Research On The Mechanism Of Acupuncture Intervention For Aphasia With "benefiting The Marrow And Awakening The Soul" Based On The Shuangliu Model Network

Background:Current treatments for post-stroke aphasia(PSA)are far from satisfactory.The'Tonifying Sui and Arousing Shen'acupuncture developed by our team has showed its benefit for PSA in clinical practice and clinical trials.However,the mechanism underlying the benefit of 'Tonifying Sui and Arousing Shen'acupuncture for PSA remains unclear,which may limit the use of this treatment in other countries.Recently,a number of language processing models had been developed.One of the most promising models is the dual-stream model.Using the dual-stream model,we aimed to investigate the mechanism underlying the language impairment of PSA and the curative effect of 'Tonifying Sui and Arousing Shen' acupuncture for PSA.Methods:Thirty-one PSA patients(native Chinese speaker)and twenty-six healthy controls(HC)matched with age,gender,education,and handedness were included.The patients were treated by"Tonifying Sui and Arousing Shen"acupuncture.Before and after the treatment,the resting-state functional magnetic resonance imaging(rs-fMRI)and high-resolution three dimensional brain structural imaging(3D-T1)were collected.The language impairment of the patients were evaluated by Boston Diagnostic Aphasia Examination(BDAE)and Western Aphasia Battery(WAB).Region-wise lesion-symptom mapping(RLSM)analysis was used to testify the generalizability of dual-stream network(as developed in previous studies)in Chinese PSA patients.Then,regions of interest(ROI)-ROI functional connectivity analysis was used to measure the connectivity status of dual-stream network,and graph-theory based network analysis was used to measure the network properties of dual-stream network.The difference between PSA patients and HC subjects and the brain change in PSA patients after acupuncture treatment were evaluated using the network measurements above.Results:The WAB and BDAE severity score were improved after the acupuncture treatment.The results of RLSM showed that the brain regions predicting the impairment of language function located within the dual-stream network.The strength of inner network connectivity of the dual stream network were increased in PSA patients as compared to HC,and normalized(decreased)after acupuncture treatment.PS A patients showed decreased connectivity between the dual stream network and their homologues in the right hemisphere,and normalized(increased)connectivity between dual stream network and their homologues in the right hemisphere after acupuncture treatment.The normalized(increased)connectivity was seen in the increase of connectivity between the left inferior temporal gyrus and the right middle frontal gyrus,which was positively correlated with aphasia quotient(AQ)and spontaneous scores in PSA patients.The PSA patients showed decreased global efficiency in the dual stream network as compared to HC subjects,and increased average path length and betweenness centrality in the dual stream network after acupuncture treatment.Compared to HC subjects,the average path length in the left middle occipital gyrus was decreased and positively correlated with spontaneous speech and BDAE severity score in PSA patients.After acupuncture treatment,PSA patients showed increased betweeness centrality in the left posterior middle frontal gyrus,and the change of betweeness centrality in the left posterior middle frontal gyrus was positively correlated with the change of BDAE severity score.Conclusions:PSA patients showed decreased inner network connectivity in the dual-stream network and increased connectivity between dual stream network regions and their homologues in the right hemisphere.After the intervention of "Tonifying Sui and Arousing Shen"acupuncture,PSA patients showed improvement in their language function and normalization of abberant network connectivity.The normalization of network connectivity may be the mechanism underlying the curative effect of"Tonifying Sui and Arousing Shen"acupuncture for PSA.In addition,PSA patients showed decreased global efficiency in the dual-stream network compared to HC subjects.After the acupuncture treatment,PSA patients showed increased average path length and betweenness centrality in the dual-stream network,which may be the result of brain reorganization in PSA patients after acupuncture intervention.These findings revealed curative mechanism of acupuncture for PSA from the prospective of dual-stream network,which may shed new lights for studies in the field.Remarks:1)The dual-stream network was used to investigate the mechanism of Chinese PSA;2)the"Tonifying Sui and Arousing Shen"acupuncture was used to treat PSA patients;3)the ROI-ROI and graph theory based functional brain network analsyis were used based on the dual-stream network to investigate the pathology and recovery mechanism of PSA.