The Study On The Effect Of Electro-acupuncture At Acupoints In The Conception Vessel And Governor Vessel On Swallowing Motor Cortex In Humans

Background:Swallowing function is one of the most basic and important human’s physiological activity and its main role is to put the food from the throat to the stomach. When any trouble happens in the process, the swallowing Disorder will happen too, which is one of the common complications of cerebral apoplexy and brings serious harm to human health. Electro-acupuncture has good clinical effect on the swallowing disorder after stroke, but its physiological and pathological mechanism study is few.Objective;To observe the best stimulation point location of pharyngeal muscle for the target of bilateral swallowing motor cortexes before electro-acupuncture, to observe RMT andMEP (amplitude and latency) of pharyngeal muscle frombilateral swallowing motor cortexes with TMS, before electro-acupuncture, immediately after different electro-acupuncture parameters atacupoints in the conception vessel and governor vessel, which explores the influence of electro-acupuncture on swallowing motor cortex excitability, thus to clear the possible effect of swallowing motor cortex in the activation of the corticobulbar projection of pharynx by electro-acupuncture, and then we try to find the optimum parameter of the electro-acupuncture. Applying the optimum parameter of the electro-acupuncture in acupoints in the conception vessel and governor vessel, we study the activation range and activation degree of electro-acupuncture on swallowing motor cortex, according to the changes of amplitude of MEP of pharyngeal muscle, which explores the effect of electro-acupuncture on the activation of swallowing motor cortex.Methods:From August in 2014 to December in 2015, all healthy subjects are students from Guangzhou university of Chinese medicine. According to the approval of the Guangdong province hospital of ethics committee, this study has been completed in the key laboratory of TCMand acupuncture in science academy of Guangdong province hospital. All healthy subjects are included in the study and gave informed written consent before the study. The study is divided into two trial periods and belongs totheir own before-and-after study. During the first trialperiod,15 healthy subjects were included in the statistical analysis of the first trialperiod; During the second trialperiod,10 healthy subjects were included in the statistical analysis of the second trial period. Research method of the first trial period:Firstly, before electro-acupuncture, we recorded the best stimulation point location of pharyngeal muscle for the target, RMT and MEP of pharyngeal muscle frombilateral swallowing motor cortexes with TMS. And then, we applied electro-acupuncture intervention on the subjects using Hans acupoint nerve stimulator (model:HANS-200A) in different electro-acupuncture parameters atacupoints in the conception vessel and governor vessel(Lianquan CV23 and Fengfu GV16), such as electro-acupuncture frequency of 2 Hz and 100 Hz, the time for 5 min,15 min, 30 min, intensity for maximum strength of healthy subjects (2Hz:0.9mA-3mA; 100Hz:0.9mA-2.5mA), and continuous wave. Between two different electro-acupuncture parameter, we set two days as washout period. Immediately after every electro-acupuncture intervention, we recorded RMT and MEP of pharyngeal muscle from bilateral swallowing motor cortexes with TMS again to compare with those before electro-acupuncture. We also recorded RMT and MEP of thenar muscle from bilateral hand motor cortexes with TMS as control. Research method of the second trial period:Applying the optimum parameter from 6 different electro-acupuncture parameters of the first trial period in acupoints in the conception vessel and governor vessel(Lianquan CV23 and Fengfu GV16), we recorded the changes of MEP’s amplitude of pharyngeal musclewith TMS before and immediately after electro-acupuncture to analyze the activation range and activation degree of electro-acupuncture on swallowing motor cortex. While stillusing the changes of MEP’s amplitude of thenar muscle with TMS as control.Results:1. General information:15 healthy subjects (age range 19-23 years,9male, 6female,13 right-handed,2 left-handed, height, body weight, BMI index are within the normal range, stable life signs, Kubota drinking water test Level 1. MMSE 30 points, distance between nostil and upper esophageal sphincter range 18-21cm).2. The verification of the best stimulation point location of bilateral swallowing motor cortexes:Compare with the best stimulation point location of pharyngeal muscle for the target of bilateral swallowing motor cortexes with TMS from the study of classic literature, our study found that horizontal coordinate and vertical coordinate of the best stimulation point had no significant difference with those reported in the classic literature (P>0.05).3. The effect of electro-acupuncture at acupoints in the conception vessel and governor vessel on RMT of pharyngeal muscle:After 6 different electro-acupuncture parameters respectively, the RMT of pharyngeal muscle from bilateral swallowing motor cortexes with TMS reduced compared with those before electro-acupuncture only after the electro-acupuncture parameter 2 and 5, which had very significant or significant difference significance (P<0. Olor P<0.05). After 6 different electro-acupuncture parameters respectively, the RMT change rate of the pharyngeal muscle from left swallowing motor cortex with TMS had no significant difference (P> 0.05), the RMT change rate of pharyngeal muscle from right swallowing motor cortex with TMS had no significant difference (P> 0.05). The RMT change rate of pharyngeal muscle from left and right swallowing motor cortex had no significant difference(P>0.05). By contrast with the RMT and RMT change rate of thenar muscle from bilateral hand motor cortexes with TMS, the latter RMT didn’t change obviously after electro-acupuncture and had no significant difference(P>0.05).The RMT change rate of thenar muscle from left and right hand motor cortex had no significant difference after electro-acupuncture (P>0.05).4. The effect of electro-acupuncture at acupoints in the conception vessel and governor vessel on amplitude of MEP of pharyngeal muscle:After 6 different