A Clinical Evaluation And Preliminary MRI Study On The Effect Of "Tonifying Kidney And Invigorating Brain" Acupuncture In Motor Disorders Of Children With Spastic Cerebral Palsy

Background:Motor disability is the core symptom of cerebral palsy(CP).Recently,there is a tremendous interest in the use of acupuncture in treating CP,however,there is still a lack of high-quality clinical research on it.Therefore,our study aimed to determine the effectiveness of acupuncture plus rehabilitation therapy on motor disability in children with spastic cerebral palsy(SCP)and to explore its possible mechanism from the perspective of neuroimaging.Methods:Randomized and controlled trial was used in this study.A total of 72 SCP patients were randomly assigned to receive either acupuncture plus standardized rehabilitation therapy(Experimental Group,EG)or only standardized rehabilitation therapy(Control Group,CG)for 6 months.All patients received 12 treatment sessions per month;36 sessions as one course of treatment and they were required to received continuous treatment for 2 courses of treatment with a total of 72 sessions.Gesell Development Schedules(GDS)and Gross Motor Function Measure(GMFM)were used to assess the treatment effectiveness and the assessments were recorded and evaluated on 3 and 6 months after intervention.Patients undergone Magnetic Resonance Imaging(MRI)scans before and after interventions,and Surface-based morphometry(SBM)analysis was performed to measure the cortical structure changes.Results:A total of 72 children were recruited and randomly assigned in this study with 36 patients allocated in each group.Among them,only 64 children managed to complete the whole treatment duration,with 32 patients in each group.3 patients dropped out in EG;1 patient was eliminated;and 4 patients dropped out in CG.Following intervention,GDS and GMFM scores in both groups were significantly improved(P<0.05).Compared with CG,the GDS scores of gross motor skills and fine motor skills were significantly higher in EG.GMFM scores of D dimension:Standing;E dimension:Walking,running and jumping.and the total scores of GMFM in EG were significantly higher than that of the CG(P<0.05).There were 21 patients that voluntarily undergone MRI scans before and after treatments,with 12 patients in EG and 9 patients in CG,and 1 patient in CG was excluded.SBM analyses revealed that following intervention,patients of both groups displayed a significantly thicker cortices in the right hemisphere(rostral middle frontal,pars orbitalis,pars triangularis,precuneus,isthmus cingulate,supramarginal,posterior cingulate,and caudal anterior cingulate),and significantly thinner cortices in the left lateral occipital.Compared with CG,patients in EG displayed a significantly thicker cortices in the left hemisphere(postcentral and supramarginal),and the right temporal pole(P<0.05,FDR corrected).An increase in GM,WM and total intracranial volume(TIV)was observed after treatment in both groups(P<0.05).Furthermore,the increase in gross motor behavior score in EG was significantly related to the increase in WM volvme(P<0.05).Conclusions:Acupuncture plus rehabilitation therapy or rehabilitation therapy alone were proved to be safe and effective in the treatment of motor disability in children with SCP,however,acupuncture plus rehabilitation therapy showed a greater significant improvement of gross motor skills such as standing,walking as well as fine motor skills."Tonifying Kidney and Invigorating Brain" acupuncture technique could lead to a thicker cortices of posterior central gyrus,temporal pole and other brain regions,which aids in promoting the development of sensory perception and cognitive function in children,this might be the possible mechanism of acupuncture in improving the fine motor skills."Tonifying Kidney and Invigorating Brain" acupuncture technique or rehabilitation therapy alone could lead to a thicker cortex of right hemisphere(rostral middle frontal,pars orbitalis,pars triangularis,precuneus,isthmus cingulate,supramarginal,posterior cingulate,and caudal anterior cingulate),and significantly thinner cortices in the left lateral occipital.An increase in GM,WM and total intracranial volume(TIV)might be the possible mechanism in restoring the gross motor skills and fine motor skills.There may be a positive correlation on these 3 subjects:1)"Tonifying Kidney and Invigorating Brain" acupuncture technique;2)an increase of WM volume;3)an improvement of gross motor skills.Changes of WM volume might be the potential factor for evaluating the efficacy of acupuncture in treating motor disability in children with SCP.