Acupuncture Therapy for Insomnia: An Alternative Therapy for the Modulation of Brain Functions

To explore the default mode network (DMN) in childhood absence epilepsy (CAE) patients and examine their correlations between functional connectivity (FC) and clinical characteristics. Fourteen CAE patients and 14 healthy volunteers were prospectively recruited from Henan Provincial People's Hospital from September 2012 to June 2014. FC in DMN of each group, between-group comparison of DMN FC and their relationships with clinical characteristics were respectively analyzed with 3.0T resting-state functional magnetic resonance imaging (fMRI) FC analysis seeding at bilateral precuneus/posterior cingulate cortex (PCC). Seeding at bilateral precuneus/posterior cingulate cortex (PCC), positive connection was found in bilateral angular gyrus, bilateral superior parietal gyrus, bilateral superior and middle frontal gyrus, bilateral superior medial frontal gyrus, bilateral middle temporal gyrus and bilateral superior and middle occipital gyrus in controls. However, positive connection in CAE patients was observed in bilateral superior parietal gyrus and bilateral superior occipital gyrus. Between-group analysis of DMN connectivity revealed a reduction of DMN FC in bilateral medial orbitofrontal cortex, bilateral anterior cingulate cortex, bilateral superior frontal gyrus, bilateral middle frontal gyrus and left caudate in CAE patients. Moreover, increased DMN FC was present in right paracentral lobule and right middle cingulate gyrus. FC between PCC and bilateral medial orbitofrontal cortex or bilateral superior/middle frontal gyrus correlated negatively with disease duration, but there was no correlation with seizure frequency or initial age. Brain's default mode network in childhood absence epilepsy is impaired, presumably, as a result of unconsciousness and cognitive impairment during absence seizure. Abnormal DMN activities may be a biomaker of disease progress in absence epilepsy.

Objective To investigate the resting-state functional connectivity between the two hemispheres in primary insomnia(PI) using voxel-mirrored homotopic connectivity(VMHC) based on restingstate functional MRI(fMRI).Methods Eighteen PI patients and 19 healthy volunteers matched for age and sex underwent resting-state fMRI scans in a 1.5T scanner.Pittsburgh sleep quality index(PSQI) was performed for all subjects.The data was pre-processed by SPM 8 and then the VMHC values were calculated by REST software.The VMHC values between the two groups were compared by two-sample t-test.The statistical map with significant differences of VMHC value was obtained.Results Compared to the controls,PI patients showed significant VMHC decreases in the middle frontal gyrus(MFG),superior frontal gyrus(SFG),orbitofrontal cortex(OFC),hippocampus,thalamus,insula and a few occipital regions including cuneus and lingual gyrus(voxel size 1 269-7 425 mm3,t=-4.47-2.74 P＜ 0.05,Alphasim corrected).Negative correlation was observed between VMHC coefficients(0.324±0.247) of OFC and the PSQI score (10.1 ± 1.7) in PI patients(r=-0.69,P＜0.01).The other regions showing significant VMHC changes had no correlation with the PSQI score(P＞0.05).Conclusions These findings suggest that the functional coordination between homotopic brain regions is impaired in PI patients.Interhemispheric RSFC may serve as a useful method for evaluating PI where neural connectivity is implicated in the pathophysiology. Key words: Sleep initiation and maintenance disorders; Magnetic resonance imaging; Neural networks(computer)

