The Rs-fMRI Study Of International Standard Scalp Acupuncture In Patients With Acute Ischemic Stroke

Objective:To observe the clinical effects of international standard scalp acupuncture on patients with acute ischemic stroke(AIS).To explore the effect of international standard scalp acupuncture on brain function of AIS patients with motor dysfunction based on resting-state functional magnetic resonance imaging(Rs-fMRI).Then to explore the brain effect mechanism of international standard scalp acupuncture in the treatment of AIS.Methods:Thirty patients with left middle cerebral artery acute infarction(left basal ganglia and corona radiata)of the dominant hemisphere were selected and divided into the scalp acupuncture group and control group randomly,with 15 patients in each group.The patients in the scalp acupuncture group were treated with international standard scalp acupuncture,needling at parietal midline and left anterior/posterior parietal-temporal oblique lines,combined with conventional western medicine treatment.While other 15 patients in the control group received conventional western medicine treatment only.Clinical data and Rs-fMRI data were collected before treatment and after 1 week of treatment.Neurological deficits and motor dysfunction were evaluated by the National Institute of Health Stroke Scale(NIHSS)and simplified Fugl-Meyer Assessment(SFMA)scores.SPSS 22.0 software was used for statistical analysis of general data and clinical efficacy.Based on the Matlab2012a platform,DPABI and SPM12 software were used to preprocess,module,statistical analyze and map the data.The observational indicators included:1.clinical efficacy:the NIHSS scores and SFMA scores;2.differences in brain function:analyses of the amplitude of low-frequency fluctuation(ALFF),regional homogeneity(ReHo),voxel-mirrored homotopic connectivity(VMHC)and functional connectivity(FC).Results:Thirty patients with AIS were finally included for clinical efficacy analysis,with 15 cases in each group.Thirteen patients were included for Rs-fMRI analysis,6 patients in the scalp acupuncture group and 7 patients in the control group.1.The NIHSS scores and SFMA scores of the scalp acupuncture group and control group after treatment were significantly improved compared with those before treatment(P<0.005).The difference in the NIHSS scores before and after treatment in the scalp acupuncture group showed significant improvement compared with the control group(P<0.001).2.The differences in brain function between the two groups after treatment were as follows:(1)the zALFF values of left BA39,middle temporal gyrus and superior temporal gyrus in the scalp acupuncture group were significantly increased than those in the control group;(2)the ReHo values of left middle temporal gyrus(including BA21),BA37,BA40,angular gyrus and BA7 brain regions in the scalp acupuncture group were significantly increased than those in the control group;(3)the VMHC values of bilateral BA6 and BA8 brain regions in the scalp acupuncture group were significantly increased than those in the control group;(4)compared with the control group,the functional connectivity between the seed region of the left supplementary motor area and left middle cerebellar peduncle,left cerebellum posterior lobe(uvula and declive),vermis,fusiform gyrus,lingual gyrus,inferior occipital gyrus,calcarine,cuneus,precuneus,BA7,BA18,BA19 were significantly enhanced in the scalp acupuncture group;the functional connectivity between the seed region of the left parahippocampal gyrus and left precuneus,inside-paracingulate,inferior parietal gyrus,paracentral lobule,BA5,BA6,BA7,BA40,right median cingulate,precuneus,BA19,BA23,BA31 were significantly enhanced in the scalp acupuncture group.Conclusions:This study preliminarily found that international standard scalp acupuncture combined with conventional drug therapy,or conventional drug therapy alone,can improve neurological deficits and motor dysfunction in patients with acute middle cerebral artery infarction in the dominant hemisphere.Scalp acupuncture combined with conventional drug therapy can better improve neurological deficits in patients with AIS than conventional drug therapy alone.This study indicated that scalp acupuncture can specifically strengthen the functional activities of the brain regions related to motor coordination,sensory integration and language processing in the patients with AIS of the dominant cerebral hemisphere,can strengthen the connectivity of brain regions related to bilateral frontal lobe motor control,and can strengthen the functional connectivity between visual,cognitive,motor control,and planning-related brain regions prior to random movement.