| Objective(1)To observe the clinical efficacy of acupuncture in treating refractory facial paralysis before and after acupuncture treatment of patients with refractory facial paralysis,and to provide a simple and effective program for the further treatment of refractory facial paralysis.(2)Resting-state functional magnetic resonance imaging(rs-fMRI)technique used to treat bilateral cingulate gyrus(PCC)before and after treatment in patients with refractory facial paralysis and healthy controls.A comparative study of brain function connectivity was performed to analyze the differences in cerebral functional connections between patients with refractory facial paralysis and healthy volunteers,and to explore the possible mechanisms of brain regulation in acupuncture patients with refractory facial paralysis.MethodTwenty patients with refractory facial paralysis were included in the study,and 20 patients were matched according to gender and age in a healthy control group.The refractory facial paralysis group received acupuncture treatment.The acupuncture points were referenced to the acupoint selection operation of Facial Moxibustion in the 2nd edition of Acupuncture Science of Shanghai Science and Technology Press.The acupuncture frequency was 3/1 week for 5 weeks.Facial nerve grading(HB)scale and facial disability index(FDI)scale were collected before treatment and after treatment.SPSS 23.0 statistical software was used to analyze and compare to evaluate clinical curative effect.Adverse reactions occurred during acupuncture treatment.Recorded in the patient’s own information collection table and statistics of adverse events and the frequency of occurrence to assess the safety of acupuncture treatment of refractory facial paralysis.fMRI data acquisition program:Patients were treated with resting fMRI data before treatment and after treatment,and data were collected once in the control group.With PCC as the region of interest,brain magnetic resonance image processing was analyzed to compare the resting state functional connections between patients with refractory facial paralysis and healthy controls before and after treatment.Results3.1 This study in acupuncture treatment of refractory facial paralysis found in clinical studies,refractory facial paralysis group,H-B scale score group within the comparison,*p<0.01,and the treatment results showed clinically effective in 1 case,effective in 15 cases,4 cases were ineffective,the total effective rate was 80%,X2=9.18,p=0.005.Pre-treatment FDIP(16.85±3.151)and FDIS(10.9±5.761*)vs.FDIP(19.95±2.037)and FDIS(7.7±3.874*)scores after treatment were compared,*p=0.000,*p=0.008.3.2 Left posterior cingulate cortex(LPCC)was used as the functional connectivity of the whole brain in the region of interest.The results of the resting state of the healthy control group in the fMRI group showed that the brain regions with enhanced functional connectivity were:Upper back,dorsolateral supra-frontal frontal gyrus,anterior precuneus,angle gyrus,mid-temporal gyrus,medial and lateral cingulate gyrus,middle occipital gyrus,middle gyri gyrus,parahippocampal gyrus;functionally weakened brain regions:triangle The next time,the top and bottom marginal gyrus,the marginal gyrus,and the central frontal gyrus(p<0.001,cluster>27).The right posterior cingulate cortex(RPCC)provides functional connections for the entire brain in the region of interest.Functionally enhanced brain regions include:superior frontal gyrus,anterior precuneus,anterior cingulate gyrus,and lateral cingulate gyrus.,angle gyri,middle temporal gyrus,parahippocampal gyrus,middle temporal gyrus;functionally weakened brain regions were:supraorbital gyrus,superior and inferior marginal gyrus,inferior temporal gyrus(p<0.001,cluster>39).3.3 Prior to acupuncture treatment,the results of analysis of LPCC resting-state fMRI between the refractory facial paralysis group and the healthy control group showed that the whole brain function connection showed enhancement.The enhanced brain regions were:frontal middle gyrus,cerebellum,inferior temporal gyrus,Middle temporal gyrus,anterior wedge leaflet(p<0.001,cluster>34).RPCC resting state fMRI between the results of the analysis and comparison,the whole brain function connectivity are displayed enhanced,enhanced brain areas are:the middle temporal gyrus,cerebellum,angle gyrus,anterior wedge,frontal gyrus,middle frontal gyrus,medial frontal gyrus,Inferior orbital front,medial and accessory cingulate back(p<0.001,cluster>25).3.4 After acupuncture treatment,the results of the LPCC resting-state fMRI between the refractory facial palsy group and the healthy control group showed that the whole brain function connection showed enhancement.The enhanced brain regions were:central posterior gyrus,supraorbital gyrus,and sacral midgut.Back and frontal gyrus(p<0.001,cluster>63).The results of the RPCC resting-state fMRI group analysis showed that the whole brain function connectivity showed enhancement.The enhanced brain areas were:central posterior gyrus,cuneiform,middle temporal gyrus(p<0.001,cluster>128).3.5 Before and after acupuncture treatment,the intractable facial paralysis group LPCC resting state fMRI intragroup analysis of the results,the connection of reluctant brain regions for the cuneus,frontal gyrus,middle occipital gyrus,posterior middle gyrus,cerebellum(p<0.001,Cluster>60).There was no significant difference between RPCC and whole brain resting state function.Conclusion4.1 Acupuncture can improve the clinical symptoms of patients with refractory facial paralysis,improve the quality of life of patients,and in the course of the progress of the trial,there was no major adverse acupuncture events,indicating that acupuncture treatment of refractory facial paralysis method is safe and reliable,worthy of clinical Application and promotion.4.2 The posterior cingulate gyrus is involved in the compensatory mechanisms of facial motor and sensory systems in patients with refractory facial paralysis and is closely related to the rehabilitation of refractory facial paralysis.4.3 Acupuncture treatment of refractory facial paralysis may be through the adjustment of the default mode network to promote reorganization of brain function,thereby improving the facial sensation and the function of the motor area. |
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