Effect of adjunctive acupuncture on the white matter tract integrity in ischemic stroke patients
Poster No:
1619
Submission Type:
Abstract Submission
Authors:
Pearly Joubert1, Jia Fan1, Frances Robertson1, Hai Lu2, Fleur Warton1, Yu Wang3, Sebnem Er1, Jiu Chen2, Nelleke Langerak1, Marc Combrinck1, Xuesheng Ma4, Xuesong Ren3, Ernesta Meintjes1, Chunhong Zhang3
Institutions:
1University of Cape Town, Cape Town, Western Cape, 2Nanjing University, Nanjin, Jiangsu, 3First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, Tianjin, 4University of the Western Cape, Cape Town, Western Cape
First Author:
Co-Author(s):
Yu Wang
First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
Tianjin, Tianjin
First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
Tianjin, Tianjin
Xuesong Ren
First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
Tianjin, Tianjin
First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
Tianjin, Tianjin
Chunhong Zhang
First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
Tianjin, Tianjin
First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
Tianjin, Tianjin
Introduction:
Stroke is the second leading cause of mortality and the third leading cause of disability, worldwide [1]. Rehabilitation is necessary for reducing disability in stroke patients [2]. Acupuncture is an alternative and complementary strategy for the rehabilitation of stroke patients [3]. However, the mechanism of acupuncture on stroke rehabilitation is poorly understood. This study evaluated the effects of adjunctive acupuncture treatment on white matter (WM) integrity in ischemic stroke patients using diffusion tensor imaging (DTI), which allows the characterization of water diffusion in voxels [4].
Methods:
Twenty-three right-handed stroke patients with unilateral limbs dysfunction (mean ±sd: 58.8 ±8.1 yr) were recruited from the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine. Participants were randomized into three treatment groups: 1) True Acupuncture (TA), 2) TA and Physiotherapy (PT), and 3) PT and Sham Acupuncture (SA, a placebo or non-acupoint acupuncture). The patients were imaged on a 3T Skyra MRI (Siemens, Erlangen, Germany). DTI and T1-weighted images were acquired on participants after receiving five acupuncture sessions per week for 3 weeks. Distortion correction and co-registration were done in FSL [5]. Unweighted (b0) images were co-registered to their own T1-weighted structural image using linear and nonlinear co-registration algorithms. T1 images were co-registered to 1x1x1 mm3 Montreal Neurological Institute (MNI) standard space. Fractional anisotropy (FA) images were warped using the same transforms from co-registration to achieve intra- and inter-subject alignment. A threshold of FA > 0.2 was applied to ensure that only WM was included in the analysis. F-tests in FSL-randomise were used to determine clusters showing significant group differences in FA. 3dFWHMx and 3dClustSim from AFNI [6] were used to identify the clusters that survived a cluster threshold of p<0.01 and α<0.05. One-way ANOVA with LSD post-hoc was employed to assess significance among three treatment groups regarding mean FA values within clusters. Fugl-Meyer Assessment (FMA) was performed to measure the sensorimotor stroke recovery and to evaluate the impact of various treatments [7], subsequently, was associated with the mean FA conducted in SPSS [8].
Results:
Higher FA was seen in both TA+PT and SA+PT group in R VIIb compared to the TA group. where higher FA in the TA group were seen in the L MCP compare to other groups. Cluster size, peak coordinates, and location of each region of interest (ROI) are shown in Table 1. The FMA increased for all three groups in the middle of treatment and after treatment compared to before treatment (Figure 1. C). There was a significant increase in FMA after treatment compared to before treatment for all the groups (Figure 1. D). The mean FA values within the ROIs were not significantly correlated with the FMA.
Conclusions:
Higher FAs in R VIIb in both TA+PT and SA+PT groups might suggest that combined treatment have no added benefit on WM within the region compared to physiotherapy alone. Higher FA in the L MCP suggest acupuncture alone is beneficial for this brain region. Additionally, the mean FA and FMA was not significantly correlated and might suggest that motor performance could improve despite WM disruption or it might be as a result of the small sample size. Interestingly, patients with basal ganglia infarcts have delayed visual memory. The Right VIIb, a cerebellar lobule, is functionally connected with the visual dorsal attention network, important for working memory [9]. Furthermore, the MCP is associated with planning of motor movements [10]. Taken together, the acupuncture and physiotherapy might affect motor planning and visual memory in ischemic stroke patients, respectively, independent of WM integrity.
Modeling and Analysis Methods:
Diffusion MRI Modeling and Analysis 1
Novel Imaging Acquisition Methods:
Diffusion MRI 2
Keywords:
ADULTS
Data analysis
MRI
Physical Therapy
Treatment
White Matter
1|2Indicates the priority used for review
Provide references using author date format
S., Hoelter, P., Lücking, H., Engelhorn, T., Dörfler, A., et al.: Disability-adjusted
life-years associated with intracerebral hemorrhage and secondary injury. JAMA
Network Open 4(7), e2115859–e2115859 (2021)
2. Lynch, E.A., Labberton, A.S., Kim, J., Kilkenny, M.F., Andrew, N.E., Lannin,
N.A., Grimley, R., Faux, S.G., Cadilhac, D.A.: Out of sight, out of mind: long-term
outcomes for people discharged home, to inpatient rehabilitation and to residential
aged care after stroke. Disability and rehabilitation 44(12), 2608–2614 (2022)
3. Chavez, L.M., Huang, S.S., MacDonald, I., Lin, J.G., Lee, Y.C., Chen, Y.H.: Mech-
anisms of acupuncture therapy in ischemic stroke rehabilitation: a literature review
of basic studies. International journal of molecular sciences 18(11), 2270 (2017)
4. Soulard, J., Huber, C., Baillieul, S., Thuriot, A., Renard, F., Broche, B.A., Krainik,
A., Vuillerme, N., Jaillard, A., et al.: Motor tract integrity predicts walking recovery:
a diffusion mri study in subacute stroke. Neurology 94(6), e583–e593 (2020)
5. Beckmann, C.F., DeLuca, M., Devlin, J.T., Smith, S.M.: Investigations into resting-
state connectivity using independent component analysis. Philosophical Transac-
tions of the Royal Society B: Biological Sciences 360(1457), 1001–1013 (2005)
6. Cox, R.W.: Afni: software for analysis and visualization of functional magnetic res-
onance neuroimages. Computers and Biomedical research 29(3), 162–173 (1996)
7. Gladstone, D.J., Danells, C.J., Black, S.E.: The fugl-meyer assessment of motor
recovery after stroke: a critical review of its measurement properties. Neurorehabil-
itation and neural repair 16(3), 232–240 (2002)
8. Masuadi, E., Mohamud, M., Almutairi, M., Alsunaidi, A., Alswayed, A.K., Ald-
hafeeri, O.F., Almutairi, M.B.: Trends in the usage of statistical software and
their associated study designs in health sciences research: A bibliometric analysis.
Cureus 13(1) (2021)
9. Brissenden, J.A., Somers, D.C.: Cortico–cerebellar networks for visual attention
and working memory. Current opinion in psychology 29, 239–247 (2019).
10. Zhou, C., Fan, H., Chen, H., Wang, H., Li, Z., Xu, N., Sun, R., Zhu, Y., He, Y.:
Evaluation of clinical features and stroke etiology in patients with bilateral middle
cerebellar peduncle infarction. European Neurology 83(3), 271–278 (2020).