MRI Study On Brain Microstructure And Functional Network Of "Yi Sui Xing Shen" Acupuncture For Post-stroke Aphasia

Background:Stroke is one of the leading causes of disability and death in adults and is characterized by high morbidity,disability,mortality,and recurrence rates.As a common sequela of stroke,post-stroke aphasia(PSA)occurs in about 30-40%of stroke patients,resulting in a severe reduction in the social communication skills of PSA patients,which affects their work and life and places a heavy burden on society and families.Language is a uniquely human cognitive function,and because of its unique properties,language is difficult to model in animals for experimental studies,so the study of its damage and recovery mechanisms has been a major focus of research and a challenge that the field of neuro-linguistic rehabilitation has been trying to overcome.After years of clinical practice and research,our team has developed a treatment principle based on the "brain-kidney-medulla"theory,with "benefitting the medulla as the basis,awakening the mind as the outline,and opening the orifices as the key"."In this study,we used the non-meridian and non-acupuncture point groups to investigate the difference in the efficacy of the "Yi Sui Xing Shen " acupuncture treatment for PSA and the non-meridian and non-acupuncture point groups.Because functional and structural brain imaging can effectively compensate for the subjective shortcomings of behavioral scales,it can evaluate brain structure and function and even linguistic function from a more objective perspective,which brings new opportunities for the study of recovery mechanisms of aphasia injury and clinical treatment.This study combines high spatial resolution high-resolution structural imaging(3D-T1),resting-state functional magnetic resonance imaging(rs-fMRI),and diffusion tensor imaging(DTI)to investigate the mechanisms of language impairment in PSA and the microscopic mechanism of the white matter and functional networks mechanism of the brain in post-stroke aphasia treated with "Yi Sui Xing Shen" acupuncture scheme.The study aims to investigate the mechanisms of brain damage in the white matter microstructure and functional network of the brain in PSA,and to verify the efficacy of "Yi Sui Xing Shen"acupuncture in the treatment of PSA and explore the mechanisms in the microstructure white matter and functional network of the brain in PSA.Methods:In the first part of the study,a case-control study design was used to include patients with PSA who met the inclusion criteria and healthy subjects matched for age,gender,and education with the treatment group(Heathy Control,HC).Automated Fibre Quantification technique(AFQ)analysis of DTI data and functional brain network connectivity and graph theory analysis of rs-fMRI data were performed to explore the mechanisms of brain white matter microstructure and functional network damage in PSA patients.In the second part of the study,using a prospective parallel randomized controlled study design,patients with PSA were randomly assigned to the "Yi Sui Xing Shen"acupuncture group or the non-transverse non-acupoint acupuncture group,and two separate treatment protocols were implemented for these two groups.In the "Yi Sui Xing Shen"acupuncture group,"Yi Sui Xing Shen" acupuncture plus speech rehabilitation training was used as the treatment group;in the non-meridian and non-acupuncture group,non-meridian and non-acupuncture acupuncture plus speech rehabilitation training was used as the control group.The language function of the PSA patients was evaluated at the time of entry,4 weeks after treatment,8 weeks after treatment,and 12 weeks after treatment using the Chinese standard aphasia test(CRRCAE).Subsequently,the efficacy of the "Yi Sui Xing Shen"acupuncture treatment protocol was compared with that of the non-meridian non-acupoint control group to verify the efficacy of the "Yi Sui Xing Shen" acupuncture treatment protocol.Once the efficacy of the acupuncture treatment was verified,and the mechanism of the efficacy of the acupuncture treatment was investigated in conjunction with AFQ analysis and brain functional network connectivity,and graph theory analysis.Results:In the first part of the study,among the PSA patients included in this study,AFQ-based white matter microstructure analysis showed that PSA patients had significantly lower FA values in the corresponding segments of the Left Thalmic Radiation,Left Corticospinal,Left Cingulum Cingulate,Callosum Forceps Minor,Left IFOF,Left SLF,Left Uncinate,and Left Arcuate compared to the HC group.Compared with the HC group,the PSA group showed significantly lower connectivity between the sensorimotor subnetwork and the visual subnetwork,the dorsal attention subnetwork and the sensorimotor subnetwork,the frontoparietal subnetwork and the dorsal