Editor’s Note: The author credits Dr. Arthur Yin Fan for his contributions to this article. Pt. 1 appeared as a web exclusive in the September issue.
Zhang, et al.,8 conducted a meta-analysis to summarize the immediate and long-term brain activation effects of acupuncture on patients with ischemic stroke (IS), as measured by changes in fMRI. The results indicated that immediately following treatment, IS patients exhibited enhanced clusters centered on the right precuneus (PCUN) and a weakened cluster centered on the left middle frontal gyrus (MFG).
After prolonged acupuncture treatment, the left PCUN showed enhanced clusters, while the right insula (INS) and hippocampus (HIP) each exhibited reduced clusters. Furthermore, compared to long-term acupuncture treatment, the right angular gyrus (ANG) showed higher activation immediately after acupuncture, while long-term acupuncture led to higher scores in the left superior parietal gyrus (SPG). These two activated intersecting clusters were located in the left cuneus (CUN).
Both immediate and long-term acupuncture treatments demonstrated distinct patterns of brain activation, with the left CUN emerging as a key regulatory region in their association.
Yang, et al.,9 utilized ReHo analysis to evaluate the short-term effects of Jin’s three-needle (JTN) technique, combined with mirror therapy (MT), on brain function in patients with upper-limb disability following ischemic stroke.
Mirror therapy progressively transitions from treating limb discomfort to restoring motor function in the impaired limb. The JTN points include the contralateral temporal three needles (the first needle is 2 inches above the ear apex, with the second and third needles placed 1 inch forward and backward horizontally from the first); the impaired limb hand three needles (He Gu, Qu Chi, Wai Guan); shoulder three needles (the first needle is placed at the shoulder point, with the second and third needles 2 inches forward and backward along the same horizontal level); and Ren Zhong and Bai Hui points.
The JTN+MT combined treatment involved fMRI assessments before and after treatment, showing uniform changes in brain regions. The combination of JTN and MT activated more relevant brain function areas than JTN alone, increasing brain blood oxygen perfusion.
Lu, et al.,10 designed a clinical trial to investigate the use of electroacupuncture (EA) in treating post-stroke depression (PSD) and explore its central mechanisms. The study primarily focused on changes in brain cortical morphology, local spontaneous brain activity, and the default mode network (DMN) using functional magnetic resonance imaging (fMRI). Observations were made at baseline (week 0) and after four weeks of treatment.
The anticipated results of the trial are expected to provide reliable clinical evidence for the future use of EA and MRI navigation in treating PSD. The study also assessed the acceptability and cost-effectiveness of the treatment approach.
Dr. Fan also reminded me that SPECT can be used to assess changes in the brain, although I thought that might be a bit too extravagant. Azhari11 reviewed the application of nuclear medicine in the diagnosis and treatment of stroke. Radiotracers can effectively differentiate between stroke and stroke mimics, especially in high-risk patients.
The combination of the novel positron emission tomography (PET) radiotracer 18F-fluorodeoxyglucose and radionuclide angiography can improve the sensitivity and specificity of thrombus detection, aiding decisions regarding stent implantation or carotid endarterectomy. Furthermore, integrating single-photon emission computed tomography (SPECT) and PET with ferumoxytol-labeled MRI enhances functional diagnostics for evaluating cerebral perfusion, metabolic activity and neuroinflammatory markers after stroke.
Overall, integrating nuclear medicine with multimodal imaging devices, such as CT-PET and MRI-PET, provides a more comprehensive brain image.
Clinical Relevance
Whether it is hemiplegia, aphasia, post-stroke depression, or cognitive dysfunction syndrome that follows a stroke, various body or scalp acupuncture treatment methods have shown good clinical efficacy. The World Health Organization recommends acupuncture as an alternative and adjunctive strategy for stroke treatment. TCM acupuncture treatment has been recognized to varying degrees in countries worldwide for its clinical effectiveness. However, the neurological mechanisms underlying acupuncture for stroke remain inconclusive.
While some of the studies shared in this paper do not specifically focus on scalp acupuncture, but also include body acupuncture research, fMRI as an objective measure has shown that acupuncture (including scalp acupuncture) induces significant functional activity changes in several brain regions, particularly the left precuneus (PCUN), right angular gyrus (ANG), left cuneus (CUN) and left inferior temporal gyrus. These findings could serve as a reference for future studies on the mechanisms of acupuncture at specific scalp points.
As clinicians, we should not only aim for effective treatments, but also understand the underlying mechanisms to better comprehend acupuncture's role in treating central nervous system disorders. This will facilitate improved dialogue with the mainstream medical community and enhance communication with patients, ultimately increasing patient adherence.
References
- Zhang Y, Lu H, Ren X, et al. Immediate and long-term brain activation of acupuncture on ischemic stroke patients: an ALE meta-analysis of fMRI studies. Front Neurosci, 2024 Jul 19:18:1392002.
- Yang Y, Wang Z, Hu Q, et al. The short-term effects of Jin’s three needles in conjunction with mirror therapy on brain function in patients with upper limb disability following an ischemic stroke were evaluated using ReHo analysis. Medicine, .2024 July 5;103(27):e38707.
- Lu H, Wang Y, Shen D, et al. Effects and central mechanism of electroacupuncture and MRI-navigated rTMS for PSD: study protocol for an fMRI-based single-center, randomized, controlled, open-label trial. Front Psychiatry, 2024 Jan 4:14:1226777.
- Azhari HF. Advancing stroke diagnosis and management through nuclear medicine: a systematic review of clinical trials. Front Med, 2024 Aug 19;11:1425965.
