| Background:Functional magnetic resonance imaging(fMRI)is a major breakthrough in Neuroimaging It has realized the leapfrog development from brain morphological examination to brain functional state imaging.Blood oxygen level dependent functional magnetic resonance imaging is an in vivo detection technology that reflects the activity of brain region through the change of magnetic resonance signal caused by the change of blood oxygen level.Functional MRI can directly observe the spatial position of brain functional areas of various neural activities and the time relationship between different brain functional areas when dealing with the same external stimulus.Therefore,it is of great significance in the basic research of brain neuroscience and the application of clinical neurology and surgery.This technique plays an important role in studying the central nervous mechanism of acu-points.Fengchi point is an important acupoint for the treatment of head and face diseases,especially for the treatment of cervical vertigo.The acupoints selected by doctors of past dynasties and modern literature are mainly Fengchi,Hegu,Baihui and other acupoints.The occurrence frequency of Fengchi is the highest.However,the central nervous mechanism of acupuncture at Fengchi point in the treatment of cervical vertigo is still unclear.At present,the research on the action mechanism of Fengchi point mostly focuses on the study of blood vessels and blood flow velocity.However,in clinical practice,it shows that the flow velocity of vertebral artery is not abnormal in many patients with cervical vertigo.We believe that vascular factors cannot fully explain the therapeutic effect of Fengchi point.In addition,acupuncture treatment often adopts multi-point combination,adding and subtracting acupoints according to different clinical manifestations of patients,so;as to increase the difficulty of studying the mechanism of acupuncture curative effect.In this subject,we choose acupuncture at Fengchi point to treat cervical vertigo,and preliminarily explore the mechanism of acupuncture at Fengchi point to treat cervical vertigo from the perspective of clinical efficacy and changes of brain function.Aim:1 To observe the effect of acupuncture at Fengchi point on patients with cervical vertigo.2 Based on the analysis of resting brain function,the difference of brain function connection mode between patients with cervical vertigo and normal control group was observed.3 Select Fengchi point to treat patients with cervical vertigo in the attack stage with acupuncture,and take the hippocampal region as the seed point.Use the seed point analysis method to analyze the brain function connection,and preliminarily explore the possible central mechanism of Fengchi point in the treatment of cervical vertigo.Method:This study is divided into two parts.The first part is the clinical observation of acupuncture at Fengchi point.Result:For the patients with cervical vertigo in the attack stage,acupuncture Fengchi point,vertically enter the needle for 25-30mm,and apply the manipulation of flat tonic and flat diarrhea.The amount of stimulation is moderate to the patient’s feeling.Once every other day,a total of 3 times.The clinical efficacy was evaluated by cervical vertigo symptom and function evaluation scale and dizziness handicap inventory(DHI).The second part is the experimental study of functional nuclear magnetic resonance.Patients with cervical vertigo underwent brain structure and resting magnetic resonance imaging before treatment,immediately after treatment,and healthy volunteers.RS fMRI data were preprocessed by AFNI software,and the functional connectivity map of bilateral hippocampus was obtained by taking bilateral hippocampus as the region of interest.Independent sample t-test was used to compare the changes of hippocampal related brain function connection between cervical vertigo group and healthy volunteers before treatment.Paired sample t-test was used to compare the differences of hippocampal related brain function connections before and after treatment in cervical vertigo group.Result:1 A total of 18 patients with cervical vertigo were enrolled,with a minimum age of 25 years and a maximum age of 56 years,with an average age of 35.89 ± 9.43 years.There were 2 males and 13 females.DHI scale:26.53 ± 6.78 before treatment and 38.89 ± 4.36 after treatment,t=6.51,P=0.000,P<0.01.The vertigo disorder rating scale was 32.00 ± 22.05 before treatment and10.56 ± 8.34 after treatment.It obeys the normal distribution,using t-test,t=-4.01,P<0.01.Both scales showed that acupuncture at Fengchi point had obvious curative effect on the symptoms of cervical vertigo.2 There were 14 healthy subj ects,5 males and 9 females,aged 23-62 years,with an average age of(40.21 ± 13.80).Before treatment,the functional magnetic resonance imaging(fMRI)of the cervical vertigo group and the healthy group showed that the functional connections between the seed points of bilateral hippocampus and the right superior parietal lobule,the right parahippocampal gyrus,the left anterior cerebral gyrus,the left cerebellum and the right middle frontal gyrus were weakened.The connections with brainstem,right precuneus gyrus and central anterior gyrus were enhanced.3 In the cervical vertigo group,the connection between the hippocampus and the left cuneiform gyrus,the right parahippocampal gyrus,the right middle frontal gyrus,the right cerebellum,the left cerebellum and the right caudate nucleus was enhanced after acupuncture.The connection of hippocampus with right cingulate gyrus and right medial frontal gyrus was weakened after acupuncture.Conclusion1 Acupuncture at Fengchi point has a very good clinical effect on the treatment of cervical vertigo.2 Comparison of brain functional connections between patients with cervical vertigo and healthy controls:brain stem,right anterior cuneate gyrus and left anterior central gyrus were enhanced;The regions with reduced connectivity include the right superior parietal lobule,the right parahippocampal gyrus,the left anterior cerebral gyrus,the left cerebellum,and the right middle frontal gyrus.It may be related to specific changes in brain structure and function.The changes of brain function during the onset of cervical vertigo involve multiple brain regions,multiple brain function network systems,default network,dorsal attention network,visual network,sensorimotor network,executive control network,vestibular function network,limbic system,etc.It affects patients’ cognition,balance,spatial orientation,vision,sensorimotor,and emotional regulation.During the onset of cervical vertigo,the brain needs more central effects to coordinate the functional activities of brain areas to ensure the ability of body control.This is the effect of integration of different brain functional networks.3 Acupuncture at Fengchi point at rest can make the connection between hippocampus and left cuneiform gyrus,right parahippocampal gyrus,right middle frontal gyrus,right cerebellum,left cerebellum and right caudate nucleus of patients with cervical vertigo stronger than before acupuncture.The connection of hippocampus with right cingulate gyrus and right medial frontal gyrus was weakened after acupuncture.Acupuncture at Fengchi can cause default network,dorsal attention network,sensorimotor network,visual network,executive control network and highlight network changes.Each brain network integrates with each other,thus affectingpatients’ visual balance,spatial cognition,memory,self motion perception,random movement of limbs,autonomic nerve regulation,visceral response,pain transmission,and emotional regulation. |
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