Uncinate fasciculus and its cortical terminals in aphasia after subcortical stroke: A multi-modal MRI study

Zhang, Binlong; Chang, Jingling; Park, Joel; Tan, Zhenghuai; Tang, Lu; Lyu, Tianli; Han, Yi; Fan, Ruiwen; Gao, Ying; Kong, Jian

doi:10.1016/j.nicl.2021.102597

Cited by 16 publications

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“…The included 16 studies contain the following 7 comparison types: acupuncture plus language rehabilitation vs. language rehabilitation [ 42 , 57 – 59 , 64 , 65 ], acupuncture plus language rehabilitation vs. nonpoint needle plus language rehabilitation [ 45 ], acupuncture plus language rehabilitation vs. healthy volunteer [ 56 , 62 , 63 ], acupuncture plus conventional treatment vs. conventional treatment [ 61 ], acupuncture vs. nonpoint needle [ 53 ], acupuncture vs. acupuncture [ 54 , 55 ], and acupuncture vs. healthy volunteer [ 60 ] ( Table 3 ).…”

Section: Resultsmentioning

confidence: 99%

“…7 studies conducted task-based fMRI using BOLD to observe the brain activation, with linguistic tasks such as word generation; the other 9 studies conducted rsfMRI to detect the spontaneous brain activity (6 with BOLD technology [ 52 , 53 , 56 , 59 , 60 , 62 ], 2 with DTI technology [ 45 , 63 ], and 1 with both BOLD and DTI technologies [ 42 ]). For the observing time point, 2 studies compared the instant effects of acupuncture [ 53 , 54 ]; the other 14 studies compared the acupuncture effects after the constant treatments (12 to 30 sessions).…”

Section: Resultsmentioning

confidence: 99%

“…The aphasia quotient (AQ) of WAB was correlated with the fraction anisotropy (FA) value of the left uncinate fasciculus in the poststroke aphasia patients. After treatment, the improvement of AQ was correlated with the ALFF value change in the left TP [ 42 ]. Using the functional connectivity analysis method, one trial revealed the AQ changes had a positive correlation with the intensified connectivity between the left inferior temporal gyrus and the middle frontal gyrus [ 60 ].…”

Section: Resultsmentioning

confidence: 99%

“…Accordingly, rsfMRI was used to evaluate the cerebral functional state before and after acupuncture treatment. Based on the classical language function theory, studies focused on the anatomic structural regions proved that the decreased ALFF value in the left temporal pole was correlated with the naming function [ 42 ]. Recent studies revealed the connectivity in the surviving brain regions, which played a role in brain network studies [ 43 , 44 ].…”

Section: Introductionmentioning

confidence: 99%

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Revealing the Neuroimaging Mechanism of Acupuncture for Poststroke Aphasia: A Systematic Review

Deng

Sang

et al. 2022

Neural Plasticity

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Background. Aphasia is a common symptom in stroke patients, presenting with the impairment of spontaneous speech, repetition, naming, auditory comprehension, reading, and writing function. Multiple rehabilitation methods have been suggested for the recovery of poststroke aphasia, including medication treatment, behavioral therapy, and stimulation approach. Acupuncture has been proven to have a beneficial effect on improving speech functions in repetition, oral speech, reading, comprehension, and writing ability. Neuroimaging technology provides a visualized way to explore cerebral neural activity, which helps reveal the therapeutic effect of acupuncture therapy. In this systematic review, we aim to reveal and summarize the neuroimaging mechanism of acupuncture therapy on poststroke aphasia to provide the foundation for further study. Methods. Seven electronic databases were searched including PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, the Wanfang databases, and the Chinese Scientific Journal Database. After screening the studies according to the inclusion and exclusion criteria, we summarized the neuroimaging mechanism of acupuncture on poststroke aphasia, as well as the utilization of acupuncture therapy and the methodological characteristics. Result. After searching, 885 articles were retrieved. After removing the literature studies, animal studies, and case reports, 16 studies were included in the final analysis. For the acupuncture type, 10 studies used manual acupuncture and 5 studies used electroacupuncture, while body acupuncture (10 studies), scalp acupuncture (7 studies), and tongue acupuncture (8 studies) were applied for poststroke aphasia patients. Based on blood oxygen level-dependent (BOLD) and diffusion tensor imaging (DTI) technologies, 4 neuroimaging analysis methods were used including amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), seed-based analysis, and independent component analysis (ICA). Two studies reported the instant acupuncture effect, and 14 studies reported the constant acupuncture’s effect on poststroke aphasia patients. 5 studies analyzed the correlation between the neuroimaging outcomes and the clinical language scales. Conclusion. In this systematic review, we found that the mechanism of acupuncture’s effect might be associated with the activation and functional connectivity of language-related brain areas, such as brain areas around Broca’s area and Wernicke’s area in the left inferior temporal gyrus, supramarginal gyrus, middle frontal gyrus, and inferior frontal gyrus. However, these studies were still in the preliminary stage. Multicenter randomized controlled trials (RCT) with large sample sizes were needed to verify current evidence, as well as to explore deeply the neuroimaging mechanisms of acupuncture’s effects.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Revealing the Neuroimaging Mechanism of Acupuncture for Poststroke Aphasia: A Systematic Review

Deng

Sang

et al. 2022

Neural Plasticity

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“…31 Lesions of this structure have been associated with psychiatric conditions, learning difficulty, and language impairment. 46,47 While lesions affecting subcortical nuclei had the highest relevance in explaining acute stroke severity, lesions affecting WM tracts had the highest relevance in explaining 90-day mRS scores. In the case of acute stroke severity, the joint effect of all subcortical GM lesions was the only one substantially different from zero.…”

