| Objective:This study was conducted to explore the characteristics of cerebral hemisphere functions in depressed patients from the perspective of left and right hemisphere functions of the brain based on neuroelectrophysiological techniques combined with clinical efficacy evaluation.The differences in the effects of acupuncture,shamacupuncture and waiting-list on the cerebral hemisphere functions of depressive patients were compared,aiming to provide a scientific basis for the clinical use of acupuncture in the treatment of depression and to explore the central mechanisms of acupuncture in the treatment of depression from a neuroelectrophysiological perspective.Methods:1.In this case-control study,30 patients with depression and 30 healthy subjects each received the Hamilton Depression Scale score-24(HAMD-24),Depression SelfRating Scale(SDS),Hamilton Depression Inventory score(HAMA),and Social Functioning Deficit Screening Scale(SDSS)for the assessment of depression and anxiety.Subjects in both groups were received tests of neurophysiological techniques based on motor cortex excitability testing,evoked event-related potentials(ERP)under the International Affective Picture System(IAPS)to explore the differences between depressed patients’ and healthy individuals in resting motor threshold(rMT),intracortical vulnerability(ICF),cortical resting period(CSP),intracortical inhibition(SICI),ipsilateral cortical resting period(ISP),the endogenous components P3 and N2.2.In this randomized controlled trial,eligible depressive patients were divided into acupuncture group,sham-acupuncture group,and waiting-list group according to a randomized number table.The subjects were evaluated for clinical efficacy and neurophysiological testing of cerebral hemisphere function at baseline and after 4-week intervention or waiting.Firstly,we evaluated the clinical effects of three groups to observe the effect of acupuncture on symptoms improvement in depressive patients under different interventions.Secondly,based on the neurophysiological techniques such as TMS-MCE and IAPS-ERP,we compared the effects of acupuncture treatment,sham-acupuncture treatment,and waiting-list group on the electrophysiological indexes such as rMT,ICF,CSP,SICI,ISP,P3 and N2,and correlated the difference indicators with clinical symptoms,so as to clarify the clinical significance of the phenomenon of lateralization of brain function in depression treated with acupuncture.Results:1.Characteristics of hemispheric functions in depressed patients based on neurophysiological techniques(1)Baseline conditions:Baseline balanced demographic data between depressed patients and healthy subjects(P>0.05),with significant differences in clinical symptom scores(P<0.05).(2)Comparison of TMS-EMG-based cortical excitability in the left and right hemispheres of the brain between healthy subjects and depressed patients:①There were no significant differences in cortical excitability indices between the left and right hemispheres and hemispheres of the brain between healthy subjects and depressed patients(P>0.05).② SICI at 1 ms was significantly higher in the left cerebral hemisphere of depressed patients compared to healthy subjects(P<0.05).③ICF at 15ms was significantly lower in the left cerebral hemisphere of depressed patients compared with healthy subjects(P<0.05),while the data for the remaining items were not significantly different(P>0.05).④ HAMD-24 scores in depressed patients were positively correlated with SICI(1ms)in the left cerebral hemisphere(r=0.52,P=0.003).HAMA scores were positively correlated with left SICI(1ms)(r=0.57,P=0.001)and negatively correlated with left cMEP(r=-0.38,P=0.04).SDSS scores were negatively correlated with right ICF(15ms)(r=-0.60,P=0.001).(3)Comparison of IAPS-ERP-based ERPs evoked in the left and right brain regions of the brain in healthy subjects and depressed patients:① Compared to negative mood pictures,positive and neutral mood pictures evoked higher N2 peaks and lower P3 peaks in the left brain region of healthy subjects(P<0.05),and higher N2 wave amplitudes in the left brain region of depressed patients(P<0.05),with no statistical difference in P3 wave amplitudes(P>0.05).In the right brain region,N2 wave amplitudes evoked by positive and neutral mood pictures were higher in healthy subjects and patients than those evoked by negative mood stimuli(P<0.05),and P3 wave amplitudes were not statistically different(P>0.05).② Healthy subjects had higher N2 and lower P3 evoked in the left hemisphere brain regions of the brain than in the right hemisphere brain regions when processing positive and neutral pictures(P<0.05),and there was no significant difference in the waveforms of the left and right brain regions when viewing negative mood pictures(P>0.05).There was no significant difference between left and right brain area waveforms when processing positive,neutral and negative pictures in depressed patients(P>0.05).③Compared with healthy subj ects,the peak N2 waveform evoked by depressed patients was reduced and the peak P3 waveform was increased in both brain regions when processing positive pictures(P<0.05),the peak N2 evoked by depressed patients was reduced in the left brain region and the peak P3 waveform evoked by the right brain region when processing neutral pictures(P<0.05),and the peak N2 waveform evoked by depressed patients was reduced in both brain regions when processing negative pictures(P<0.05).The peak N2 waveform was reduced in both brain regions of depressed patients when negative pictures were processed(P<0.05).