| ObjectiveStudies have shown that the face and hand relationship exists unidirectional link, that stimulating Hegu area can induce orofacial EMG response, but in turn, stimulating orofacial can not induce EMG Hegu reaction zone. In this study, using transcranial magnetic stimulation (TMS) method in healthy volunteers, patients cut fingers and been with brachial plexus injury distribution to explore after Hegu area removing motion the brain regular of motor cortical reorganization, explain the biological mechanism the face and hand relationship showing one-way links.MethodsTest is divided into three parts:(1) Effect of acupuncture on unilateral Hegu on regulation of motor cortex hand area and the surface area in physiological conditions. Total of 20 healthy volunteers were selected, they are in line with the inclusion criteria and signed informed consent. Test before the whole process is divided into two phases and after acupuncture needle, and is responsible for the operation by the same researchers in the same shielded room. All subjects were to be before and after acupuncture and acupuncture performed TMS inspection. Before acupuncture, the subject was sitting, by TMS stimulation of the motor cortex hand area and the surface area, were recorded between both sides of the first dorsal interosseous muscle and the orbicularis muscle motor evoked potentials (MEPs) motion threshold, the incubation period, amplitude, and effectively stimulate the area and draw two-dimensional image to determine the location of the distribution motor cortex hand area and the surface area; determining an effective stimulation area of the hand area and the surface area, take the right side of the subject to be Hegu acupuncture needle, a 1-inch needle acupuncture Hegu, beside the puncture site to open another stab a needle in the needle electrode electrically connected to lcm. Electro-acupuncture device using HANS EA parameter is set to a constant current 1mA, frequency 2Hz, sustained EA 30min, after taking the needle to perform operations according to the above TMS determine acupuncture Hegu region and stimulate effective hand and surface area, and draw two-dimensional image. Data collection, data analysis comparing the change before and after acupuncture Hegu muscle evoked potential subjects related parameters and motor cortex hand area and the surface area of the bit field map. (2) Study on motor cortex function reorganization and acupuncture effect after Hegu area removing motion (cut finger). The healthy volunteers were enrolled in 5 cases, left finger cut 5 patients were eligible for inclusion criteria and signed informed consent. Phase I:healthy subjects data acquisition,5 healthy volunteers were collected between both sides of the first dorsal interosseous muscle and the orbicularis muscle motor evoked potentials related parameters. Subjects were sitting by TMS to stimulate bilateral hand area and surface area were recorded between both sides of the first dorsal interosseous muscle and the orbicularis muscle motor evoked potentials (MEPs) motion threshold, latency, amplitude, and effectively stimulate area, and draw two-dimensional image to determine the location of the distribution of bilateral cortical hand area and the surface area. Phase II:cut refers to patient data collection, divided into two parts before and after acupuncture needling. Before acupuncture, the patient sitting, the TMS stimulation of the motor cortex hand area and the surface area, both sides recorded between the first dorsal interosseous muscle and the orbicularis muscle motor evoked potentials (MEPs) motion threshold, latency, amplitude, and effectively stimulate area, and draw two-dimensional image to determine the position of the motor cortex hand area distribution and surface area;Determine the effective stimulate the area of surface area and the hand area, then take acupuncture on right the Hegu of patients, a 1-inch needle acupuncture Hegu, beside the puncture site to open another needle prick within lcm 1 electrically connected to a needle electrode. Electro-acupuncture device using HANS EA parameter is set to a constant current 1mA, frequency 2Hz, sustained EA 30min, after taking the needle to perform in accordance with the above TMS operation, the recording motor evoked potential parameters determined acupuncture Hegu effectively stimulate the area of the hand and the surface area, and draw two-dimensional image. Data collection, data processing and analysis of data. (3) Study on motor cortical reorganization and acupuncture effect after peripheral nerve injury. The healthy volunteers were included in 5 cases, the patients with right brachial plexus injury in 5 cases, all met the inclusion criteria and signed informed consent. The entire testing process is divided into two phases:Phase I: healthy subjects, data collection,5 healthy volunteers were gathering bilateral biceps and deltoid motor evoked potentials related parameters. Subjects were sitting by TMS to stimulate bilateral shoulder and elbow area, were recorded bilateral deltoid and biceps motor evoked potentials (MEPs) motion threshold, latency, amplitude, and effectively stimulate the area and draws two dimensional image to determine the location of the distribution of cortical bilateral shoulder area and elbow areas. Phase II:the patient’s with brachial plexus injury data collection, divided into two stages before and after acupuncture therapy and acupuncture therapy and acupuncture treatment and TMS inspection by the same investigator in charge of the operation. All subjects were to be before and after acupuncture therapy and acupuncture therapy upper limb motor function (Fugl-Meyer score) and TMS inspection. Before acupuncture treatment, the subject was sitting, by TMS stimulation of the motor cortex hand area and the surface area, are recorded on the left side of the first dorsal interosseous muscle (FDI) and bilateral orbicularis oculi (00) MEPs (MEPs) motion threshold, latency, amplitude, and effectively stimulate the area and draw two-dimensional image to determine the right hemisphere motor cortex hand area and the distribution of positions on both sides of the hemispherical surface area; at the same time, by TMS deltoid and bilateral stimulation of the motor cortex dominated region biceps, deltoid and were recorded bilateral biceps motor evoked potentials (MEPs) motion