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Electroacupuncture stimulation at sub-specific acupoint and non-acupoint induced distinct brain glucose metabolism change in migraineurs: a PET-CT study.

Yang M, Yang J, Zeng F, Liu P, Lai Z, Deng S, Fang L, Song W, Xie H, Liang F - J Transl Med (2014)

Bottom Line: Positron emission tomography with computed tomography (PET-CT) was used to identify differences in brain glucose metabolism between groups.In the AG, brain glucose metabolism increase compared with the MG was observed in the middle frontal gyrus, postcentral gyrus, the precuneus, parahippocampus, cerebellum and middle cingulate cortex (MCC), and decrease were observed in the left hemisphere of Middle Temporal Cortex (MTC).In the SAG, compared with MG, glucose metabolism increased in the poster cingulate cortex (PCC), insula, inferior temporal gyrus, MTC, superior temporal gyrus, postcentral gyrus, fusiform, inferior parietal lobe, superior parietal lobe, supramarginal gyrus, middle occipital lobe, angular and precuneus; while, decreased in cerebellum, parahippocampus.The pattern of brain glucose metabolism change in acupoint is pertinent and targeted, while in non-acupoint that was disordered and randomized.

View Article: PubMed Central - PubMed

Affiliation: Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China. mingxiaoyang@hotmail.com.

ABSTRACT

Background: Acupuncture has analgesic effect to most pain conditions. Many neuroimaging studies were conducted to explore acupoint specificity in pain and other condition, but till now there is still discrepancy. Based on our previous finding, this study investigated the brain metabolism changes of acupuncture analgesia induced by sub-specific acupoint and non-acupoint stimulation.

Methods: 30 migraineurs were included and randomly assigned to 3 groups: Acupuncture Group (AG), Sham Acupuncture Group (SAG) and Migraine Group (MG). In AG, a combination sub-specific points of Shaoyang meridians, Luxi (TE19), San Yangluo (TE8), and Xi Yangguan (GB33) has been stimulated with electroacupuncture, while non-acupoints for SAG were used and MG received no treatment. Positron emission tomography with computed tomography (PET-CT) was used to identify differences in brain glucose metabolism between groups.

Results: In the AG, brain glucose metabolism increase compared with the MG was observed in the middle frontal gyrus, postcentral gyrus, the precuneus, parahippocampus, cerebellum and middle cingulate cortex (MCC), and decrease were observed in the left hemisphere of Middle Temporal Cortex (MTC).In the SAG, compared with MG, glucose metabolism increased in the poster cingulate cortex (PCC), insula, inferior temporal gyrus, MTC, superior temporal gyrus, postcentral gyrus, fusiform, inferior parietal lobe, superior parietal lobe, supramarginal gyrus, middle occipital lobe, angular and precuneus; while, decreased in cerebellum, parahippocampus.

Conclusions: Acupuncture stimulation at both sub-specific acupoint and non-acupoint yields ameliorating effect to migraine pain, but with evidently differed central mechanism as measured by PET-CT. The pattern of brain glucose metabolism change in acupoint is pertinent and targeted, while in non-acupoint that was disordered and randomized. These finding may provide new perspectives into the validation of acupoint specificity, optimizing acupuncture analgesia and revealing central mechanism of acupuncture analgesia by neuroimaging measurement.

Trial registration: This trial was registered in the Chinese Clinical Trial Registry, with registration no. ChiCTR-TRC-11001813.

No MeSH data available.


Related in: MedlinePlus

Experimental Paradigm. PET-CT scans were performed on the subjects at the PET-CT center of the Sichuan Provincial People’s Hospital. When the migraine attack began, each subject went through the following procedure(Figure 2): (1) examinations of blood sugar, blood pressure and Visual Analogue Scale (VAS) scores (range from 0 to 10) before the PET-CT scan; (2) a 20 min rest in a quiet, dim room; (3) a tracer injection at the back of the right hand (18F-FDG; synthesized with Mini Tracer accelerator; 0.11 mCi/kg dosage); (4) a 40 min rest, which included the 30 min acupuncture treatment in the AG and SAG; (5) a PET-CT scan; and (6) examination of VAS scores after the PET-CT scan (Figure 2). Subjects were instructed to remain relaxed during the whole study, with eyes blindfolded and ears plugged.
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Fig2: Experimental Paradigm. PET-CT scans were performed on the subjects at the PET-CT center of the Sichuan Provincial People’s Hospital. When the migraine attack began, each subject went through the following procedure(Figure 2): (1) examinations of blood sugar, blood pressure and Visual Analogue Scale (VAS) scores (range from 0 to 10) before the PET-CT scan; (2) a 20 min rest in a quiet, dim room; (3) a tracer injection at the back of the right hand (18F-FDG; synthesized with Mini Tracer accelerator; 0.11 mCi/kg dosage); (4) a 40 min rest, which included the 30 min acupuncture treatment in the AG and SAG; (5) a PET-CT scan; and (6) examination of VAS scores after the PET-CT scan (Figure 2). Subjects were instructed to remain relaxed during the whole study, with eyes blindfolded and ears plugged.