Section: Discussionmentioning

confidence: 99%

Association of Infarct Topography and Outcome After Endovascular Thrombectomy in Patients With Acute Ischemic Stroke

et al. 2022

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Background and Objectives:The care of patients with large vessel occlusion (LVO) stroke has been revolutionized by endovascular thrombectomy (EVT). While EVT has a large effect size, most patients treated with EVT remain disabled or die within 90 days. A better understanding of outcomes may influence EVT selection criteria, novel therapies, and prognostication. We sought to identify associations between outcomes and brain regions involved in ischemic lesions.Methods:For this cohort study, consecutive patients with LVO who were treated with EVT and underwent post-EVT MRI were identified from a tertiary referral center (2011-2019). Acute ischemic lesions were manually segmented from DWI and spatially normalized. Individual lesions were parcellated (atlas-defined 94 cortical regions, 14 subcortical nuclei, 20 white matter tracts) and reduced to ten essential lesion patterns using unsupervised dimensionality reduction techniques. Ninety-day modified Rankin Scale (mRS>2) was modeled via Bayesian regression, taking the ten lesion patterns as inputs, and controlling for lesion size, age, sex, acute NIH Stroke Scale (NIHSS), alteplase, prior stroke, intracerebral hemorrhage, and good reperfusion (TICI2b-3). In comparative analyses, 90-day mRS was modeled considering covariates and compartment-wise relevance for acute stroke severity and 90-day mRS were evaluated.Results:There were 151 patients with LVO identified (age: 68±15 years; 52% female). The median NIHSS was 16 (IQR 13-20); 56% had mRS>2. Lesion locations predictive of 90-day mRS involved bilateral, but left-hemispherically more pronounced pre- and postcentral gyri, insular and opercular cortex, as well as left putamen and caudate (area under the curve: 0.91, highest probability density interval (HPDI) covering 90%-certainty: 0.90–0.92). The lesion location model outperformed the simpler model relying on covariates only (Bayesian model comparison of weight: 97% to the model with vs. 3% to that without lesion location). While lesions affecting subcortical nuclei had the highest relevance for stroke severity (posterior distribution mean: 0.75, 90%-HDPI=0.256–1.31), lesions affecting white matter tracts had the highest relevance for 90-day mRS (0.656, 90%-HDPI=0.0864–1.12).Discussion:These data describe the significance for outcomes of specific brain regions involved in ischemic lesions on MRI after EVT. Future work in additional datasets is needed to confirm these granular findings.

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Effect of Acupuncture vs Sham Acupuncture on Patients With Poststroke Motor Aphasia

Li,

Deng,

Zhuo

et al. 2024

JAMA Netw Open

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ImportanceMotor aphasia is common among patients with stroke. Acupuncture is recommended as an alternative therapy for poststroke aphasia, but its efficacy remains uncertain.ObjectiveTo investigate the effects of acupuncture on language function, neurological function, and quality of life in patients with poststroke motor aphasia.Design, Setting, and ParticipantsThis multicenter, sham-controlled, randomized clinical trial was conducted in 3 tertiary hospitals in China from October 21, 2019, to November 13, 2021. Adult patients with poststroke motor aphasia were enrolled. Data analysis was performed from February to April 2023.InterventionsEligible participants were randomly allocated (1:1) to manual acupuncture (MA) or sham acupuncture (SA) groups. Both groups underwent language training and conventional treatments.Main Outcomes and MeasuresThe primary outcomes were the aphasia quotient (AQ) of the Western Aphasia Battery (WAB) and scores on the Chinese Functional Communication Profile (CFCP) at 6 weeks. Secondary outcomes included WAB subitems, Boston Diagnostic Aphasia Examination, National Institutes of Health Stroke Scale, Stroke-Specific Quality of Life Scale, Stroke and Aphasia Quality of Life Scale–39, and Health Scale of Traditional Chinese Medicine scores at 6 weeks and 6 months after onset. All statistical analyses were performed according to the intention-to-treat principle.ResultsAmong 252 randomized patients (198 men [78.6%]; mean [SD] age, 60.7 [7.5] years), 231 were included in the modified intention-to-treat analysis (115 in the MA group and 116 in the SA group). Compared with the SA group, the MA group had significant increases in AQ (difference, 7.99 points; 95% CI, 3.42-12.55 points; P = .001) and CFCP (difference, 23.51 points; 95% CI, 11.10-35.93 points; P &lt; .001) scores at week 6 and showed significant improvements in AQ (difference, 10.34; 95% CI, 5.75-14.93; P &lt; .001) and CFCP (difference, 27.43; 95% CI, 14.75-40.10; P &lt; .001) scores at the end of follow-up.Conclusions and RelevanceIn this randomized clinical trial, patients with poststroke motor aphasia who received 6 weeks of MA compared with those who received SA demonstrated statistically significant improvements in language function, quality of life, and neurological impairment from week 6 of treatment to the end of follow-up at 6 months after onset.Trial RegistrationChinese Clinical Trial Registry: ChiCTR1900026740

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Uncinate fasciculus and its cortical terminals in aphasia after subcortical stroke: A multi-modal MRI study

Cited by 16 publications

References 43 publications

Revealing the Neuroimaging Mechanism of Acupuncture for Poststroke Aphasia: A Systematic Review

Revealing the Neuroimaging Mechanism of Acupuncture for Poststroke Aphasia: A Systematic Review

Association of Infarct Topography and Outcome After Endovascular Thrombectomy in Patients With Acute Ischemic Stroke

Effect of Acupuncture vs Sham Acupuncture on Patients With Poststroke Motor Aphasia

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