Acupuncture's effect on nerve remodeling among patients with dysphagia after cerebral infarction: a study based on diffusion tensor imaging

Abstract

Objective

To investigate the clinical effect of acupuncture among patients with dysphagia after cerebral infarction, and the nerve remodeling of acupuncture using diffusion tensor imaging.

Methods

One hundred and twenty patients with dysphagia after cerebral infarction were randomly assigned to either acupuncture group or sham-acupuncture group with a 1:1 ratio. All patients received usual care and swallowing function training of neurology department. Additionally, acupuncture was applied at Sìshéncōng (四神聪EX-HN1), Băihuì (百会GV20), Tàiyáng (太阳EX-HN5), Fēngchí (风池GB20) and Shésānzhēn (舌三针three-tongue needling points, Extra) in acupuncture group. The needles were retained for 30 min each time, and five times a week for three weeks as a course of treatment. Two courses of treatments were required in total. In sham-acupuncture group, the blunt needles were put into the needle sleeve, and the top of needle was fixed on the skin. During treatment the blunt needle tip only had slight contact with the skin without any penetration. The blunt needle tips were placed on EX-HN1, GV20, EX-HN5, GB20 and three-tongue needling points, respectively. The duration of treatment in sham-acupuncture group was the same as that in acupuncture group. Before and after treatment, all patients underwent Kubota water swallowing test to evaluate the clinical effect. Using diffusion tensor image (DTI), the nerve remodeling was detected.

Results

Clinical effect: After treatment and assessed by water swallowing test, there were 38 cases of normal swallowing function in acupuncture group, higher than 15 cases in sham-acupuncture group (P < 0.05). Nerve remodeling: (1) apparent diffusion coefficient (ADC): before treatment, ADC in acupuncture group and sham acupuncture group were 1.76 ± 0.45 mm/s and 1.68 ± 0.51 mm/s, respectively. After treatment, ADC were 0.66 ± 0.15 mm/s and 0.74 ± 0.11 mm/s, respectively. The difference in ADC had no statistical significance between two groups after treatment (P > 0.05); (2) fractional anisotropy (FA): after treatment, FA of acupuncture group was 0.57 ± 0.06, which was significantly higher than that of sham-acupuncture group (P < 0.05); (3) observation of different infarct lesions: after treatment, ADC of temporal lobe infarction in acupuncture group was (0.57 ± 0.11) mm/s, lower than 0.82 ± 0.24 mm/s of sham acupuncture group, while FA in acupuncture group was 0.61 ± 0.07, higher than 0.45 ± 0.10 in sham-acupuncture group, both with statistical significance (both P < 0.05). Regarding the changes of FA maps for temporal lobe infarction before and after treatment, the transverse bundles of the white matter fibers increased remarkably in infarct lesions and on the healthy side of temporal lobe.

Conclusion

Acupuncture could improve the swallowing function of patients with dysphagia after cerebral infarction. It reduced ADC and increased FA, especially among patients with temporal lobe infarction after treatment. Acupuncture may have a remodeling effect on transverse cortical fibers after temporal lobe infarction.