Neurorehabilitation Combining Acupuncture and Conventional Rehabilitation in the Acute Ischemic Stroke: Evidence From Multimodal MRI.

Abstract

Background: Acute ischemic stroke (AIS) remains a leading cause of long-term disability, with approximately 70% of survivors suffering from motor, sensory, and language impairments that significantly affect their daily functioning and quality of life. Recent advances in neuroimaging have provided a more precise assessment of changes in brain gray matter volume (GMV) and functional connectivity (FC), both of which are closely correlated with disease severity, prognosis, and rehabilitation outcomes. Acupuncture, as a complementary therapy, has demonstrated potential in alleviating motor and language deficits following stroke. By integrating structural magnetic resonance imaging (sMRI) and functional MRI (fMRI) data with comprehensive clinical evaluations, this research aims to objectively investigate the neural mechanisms underlying acupuncture-induced brain plasticity. Our goal is to explore how acupuncture may augment conventional AIS treatments by promoting neuroplasticity, offering a scientific basis for its integration into standard therapeutic protocols. The findings aim to advance our understanding of the neurobiological basis for integrative rehabilitation strategies, ultimately contributing to improved prognostic evaluation and optimized recovery trajectories for AIS patients.

Methods: A total of 54 AIS patients with motor dysfunction were allocated to receive either acupuncture combined with western medicine treatment (AWT) group or WT group alone. The acupuncture points used included: Neiguan (PC6), Renzhong (DU26), Sanyinjiao (SP6), Weizhong (BL40), Zusanli (ST36), Fenglong (ST40), Taichong (LR3), and Yanglingquan (GB34). Patients in AWT groups received treatment 5 times per week for 8 weeks. National Institutes of Health Stroke Scale (NIHSS), the Fugl-Meyer assessment (FMA) and structural and fMRI data were collected at three time points: baseline (on the day of enrollment), week 8 (at the end of the acupuncture intervention), and week 12 (after a 12-week follow-up period post-intervention). GMV and FC analysis was performed to investigate the potential mechanism of acupuncture treatment by comparing differences in brain cortical structure and function between treatments.

Results: GMV: The AWT group manifested an increased GMV in the ipsilesional supplementary motor area (SMA) and contralesional anterior cingulate gyrus (ACG) by week 8. In contrast, the WT group witnessed a substantial decline in GMV within the ipsilesional median cingulate and paracingulate gyrus (DCG). At the 12-week follow-up, the AWT group further demonstrated a significantly greater increase in GMV in the ipsilesional superior temporal gyrus (STG) when compared to week 8. The between-group comparisons at week 8 disclosed that the AWT group had a significantly elevated GMV in the postcentral gyrus (PoCG) and contralesional inferior temporal gyrus (ITG) (p  = 0.005) in contrast to the WT group. By week 12, the AWT group also presented a marked increase in GMV in the ipsilesional ITG relative to the WT group. In the spearman correlation analysis, a positive correlation was identified in the AWT group between the GMV of the ipsilesional SMA at 8 weeks post-enrollment and the FMA score at week 12 (p  = 0.016, R = 0.487). Moreover, the GMV in the contralesional ACG exhibited a positive correlation with the FMA score at week 12 (p = 0.006, R = 0.540). Additionally, a negative correlation was also detected in the WT group between the GMV of contralesional PoCG and the NIHSS score at week 8 (p = 0.004, R = -0.540). FC: At 8 weeks post-enrollment, the AWT group exhibited significantly increased FC between the ipsilesional SMA and the contralesional middle temporal gyrus (MTG), between the contralesional PoCG and the ACG, and between the contralesional PoCG and the ipsilesional pallidum (PAL). In the WT group, increased FC was observed between the ipsilesional SMA and the contralesional STG, and between the contralesional PoCG and the ipsilesional middle occipital gyrus (MOG). No significant positive FC regions were identified in the between-group comparisons at either 8 weeks post-enrollment or the 12-week follow-up. In the spearman correlation analysis, the enhanced FC between the ipsilesional SMA and the contralesional MTG in the AWT group was positively correlated with the post-acupuncture FMA score (p = 0.043, R = 0.417). In the WT group, the enhanced FC between the contralesional PoCG and the ipsilesional MOG was positively correlated with the FMA score (p = 0.003, R = 0.567).

Conclusions: The increased in GMV and enhanced FC in AIS patients following acupuncture intervention are correlated with improvements in neurological and motor functions. Acupuncture may promote neural network remodeling and the coordinate of brain structure and function. These findings suggest potential neurobiological mechanisms through which acupuncture can improve clinical outcomes in patients.