Abstract
Objective: To investigate the effect of acupuncture on Parkinson's disease (PD) patients with tremor and its potential neuromechanism by functional magnetic resonance imaging (fMRI).Methods: Forty-one PD patients with tremor were randomly assigned to true acupuncture group (TAG, n = 14), sham acupuncture group (SAG, n = 14) and waiting group (WG, n = 13). All patients received levodopa for 12 weeks. Patients in TAG were acupunctured on DU20, GB20, and the Chorea-Tremor Controlled Zone, and patients in SAG accepted sham acupuncture, while patients in WG received no acupuncture treatment until 12 weeks after the course was ended. The UPDRS II and III subscales, and fMRI scans of the patients' brains were obtained before and after the treatment course. UPDRS II and III scores were analyzed by SPSS, while the degree centrality (DC), regional homogeneity (ReHo) and amplitude low-frequency fluctuation (ALFF) were determined by REST.Results: Acupuncture improved the UPDRS II and III scores in PD patients with tremor without placebo effect, only in tremor score. Acupuncture had specific effects on the cerebrocerebellar pathways as shown by the decreased DC and ReHo and increased ALFF values, and nonspecific effects on the spinocerebellar pathways as shown by the increased ReHo and ALFF values (P < 0.05, AlphaSim corrected). Increased ReHo values were observed within the thalamus and motor cortex of the PD patients (P < 0.05, AlphaSim corrected). In addition, the default mode network (DMN), visual areas and insula were activated by the acupuncture with increased DC, ReHo and/or ALFF, while the prefrontal cortex (PFC) presented a significant decrease in ReHo and ALFF values after acupuncture (P < 0.05, AlphaSim corrected).Conclusions: The cerebellum, thalamus and motor cortex, which are connected to the cerebello-thalamo-cortical (CTC) circuit, were modulated by the acupuncture stimulation to alleviate the PD tremor. The regulation of neural activity within the cognitive brain regions (the DMN, visual areas, insula and PFC) together with CTC circuit may contributes to enhancing movement and improving patients' daily life activities.
Highlights
Parkinson’s disease (PD) is an age-related neurodegenerative disorder of unknown origin that is characterized by the selective loss of dopaminergic neurons in the substantia nigra pars compacta (Miller and O’Callaghan, 2015)
The subjects were randomly assigned to a true acupuncture group (TAG), sham acupuncture group (SAG), or waiting group (WG) using a computer-generated list based on consecutive numbers that were distributed in sealed, opaque envelopes
One in the SAG who was diagnosed with acute ischaemic stroke by fMRI and another in the WG who experienced an accidental fall, were excluded
Summary
Parkinson’s disease (PD) is an age-related neurodegenerative disorder of unknown origin that is characterized by the selective loss of dopaminergic neurons in the substantia nigra pars compacta (Miller and O’Callaghan, 2015). Tremor is usually the first clinical sign of PD, and approximately 70% of PD patients manifest conspicuous tremor at rest and/or during the maintenance of posture (Wang, 2006). The management of PD tremor presents a number of challenges to clinicians (Jiménez and Vingerhoets, 2012). Stereotactic surgery provides better clinical results than medication but is poorly accepted, due to its invasiveness and high cost (Jiménez and Vingerhoets, 2012). Due to its better adaptability, fewer side effects and lower cost, acupuncture has been widely used. Clinical studies have showed a positive benefit of acupuncture in treating PD tremor (Jiang et al, 2006; Wang et al, 2015). The mechanism underlying the effects of acupuncture on tremor associated with PD remains unknown
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