Presentation On The Plasticity Of Cortical Representation After Acupuncturing Hegu(LI4) In Patients With Hemifacial Spasm

ObjectiveTo observe the possible changes in the organization of the motor cortex in patient with Hemifacial spasm (HFS),we study HFS patients by using Transcranial magnetic stimulation(TMS) before and after acupuncturing. Meanwhile, to investigate the biological mechanisms of "Relationship between orafacial areas and Hegu acupoint " which in facial excessive excited status,and search for scientific evidences for the clinical therapy of HFS.MethodsWe administered TMS to the motor cortex of 15 patients with HFS and 4 healthy subjects. For the patients, Before and after electroacupuncturing Hegu(LI4) and Sibai(ST2), We recorded the the motor evoked potentials(MEPs) from the orbicularis oculi muscle(00C) and the first dorsal interosseus (FDI). We analyzed motor evoked potentials (MEPs) and the sizes of face representation area before and after electroacupuncturing treatment. A washout period between two stages was 2 weeks. The ethical committee of the TCM Hospital of Guangdong Province had approved the conduct of the study (Permission number:B2015-057-01). Register number was received from Chinese Clinical Trial Register.ResultsThe study had finished the collection and analysis of information which contains 15 patients and 4 healthy subjects.1. Patients compared with healthy subjects(1)Compared with healthy subjects, the CoG of the iOOC representation of patients was shifted in a posterior and lateral direction. (3.22±0.56,8.60±0.58) vs (4.06±0.53,7.63±0.52), P＜0.05.(2)Compared with healthy subjects, the representation area of the 00C muscle controlateral to the twitching facial muscles was significantly larger than on the ipsilateral side. (CO/IO:1.35±0.24 vs 1.13±0.08, P＜0.05)2. Changes of the representation area of the 00C muscle and the FDI muscle after electrostimulation on Hegu(LI4)(1)Changes caused by Low-frequency(2HZ) electrostimulation on Hegu(LI4)①After electrostimulation, the healthy’s representation area of the 00C muscle ipsilateral to the acupuncturing hand was smaller than the other side. (38.5±10.40 vs 46.0±16.39,10472.07±7551.14 vs 16009.43±10867.37, P＞0.05, P＞0.05) (31.25±6.89 vs 23.25±4.19,36127.07±17168.62 vs 9496.76±7186.68, P＞0.05,P＞0.05)②After electrostimulation, the patients’representation area of the 00C muscle ipsilateral to the twitching facial muscles was significantly smaller than on the other side. The representation area of the FDI muscle controlateral to the twitching facial muscles was larger than on the ipsilateral side. (34.75±6.85 vs 38.75±6.85,8699.73±7651.44 vs 14085.63±9632.01, P＜0.05. P＞0.05) (27.50±2.52 vs 27.00±4.32,34285.30±11471.15 vs 29166.78±9592.52, P＞0.05, P＞0.05)(2)Changes caused by medium frequency(30HZ)and high frequency(100HZ) electrostimulation on Hegu(LI4)After electrostimulation, the patients’representation area of the 00C muscle ipsilateral to the twitching facial muscles was larger than on the other side. The representation area of the FDI muscle controlateral to the twitching facial muscles was smaller than on the ipsilateral side.3. Changes of the representation area of the 00C muscle and the FDI muscle after electrostimulation on Sibai(ST2)(1)Changes caused by medium frequency(30HZ) electrostimulation on Sibai(ST2)After electrostimulation, the patients’representation area of the 00C muscle ipsilateral to the twitching facial muscles was smaller than on the other side. The representation area of the FDI muscle controlateral to the twitching facial muscles was smaller than on the ipsilateral side. (36.00±0.0 vs 39.50±3.53,13650.50±8412.45 vs 14600.15±3065.10, P＞0.05, P＞0.05) (30.00±11.31 vs 31.50±12.02,47958.25±24555.34 vs 60233.20±44101.83, P＞0.05, P＞0.05)(2)Changes caused by Low-frequency(2HZ)and high frequency(100HZ) electrostimulation on Sibai(ST2)After electrostimulation, the patients’ representation area of the 00C muscle ipsilateral to the twitching facial muscles was larger than on the other side. The representation area of the FDI muscle controlateral to the twitching facial muscles was smaller than on the ipsilateral side. 2HZ:(37.50±9.20 vs 33.50±10.60,13718.00±9642.11 vs 10376.00±7014.50, P＞0.05, P＞0.05) (8.50±0.71 vs 125.50±2.12,13303.00±11185.02 vs 20992.70±19804.36, P＞0.05, P＞0.05) 100HZ:(42.00±5.66vs 39.00±2.83,14729.50±9938.39 vs 14600.15±3065.10, P＞0.05, P＞0.05) (31.50±7.78 vs 35.00±7.07,42433.10±30883.73 vs 60233.20±44101.83, P＞0.05, P＞0.05)Conclusion1.The patients’ representation area of the 00C muscle is in ststus of superexitation. The i00C output area was enlarged and expanded into the direction of the hand representation.2. It’s effective to electic-acupuncture with 2HZ on Hegu(LI4) and 30HZ On Sibai (ST2) for patients with HFS. The curative effect of Low-frequency(2HZ) electrostimulation on Hegu(LI4) is superior to medium frequency(30HZ) electrostimulation on Sibai(ST2).3. There was a cortical reorganization in the motor cortex in facial excessive excited status，which showed that the area of face motor representation enlarged and expanded to the hand motor representation. After Low-frequency (2HZ) electrostimulation on Hegu(LI4), this trend reversed. The cortical reorganization between the hand and facial representation area maybe the biological mechanisms of "Relationship between orafacial areas and Hegu acupoints".