Acupuncture Modulates the Cerebello-Thalamo-Cortical Circuit and Cognitive Brain Regions in Patients of Parkinson's Disease With Tremor

Abstract

Objective: To investigate the effect of acupuncture on Parkinson's disease (PD) patients with tremor and its potential neuromechanism by functional magnetic resonance imaging (fMRI).Methods: Forty-one PD patients with tremor were randomly assigned to true acupuncture group (TAG, n = 14), sham acupuncture group (SAG, n = 14) and waiting group (WG, n = 13). All patients received levodopa for 12 weeks. Patients in TAG were acupunctured on DU20, GB20, and the Chorea-Tremor Controlled Zone, and patients in SAG accepted sham acupuncture, while patients in WG received no acupuncture treatment until 12 weeks after the course was ended. The UPDRS II and III subscales, and fMRI scans of the patients' brains were obtained before and after the treatment course. UPDRS II and III scores were analyzed by SPSS, while the degree centrality (DC), regional homogeneity (ReHo) and amplitude low-frequency fluctuation (ALFF) were determined by REST.Results: Acupuncture improved the UPDRS II and III scores in PD patients with tremor without placebo effect, only in tremor score. Acupuncture had specific effects on the cerebrocerebellar pathways as shown by the decreased DC and ReHo and increased ALFF values, and nonspecific effects on the spinocerebellar pathways as shown by the increased ReHo and ALFF values (P < 0.05, AlphaSim corrected). Increased ReHo values were observed within the thalamus and motor cortex of the PD patients (P < 0.05, AlphaSim corrected). In addition, the default mode network (DMN), visual areas and insula were activated by the acupuncture with increased DC, ReHo and/or ALFF, while the prefrontal cortex (PFC) presented a significant decrease in ReHo and ALFF values after acupuncture (P < 0.05, AlphaSim corrected).Conclusions: The cerebellum, thalamus and motor cortex, which are connected to the cerebello-thalamo-cortical (CTC) circuit, were modulated by the acupuncture stimulation to alleviate the PD tremor. The regulation of neural activity within the cognitive brain regions (the DMN, visual areas, insula and PFC) together with CTC circuit may contributes to enhancing movement and improving patients' daily life activities.

Functional Imaging and Physiological Modulation with Acupuncture in Parkinson’s Disease and Nonhuman Primate Models of Dopamine Dysfunction

“…Other measures of brain activity, degree centrality (DC), and amplitude low-frequency fluctuation (ALFF) values, also showed decreases after acupuncture compared to sham. Meanwhile, increased ReHo values were observed within the thalamus and motor cortex [17]. The results of this clinical study demonstrate that functional imaging can directly detect and measure acupuncture-induced brain activities even at the level of the neural network.…”

“…In human studies, acupuncture stimulations that directly modulate brain activity can also be observed [17,18]. An example of this was carried out by Li and colleagues [17] who used fMRI to investigate the potential neuromechanism of acupuncture on tremor in patients with Parkinson's disease. Li and colleagues compared fMRI signals in patients with Parkinson's disease who were either in the true acupuncture group (TAG) or the sham acupuncture group (SAG).…”

“…(P < 0.05, AlphaSim corrected). Warm colors represent positive ReHo values; blue (cold) colors represent negative ReHo values ( from[17]).…”

Effects of Retinal Transcription Regulation After GB20 Needling Treatment in Retina With Optic Neuritis

“…The mechanism of needling at GB20 affects the regulation of retinal gene expression, is still unclear and may be extraordinarily complex, since the site of GB20 is at the back of the neck, far from the eyes ( Figure 1A ). A previous functional magnetic resonance imaging study revealed that needling at GB20 was able to regulate neural activity within the visual region of the brain (Li et al, 2018 ). It is reported that needling treatment also regulated the expression of nerve growth factor and brain-derived neurotrophic factor in retina (Pagani et al, 2006 ), which may regulate retinal gene expression.…”

Parkinson’s Disease Rehabilitation: Effectiveness Approaches and New Perspectives

“…However, the most important source of data that proves the beneficial effects of acupuncture in treatment of signs and symptoms in Parkinson's disease is provided from functional neuroimaging studies. These studies have shown huge modifications in neural functions after acupuncture sessions [68,69].…”