④ The N2 wave amplitudes evoked by positive pictures in the left and right brain regions of depressed patients were negatively correlated with HAMD-24 scores(left side:r=-0.40,P=0.05;right side:r=-0.43,P=0.03).2.Effects of acupuncture on clinical efficacy and cerebral hemisphere function in depression(1)Results of clinical efficacy evaluation:there were no significant differences(P>0.05)in the demographic data of gender,age,duration of illness and education,and in the HAMD-24,SDS,HAMA and SDSS scores(P>0.05)among the three groups of depressed patients,and in the left and right cerebral hemispheres of rMT,SICI,ICF,cMEP,CSP,and ISP were not significantly different(P>0.05),suggesting that the three groups of patients were comparable.After acupuncture treatment,the HAMD-24 score,SDS score,HAMA score and SDSS score of depressed patients in this group were significantly reduced,and the difference was statistically significant(P<0.001);after sham-acupuncture treatment,the SDS score and HAMA score of depressed patients in this group were significantly reduced(P<0.05),and the HAMD-24 score and SDSS scores did not significantly improve(P>0.05);after the patients in the waiting-list group finished the waiting cycle,the SDS scores in this group significantly decreased(P<0.05),and the HAMD-24 scores,HAMA scores and SDSS scores did not significantly change(P>0.05).The results of the comparison between groups showed that the HAMD-24 scores of depressed patients in the acupuncture group were significantly lower compared with the sham-acupuncture group,and the difference was statistically significant.There were no significant differences in the changes of HAMA,SDSS and SDS scores between the two groups(P>0.05).(2)Changes in cortical excitability indexes:① There were no significant changes in cortical excitability indexes in the left and right hemispheres of the brain after intervention in patients in the acupuncture group(P>0.05),ICI in the left hemisphere at 1ms was significantly reduced after intervention(P<0.05),and the differences in the remaining cortical excitability indexes were not statistically significant(P>0.05).②The cortical excitability indexes in the left and right hemispheres of the depressed patients were not significantly changed after sham-acupuncture(P>0.05),and there was no significant difference between the left hemisphere and the right hemisphere after the intervention(P>0.05).③ After waiting-cycle,there was no significant change in cortical excitability indexes in the left and right hemispheres of the brain in depressed patients compared to before the intervention(P>0.05),and there was no significant difference in the left hemisphere of the brain compared to the right hemisphere of the brain after waiting(P>0.05).④ The value of change in SICI(1ms)on the left side of the brain was negatively correlated with the value of change in SDS score(r=-0.43,P=0.03).(3)Changes in ERP-based brain function indicators:①After acupuncture intervention,there was no significant difference in the amplitude of N2 and P3 waves evoked in the left and right hemispheric brain regions of the brain in depressed patients when processing positive,neutral,and negative pictures compared with the previous values(P>0.05).The N2 evoked by positive pictures was significantly greater than the N2 wave evoked by the right brain area in the left brain area,and the P3 wave evoked by the left brain area was significantly smaller than the right brain area(P<0.05),the N2 wave evoked by neutral pictures was significantly greater in the left brain area than the right brain area(P<0.05),and the P3 wave was not significantly different(P>0.05),the negative emotional pictures evoked in the left brain area of the brain P3 wave amplitude was significantly reduced compared to the right brain area(P<0.05),and there was no significant difference in N2 waves(P>0.05).② After shamacupuncture,depressed patients viewing positive,neutral and negative pictures had no significant difference in N2 and P3 wave amplitudes evoked in the left and right brain regions of the brain(P>0.05),and there was no significant difference in N2 and P3 wave amplitudes evoked in the left and right brain regions of patients in the shamacupuncture group viewing positive,neutral and negative pictures(P>0.05).③After waiting for treatment,there was no significant difference in the N2 and P3 waveform amplitude values evoked in the left hemisphere brain regions of the depressed patients when processing positive,neutral and negative pictures(P>0.05),the peak of P3 waveform reduced when processing positive pictures in the right hemisphere brain regions(P<0.05),and there was no significant difference in the N2 and P3 waveform amplitude values evoked when processing neutral and negative pictures(P>0.05),there was no significant difference in the N2 and P3 waves evoked by the three emotional pictures in the left and right brain regions(P>0.05).④ There was no significant difference in the N2 and P3 waves evoked by the three stimuli in the left and right brain regions in three groups(P>0.05).⑤ The difference between the N2 wave amplitude evoked by positive pictures in the left side of the brain area and the N2 wave amplitude in the right side of the depressed patients was positively correlated with the reduced HAMD-24 value(r=0.46,P=0.02).Conclusions:1.Patients with depression may have abnormal hemispheric functional lateralization.2.Acupuncture may improve depression and anxiety and enhance social function,and that the clinical efficacy of acupuncture for depression is significantly better than that of the sham-acupuncture.3.Acupuncture may improve depressive symptoms by restoring physiologically lateralized hemispheric function in depressed patients. |
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