Insomnia is a common comorbidity symptom in major depressive disorder (MDD) patients. Abnormal brain activities have been observed in both MDD and insomnia patients, however, the central pathological mechanisms underlying the co-occurrence of insomnia in MDD patients are still unclear. This study aimed to explore the differences of spontaneous brain activity between MDD patients with and without insomnia, as well as patients with different level of insomnia. A total of 88 first-episode drug-naïve MDD patients including 44 with insomnia (22 with high insomnia and 22 with low insomnia) and 44 without insomnia, as well as 44 healthy controls (HC), were enrolled in this study. The level of depression and insomnia were evaluated by HAMD-17, adjusted HAMD-17 and its sleep disturbance subscale in all subjects. Resting-state functional and structural magnetic resonance imaging data were acquired from all participants and then were preprocessed by the software of DPASF. Regional homogeneity (ReHo) values of brain regions were calculated by the software of REST and were compared. Finally, receiver operating characteristic (ROC) curves were conducted to determine the values of abnormal brain regions for identifying MDD patients with insomnia and evaluating the severity of insomnia. Analysis of variance showed that there were significant differences in ReHo values in the left middle frontal gyrus, left pallidum, right superior frontal gyrus, right medial superior frontal gyrus and right rectus gyrus among three groups. Compared with HC, MDD patients with insomnia showed increased ReHo values in the medial superior frontal gyrus, middle frontal gyrus, triangular inferior frontal gyrus, calcarine fissure and right medial superior frontal gyrus, medial orbital superior frontal gyrus, as well as decreased ReHo values in the left middle occipital gyrus, pallidum and right superior temporal gyrus, inferior temporal gyrus, middle cingulate gyrus, hippocampus, putamen. MDD patients without insomnia demonstrated increased ReHo values in the left middle frontal gyrus, orbital middle frontal gyrus, anterior cingulate gyrus and right triangular inferior frontal gyrus, as well as decreased ReHo values in the left rectus gyrus, postcentral gyrus and right rectus gyrus, fusiform gyrus, pallidum. In addition, MDD patients with insomnia had decreased ReHo values in the left insula when compared to those without insomnia. Moreover, MDD patients with high insomnia exhibited increased ReHo values in the right middle temporal gyrus, and decreased ReHo values in the left orbital superior frontal gyrus, lingual gyrus, right inferior parietal gyrus and postcentral gyrus compared to those with low insomnia. ROC analysis demonstrated that impaired brain region might be helpful for identifying MDD patients with insomnia and evaluating the severity of insomnia. These findings suggested that MDD patients with insomnia had wider abnormalities of brain activities in the prefrontal-limbic circuits including increased activities in the prefrontal cortex, which might be the compensatory mechanism underlying insomnia in MDD. In addition, decreased activity of left insula might be associated with the occurrence of insomnia in MDD patients and decreased activities of the frontal-parietal network might cause more serious insomnia related to MDD.

Where am I? The neurological correlates of self and other

Efficacy of frequently-used acupuncture methods for specific parts and conventional pharmaceutical interventions in treating post-stroke depression patients: A network meta-analysis

Objective To explore the changes of rest-state functional MRI (fMRI) features in patients with Parkinson's disease. Methods Twelve patients with Parkinson's disease, collected in our hospital from September 2013 to March 2014, and 12 volunteers (controls) were recruited. The fMRI based on blood oxygen level dependent (BOLD) was performed at resting state; the differences of amplitude of low frequency fluctuation (ALFF) and regional homogeneity (ReHo) were statistically analyzed; and the correlations of values of ALFF and ReHo with uniformed Parkinsonism rating scale (UPDRS) scores and Hoehn-Yahr (H-Y) grading were analyzed. Results PD patients exhibited increased ALFF values in the limbic lobe, the right parahippocampal gyrus and the right middle temporal pole, and reduced ALFF values in the left thalamus as compared with the controls. PD patients exhibited increased ReHo values in the superior medial frontal gyrus, the left middle frontal gyrus, brodmann area (BA) 9 and medial frontal gyrus, and reduced ReHo values in the left rolandic, the left superior temporal gyrus and insula lobe as compared with the controls. ALFF values were positively correlated with the UPDRS III scores in the right posterior cerebellum lobe and cerebellar tonsil. ALFF values and H-Y grading were negatively correlated on the left superior frontal gyrus. Negative correlation was noted between the ReHo values and UPDRS III scores in the right superior temporal gyrus and insular lobe. Positive correlation was noted between the ReHo values and H-Y grading in medial frontal gyrus, limbic lobe, anterior cingulate, medial orbitofrontal area, middle superior frontal gyrus, BA32, left superior frontal gyrus and BA10. Conclusion By resting-state fMRI, abnormal brain function in Parkinson's disease was noted; ReHo and ALFF showed abnormal changes in the connection of neuronal networks, and the compensatory response may lead to the increased brain function. Key words: Parkinson’s disease; Functional MR imaging; Regional homogeneity; Amplitude of low frequency fluctuation

