese databases (China national knowledge infrastructure, CNKI; Chinese Biomedical Literature database, CBM; the Chongqing VIP database, VIP; and the Wanfang database, WF). A neuroimaging meta-analysis on ALFF, ReHo was performed on the included studies using Seed-based d Mapping with Permutation of Subject Images (SDM-PSI) software. Subgroup analyses were used to compare differences in brain regions between acupuncture and other groups. Meta-regression was used to explore the effect of demographic information and migraine alterations on brain imaging outcomes. Linear models were drawn using MATLAB 2018a, and visual graphs for quality evaluation were produced using R and RStudio software.
Results
A total of 7 studies comprising 236 patients in the treatment group and 173 in the control group were included in the meta-analysis. The results suggest that acupuncture treatment helps to improve pain symptoms in patients with migraine. The left angular gyrus is hyperactivation, and the left superior frontal gyrus and the right superior frontal gyrus are hypoactivated. The migraine group showed hyperactivation in the corpus callosum compared to healthy controls.
Conclusion
Acupuncture can significantly regulate changes in brain regions in migraine patients. However, due to the experimental design of neuroimaging standards are not uniform, the results also have some bias. Therefore, to better understand the potential mechanism of acupuncture on migraine, a large sample, multicenter controlled trial is needed for further study. In addition, the application of machine learning methods in neuroimaging studies could help predict the efficacy of acupuncture and screen migraine patients suitable for acupuncture treatment.
... It has been shown that the effect of acupuncture on muscle function is brought about through enhancing functional connectivity between the bilateral primary motor cortex, the cerebellum, and the primary somatosensory cortex [83][84][85][86]. The motor cortex forms part of the cerebral cortex and is made up of the primary motor cortex, which is responsible for initiating motor movement, and the premotor and supplementary cortex, which are involved with aspects of planning, initiating, and selecting the correct movement. ...
... GB34 has been the most commonly used acupoint to study the mechanism of acupuncture stimulation in stroke based on fMRI (20). Previous studies have proposed that acupuncture at GB34 could enhance the functional connectivity (FC) between bilateral M1 cortices and increase motor-cognition connectivity (21,22). The conventional analysis has been displayed by calculating the correlations of time series in the target regions of every single subject. ...
Motor dysfunction is common in patients with stroke. Acupuncture has become an acceptable alternative method for stroke rehabilitation. Previous studies have shown various functional connectivity changes activated by acupuncture. We introduced intersubject correlation (ISC) and intersubject functional correlation (ISFC) analyses into the functional magnetic resonance imaging (fMRI) for ischemic stroke to seek a common activation and suppression pattern triggered by acupuncture. In this study, 63 ischemic stroke patients with motor dysfunction and 42 normal controls were analyzed. Three functional scans were conducted during the resting state, motor task, and acupuncture at Yanglingquan (GB34) task. Twenty-two sensory, motor, and movement-imagination cortices in the bilateral hemispheres were selected as the region of interest (ROI). We performed ISC and ISFC analyses among these ROIs in three fMRI runs on patients and controls. Subgroup analyses by course or severity were also conducted. The results showed that acupuncture at GB34 triggered ISFC among upper limb motor, upper limb/hand/face, lower limb, tongue/larynx sensory, and movement imagination regions in the patient group. Subgroup ISC and ISFC analyses showed that patients tended to have increasing responses in the early stage of stroke (within 1 month) and decreasing responses afterward (1–3 months). Patients with mild clinical functional damage (NIHSS 2–4) tended to generate more responses via acupuncture than those with moderate damage (NIHSS 5–15). Our findings may help understand the clinical effects and modulatory features of acupuncture based on the group-level post-stroke neuroplasticity.
... This lateralization may represent an enhancement of the compensatory process through acupuncture that redistributes function to the intact cortex, especially the unaffected hemisphere. In addition, studies [44,52] also showed that acupuncture could stimulate bilateral regions, modulate whole-brain network, and enhance functional connectivity. This indicated that acupuncture could not only specifically regulate the bilateral dynamic balance of the brain but also modulate the whole brain network and functional connections as a whole. ...