attention subnetwork,the ventral attention subnetwork and the dorsal attention subnetwork,the default subnetwork and the limbic subnetwork,and the default subnetwork and the frontoparietal subnetwork on the left side of the brain.Analysis of graph-theoretic showed that the PSA group had significantly lower Betweenness centrality in the dorsal attention subnetwork and frontoparietal subnetwork compared to the HC group;the PSA group had elevated nodal Degree Centrality in the visual subnetwork,the Limbic subnetwork,and the default subnetwork compared to the HC group;the PSA group had significantly lower nodal Degree Centrality in the dorsal attention subnetwork,the default subnetwork,and the sensorimotor subnetwork compared to the HC group;the PSA group had significantly lower nodal Degree Centrality in the HC group;the PSA group had significantly lower network node Efficiency in the sensorimotor subnetwork,dorsal attention subnetwork,and default subnetwork compared to the HC group.The second part of the study results:There were statistical differences in the total scores of listening comprehension(12 weeks after enrollment),speaking(4 weeks after enrollment),and reading(4,8,and 12 weeks after enrollment)on the CRRCAE scale between the "Yi Sui Xing Shen" acupuncture group and the non-meridian non-acupuncture group,indicating the efficacy of acupuncture in,it shows that the "Yi Sui Xing Shen" acupuncture treatment is more effective than the non-meridian non-acupuncture group in the areas of listening,speaking and reading,and on the other hand,it also shows that the "Yi Sui Xing Shen"acupuncture treatment is more effective than the non-meridian non-acupuncture group in the areas of listening,speaking and reading.In a study of the micro structural mechanisms of the white matter,the FA score of the right ILF was positively correlated with the difference in CRRCAE-reading aloud total score and CRRCAE-calculate total score after 8 weeks of treatment compared to the group at entry.The FA difference of left cingulum cingulate correlation was positively correlated with CRRCAE-speak total score change,the FA difference of right SLF was positively correlated with CRRCAE-read total score change,and the FA difference of left SLF was positively correlated with CRRCAE-write total score change.In the study on the mechanism of the difference in brain functional network connections,the difference in left-brain connections between the "Yi Sui Xing Shen"acupuncture group and the non-meridian non-acupoint group before and after treatment was reflected in the difference between the sensorimotor subnetwork and the default subnetwork,the sensorimotor subnetwork and the ventral attention subnetwork,the sensorimotor subnetwork and the frontoparietal subnetwork,the dorsal attention subnetwork and the ventral attention subnetwork,and the dorsal attention subnetwork and the ventral attention subnetwork,dorsal attention subnetwork and default subnetwork,ventral attention subnetwork and frontoparietal subnetwork,and ventral attention subnetwork and default subnetwork were higher than those of the non-meridian and non-acupoint control group;the efficiency of brain network nodes in the sensorimotor subnetwork and ventral attention subnetwork in the left cerebral hemisphere was higher in the "Yi Sui Xing Shen" acupuncture group than in the non-meridian and non-acupuncture point group.In the left cerebral hemisphere,the Local Efficiency of brain network nodes in the dorsal attention subnetwork and frontoparietal subnetwork increased;the nodal Degree Centrality in the sensorimotor subnetwork and ventral attention subnetwork in the left cerebral hemisphere increased.Conclusions:(1)Impaired denseness and integrity of white matter fiber tracts may be the mechanism of microstructural damage to language function;(2)In PSA patients,reduced connectivity between the frontoparietal network,default network,and sensorimotor network in the left hemisphere is the predominant factor,which may be the mechanism of damage to language function networks;(3)The treatment of PSA with acupuncture using "Yi Sui Xing Shen" was mainly superior to the non-meridian non-acupoint group in the aspect of listening and comprehension,speak and read;(4)The main mechanisms of the efficacy of the "Yi Sui Xing Shen" acupuncture protocol in the treatment of PSA are:stimulating the functional recovery of the white matter fiber tracts in the left side of the brain;promoting the functional recovery of the white matter fiber tracts in the right side of the brain,and compensating for the transmission function of the mirror brain area in the left brain language function area;promoting the strength of the functional connection between the large scale left brain function network,and promoting the efficiency of the transmission of the language-related brain network.