To explore the cerebral blood flow (CBF) by three-dimensional arterial spin labeling (3D-ASL) and the standardized uptake value (SUV) of 18F-fluorodeoxyglucose (18F-FDG) in the prefrontal lobe of patients with major depression disorder (MDD), and analyze their correlations with patients' depressive symptoms. 3D-ASL and 18F-FDG positron emission tomography/computed tomography (PET/CT) were performed in 17 MDD patients and 16 healthy controls under the resting state. The depressive symptoms were classified into seven factors using Hamilton depression rating scale. Regional cerebral blood flow (CBF) and standardized uptake value (SUV) were compared between the patients and healthy controls using a two-sample t-test, and the correlation between the CBF and SUV with the patient Hamilton scores was examined using Spearman analysis. Decreased regional CBF values were present in the bilateral middle and the right superior frontal gyrus in patients, and decreased regional SUVs were observed in the bilateral superior, middle and inferior frontal gyrus. The significant correlation between the CBF and SUV values with the patients' Hamilton scores was mainly observed in the left middle, right middle and the right inferior frontal gyrus. 18F-FDG PET/CT is more sensitive than ASL in identifying the functional abnormalities in the prefrontal lobe. Decreased CBF and SUV in the prefrontal lobe closely correlate with the Hamilton Depression Rating Scale scores. We speculate that the left middle frontal gyrus may be a key responsible functional region in patients with MDD.

To assess the perfusion changes in brains of patients with varying levels of generalized anxiety disorder (GAD). A total of 38 GAD outpatients of Department of Psychiatry at our hospital from February to August, 2014 and 10 healthy controls received a 99mTC-ECD SPECT/CT scan with scenium analysis. Differences between brain perfusion and anxiety levels were analyzed by SPSS 16. 0 with one-way ANOVA, Pearson's Chi-square, t test and Spearman's correlation. They were grouped according to the levels of anxiety severity, i. e. mild (n = 11) , moderate (n = 16) and severe (n = 11). They had significantly lower blood flow in right superior frontal medial gyrus, right precuneus, right putamen, bilateral paracentral lobule and bilateral supplementary motor area (t = -2.19, -2.14, -2.22, -2.34, -2.08, -3.26, -2.72, P < 0.05). Individuals had significantly greater blood flow in mild group than those of control group in right olfactory (t = 2.09 P = 0.05). Individuals of moderate group had significantly lower blood flow than those of control group in left superior frontal gyrus medial orbital, right superior frontal gyrus medial orbital and left supplementary motor area, but greater in right olfactory (t = -2.16, -2.24, -2.49, 2.17, P = 0.04, 0.04, 0.02, 0.04). Individuals had lower blood flow in severe group than those of control group in left frontal lobe, right putamen, left paracentral lobule, right paracentral lobule, left precuneus, right precuneus, left parietal lobe, left precentral, right precentral, right postcentral, left rolandic operculum, left supplementary motor area, right supplementary motor area and left central region (t = -2.32, -2.11, -3.16, -2.61, -2.39, -2.18, -2.32, -2.67, -2.14, -2.11, -2.25, -4.38, -3.54, -2.38, P = 0.03, 0.05, 0.01, 0.02, 0.03, 0.04, 0.03, 0.02, 0.05, 0.05, 0.04, 0.00, 0.00, 0.03). Statistical differences existed in right middle frontal gyms orbital part (mild: 0.96 ± 0.07, moderate: 1.03 ± 0.06, severe: 0.98 ± 0.08, P = 0.04) and left paracentral (mild: 0.91 ± 0.07, moderate: 093 ± 004 severe: 0.87 ± 0.07, P = 0.02). There was a tendency of negative correlation between perfusion in right middle cingulate and paracingulate gyri, left precuneus, right precuneus and left thalamus and anxiety scores by Spearman's correlation analysis (r = -0.28, -0.28, -0.27, -0.29, P = 0.09, 0.09, 0.10, 0.07). Scenium software provides quantitative measurements for diagnosis of GAD in different anxiety levels. Also larger samples are required for confirming the results in further studies.