electro-acupuncture parameters respectively, the amplitude of MEP of pharyngeal muscle from bilateral swallowing motor cortexes with TMS increased compared with those before electro-acupuncture, which had very significant difference (P<0.01). The amplitude change rate of MEP of pharyngeal muscle from bilateral swallowing motor cortexes were both maximal only after the electro-acupuncture parameter 2, which had significant difference(P<0.05). The amplitude change rate of MEP of pharyngeal muscle from left and right swallowing motor cortex had no significant difference after electro-acupuncture (P>0.05). By contrast with the amplitude of MEP and amplitude change rate of MEP of thenar muscle from bilateral hand motor cortexes with TMS, the latter MEPs’amplitudes didn’t change obviously after electro-acupuncture and had no significant difference(P>0.05).Theamplitude change rate of MEP of left and right hand motor cortex had no significant difference respectively after electro-acupuncture (P>0.05).5. The effect of electro-acupuncture at acupoints in the conception vessel and governor vessel on latency of MEP of pharyngeal muscle:After 6 different electro-acupuncture parameters respectively, the latency of MEP of pharyngeal muscle from bilateral swallowing motor cortexes with TMS increased compared with those before electro-acupuncture, which had no significant difference (P>0.05). By contrast with the latency of MEP of thenar muscle from bilateral hand motor cortexes with TMS, the latter latency of MEP didn’t changeobviously after electro-acupuncture and had no significant difference(P>0.05). Thus, there were no need that calculating the latency change rate of MEP of pharyngeal muscle and thenar muscle.6. The effect of optimal electro-acupuncture parameter at acupoints in the conception vessel and governor vessel on the activation range of swallowing motor cortex:After the optimal electro-acupuncture parameter, the number of activation points of pharyngeal muscle for the target of bilateral swallowing motor cortexes with TMS increased compared with those before electro-acupuncture, which had significant difference (P<0.05). The number of activation points change rate of left and right swallowing motor cortex had no significant difference(P>0.05). By contrast with the number of activation points and number of activation points change rate of thenar muscle for the target of bilateral hand motor cortexes with TMS, the latter number of activation points didn’t change obviously after electro-acupuncture and had no significant difference(P>0.05). The number of activation points change rate of left and right hand motor cortex had no significant difference after electro-acupuncture (P>0.05).7. The effect of optimal electro-acupuncture parameter at acupoints in the conception vessel and governor vessel on the activation degree of swallowing motor cortex:After the optimal electro-acupuncture parameter, the degree of same activation points of pharyngeal muscle for the target of bilateral swallowing motor cortexes with TMS enhanced compared with those before electro-acupuncture, which had very significant difference (P<0.01). The same degree of activation points change rate of left and right swallowing motor cortex had no significant difference(P>0.05).By contrast with the degree of same activation points and degree of sameactivation points change rate of thenar muscle for the target of bilateral hand motor cortexes with TMS, the latter degree of same activation points didn’t change obviouslyafter electro-acupuncture and had no significant difference(P>0.05). The degree of activation points change rate of left and right hand motor cortex had no significantdifference respectively after electro-acupuncture(P>0.05).Conelusion:1. Compare with the best stimulation point location of pharyngeal muscle for the target of bilateral swallowing motor cortexes with TMS from the study of classic literature, our study found that the positions of the best stimulation point are basically the same as those reported in the classic literature, which perhaps concludes that there are no racial difference in the best stimulation point location of bilateral swallowing motor cortexes in humans with TMS. But,it needs more samples to confirm the conclusion.2.After six different electro-acupuncture parameters atacupoints in the conception vessel and governor vessel(Lianquan CV23 and Fengfu GV16), such as electro-acupuncture frequency of 2Hz and 100Hz, the time for 5min,15min, 30min, intensity for maximum strength of healthy subjects, the excitability of bilateral swallowing motor cortexes has been improved and the excitability of corticobulbar projection of pharynx has been enhanced further. Among six different electro-acupuncture parameters.it is electro-acupuncture parameter 2(frequency of 2Hz, the time for 15min, intensity for maximum strength of healthy subjects) that can improve the excitability of bilateral swallowing motor cortexes in humans, thus, it is called as the optimal electro-acupuncture parameter.3. After six different electro-acupuncture parameters atacupoints in the conception vessel and governor vessel (Lianquan CV23 and Fengfu GV16), compare with the excitability of bilateral hand motor cortexes the excitability of bilateral swallowing motor cortexes has been improved, but the excitability of bilateral hand motor cortexes didn’t change obviously, which indicates the effect of electro-acupuncture at acupoints in the conception vessel and governor vessel on the improved excitabilityof swallowing motor cortex in humans is specific.4. After the optimal electro-acupuncture parameter at acupoints in the conception vessel and governor vessel (Lianquan CV23 and Fengfu GV16), the activation range of bilateral swallowing motor cortexes has been enlarged and the activation degree of bilateral swallowing motor cortexes in humans have been enhanced compare with those of bilateral hand motor cortexes as control, the latter activation range and degree didn’t change, which shows that electro-acupuncture at acupoints in the conception vessel and governor vessel acupoints has the specific activation. The mechanism of the activation may be related with brain plasticity and specifically may be connected with the STP of synaptic short-term plasticity or the LTP of synaptic long-term plasticity.