Abstract
Objective To analyze the pattern of intrinsic brain activity variability that is altered by acupuncture compared with conventional treatment in stroke patients with motor dysfunction, thus providing the mechanism of stroke treatment by acupuncture. Methods Chinese and English articles published up to May 2020 were searched in the PubMed, Web of Science, EMBASE, and Cochrane Library databases, China National Knowledge Infrastructure, Chongqing VIP, and Wanfang Database. We only included randomized controlled trials (RCTs) using resting-state fMRI to observe the effect of acupuncture on stroke patients with motor dysfunction. R software was used to analyze the continuous variables, and Seed-based d Mapping with Permutation of Subject Images (SDM-PSI) was used to perform an analysis of fMRI data. Findings. A total of 7 studies comprising 143 patients in the treatment group and 138 in the control group were included in the meta-analysis. The results suggest that acupuncture treatment helps the healing process of motor dysfunction in stroke patients and exhibits hyperactivation in the bilateral basal ganglia and insula and hypoactivation in motor-related areas (especially bilateral BA6 and left BA4). Conclusion Acupuncture plays a role in promoting neuroplasticity in subcortical regions that are commonly affected by stroke and cortical motor areas that may compensate for motor deficits, which may provide a possible mechanism underlying the therapeutic effect of acupuncture.
Highlights
Stroke is a syndrome characterized by an acute onset of neurologic deficit resulted from ischemia or hemorrhage
Studies were included based on the following criteria: (1) an randomized controlled trials (RCTs) conducted in patients with stroke sequelae at any-stroke stage, of any age and gender; (2) manual acupuncture or electroacupuncture with or without other therapies in the treatment group, while other therapies including conventional rehabilitation or sham acupuncture in the control group; (3) involved whole-brain functional imaging (ReHo or amplitude of low-frequency fluctuations (ALFFs)) in resting state; (4) threedimensional coordinates (x, y, z) reported in standard stereotactic space Talairach or Montreal Neurological Institute (MNI); (5) if one study involved two or more comparable datasets, all samples were included; and (6) used secondary outcomes to assess clinical efficacy
Three studies reported the patient limb dysfunction of the right side and the most lesions of brain regions had the left laterality [32, 35, 36]. All patients in both groups received conventional treatment and, on this basis, participants in the treatment group underwent two or four courses of manual acupuncture therapy, one study combined with sham acupuncture as comparison [32]
Summary
Stroke is a syndrome characterized by an acute onset of neurologic deficit resulted from ischemia or hemorrhage It became the leading cause of death and years of life lost (YLLs) at the national level in China [1]. Sufficient previous studies including animal experiments, clinical trials, and systematic reviews have proven that acupuncture was beneficial for stroke rehabilitation [10]. Aimed at a better understanding of the cerebral characters of acupuncture treatment, more and more acupuncture studies have applied rs-fMRI in the clinical trials. In order to elucidate which brain area plays a crucial role in the therapeutic effect of acupuncture, this review synthesized corresponding studies and introduced coordinate-based meta-analysis (CBMA) to quantitatively integrate the results of individual neuroimaging studies [22, 23]. The apprehension of neuroplasticity mechanisms induced by acupuncture can elucidate the central mechanism of acupuncture and possibly provide novel ideas for applying acupuncture to the treatment of other neurodegenerative diseases
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