Enhanced Functional Connectivity between the Bilateral Primary Motor Cortices after Acupuncture at Yanglingquan (GB34) in Right-Hemispheric Subcortical Stroke Patients: A Resting-State fMRI Study

I don't see how acupuncture can have any effects except placebo or spontaneous recovery since energy meridians have never been proven to exist.
http://journal.frontiersin.org/article/10.3389/fnhum.2017.00178/full?

Yanzhe Ning^1†, Kuangshi Li^2†, Caihong Fu¹, Yi Ren¹, Yong Zhang¹, Hongwei Liu¹, Fangyuan Cui^1* and Yihuai Zou^1,3*

• ¹Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
• ²Department of Internal Medicine, Gulou Hospital of Traditional Chinese Medicine of Beijing, Beijing, China
• ³The Key Laboratory of Internal Medicine of TCM, Ministry of Education, Beijing University of Chinese Medicine, Beijing, China

Increasing neuroimaging researches in stroke rehabilitation had revealed the neural mechanisms of rehabilitation therapy. However, little was known about the neural mechanisms of acupuncture therapy in subcortical stroke patients. The aim of this study was to investigate the changes of functional connectivity (FC) between the bilateral primary motor cortices (M1s) after acupuncture intervention in right subcortical stroke patients. Twenty right-hemispheric subcortical stroke patients and 20 healthy subjects were recruited to undergo one functional magnetic resonance imaging (fMRI) scanning. The scanning consisted of resting-state fMRI before and after needling at Yanglinquan (GB34), and task-evoked fMRI. The most significant active point during the left passive thumb-to-index task was chosen as the seed point. The seed-based FC analysis of the bilateral M1s was performed. Stroke patients revealed decreased FC between the bilateral M1s compared with healthy subjects, and the decreased FC was significantly enhanced after acupuncture at GB34. Acupuncture could increase the intrinsically decreased FC between the bilateral M1s which provided further insight into the neural mechanisms of acupuncture for motor function recovery in stroke patients.

Introduction

Stroke has been ranked as the leading cause of motor disability among adults across the world, which had brought heavy burden to the family and the society (Lozano et al., 2012). Motor impairments of limbs gravely affect their ability to perform activities of daily living (ADL), as well as social participation. The ability to live independently after stroke depends largely on the recovery of motor function. A large number of studies had demonstrated that adequate rehabilitation therapies could promote motor function recovery (Klamroth-Marganska et al., 2014; Liu et al., 2014; Saunders et al., 2014).

In recent years, functional magnetic resonance imaging (fMRI) has been introduced as a novel method to explore the reorganization of function and structure after stroke. The primary motor cortex (M1) is a brain region related with voluntary movement, which involves in motor function recovery. Abundant cross-sectional and longitudinal neuroimaging studies in subcortical stroke patients had confirmed that functional reorganization in the ipsilesional M1 existed (Pelicioni et al., 2016), and the resting-state functional connectivity (rsFC) between the bilateral M1s initially decreased and then it gradually increased during motor function recovery (Wang et al., 2010; Rehme et al., 2011; Zhang J. et al., 2014).

The efficacy of acupuncture on stroke rehabilitation were confirmed by numbers of randomized, controlled clinical trials (Kjendahl et al., 1997; Wayne et al., 2005; Zhang et al., 2015). Abundant reviews also indicated that acupuncture was beneficial for the post-stroke rehabilitation (Wu et al., 2010; Lim et al., 2015). According to the traditional Chinese medicine (TCM) theory, GB34, called Yanglingquan, was not only the “he” (meeting) point of the Gallbladder Meridian of Foot-Shao yang, but also was the influential point of tendons. GB34 was frequently chose in recovering motor function for stroke hemiplegia patients in clinical practice and trials (Fang et al., 2016; Ratmansky et al., 2016; Yang et al., 2016). A previous study on task related fMRI had revealed that needling at GB34 could induce some motor related brain regions overlapped key regions of the sensorimotor network (SMN; Na et al., 2009). Our previous studies also had confirmed that needling at GB34 in hemiplegic patients could increase motor-cognition connectivity as well as decrease contralesional compensation of M1 and enhance the (FC) of the default mode network (DMN; Zhang Y. et al., 2014; Chen et al., 2015). However, little is known about the changes of FC between the bilateral M1s with respect to acupuncture therapy after subcortical stroke.

Therefore, in the current study, we recruited 20 patients with right-hemispheric subcortical stroke and 20 healthy subjects as controls, and obtained task-evoked activation and rsFC between the bilateral M1s data via fMRI scanning. FC analysis was used to estimate FC between the bilateral M1s before and after needling at GB34 in both patients and controls. We postulated that (1) following from previous studies, the patients would show abnormal FC between the bilateral M1s compared to the healthy subjects. (2) The abnormal FC will be changed after needling at GB34, while no change occurs in healthy subjects. In this study, we only recruited ischemic stroke patients with subcortical infarctions involving the motor pathways. In order to eliminate the dominant effect of the left hemisphere, patients with right-handed before stroke and right hemispheric lesions were included.