Effects Of Acupuncture Therapy On The Dyskinesia In Patients With Ischemic Stroke

Objective:1.To evaluate the effects of acupuncture therapy on motor dysfunction and quality of life in patients with acute ischemic stroke(AIS).2.To explore effects of acupuncture therapy on the brain structure network topological characteristics based on Diffusion Tensor Imaging(DTI)in patients with AIS.Methods:Thirty-six AIS patients were recruited from December 2019 to December 2020 in Department of Neurology,Affiliated Hospital of North Sichuan Medical College.The patients were randomly divided into group A(acupuncture acupoint group,n=24),group B(acupuncture non-acupoint group,n=12).Thirty-six healthy volunteers were recruited in group C(normal controls,n=3 6)as the baseline level of imaging data.Group A was treated with acupoint therapy at Shuigou(DU-26),Neiguan(PC-6,bilateral),Sanyinjiao(SP-6,bilateral).Group B was treated with non-acupoint therapy.Both group were recieved acupuncture therapy for 10 days.The Fugl-Meyer Assessment(FMA),Brunnstrom,Modified Rankin Scale(mRS),Barthrl Index(BI),and DTI scans were evaluated before and after acupuncture therapy of group A and B.Group C only completed once DTI scan.All data were run on SPSS 25.0 statistical software.The independent sample t test and Chi-Square test were used to compare the two groups of general clinical data(including gender,age,level of education,use of antiplatelet drugs,hemiplegic sides,TOAST classification,individual risk factors,etc.).The Shapiro-Wilk test(W test)was used to check whether the data conformed to the normal distribution.The data that conformed to the normal distribution were expressed as mean ±standard deviation,Independent sample t test was used when comparing difference between groups,and paired t test was used when analyzing difference within groups.Data that did not conform to the normal distribution were expressed as median(interquartile range)and statistical analysis was performed using Mann-Whitney U test when comparing difference between groups,Wilcoxon test was used when analyzing difference within groups.The ranked data were analyzed by chi-square test.The changes before and after treatment,baseline level before treatment and the score changes in before and after treatment between group A and group B were compared,and P<0.05 was considered statistically significant.The DTI data was fully automated processed by PANDA software package based on MATLAB,then Gretna software package was used to calculate the brain network topological characteristics,The SPSS 25.0 statistical software was used to analyze the value of brain network topological characteristics,the independent sample t test was used to compare the difference between groups,and the paired t test was used to analyze the difference within groups.The values mentioned above were expressed as mean ± standard deviation,and P<0.05 was considered statistically significant.Results:1.General clinical data:21 patients in group A and 8 in group B were Finally analyzed.We found that gender,age,level of education,use of antiplatelet drugs,hemiplegic sides,TOAST classification,and individual risk factors were not statistically significant between the two groups(P>0.05).2.Scale:(1)FMA:Self-control before and after treatment in group A and B:the FMA scores of both upper and lower limbs before and after treatment were statistically significant(P<0.05).No statistical difference was found in the baseline FMA score between the two groups before treatment(P>0.05),which means the two groups are comparable.Compared between the two groups,the differences of FMA score in upper limb before and after treatment was statistically significant(P<0.05),whereas,the differences of FMA score in lower limb before and after treatment was not statistically significant(P>0.05).(2)Brunnstrom:Self-control before and after treatment in group A and B:all the evaluation indices from upper limbs,hands and lower limbs before and after treatment were statistically significant(P<0.05).The difference in the baseline between the two groups before treatment had no statistical significance(P>0.05),which implies the two groups are comparable.Compared between the two groups,the differences of Brunnstrom scale from upper limbs and hands before and after treatment were statistically significant(P<0.05 for both).but the differences of Brunnstrom scale from lower limbs before and after treatment were not statistically significant(P>0.05).(3)BI and mRS:Self-control before and after treatment in group A and B:the BI and mRS scores before and after treatment were statistically significant(P<0.05).No statistical difference was found in the baseline between the two groups before treatment(P>0.05),which means the two groups are comparable.Compared between the two groups,the differences of BI and mRS scores before and after treatment were not statistically significant(P>0.05).3.DTI:(1)Local brain network topological characteristics:Self-control before and after treatment in group A and B,the differences in the degree centrality(DC)and nodal efficiency(NE)of local brain network topological characteristics were statistically significant(P<0.05).Compared between the two groups,NE enhanced areas had right middle frontal gyrus,orbital part(ORBmid.R),right inferior frontal gyrus,orbital part(ORBinf.R),right middle frontal gyrus(MFG.R),right inferior frontal gyrus,opercular part(IFGoperc.R),right insula(INS.R),right thalamus(THA.R),right lenticular nucleus,pallidum(PUT.R),right paracentral lobule(PCL.R),left gyrus rectus(REC.L).DC enhanced areas had right amygdala(AMYG.R).(2)Global brain network topological characteristics:the differences of each self-control and between the two groups before and after treatment for group A and group B were not significant(P>0.05).(3)FA:self-control before and after treatment in group A and B:the differences before and after treatment were not statistically significant(P>0.05).Compared between the two groups,the FA value in the right corticospinal tract(CST)was higher in group A,and their difference reached statistically significant level after treatment(P<0.05).Conclusion:(1)Acupuncture therapy has a certain effect on improving motor function,especially for the upper limbs,in patients with AIS(2)Acupuncture therapy has no significant effect on quality of life in AIS patients with motor dysfunction.(3)Acupuncture therapy probably improves motor function by reshaping brain structure network.(4)Brain network topological characteristics based on DTI combined with graph theory(GT)might be hopeful to become an effective method for studying acupuncture therapy.(5)The improvement of motor function resulted from the acupuncture therapy may be probably related to the repair of CST.