... Importantly, although different acupoints were used across studies, they all could remodel brain areas associated with stroke lesions. For instance, several studies [31,33,51,52] have demonstrated that acupuncture could enhance FC of between bilateral M1s, between the cerebellum and primary sensorimotor cortex, which indicated that acupuncture has not only specific but also common effects on the disease. ...
Acupuncture is widely recognized as a potentially effective treatment for stroke rehabilitation. Researchers in this area are actively investigating its therapeutic mechanisms. Magnetic resonance imaging (MRI), as a noninvasive, high anatomical resolution technique, has been employed to investigate neuroplasticity on acupuncture in stroke patients from a system level. However, there is no review on the mechanism of acupuncture treatment for stroke based on MRI. Therefore, we aim to summarize the current evidence about this aspect and provide useful information for future research. After searching PubMed, Web of Science, and Embase databases, 24 human and five animal studies were identified. This review focuses on the evidence on the possible mechanisms underlying mechanisms of acupuncture therapy in treating stroke by regulating brain plasticity. We found that acupuncture reorganizes not only motor-related network, including primary motor cortex (M1), premotor cortex, supplementary motor area (SMA), frontoparietal network (LFPN and RFPN), and sensorimotor network (SMN), as well as default mode network (aDMN and pDMN), but also language-related brain areas including inferior frontal gyrus frontal, temporal, parietal, and occipital lobes, as well as cognition-related brain regions. In addition, acupuncture therapy can modulate the function and structural plasticity of post-stroke, which may be linked to the mechanism effect of acupuncture.
... Acupuncture is considered to have a regulating effect on the biliary system, including inhibiting the contractions of Oddi's sphincter, bi-directionally regulating the gallbladder pressure, promoting the secretion of hepatic bile, and changing the content of the cholesterol in plasma and bile, and in further to reduce the formation rate of cholelithiasis, the number of gallstones, and the huge gallstones [24][25][26][27][28]. Recently, acupuncture on GB34 is found specifically activated the cognitive, motor, default network, and other parts of brain regions [29][30][31][32]. However, the underlying central effect of GB34 and EX-LE6 on the gallbladder of patients with GBD has not been covered. ...
Background
As it has been recorded in ancient Chinese classics, Yanglingquan (GB34) and Dannangxue (EX-LE6) are two important acupoints that can regulate the function of the gallbladder. Acupuncture at these two acupoints is considered particularly effective for gallbladder disease treatment, especially for alleviating gallbladder stone disease (GSD) symptoms that can be aggravated after intaking high-fat food. However, the superior effect between the two acupoints still needs to be further explored, as well as the underlying central mechanism has never been investigated to date.
Methods and design
Ninety participants diagnosed with GSD will be randomly divided into group A (acupuncture at GB34), group B (acupuncture at EX-LE6), and group C (acupuncture at non-acupoint) in a ratio of 1:1:1. All of them will receive a 30-min acupuncture treatment with fatty-food cues being presented before and after acupuncture. During the task, participants will be scanned by MRI and required to rate their desire for high-/low-fat food with an 11-point Likert scale. Additionally, the participants’ pain/discomfort sensation will be evaluated using the Numeric Rating Scale (NRS) at four timepoints, including before the 1st task fMRI scan, before and after acupuncture, and after the 2nd task fMRI scan. For both behavior and fMRI data, the ANOVA analysis will be conducted among three groups to testify the immediate effect of GB34 and EX-LE6. The post hoc t-test will be employed to further explore the superiority between acupuncture with GB34 and EX-LE6. Furthermore, correlation analyses will be conducted to investigate a possible correlation between neural changes and clinical data.
Discussion
In comparison to the non-acupoint, the results will firstly explore the superior effect between acupuncture with GB34 and EX-LE6 on GSD patients by observing their behavioral and neural response change to fatty-food cue, and then to investigate the underlying central mechanism.
Trial registration
Chinese Clinical Trial Registry ChiCTR2000034368 . Registered on 3 July 2020.
