Acupuncture Enhances Communication between Cortices with Damaged White Matters in Poststroke Motor Impairment

Abstract

Stroke is a leading cause of motor disability. Acupuncture is an effective therapeutic strategy for poststroke motor impairment. However, its mechanism is still elusive. Twenty-two stroke patients having a right-hemispheric subcortical infarct and 22 matched healthy controls were recruited to undergo diffusion tensor imaging (DTI) and functional magnetic resonance imaging (fMRI) scanning. The resting-state fMRI was implemented before and after needling at GB34 (Yanglingquan). The stroke patients presented a substantially reduced fractional anisotropy value in the right superior longitudinal fasciculus (SLF), corticospinal tract, and corpus callosum. The structural integrity of the frontoparietal part of the SLF (SLF-FP) correlated with the motor scores of lower limbs in stroke patients. This corticocortical association bundle originated from the premotor cortex (PM) and the adjacent supplementary motor area (SMA), known as secondary motor areas, and terminated in the supramarginal gyrus (SMG). After acupuncture intervention, the corresponding functional connectivity between the PM/SMA and SMG was enhanced in stroke patients compared with healthy controls. These findings suggested that the integrity of the SLF is a potential neuroimaging biomarker for motor disability of lower limbs following a stroke. Acupuncture could increase the communication between the cortices connected by the impaired white matter tracts, implying the neural mechanism underlying the acupuncture intervention.

Acupuncture Modulates Disrupted Whole-Brain Network after Ischemic Stroke: Evidence Based on Graph Theory Analysis

“…Acupuncture is a well-known therapeutic strategy in China for over two millennia of practice, which is also widely accepted in modern Western countries [17,18]. Increasingly, empirical and clinical evidence suggests that acupuncture is effective and safe for subacute stroke rehabilitation [19,20]. According to the theory of Chinese medicine, acupuncture can dynamically harmonize the inherent imbalances that result from diseases.…”

The underlying mechanisms of bilateral cerebral remodeling and acupuncture for rehabilitation after post-stroke hemiplegia: study protocol for a cross-sectional multimodal fMRI trial

“…In our previous studies [46][47][48][49][50], we gradually and deeply proved that compared with healthy subjects, acupuncture at Yanglingquan(GB34) in patients with hemiplegia showed speci c activation of brain regions and expressed bilateral effects, from the perspectives of single spot, single network and compound network, which provides a relatively deep research foundation for the hypothesis of bilateral cerebral coordinated regulation in this study. For the purposes of task control and reducing the confounding factors of intervention, single acupoint is selected in this study, which is not the actual clinical practice.…”

Resting-State fMRI in Studies of Acupuncture

“…Main findings AD [38] Cognition regions AD [39] Hippocampal Depression [40] Limbic system, amygdala, and the ACC CM [41] DMN Stroke [42] Bilateral motor cortex Stroke [43] Motor-related network MCI [44] Cognition regions Ischemic stroke [45] Sensorimotor network Depression [40] Limbic system, amygdala, and ACC Stroke [46] PM/SMA and SMG RFPN Migraine [47] ACC and PCC Stroke [48] chronic pain [49][50][51] Networks: DMN, salience, central executive, and sensorimotor ALBP [52] Limbic, pain, attentional and somatosensory system, and DMN CD [53] Afferent processing network and DMN Smoking craving [54] SN Hypertension [55] Frontal lobe, cerebellum, and insula PMS [56] Aberrant neural activity Cardiovascular [57] Cortical, hypothalamus and brainstem stimulation; and specific visualization of acupoints. Specifically, the following conclusions can be drawn from the physiological mechanism of acupuncture at acupoints and its specificity research: there are differences in the brain connectivity and local activities between single and different acupoints, and combination points have more wide activate areas than single point; the regulate areas are mostly related to the emotional, cognitive, and painful functions; limbic system and subcortical areas are found to be hubs after acupuncture; verum acupuncture may increase DMN, PAG, PCC, and pain matrix connectivity compared with sham acupuncture, and sham acupuncture influenced less functional areas than true acupuncture; the local brain functional activities of ipsilateral acupuncture are different from those of contralateral acupuncture; the effect of acupuncture has an obvious individual difference; and there are different degrees of changes in brain functional connectivity among different acupunctures, intensities, methods, and different subjects, and an adjusting acupuncture approach can be used as a means of regulating brain activity.…”