| ObjectivesUnder the condition of visualization and through SPECT molecular imaging,①to explore the targets and extent of brain impairment in children with childhood autism (CA),②to describe the the effect of target response with fixed acupuncture point and fixed frequency and intensity of stimulation and③to confirm the theraputic effect of acupuncture in children with CA and provide an objective basis for evaluation of CA acupuncture treatment.Materials and Methods⑴According to the standards of "Clinical Skills & Nuclear Medicine practices", the main equipment of SPECT instrument and the molecular probe of 99Tcm-ECD used in this study were examined and corrected.⑵According to the diagnostic criteria of CCMD-3R 75.1, ICD-10 F84.0 and DSM-IV 299.00, 55 cases of CA were clinically diagnosed from Peking University Shenzhen Hospital outpatients and included in this study, with ABC rating score >57 and without sex being limited. The CA children got the first SPECT imaging with the molecular probe of 99Tcm-ECD before acupuncture treatment.⑶In the treatment, electric HANS digital acupuncture device was used and the fixed acupuncture point of bilateral Hegu, Quchi, Foot Three Li and Sanyinjiao were chosen for stimulation, with the stimulation intensity of 10~15 mA in the upper limbs and 20~25 mA in the lower limbs, and the stimulation frequency of 2/15Hz. the acupuncture treatment for each CA child was acquired two times in one day, stimulation time needed 30min for either site of limbs and the treatment process last for more than 12 months. After the acupuncture treatment, the CA children who had complete medical records and regular return visit in accordance with physician referral requirement got the second SPECT imaging.⑷After treatment, according to records return visit and the CA parents'diaries to assess symptom CA children, ABC rating score decreased more than 5 points was determined as effective. Visual assessment was according to the standards of "Nuclear Medicine Diagnosis and Treatment Guidelines". ROI technique was used in the process of quantity assessment. radioactivity counts of the same brain site in the SPECT transverse images were extracted for the calculation using the BFCR% physiological mathematical model. BFCR%≥15% was determined as acupuncture treatment effect is significant and 15%>BFCR%≥10% as effective. In the statistical analysis student t test was used.Results⑴The SPECT instrument inherent source uniformity, intrinsic spatial resolution, the rotation center and the transverse sections of pixel linear were all in accordance to the routine quality control standars.99Tcm-ECD injection was colorless, clear and transparent, no particles suspended solids and impurities, with PH value 5.5 ~ 6.2 and radiochemical purity 90.61% ~ 99.23%.⑵55 cases of CA children accomplished the treatment program, of which 49 cases were male and 6 were female. Before treatment, the mean age of the CA children were 4.50±2.39y and 226 focal hypoperfusion and hypofunction regions were found in the SPECT images. In 48 cases of CA children (87.27%), left ( or bilateral) prefrontal lobe, left Broca area, and left side (or bilateral) temporal lobe showed dysfunction. The course of acupuncture treatment was from 12 to 48 months, with mean 17.89±8.09 months.⑶After treatment, the CA children were 6.02±2.55y, with social communication, speech disorder and stereotyped behavior significantly improved, and ABC rating scores decreased by 5 points or more in 72.7% of CA children. Visual analysis showed that the cerebral blood flow and function in the lesion areas displayed in the first of SPECT imaging improved obviously or partially. Quantitative analysis showed that Fe and Fb of the left prefrontal lobe, right prefrontal lobe, left Broca area, left temporal lobe, right temporal lobe had significant differences (t=5.01, 2.32, 5.82, 4.54, 2.90, with p<0.05). According to the results of BFCR% calculation, for acupuncture treatment effect 48.67% was significant and 9.29% was effective,and the total effective is 57.96%.ConclusionsThe impaired nucleus and brain cortexes were mostly in the left ( or bilateral) prefrontal lobe, left Broca area, and left side (or both) temporal lobe. The approach of acupuncture treatment in CA is effective.SPECT molecular neuroimaging techniques can be used as the powerful tool to evaluate the efficacy of CA acupuncture treatment with the accuracy.
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