threshold, latency, amplitude, and effectively stimulate the area and draw two-dimensional image, and to determine bilateral shoulder area distribution location elbow area. Accordance with the "ten-two-five" planning textbook acupuncture flaccidity related acupoints, the patient month acupuncture treatment, after acupuncture treatment, the patient upper limb motor function scores, and acquisition of acupuncture treatment in accordance with the above described method to collect related data. Data collection, data processing and analysis of data.Results(1) Effect of acupuncture on unilateral Hegu on regulation of motor cortex hand area and the surface area in physiological conditions1. after acupuncture the left hemisphere surface area MEPs latency district level, the amplitude increases, the threshold lowering, the effective area is increased stimulation (p<0.05); the right hemisphere surface area MEPs the latency unchanged, the amplitude increases, the threshold lowering, effective stimulus area increases (p<0.05);before and after acupuncture effectively stimulate the area of surface unchanged.2. after acupuncture the left hemisphere hand area MEPs latency and the threshold district level, the amplitude increases, the effective stimulation area is increased (p<0.05); the right hemisphere hand area MEPs the latency prolonging, the amplitude lowering, the threshold increases, effective stimulus area reduced(p<0.05).3. acupuncture Hegu can increase the excitability of the hand area and surface area, which the total amplitude side, effectively stimulate the area of double surface area before and after acupuncture compared to no change; in comparison with bilateral hand area, the left hemisphere after acupuncture the total amplitude was significantly higher than on the right hand (p<0.05), while the left hemisphere after acupuncture needling total amplitude greater than the previous (p<0.05), while the right hemisphere is less than the total amplitude before acupuncture (p<0.05); the left hemisphere hands before and after effective stimulating area of difference is greater than the area of the right hemisphere.4. after acupuncture, in bilateral motor area the center of gravity of the hand area are different degrees of offset, wherein the surface area of the vertical displacement of the center of gravity shifted to the direction of the hand area, up to the maximum displacement distance of the left hemisphere up to 3.3mm, the right hemisphere up to 4.5mm; hand area without significant deviation or center of gravity shifted to the direction of the hand area of distribution, the left hemisphere of the vertical displacement distance up to 5.3mm, the right hemisphere of up to 9. 1mm.(2) Study on motor cortex function reorganization and acupuncture effect after Hegu area removing motion (cut finger)1. after Hegu area removing motion (cut finger), the ratio of patients with left hemisphere and the right hand area less than the minimum area of healthy volunteers ratio; the ratio of surface area to effectively stimulate an area larger than the healthy volunteers max’s ratio.2. after acupuncture, cut refers to patients with bilateral hemispheric hand area MEPs threshold, latency, effectively stimulate the area no change, the amplitude decreased (p<0.05); two-side surface area latency shortening, amplitude increases, the threshold lowering, effectively stimulate area increases (p<0.05), the hand region and face region overlap area increases. After acupuncture, the center of gravity of cut refers with bilateral hemispheric hand area shifted and displaced away from the surface area.(3) Study on motor cortical reorganization and acupuncture effect after peripheral nerve injury1. after brachial plexus injury, in patients brain the ratio of the left hemisphere shoulder area, the elbow with right hemisphere, was greater than the maximum ratio of healthy volunteers; ratio of surface area to effectively stimulate compared with healthy persons showing no change significantly.2. taking brachial plexus injury patients one-month acupuncture treatment, after treatment, the patient conscious upper limb motor function had no significant improvement, in upper limb motor function scores before and after the acupuncture treatment had no significant change.3. after the acupuncture treatment, the patient with brachial plexus injury elbow area MEPs latency no change, bilateral cortical amplitude decreased (p<0.05), the effective stimulation area unchanged; shoulder area MEPs latency no change, bilateral cortical amplitude decreased (p<0.05), the effective stimulation area unchanged. The surface area of the left hemisphere in patients with brachial plexus injury MEPs latency shortening, amplitude increases, threshold reduce, effectively stimulate the area is increased (p <0.05); the right hand area MEPs latency unchanged, reduced amplitude, the threshold increases, the effective stimulation area is decreased (p<0.05). The center of gravity of elbow and shoulder areas in brachial plexus injury patients showed different degrees of displacement, in which the performance of the vertical displacement direction away from the hand area.Conclusion1. after Hegu area removing motion, motor cortex functional reorganization appears:in cut refers, it shows that the damaged parts of the region on behalf of the cortex adjacent cortex expand; in patients with brachial plexus injury, the shoulder area and elbow areas expand to the adjacent parts of the cortex damaged behalf of the district, the surface area of the cortex adjacent did not appear expending to the damaged parts, suggesting that functional reorganization of the motor cortex showed unidirectional. Way function recombination between motor cortex hand area and the surface area may be a biological mechanism of the face and hand relationship showing one-way links.2. under physiological conditions, acupuncture on Hegu area can excite double side contralateral face area and inhibit ipsilateral hand area of motor cortex, hand area and the surface area are affected; pathological conditions, acupuncture can inhibit invasion cortex excitability, to strengthen the damaged area on behalf of the cortex and adjacent cortex function contact. This regulation implementations may provide a theoretical basis for the treatment of orofacial disorders by acupuncture on Hegu. |
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