Based On Resting State FMRI And DTI, The Mechanism Of Scalp Acupuncture Treatment For Hemiplegia In Stroke Was Discussed

ObjectiveIn order to provide data support for the optimization of rehabilitation program.We tried to identify the influence of scalp acupuncture on related brain regions of post-stroke hemiplegia and to shed light on the central mechanism of the scalp acupuncture therapy by the combination of resting state functional connectivity and diffusion tensor imaging.MethodIn this study,we recruited patients with left cerebral infarction and healthy control subjects matched for age,sex and education.All patients were randomly divided into scalp acupuncture group and control group.Patients allocated to the acupuncture group received scalp acupuncture treatment besides conventional therapy,while the control group received conventional therapy alone.We collected the imaging data as well as clinical information of all patients.All patients were scanned before and after the 14-day therapy,while healthy people scanned only once.We collected the resting state fMRI and DTI imaging data for each scan and then calculated the functional connectivity(FC)between the seed region(basal ganglia)and other brain regions and the distribution of FA(fractional anisotropy)of in the whole brain was obtained by TBSS.A correlation analysis was also performed between the imaging data and clinical data.Results1.The contralateral and ipsilateral cortex of hemiplegic patients with cerebral infarction are connected with the basal internode function abnormal increase and decrease,between cortex and basal ganglia in which abnormal enhancement of functional connectivity exists mainly in the ipsilateral hemisphere,reduce the abnormal functional connectivity in the cortex and contralateral basal ganglia.2.With the bilateral basal ganglia are improved connectivity bilateral BA6 scalp acupuncture group after treatment,and the connectivity between bilateral basal ganglia is enhanced,while the control group only had unilateral(right)basal ganglia connected with the contralateral BA6 area function enhancement.All two groups in treatment of patients with cerebral infarction to improve cortical and subcortical motor pathways are functionally connected,but the effect of scalp acupuncture on stronger function were bilateral motor cortex significantly improved,the injury declined after bilateral hemispheric functional connectivity between greater recovery degree.Compared with the control group,acupuncture group after treatment,left middle frontal gyrus(BA6,9),superior temporal gyrus(BA3 9)and precuneus(BA7)and contralateral multiple brain regions have a greater degree of functional connectivity decreased,sa d than conventional therapy patients can depend on contralateral motor function compensatory more significantly reduce after stroke.3.Scalp acupuncture therapy improves the bilateral frontal cortex and contralateral basal ganglia functional connectivity,including not only the bilateral BA6 areas,also involving BA9 and BA10 in prefrontal cortex area and postcentral gyrus(BA1,3),insula(BA13)brain areas related to sensory and cognitive.DTI results showed that scalp acupuncture treatment of patients with right insula,left cingulate gyrus FA value was significantly higher than the control group,scalp acupuncture group FA value high brain areas mainly right precentral gyrus,frontal cortex,supplementary motor area,paracentral lobule.4.Scalp treatment there is a negative correlation between the height between NIHSS scale and BI scale(r =-0.898,P<0.01),NIHSS scale and MMSE scale has a weak negative correlation between(r =-0.159),BI scale and MMSE scale weak positive correlation exists between(r = 0.384),but two the correlation of P value was>0.05.High negative correlation still exists between the scalp acupuncture and NIHSS after treatment BI score(r =-0.869,P<0.01),and MMSE scale and NIHSS BI scale,the correlation between before treatment by the weak correlation improve moderate correlation(-0.472 and 0.414 respectively),but the P value is>0.05.5.The change of functional connectivity between scalp acupuncture treatment and clinical rating scale was mainly found in the basal ganglia and the contralateral cortex.The functional connectivity between the right basal ganglia and the left BA6 area was enhanced after scalp acupuncture,and was negatively correlated with the NIHSS score,and was positively correlated with BI,and was weakly correlated with MMSE.The functional connectivity between the left basal ganglia and the left BA39 area was positively correlated with the NIHSS score(P<0.05),which was negatively correlated with BI,and negatively correlated with MMSE.The functional connectivity,which has a positive effect on clinical rehabilitation,mainly exists in the left cortex and the contralateral basal ganglia.6.After the treatment of scalp acupuncture,the FA and NIHSS score was negatively related to the area mainly located in right BA 13 and right corticospinal tract white matter structure,With the score of BI was positively related to the area is mainly located on the right side of the corticospinal tract of white matter structure and part of the left BA19,The effect of scalp acupuncture on the motor function recovery after stroke is closely related to the structural integrity of the motor pathway in the white matter fiber layer.The area of positive correlation between FA value and NIHSS score was mainly located in the left B A6,8 area and the nearby white matter structure,the right BA 10 and the nearby white matter structure.The negative correlation between score and the BI score was mainly located in the left BA4,9 area,the right side of the BA6,The reorganization of white matter fibers near the motor cortex has some negative effects on the patients' functional recovery.ConclusionThe changes of functional connectivity between cerebral cortex and basal ganglia in patients with cerebral infarction showed a weakening of the bilateral hemispheres and the enhancement of the connections between the hemispheres.It is suggested that the changes of brain functional connectivity after stroke may be related to the subcortical motor pathways involved in basal ganglia nuclei.Scalp acupuncture has the function of bidirectional regulation,which makes the unbalanced abnormal brain function state tend to balance.The effect of scalp acupuncture is not limited to the motor system,it has the effect of regulating the brain function.The central effect of scalp acupuncture on brain function and structure is not completely consistent,the combined use of fMRI and DTI is helpful to reflect the central effect of scalp acupuncture on hemiplegia after stroke.