| Background and ObjectivesChildren with autism spectrum disorder(ASD)were formally put forward in American diagnostic and statistical manual of mental disorders-fifth edition(DSM-5)in 2013.ASD is a serious neurodevelopmental disorder in children.The characteristics of ASD not only brought a serious impact on children's physical and mental development but also brought the children of the family and society a heavy burden.There is no definite and effective treatment for ASD so far,so how to choose a safe and effective treatment for children with ASD is particularly important.Acupuncture treatment of ASD has a long history.Acupuncture therapy has a good effect on improving the language development,self-care ability of daily life and social skills of children with ASD,and has no obvious side effects.In recent years,it has been popularized and widely used in the treatment of ASD.At present,there are more acupuncture treatments for ASD.Both Chinese and western medicine think that ASD disease is located in the brain,so no matter what type of TCM syndrome ASD children belong to,the treatment of scalp acupuncture can directly regulate the blood and qi of the head meridians,activate and adjust the corresponding functional areas of the brain,so as to achieve the effect of treatment.In addition,head acupuncture are easy to be carried out in conjunction with rehabilitation training to enhance the therapeutic effect.Therefore,scalp acupuncture therapy,especially improved scalp acupuncture therapy,may be superior to other acupuncture therapies in the treatment of ASD.Scalp acupuncture,also known as cranial acupuncture,seeing the name of a thing one thinks of its function,is a acupuncture therapy for treating diseases by poking points on the head.The most representative treatment of ASD by scalp acupuncture therapy is the five items of "Jin's three-needle therapy" which evolved from "Jin's three-needle therapy" autistic eight items,according to the third batch of Chinese medicine clinical suitable technology extension project "Jin's three-needle therapy" of the State Administration of traditional Chinese Medicine in 2008.The five items of "Jin's three-needle therapy" cause less crying and screaming than "Jin s three-needle therapy" autistic eight items,and it is easier to get the cooperation of children and the acceptance of parents.The clinical application is extensive,and its effectiveness has been confirmed by many studies.In fact,"Jin's three-needle therapy" itself is a kind of acupuncture therapy based on the points of the head.At present,the exact therapeutic mechanism of acupuncture on ASD is not clear,which may be related to the improvement of neurochemistry,the increase of cerebral blood flow,the enhancement of brain function and the growth and development of nerve fibers.The above views are only corollaries or hypotheses and lack clear imaging data to support brain function.The development of blood oxygenation level dependent functional magnetic resonance imaging(BOLD-fMRI)technology has brought about the possibility of exploring the central mechanism of acupuncture therapy,and has been widely used.The resting-state fMRI(rs-fMRI)technology has become the mainstream technology of fMRI research in recent years for noninvasive detection of the brain in the basic state of spontaneous neuronal activity,without complex task-state design and training subjects,the experimental cost is lower and the result is more reliable etc.This research investigates the pathogenesis and therapeutic mechanism of acupuncture treatment of ASD in 3-6 year old male ASD patients by applying the five items of "Jin's three-needle therapy",rs-fMRI technology and regional homogeneity(ReHo)analysis method.MethodsA total of 15 children with ASD and 15 normal children were selected for the study.The subjects were Han nationality,male,aged 3?6 years.Before the experiment,ASD scalp acupuncture treatment group was collected for general statistical data,intelligence quotient(IQ),childhood autism rating scale(CARS)score and autism treatment evaluation checklist(ATEC)score,and normal control group was collected for general statistical data and IQ.Rs-fMRI scans were performed on subjects who met the research standards.In addition,the children in the ASD scalp acupuncture treatment group,after completing the rs-fMRI scan before treatment,began the scalp acupuncture treatment.All the children were treated by the same chief Chinese medicine doctor according to the points of the five items of "Jin's three-needle therapy".Acupuncture once a day,1 hour each time,5 times a week,2 days rest a week,3 months as a course of treatment(A total of 60 times).At the end of the scalp acupuncture treatment,ATEC and rs-fMRI scanning were performed on the children with ASD.Results1.In the ASD scalp acupuncture treatment group,179 children were selected,18 of them were in accordance with the conditions of entry,15 of them had complete two rs-fMRI scans and the imaging data were available.The completion rate of the experiment was 83.33%.In shedding children,one child gave up the test because his sleep depth was not up to