The Study Of The Effect Of Electrical Stimulation Of The Auricular Acupoint On The PAG Functional Connection In MWoA Patients Based On The FMRI

ObjectiveThe aims of this study were to 1)To observe the therapeutic effect of tVNS on Migraine Without Aura(MWoA).2)Observe the therapeutic effect with the PAG seeding functional connection changing bases on fMRI.3)Combined with the TCM theory,and the relationship between the therapeutic effect and the acupoint areas,which provides new evidence for the theory of auricular points in TCM.MethodsIn this study,a randomized controlled and single blind clinical study was used.From February 2017 to March 2018,22 patients with MWoA were diagnosed from the Department of Neurology in Dade Road,Guangdong Province Traditional Chinese Medical Hospital.According to the order of entering the study,the envelope method was randomly divided into the ear concha treatment group and the ear scapha control group,and the tVNS was used as the intervention method.Before and after 4 weeks therapeutic interference,the score of headache,the specific quality of migraine questionnaire,and the changes in the brain function connection with the right PAG as the seeding were noted.According to the <acupuncture and moxibustion>(Ninth Edition),it is certified that the stimulation areas in the treatment group are the Otopoint CO12 Liver and the Otopoint CO11 Pancreas and Gallbladder,and the stimulation areas of the control group are the Otopoint SF3 Elbow and the Otopoint SF2 Wirst,and the relationship between the therapeutic effect and acupoint selection was discussed from the perspective of traditional Chinese medicine.Results1.Headache score evaluation: After the intervention,the difference of headache score between the treatment group and the control group after 4 weeks of intervention was statistically significant(P<0.05).2.Migraine-specific Questionnaire(MSQ):Ear concha tVNS treatment in patients with migraine without aura,MSQ scores of the treatment group before and after intervention in the three areas compared with the control group,the difference was statistically significant(P<0.05).3.The change of brain function connection with the right PAG as the seeding:(1)Comparative analysis of fMRI data before and after intervention in the treatment group showed that the brain areas with increased functional connectivity to the seed which are: left anterior lobe,left superior frontal gyrus,cerebellar vermis,left Cerebellum,fusiform gyrus;brain area with weakened functional connections: right middle cingulate gyrus,right postcentral gyrus,right precentral gyrus,right parahippocampal gyrus,right insula,right inferior parietal lobe,right supramarginal gyrus,left middle temporal gyrus,bilateral supplementary motor area,etc.;the control group had only bilateral precuneus lobe,and the functional connection between the right superior parietal lobule and the seed was enhanced.(2)Comparative analysis of fMRI data after intervention between the two groups of subjects showed that the left cerebellum and bilateral precuneus with enhanced functional connectivity to the seed;and functional connectivity weakened between the seed and the left temporal pole,left parahippocampal gyrus,left fusiform gyrus and bilateral middle cingulate gyrus.Conclusion1.In this study,the preliminary study confirmed that the ear concha tVNS could effectively improve the clinical symptoms of MWoA patients,and improve the health status of migraine patients.2.A central mechanism of auricular acupuncture in the treatment of migraine without aura may be through the activation of the vagus nerve activation of the ear pathways,the introduction of nociceptive stimuli into the central brain stem,causing a series of pain-related changes in the unit,resulting in the regulation of pain,and achieve the therapeutic effect.3.The process of migraine is related to the weakening and / or enhancement of functional connectivity of the periaqueductal gray,a a key region in thedescending pain modulatory system(DPMS).Effective treatment could change the atypical functional connectivity.4.Combined with the theory of auricular point of TCM,the stimulation site of the ear concha were the Otopoint CO12 Liver and the Otopoint CO11 Pancreas and Gallbladder,and the stimulation site of the ear scapha were the Otopoint SF3 Elbow and the Otopoint SF2 Wirst.The effectiveness of the treatment proves the cause and pathogenesis of the migraine liver and gallbladder fire depression,as well as the treatment principle from the liver and the bile theory,which has added new connotation to the theory of traditional Chinese medicine.