Research On The Mechanism Of Acupuncture Regulation Effect Of Stroke Hemiplegia Based On The Bilateral Sexual Connection Of The Brain

Objective:Based on the resting-state fMRI and DTI techniques,from the perspective of bilateral connections,this study was aimed to figure out the changes in brain function and structure after unilateral cerebral infarction and to illustrate the central mechanism of acupuncture treatment.Methods:21 stroke patients with left or right hemiplegia who met the inclusion and 23 age-and gender-matched healthy subjects were recruited in this study.The stroke participants received "Shou Zu Shi Er Zhen" acupuncture treatment and received the needle sensation assessments after every acupuncture treatment by the acupuncturist.Stroke patients accepted two-time neuroimaging scannings and two-time scales assessments before and after the entire acupuncture treatment,while healthy participants only received once.Based on voxel-mirrored homotopic connectivity analysis method,function connectivity analysis based on region of interest and atlas-based analysis,we computed the function and structure neuroimaging indicators.Two-sample t-test and paired t-test were carried out to analysize the differences of brain function and brain structure between stroke patients and healthy pariticipants,at the baseline and after the acupuncture treatment course,respectively.Besides,we analyzed the relationship between neuroimaging indicators and motor function scales.Results:1.Characteristics of brain function changes based on mirror homotopy functional connection:The homotopy function of hemiplegic patients were destroyed after cerebral infarction.Compared with healthy subjects,hemiplegic patients with cerebral infarction showed weakened VMHC in bilateral cerebellum,bilateral hippocampus areas,bilateral basal ganglia,bilateral thalamus,bilateral cingulate gyrus and bilateral paracenter lobule.After acupuncture treatment,the changes of VMHC of bilateral cerebellar tonsils were correlative with the changes of motor function.2.Analysis of whole brain function connections based on ROI:Taking the bilateral cerebellar tonsils as ROIs,compared with healthy controls,before the acupuncture treatment,we found that brain areas in bilateral prefrontal cortex,left posterior parietal cortex,bilateral cingulate gyrus and left precentral gyrus showed weak function connection with bilateral cerebellar tonsil while brain areas in unilateral motor-related regions,bilateral anterior cuneate lobe,bilateral postcentral gyrus,bilateral superior temporal gyrus,middle temporal gyrus and bilateral insula showed enhanced function connections.After acupuncture treatment,the results showed that only brain areas in bilateral prefrontal cortex,and bilateral cingulate gyrus showed the weak function connections while lots of brain regions in bilateral motor-related regions,bilateral cingulate gyrus,bilateral prefrontal cortex,bilateral postcentral gyrus,bilateral insula and superior parietal lobule plus newly emerging brain regions related to the processing of visual and auditory information displayed enchanced function connetions.By reducing the numbers of voxels and function types of the brain areas presented weakened function connections and up-regulating the numbers of voxels and function types of the brain regions exhibited enhanced functionconnections with bilateral cerebellar tonsils,acupuncture treatment enhanced the transformation of functional connection patterns with subcortical motor regulation center to promote the motor recovery.3.FA changes of white matter fibers in stroke patients:Before and after acupuncture treatment,the white matter fibers in affected hemisphere showed significant differences with healthy controls and unaffected hemisphere in stroke patients in the following regions,including corticospinal tract,cerebral peduncle,anterior limb of internal capsule,posterior limb of internal capsule,anterior part of corona radiata,superior part of corona radiata,posterior part of corona radiata,posterior thalamic radiation,sagittal stratum,external capsule,cingulum,superior longitudinal fasciculus,superior fronto-occipital fasciculus,tapetum,and the genu,body and splenium of the corpus callosum.Secondary degenarations of white matter fibers in the whole brain were widely happened among the motor system and non-motor system,ipsilateral hemispheres and contralateral hemispheres.Before and after acupuncture treatment,the FA value of whole brain white matter fibers showed no significantly statistical changes,some exhibited an upward trend,and the FA values of most white matter fiber declined slowly.4.Changes of corticospinal tract in stroke patients:The value of rFA in the focal area of corticospinal tract in stroke hemiplegic patients was the lowest part in the affected CST.The secondary degeneration of CST occurred in the remote areas away from the infarction.Among different lays of the walking area of the CST,rFA of the ipsilateral CSTwas always the lowest part.The order was as follows:rFA in the posterior limb of the internal capsule<rFA in the cerebral foot<rFA in the upper coronal part<rFA in the inferior coronal part<rFA in the anterior coronal part.After acupuncture treatment,except the upper part of corona radiata showed a slightly increasing trend,the other lays of rFA showed a downward trend compared with those before treatment,which didn’t reach the statistical difference.Conclusions:After the stroke hemiplegia,the damaged features of cerebral function and structure both showed bilateral hemispheric generalization.The cerebral function and structure exhibited the concurrence of damage and remodeling.The function reorganization happened quickly after the stroke and played a major compensatory role in the reconstruction of motor function.The structure remodeling occurred slowly and the whole process was dominated by secondary degeneration,supplemented by partial white matter fibers repairation.Acupuncture may take bilateral cerebellar tonsils as anchor points to integrate and regulate the function connections among motor-related brain regions,vision processing-,hearing processing-,somatosensory-related,cognitive-related brain regions and emotional regions,so as to promote the motor recovery of hemiplegia.