| Objective:To observe the changes in brain functional connectivitiy(FC)between premotor area(PMA)and primary motor cortex(M1)in motor-related brain regions after functional impairment at different levels based on functional magnetic resonance imaging(fMRI).To explore the mechanism of brain functional plasticity and target of acupuncture treatment after different degrees of motor functional impairment,and to provide imaging evidence for acupuncture to promote brain functional plasticity after motor functional impairment in ischemic stroke.Methods:A total of 31 patients with left motor dysfunction after ischemic stroke that met the inclusion criteria were selected and evaluated by clinical scales.Patients were divided into mild to moderate functional impairment(50-99 points)group,and other severe motor functional impairment(0-49 points)group according to Fugl-Meyer assessment(FMA).Patients were scanned at resting state and acupuncture state functional magnetic resonance imaging.The bilateral dorsal premotor area(PMd),ventral premotor area(PMv)and primary motor cortex(M1)were selected as seed-points,and the changes in the FC between the 15 seed-point-pairs before and after acupuncture on the affected side of Yanglingquan(GB34)were calculated and compared with the correlation with FMA.Results:1.Comparison of the basic data of the patients:there was no significant difference between the two groups in terms of gender,age,course of disease,acupuncture feelings,acupuncture level and MMSE(P<0.05).They had comparable baseline and could complete related experiments and evaluations.2.Comparison of the FC strength between the seed-points:(1)In the resting state,the functional connectivity strength between the 15 pairs of seed-points in the two groups was enhanced.The FC between ipsilesional PMv and contralesional M1 of the severe motor impairment group was significantly stronger than that of the mild to moderate motor impairment group.The difference between the two groups was statistically significant(P<0.05).There was no significant difference in the FC between the remaining 14 pairs of seed-points(P>0.05).(2)In the acupuncture state,there was no significant difference in the FC between the 15 pairs of seed-points between the two groups(P>0.05).3.Comparison of the functional connectivity strength between each pair of seed-points in the two groups of resting state and acupuncture state:(1)The functional connectivity between each pair of seed-points in the rest group and acupuncture state in the whole group was enhanced,especially,the FC between the contralesional PMd and the ipsilesional M1 and bilateral PMv during the acupuncture was significantly stronger than that during the resting state(P<0.05).There was no significant difference in the FC between the remaining 13 pairs of seed-points(P>0.05).(2)In the mild to moderate motor impairment group,the FC between the contralesional PMd and the ipsilesional M1 and bilateral PMv during acupuncture was significantly stronger than that during the resting state,and the difference within the group was statistically significant(P<0.05).There was no significant difference in the FC between the remaining 13 pairs of seed-points either in the resting state and the acupuncture state(P>0.05).The changes of the FC between seed-point-pairs were consistent with the changes of the entire set of data.(3)In the severe motor impairment group,the intensity of FC between the ipsilesional PMv-M1 was significantly weakened in the acupuncture state than in the resting state,and the difference within the group was statistically significant(P<0.05).There was no significant difference in the FC between the remaining 14 of seed-points(P>0.05).Tthe changes in the FC between the seed-point-pairs were inconsistent with the changes in the entire group of data.4.Analysis of the correlation between the FMA and the FC between 15 pairs of seed-points:(1)In the resting state,there was a negative correlation between FMA and FC between lesion side PMv-Ml(r=-0.371,P<0.05);in the severe motor impairment group,the FMA score was positively correlated with the FC between the contralesional PMd-M1 and bilateral PMv(r=0.704 and r=0.845,P<0.05).(2)In the acupuncture state,the FMA in the severe motor impairment group had a positive correlation with the FC between the contralesional PMv-M1 and the ipsilesional PMd-M1(r=0.691 and r=0.747,P<0.05).Conclusion:Brain functional plasticity exists in different forms and corresponding brain regions after ischemic stroke with different degrees of motor functional impairment.The more severe impairment patients had,the stronger that FC between the contralesional M1 and the ipsilesional PMv was.Acupuncture selects specific effect targets between PMd、PMv and M1,according to the degree of motor functional impairment.Acupuncture can inhibit abnormal functional connectivity,strengthen the FC between the contralesional hemisphere and interhemispheres,and compensate the damaged function of the ipsilesional hemisphere,to promote brain functional recovery and plasticity of hemiplegia after ischemic stroke. |
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