| Objective: To discern and appraise the efficacy of Xingnao Kaiqiao acupuncture(XNKQ)combined with physical therapy(PT)in the treatment of lower limb motor dysfunction in patients with acute ischemic stroke,and to preliminarily explore the mechanism of the effects.Methods: 30 patients with first-onset acute ischemic stroke accompanied by dyskinesia of the left lower limb whose infarction was in the right basal ganglia and/or corolla radiata were included as the intervention group in this study.They were treated with XNKQ combined with PT,and the treatment frequency was 5 times/week for 3 consecutive weeks,15 times in total.The simplified Fugl-Meyer assessment scale-lower extremity(sFMA-L)and modified Barthel index(MBI)scores were evaluated at baseline and after treatment to observe the clinical efficacy.In addition,10 subjects from the intervention group were selected as the patient group and underwent fMRI scans before and after the treatment.Another 10 healthy subjects whose baseline data were matched with the patient group were included as the healthy group and also underwent fMRI scans as controls.The amplitude of low frequency fluctuation(ALFF)analysis was used to compare the MRI data between patients before the treatment and healthy people,patients after and before the treatment,to obtain the different brain regions,then made correlation analysis between the change in the ALFF of motor-related brain regions with significant differences and the change in sFMA-L and MBI scale scores before and after treatment to further explore the relevant mechanism in central nervous.Results:1.The sFMA-L and MBI scores of the intervention group after the treatment were higher than those at the baseline,which were statistically noticeable(P<0.01).2.Compared with the healthy group,the brain regions with increased ALFF value before treatment mainly included bilateral supplementary motor area,median cingulate gyrus,left cuneus,calcarine fissure,lingual gyrus and brainstem,while the brain regions with decreased ALFF value mainly included bilateral cerebellum and precuneus(GRF correction,P-voxel< 0.01,P-cluster < 0.05).3.Compared with pre-treatment,the brain regions with increased ALFF value in the patient group after treatment mainly included the right precentral gyrus,postcentral gyrus,paracentral lobule,precuneus,superior marginal gyrus,superior occipital gyrus,bilateral superior parietal gyrus,precuneus,while the brain regions with decreased ALFF value were mainly located in the left fusiform gyrus(GRF correction,P-voxel< 0.05,P-cluster < 0.05).4.There was a linear positive correlation between the ALFF change value of the right paracentral lobule with the sFMA-L change score(r=0.704,P=0.023)and the MBI change score(r=0.721,P=0.019)before and after treatment.Conclusions:1.Lower limb motor function and daily living ability of patients with acute ischemic stroke can be effectively improved by using XNKQ combined with PT.2.Patients with acute ischemic stroke had a significantly lower spontaneous neural activity in cerebellum which may be the key central mechanism for the decline of lower limb motor,besides,higher spontaneous neural activity in the bilateral supplementary motor area and heathy side brainstem which imply the early neurological compensation.3.Recovering and remodeling of the sensorimotor networks on affected side,such as the precentral gyrus,postcentral gyrus and paracentral lobule,may be a crucial central mechanism for the improvement of lower limb motor function in patients with acute ischemic stroke by using XNKQ combined with PT.4.The paracentral lobule on the side of the lesion may be the effect brain region for the recovery of lower limb motor function and daily living ability in patients with acute ischemic stroke,and its ALFF change value may be used as a biomarker to evaluate the recovery of cerebral infarction in the further. |
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