the test requirement and two children were found to have their head flattened over 2mm or rotation angle more than 2°after fMRI scanning,and the data were discarded.A total of 143 children were selected in the normal control group,17 of them were in accordance with the condition of entering the group,15 of them had complete rs-fMRI scan once and the imaging data were available.The complete rate of the experiment was 88.24%.One of the subjects woke up and gave up the examination in the middle of the fMRI scan.One of the subjects analyzed the data after fMRI scanning and found that the head was more than 2mm or the rotation angle was more than 2°,and the data was discarded.2.Compared with ASD scalp acupuncture treatment group before treatment and normal control group in age,height,weight,head circumference and IQ,there were no significant differences between the groups(P>0.05).3.Compared with the normal controls,the ReHo values significantly increased in left putamen(P<0.05,Alphasim correction),and significantly decreased in right inferior temporal gyrus,left fusiform gyrus,bilateral rolandic operculum,left postcentral gyrus and right median cingulate and paracingulate gyri(P<0.05,Alphasim correction)in ASD scalp acupuncture treatment group before treatment.4.Compared with the normal controls,the ReHo values significantly increased in right cerebellum 4,5 region,right inferior occipital gyrus and left calcarine fissure and surrounding cortex(P<0.05,Alphasim correction),and significantly decreased in left heschl gyrus,right insula,and left precentral gyrus(P<0.05,Alphasim correction)in ASD scalp acupuncture treatment group after treatment.5.Compared with the ASD patients before treatment,the ReHo values significantly increased in right inferior temporal gyrus and right inferior occipital gyrus(P<0.05,Alphasim correction),and significantly decreased in left amygdala(P<0.05,Alphasim correction)in ASD scalp acupuncture treatment group after treatment.6.In addition to the behavior factor(P>0.05),there was significant difference in ATEC total scores and other factor scores before and after the treatment in the ASD scalp acupuncture treatment group(P<0.01).7.In ASD scalp acupuncture treatment group before treatment the Pearson correlation analysis showed that the ATEC total scores(r=-0.652,P=0.008)and sensation/perception scores(r=-0.550,P=0.034)were correlated negatively with ReHo values in right median cingulate and paracingulate gyri;The language scores were correlated positively with ReHo values in right rolandic operculum(r=0.608,P=0.016);The behavior scores were correlated negatively with ReHo values in left putamen(r=-0.572,P=0.026);The behavior scores were correlated positively with ReHo values in left fusiform gyrus(r=0.546,P=0.035).In ASD scalp acupuncture treatment group after treatment,the Pearson correlation analysis showed that the social scores were correlated positively with ReHo values in right insula(r=0.635,P=0.O11).The Pearson correlation analysis indicated there was a negative correlation between the ATEC total score differences before and after treatment and the ReHo values in left amygdala(r=-0.818,P=0.000).Also a negative correlation existed between sensation/perception scoredifferences before and after treatment and the ReHo values in left amygdala(r=-0.517,P=0.049).In addition,there was a negative correlation between behavior score differences before and after treatment and the ReHo values in left amygdala(r=-0.553,P=0.032).Conclusions1.The pathogenesis of initial ASD may be related to the changes of ReHo in the left putamen,right inferior temporal gyrus,left fusiform gyrus,bilateral rolandic operculum,left postcentral gyrus and right median cingulate and paracingulate gyri etc,especially those brain regions with obvious correlation between ReHo value and ATEC score,such as left putamen,left fusiform gyrus,right rolandic operculum and right median cingulate and paracingulate gyri etc,may be more closely related to the pathogenesis of ASD.2.Scalp acupuncture was effective in the treatment of children with ASD.The effect was mainly reflected in the improvement of children's language,social and perceptual symptoms,but not in the improvement of children's behavioral symptoms.3.The therapeutic mechanism of scalp acupuncture in the treatment of ASD may be related to the brain function changes in the left putamen,right inferior temporal gyrus,left heschl gyrus,left fusiform gyrus,bilateral rolandic operculum,left postcentral gyrus,left precentral gyrus,right median cingulate and paracingulate gyri,right cerebellum 4,5 region,right inferior occipital gyrus,left calcarine fissure and surrounding cortex,right insula and left amygdala etc,especially in areas where there was a significant correlation between ReHo values and ATEC scores or score difference,such as the left putamen,left fusiform gyrus,right rolandic operculum,right median cingulate and paracingulate gyri,right insula and left amygdala etc,may be more closely related to the therapeutic effect of scalp acupuncture on children with ASD. |
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