Tinnitus, a phantom ringing, buzzing, or hissing sensation with potentially debilitating consequences, is thought to arise from aberrant spontaneous neural activity at one or more sites within the central nervous system; however, the location and specific features of these oscillations are poorly understood with respect to specific tinnitus features. Recent resting-state functional magnetic resonance imaging (fMRI) studies suggest that aberrant fluctuations in spontaneous low-frequency oscillations (LFO) of the blood oxygen level-dependent (BOLD) signal may be an important factor in chronic tinnitus; however, the role that frequency-specific components of LFO play in subjective tinnitus remains unclear. A total of 39 chronic tinnitus patients and 41 well-matched healthy controls participated in the resting-state fMRI scans. The LFO amplitudes were investigated using the amplitude of low-frequency fluctuation (ALFF) and fractional ALFF (fALFF) in two different frequency bands (slow-4: 0.027–0.073 Hz and slow-5: 0.01–0.027 Hz). We observed significant differences between tinnitus patients and normal controls in ALFF/fALFF in the two bands (slow-4 and slow-5) in several brain regions including the superior frontal gyrus (SFG), inferior frontal gyrus, middle temporal gyrus, angular gyrus, supramarginal gyrus, and middle occipital gyrus. Across the entire subject pool, significant differences in ALFF/fALFF between the two bands were found in the midbrain, basal ganglia, hippocampus and cerebellum (Slow 4 > Slow 5), and in the middle frontal gyrus, supramarginal gyrus, posterior cingulate cortex, and precuneus (Slow 5 > Slow 4). We also observed significant interaction between frequency bands and patient groups in the orbitofrontal gyrus. Furthermore, tinnitus distress was positively correlated with the magnitude of ALFF in right SFG and the magnitude of fALFF slow-4 band in left SFG, whereas tinnitus duration was positively correlated with the magnitude of ALFF in right SFG and the magnitude of fALFF slow-5 band in left SFG. Resting-state fMRI provides an unbiased method for identifying aberrant spontaneous LFO occurring throughout the central nervous system. Chronic tinnitus patients have widespread abnormalities in ALFF and fALFF slow-4 and slow-5 band which are correlated with tinnitus distress and duration. These results provide new insights on the neuropathophysiology of chronic tinnitus; therapies capable of reversing these aberrant patterns may reduce tinnitus distress.

Structural alterations and functional reorganizations related to motor dysfunction after stroke remain unclear. This study aims to investigate alterations in structural connectivity (SC) and functional connectivity (FC) in non-acute post-stroke patients, and their associations with motor performance. Thirty-six non-acute post-stroke patients and thirty-eight well-matched healthy controls (HCs) were included. SC and FC differences between groups were analyzed using diffusion tensor imaging and resting-state fMRI, respectively. Correlations between SC and FC in regions with significant intergroup differences, along with their correlations with motor performance, were assessed. Compared with HCs, significant decreases in both SC and FC were observed in stroke patients among the right precentral gyrus, right superior frontal gyrus, right supplementary motor area, right paracentral lobule, right middle cingulate gyrus, right superior marginal gyrus, right middle temporal gyrus, and left inferior temporal gyrus. A negative correlation of SC-FC was found between the right middle cingulate gyrus and right paracentral lobule in stroke group, while a positive correlation was found between the right superior marginal gyrus and right middle temporal gyrus. Moreover, the FC between the right superior marginal gyrus and right middle temporal gyrus showed negative correlations with the Fugl-Meyer assessment of the Upper/Lower Extremity scores. This study identified disconnections in both SC and FC in sensorimotor-related and high-order brain regions, which may enhance understanding of the structure-function interactions underlying motor deficits in post-stroke patients.

Subthreshold depression (SD) is regarded as a major risk factor for major depression. However, little is known about the neural mechanism of negative emotion processing in SD. The study aimed to examine the different neural correlates for negative emotion processing in SD and health controls (HCs) and to investigate changes in functional connectivity in SD compared with HC. Blood oxygenation level-dependent (BOLD) responses of SD and HC were captured while performing a passive viewing task, which comprised a negative condition and a masked condition. A total of 42 SD and 32 HC adolescents participated in the study. Between-group comparisons revealed significant reduced activations in the superior frontal gyrus (SFG), middle frontal gyrus and middle cingulate gyrus. Region of interest (ROI) analyses did not find correlations between contrast values of the ROIs and depressive symptoms. In addition, we found a significant increased functional connectivity between the SFG and caudate, pallidum and insula, which was significantly correlated with depressive symptoms in the SD group (P < 0.05). Altered functional connectivity between the SFG and caudate, pallidum and insula may underlie the pathology of SD. This is the first study to investigate neural mechanisms of negative emotion processing in SD using task-based functional magnetic resonance imaging.

