Founctional Connectivity Of The RsfMRI Study On Hemiplegic Patients After Multi-acupoints Combined With Electro-acupuncture Treatment

ObjectiveThe resting state functional magnetic resonance imaging(fMRI) were performed to observed the change of the connectivity ways of neural network on stroke patients. Basing on the holistic view of traditional Chinese medicine (TCM), we tried to discover the role of multi-acupoints combined with electro-acupuncture (EA) playing in the mechanism of neural network more than on therapeutic effect of movement function.MethodsThe study has gained the Ethics Committee of the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine(B2014-032-01). This study was a randomized controlled clinical trial. Twelve patients came from the Encephalopathy Center of Guangdong Provincal Hospital from July 2014 to March 2015 blamed on hemiplegia after cerebral infarction, who met the inclusion criteria and had informed consent right, with infarcts in basal ganglia or corona radiata in acute or recovery stage of cerebral infarction, were divided into control group (non-acuptoint group) and treatment group (2Hz EA treatment group). All patients had completed the experiment, who had gone through ten times acupuncture treatment, and three times functional assessment (Brunnstrom scale, Fugl-Meyer scale, Barthel index)were carried out in the process of early、middle and late. Two times rs-fMRI examination.were taken before and after the study.The resting state fMRI data preprocessing:SPM8, REST, DPARSFA softwares were used to process fMRI data about resting state. Brain functional images statistical analysis:first, we used linear regression method to analysis the preprocessing date. Secondly,the left primary motor cortex was chosen as the seed point, and we tried to find the significant functional areas (P>0.05, activated voxel range k>27) contacted with the left primary motor cortex by the REST software for single sample t-test.Finally, we filled in all clinical observation tables, collected datas in Excle form, used the statistical method of software SPSS17.0 processing dates. All analysis results were considered statistically significant in P <0.05.ResultsResting state fMRI data statistical analysis results:in the correction (P> 0.05), the scope of activated voxel K> 27 statistical threshold level, the left cerebellum 6 area (-30,-36,-36) and 8 area (-24,-48,-48) and insula of the right cerebral (36,21,6) were observed in the treatment group which connected the left side of the primary motor cortex significantly. While in the control group did not see a single significant functional connectivity area of the brain, even in the left cerebellum 4、 5area (-24,-30,-33)、 left cerebellum 8 area (-9,-33,-42) and insula of the right cerebral (33,21,9) (above of the brain regions we mentioned P >0.05).As for the clinical evaluation indexes (Mini-Mental State Examination Scale、 Hamilton Depression Scale、 Hamilton Anxiey Scale、 National Institute of Health stroke, upper limb FMA and Bathel) and demographic datas, there was no significant difference before treatment for both groups.Results for clinical evaluation scales for two groups:①Intragroup comparision:as for the upper limb FMA index, there was no significant difference before、mid-term and after the treatment in both treatment group and control group (P>0.05), but not for the Bathel index (P<0.05). ②Intergroup comparision:There was no significant differece between control group and treatment group after the treatment as for all clinical evaluation indexes (P>0.05), and the intergroup improvement indexes of upper limb FMA and Bathel indexes (P>0.05).ConclusionUsing fMRI check to explore that patients of basal ganglia and (or) corona radiata infarction with 2 Hz low frequency electric acupuncture treatment patients was observed significant function connection between the left side of the primary motor cortex and the left cerebellum and right insula, but no different in the control group. We concluded that multi-acupoints combine with electric acupuncture treatment can produce a "whole" effect for neural network connected with the primary motor cortex, which works together with cerebellum to control movement and behavior memory neural pathways, and with insula to control emotion regulation effects. Finally we observed the two areas assorting with the primary motor area to procedure clinical effect and neuroregulation by fMRI.Analysis from the clinical data:treatment group (2 Hz EA group) and control group treatment (non-acupoint group) could improve the viability of hemiplegia after stroke, but could not improve the upper limb movement function, blamed to the less sample size, so we could not deny the EA effect.The fMRI functional connectivity analytical method was a significant approach to observe the brain function reorganization in patients with hemiplegia, which reflect the holistic view of TCM. Sample of this study was too small and date analysis method was too simple to come to conclusion.