Journal Article

Bilateral effect of acupuncture on cerebrum and cerebellum in ischaemic stroke patients with hemiparesis: a randomised clinical and neuroimaging trial

Chen, Tianyan, Zou, Yihuai, Chen, Tianzhu, Wu, Kang, Zhang, Yong

2024

Overview

BackgroundAcupuncture involving the limb region may be effective for stroke rehabilitation clinically, but the visualised and explanatory evidence is limited. Our objectives were to assess the specific effects of acupuncture for ischaemic stroke (IS) patients with hemiparesis and investigate its therapy-driven modification in functional connectivity.MethodsIS patients were randomly assigned (2:1) to receive 10 sessions of hand-foot 12 needles acupuncture (HA, n=30) or non-acupoint (NA) acupuncture (n=16), enrolling gender-matched and age-matched healthy controls (HCs, n=34). The clinical outcomes were the improved Fugl-Meyer Assessment scores including upper and lower extremity (ΔFM, ΔFM-UE, ΔFM-LE). The neuroimaging outcome was voxel-mirrored homotopic connectivity (VMHC). Static and dynamic functional connectivity (sFC, DFC) analyses were used to study the neuroplasticity reorganisation.Results46 ISs (mean(SD) age, 59.37 (11.36) years) and 34 HCs (mean(SD) age, 52.88 (9.69) years) were included in the per-protocol analysis of clinical and neuroimaging. In clinical, ΔFM scores were 5.00 in HA group and 2.50 in NA group, with a dual correlation between ΔFM and ΔVMHC (angular: r=0.696, p=0.000; cerebellum: r=−0.716, p=0.000) fitting the linear regression model (R2=0.828). In neuroimaging, ISs demonstrated decreased VMHC in bilateral postcentral gyrus and cerebellum (Gaussian random field, GRF corrected, voxel p<0.001, cluster p<0.05), which fitted the logistic regression model (AUC=0.8413, accuracy=0.7500). Following acupuncture, VMHC in bilateral superior frontal gyrus orbital part was increased with cerebro-cerebellar changes, involving higher sFC between ipsilesional superior frontal gyrus orbital part and the contralesional orbitofrontal cortex as well as cerebellum (GRF corrected, voxel p<0.001, cluster p<0.05). The coefficient of variation of VMHC was decreased in bilateral posterior cingulate gyrus (PPC) locally (GRF corrected, voxel p<0.001, cluster p<0.05), with integration states transforming into segregation states overall (p<0.05). There was no acupuncture-related adverse event.ConclusionsThe randomised clinical and neuroimaging trial demonstrated acupuncture could promote the motor recovery and modified cerebro-cerebellar VMHC via bilateral static and dynamic reorganisations for IS patients with hemiparesis.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Acupuncture / Acupuncture Therapy / Adult / Aged / Cerebellum - diagnostic imaging / Cerebellum - physiopathology / Cerebral Infarction / Cerebrum - diagnostic imaging / Cerebrum - physiopathology / Clinical Trial / Disability Evaluation / Drug dosages / Female / Functional Status / Humans / Investigations / Ischemia / Ischemic Stroke - diagnosis / Ischemic Stroke - diagnostic imaging / Ischemic Stroke - physiopathology / Ischemic Stroke - therapy / Machine learning / Magnetic Resonance Imaging / Male / Medical imaging / Mental disorders / Middle Aged / Neuroimaging / Neuronal Plasticity / Neuroplasticity / Original Research / Paresis - diagnostic imaging / Paresis - etiology / Paresis - physiopathology / Paresis - therapy / Quality standards / Recovery of Function / Rehabilitation / Stroke / Stroke Rehabilitation / Time Factors / Treatment Outcome