Introduction: Variability in blood pressure (BP) has been associated with Alzheimer's disease (AD). However, it is unclear whether high variability in BP over 24-hours (24-h) is associated with the pre-clinical stage of AD. By examining brain MRI regions that atrophy decades before AD develops, we investigated the association between 24-h BP variability and MRI regions of interest for AD. Methods: We included baseline information of 324 participants aged ≥40 years old from a population-based study who underwent 24-h ambulatory BP monitoring and brain MRI scans. 24-h systolic BP variability was quantified using the average real variability (ARV) index. Brain MRI regions of interest for AD included the superior and middle frontal gyrus, supramarginal, superior, and precuneus gyrus, temporal pole, medial and inferior gyrus, entorhinal cortex, and hippocampus. We performed adjusted linear regression models to evaluate the association between 24-h systolic BP variability and MRI regions of interest for AD. Results: The mean age was 58.8±12.5 and 75.3% (n=244) were women. The mean thickness of MRI regions of interest for AD ranged from 2.12 mm3 to 4.04 mm3. In linear regression models, every +1.85 mmHg increase in 24-h systolic ARV was associated with lower thickness of the superior (adjusted mean mm3, -0.10; 95% confidence interval [CI], -0.21 and -0.01) and middle (adjusted-mean, -0.12 mm3; 95% CI, -0.24 and -0.01) frontal gyrus, medial temporal gyrus (adjusted mean, -0.21 mm3; 95% CI, -0.32 and -0.10), entorhinal cortex (adjusted-mean, 0.11 mm3; 95% CI, -0.21 and -0.01), and hippocampus (adjusted-mean, -0.14 mm3; 95% CI, -0.25 and -0.03); analyses also accounted for the 24-h systolic BP level. High 24-h systolic BP level was associated with lower thickness in 3/10 regions of interest for AD (P≤0.029). Conclusions: Elevated 24-h systolic BP variability is associated with thinning of brain MRI regions of interest for AD. Prospective data are needed to examine whether 24-h BP variability associated with thinning in brain MRI regions will increase the risk of AD.

Study objectivesPrimary insomnia (PI) triggers a decline in cognitive function, and the thalamus plays an integral role in this process; however, the mechanisms are unclear. The purpose of this study was to investigate the altered functional connectivity (FC) of the thalamus in PI patients with mild cognitive impairment (MCI) and to explore the potential neural mechanisms of thalamic involvement in these patients.MethodsThis case–control study was conducted in older adults from various communities in Fuzhou, China with a PI diagnosis. These participants underwent neuropsychological assessment and were matched in a 1:2 ratio to the healthy control (HC) group and the PI group according to sex, age, and education level. Resting‐state functional magnetic resonance imaging was used to explore changes in thalamic FC in PI patients. To further compare changes in thalamic and whole‐brain FC, we further divided the PI group into cognitively normal patients and patients with MCI according to the diagnostic criteria for MCI. The relationship between abnormal FC and cognitive function was investigated.ResultsThe 28 HCs and 58 participants with PI showed significant differences in Montreal Cognitive Assessment (MoCA) scores (p = .044). In comparison to the HC group, the PI group showed enhanced FC of the occipital thalamus with the left inferior occipital gyrus, right lingual gyrus, left middle temporal gyrus, left superior marginal gyrus, left dorsolateral superior frontal gyrus, and right anterior central gyrus. The MoCA total score and the executive function, attention, and abstraction scores of PI patients with MCI (PI–MCI) were worse than those of PI patients without MCI. In comparison to the simple PI group, FC was enhanced in the PI–MCI group between the left occipital thalamus and the middle occipital gyrus, and between the right occipital thalamus and the right superior frontal gyrus, left middle frontal gyrus, right superior occipital gyrus, and orbital inferior frontal gyrus. There was a significant negative correlation between the MoCA total score and the enhanced FC between the right occipital thalamus and right superior occipital gyrus (r = −.419, p = .042).ConclusionThe early onset of cognitive impairment in patients with PI is associated with altered FC between the thalamus and the cortex. Enhanced FC between the thalamus and the visual cortex, that is, the superior occipital gyrus, which is involved in attentional processing, may play a role in the early onset of cognitive impairment in insomnia patients. Moreover, due to the fact that PI patients “overdraw” the compensatory capacity of these brain regions earlier, the PI–MCI may fall into the abyss of “decompensation” faster and face more severe cognitive impairments.

Functional network connectivity changes in children with attention-deficit hyperactivity disorder: A resting-state fMRI study

1012 CORTICAL SUBSTRATE OF BLADDER CONTROL IN SCI AND THE EFFECT OF PERIPHERAL DORSAL GENITAL NERVE STIMULATION