Scalp acupuncture plus low-frequency rTMS promotes repair of brain white matter tracts in hemiplegic patients with stroke: A diffusion tensor imaging study

Abstract

To study the clinical effects of scalp acupuncture plus low frequency rTMS in hemiplegic stroke patients. A total of 28 hemiplegic stroke patients were recruited and randomly assigned to the experimental group (scalp acupuncture low frequency rTMS routine rehabilitation treatment) or the control group (scalp acupuncture routine rehabilitation treatment). All patients received a diffusion tensor imaging examination on the day of admission and on the fourteenth day. Compared with pre-treatment, the upper limb motor function score and ability of daily life score increased significantly in the two groups, and motor function improvement was much greater in the experimental group. Fractional anisotropy values significantly increased in white matter tracts, such as the corticospinal tract, forceps minor, superior longitudinal fasciculus and uncinate fasciculus in the two groups. Compared with pretreatment, the fractional anisotropy values increased and mean diffusion values decreased synchronously in the forceps minor, left inferior fronto-occipital fasciculus, left inferior longitudinal fasciculus, left superior longitudinal fasciculus and left uncinate fasciculus in the experimental group. Before and after treatment, there were no significant differences in the changes of fractional anisotropy values between the two groups, but the changes of the mean diffusion values in the experimental group were much greater than those in the control group in the left superior longitudinal fasciculus and the left uncinate fasciculus (p < 0.05). Moreover, the increased fractional anisotropy values in the forceps minor in the experimental group were significantly positively correlated with the increased Fugl-Meyer assessment score. Our study concluded that based on routine rehabilitation treatment, scalp acupuncture plus low frequency rTMS can promote white matter tracts repair better than scalp acupuncture alone; the motor function improvement of the hemiplegic upper limb may be closely related to the rehabilitation of the forceps minor; the combination of scalp acupuncture and low frequency rTMS is expected to provide a more optimal rehabilitation protocol for stroke hemiplegic patients.

The stratified effects of repetitive transcranial magnetic stimulation in upper limb motor impairment recovery after stroke: a meta-analysis

“…The sample sizes ranged from 12 (32) to 199 (10). Two articles focused on acute stroke ( 28 , 34 ), seven articles focused on subacute stroke ( 7 , 8 , 29 – 31 , 36 , 38 ), one article focused on both acute and subacute stroke ( 39 ), six articles focused on chronic stroke ( 25 – 27 , 33 , 35 , 37 ), and the remaining three articles focused on acute, subacute, and chronic stroke ( 10 , 11 , 32 ). Among the articles, 10 focused on less severe hemiplegia ( 7 , 8 , 10 , 27 – 31 , 33 , 39 ), four focused on severe hemiplegia ( 26 , 35 , 36 , 38 ), four did not mention the severity of hemiplegia ( 11 , 25 , 34 , 37 ), and one article focused on both severe and less severe hemiplegia ( 32 ).…”

“…The stimulation location for excitatory rTMS was primary motor cortex (M1) of the affected hemisphere, while for inhibitory rTMS was M1 of the unaffected hemisphere, except for one article that focused on inhibitory rTMS with supplementary motor area (SMA) and premotor cortex (PMC) regions of the unaffected hemisphere ( 37 ). Ten articles selected a 10-session protocol ( 7 , 11 , 25 , 26 , 28 – 32 , 35 ); three articles selected a 14-session protocol ( 36 – 38 ); and the remaining articles involved protocols of 24 sessions ( 39 ), 20 sessions ( 27 ), 18 sessions ( 10 ), 16 sessions ( 33 ), 15 sessions ( 8 ), and five sessions ( 34 ). The control intervention in the studies was therapy with or without sham rTMS.…”

“…All of the articles were randomized controlled trials. Geographically, 15 studies were conducted in Asia (7,8,11,(26)(27)(28)(29)(30)(31)(34)(35)(36)(37)(38)(39), three in the United States (10,32,33), and one in New Zealand (25). The sample sizes ranged from 12 (32) to 199 (10).…”

Application and underlying mechanism of acupuncture for the nerve repair after peripheral nerve injury: remodeling of nerve system

“…Previous studies found that acupuncture treatment has a complex effect on the corticospinal system for a variety of disorders ( Chen et al, 2015 ; Yang et al, 2017 ). It is demonstrated that based on routine rehabilitation treatment, scalp acupuncture plus low-frequency rTMS can promote white matter tracts repair better than scalp acupuncture alone for stroke hemiplegic patients ( Zhao N. et al, 2018 ). Prior research changed the focus of plasticity from gray matter, which includes the motor cortex, to white matter, which includes the CST.…”

Magnetic Resonance Imaging Features under Deep Learning Algorithms in Evaluated Cerebral Protection of Craniotomy Evacuation of Hematoma under Propofol Anesthesia

“…DTI has abandoned the traditional animal model or autopsy research and can observe the integrity and coherence of tissue structure in vivo, which has a high adoption value in the investigation and determination of the damage degree and area of the white matter conduction bundle caused by diseases. It also has great advantages in displaying the transmission direction of nerve fiber bundles in white matter and accurate imaging of the central nervous system [ 11 , 12 ]. However, due to the limitations of imaging equipment and other factors, DTI images may have problems such as slow imaging speed, low resolution, and redundant interference noise [ 13 ], which makes it impossible to accurately read the image information, posing great trouble for clinical work.…”