Mentions: PET-CT scanning was performed in the PET-CT Center of Sichuan Provincial People’s Hospital, Chengdu, Sichuan, China. All patients with acute migraine attack were required to fast for at least 4 hours before PET-CT scan. Before all trials procedure, fasting plasma glucose and resting blood pressure were examined prior to acupuncture treatment and PET-CT scan to avoid faint. PET-CT imaging data sets were acquired by using a Biograph Duo BGO scanner (Siemens, Germany). Our previous attempt to characterize central response of acupuncture by using PET-CT suggested that in migraine patients the curative effect of acupuncture in brain could be responsively reflected by neuroimaging tools such as PET-CT approximately 30 to 40 min since the initiation of acupuncture stimulation [25]. Moreover, according to the guidelines of the European Association of Nuclear Medicine Neuroimaging Committee (ENC)For PET brain imaging using [18F]FDG, version 2 [30], it is recommended that for interventions the paradigm usually start at the time of injection and have to be maintained for a time period of at least 15–20 min [31,32]. Thus, the acupuncture treatment in this study started immediately after the injection of tracer and maintained for 30 min. The ENC also suggested that the acquisition should not start earlier than 30 min after the tracer ([18F]-FDG with a half-time of 109 min [33]) injection, and commonly the time frame of 30 to 60 min after tracer injection was recommended to acquire PET-CT data set. Therefore the PET-CT data set was acquired 40 min after the tracer injection, aiming to elucidate the dynamic change of brain metabolism after acupuncture. The pain severity of migraine was measured by VAS before and after scanning, respectively. The PET-CT scanning paradigm was shown in Figure 2. The whole brain image was captured in a way to be horizontal to the AC-PC line. There was a 40 min uptake period before image acquisition(bed: 1; collection mode: 3D; slice thickness: 3 mm; slice interval: 1.5 mm; matrix size: 256 × 256; total counts: 3 × 109). The ordered-subset expectation maximization (OSEM) with 6 iterations and 16 subsets was utilized to reconstruct the images once the data acquisition was accomplished.Figure 2


Electroacupuncture stimulation at sub-specific acupoint and non-acupoint induced distinct brain glucose metabolism change in migraineurs: a PET-CT study.

Yang M, Yang J, Zeng F, Liu P, Lai Z, Deng S, Fang L, Song W, Xie H, Liang F - J Transl Med (2014)

Experimental Paradigm. PET-CT scans were performed on the subjects at the PET-CT center of the Sichuan Provincial People’s Hospital. When the migraine attack began, each subject went through the following procedure(Figure 2): (1) examinations of blood sugar, blood pressure and Visual Analogue Scale (VAS) scores (range from 0 to 10) before the PET-CT scan; (2) a 20 min rest in a quiet, dim room; (3) a tracer injection at the back of the right hand (18F-FDG; synthesized with Mini Tracer accelerator; 0.11 mCi/kg dosage); (4) a 40 min rest, which included the 30 min acupuncture treatment in the AG and SAG; (5) a PET-CT scan; and (6) examination of VAS scores after the PET-CT scan (Figure 2). Subjects were instructed to remain relaxed during the whole study, with eyes blindfolded and ears plugged.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4279794&req=5

Fig2: Experimental Paradigm. PET-CT scans were performed on the subjects at the PET-CT center of the Sichuan Provincial People’s Hospital. When the migraine attack began, each subject went through the following procedure(Figure 2): (1) examinations of blood sugar, blood pressure and Visual Analogue Scale (VAS) scores (range from 0 to 10) before the PET-CT scan; (2) a 20 min rest in a quiet, dim room; (3) a tracer injection at the back of the right hand (18F-FDG; synthesized with Mini Tracer accelerator; 0.11 mCi/kg dosage); (4) a 40 min rest, which included the 30 min acupuncture treatment in the AG and SAG; (5) a PET-CT scan; and (6) examination of VAS scores after the PET-CT scan (Figure 2). Subjects were instructed to remain relaxed during the whole study, with eyes blindfolded and ears plugged.
Mentions: PET-CT scanning was performed in the PET-CT Center of Sichuan Provincial People’s Hospital, Chengdu, Sichuan, China. All patients with acute migraine attack were required to fast for at least 4 hours before PET-CT scan. Before all trials procedure, fasting plasma glucose and resting blood pressure were examined prior to acupuncture treatment and PET-CT scan to avoid faint. PET-CT imaging data sets were acquired by using a Biograph Duo BGO scanner (Siemens, Germany). Our previous attempt to characterize central response of acupuncture by using PET-CT suggested that in migraine patients the curative effect of acupuncture in brain could be responsively reflected by neuroimaging tools such as PET-CT approximately 30 to 40 min since the initiation of acupuncture stimulation [25]. Moreover, according to the guidelines of the European Association of Nuclear Medicine Neuroimaging Committee (ENC)For PET brain imaging using [18F]FDG, version 2 [30], it is recommended that for interventions the paradigm usually start at the time of injection and have to be maintained for a time period of at least 15–20 min [31,32]. Thus, the acupuncture treatment in this study started immediately after the injection of tracer and maintained for 30 min. The ENC also suggested that the acquisition should not start earlier than 30 min after the tracer ([18F]-FDG with a half-time of 109 min [33]) injection, and commonly the time frame of 30 to 60 min after tracer injection was recommended to acquire PET-CT data set. Therefore the PET-CT data set was acquired 40 min after the tracer injection, aiming to elucidate the dynamic change of brain metabolism after acupuncture. The pain severity of migraine was measured by VAS before and after scanning, respectively. The PET-CT scanning paradigm was shown in Figure 2. The whole brain image was captured in a way to be horizontal to the AC-PC line. There was a 40 min uptake period before image acquisition(bed: 1; collection mode: 3D; slice thickness: 3 mm; slice interval: 1.5 mm; matrix size: 256 × 256; total counts: 3 × 109). The ordered-subset expectation maximization (OSEM) with 6 iterations and 16 subsets was utilized to reconstruct the images once the data acquisition was accomplished.Figure 2

Bottom Line: Positron emission tomography with computed tomography (PET-CT) was used to identify differences in brain glucose metabolism between groups.In the AG, brain glucose metabolism increase compared with the MG was observed in the middle frontal gyrus, postcentral gyrus, the precuneus, parahippocampus, cerebellum and middle cingulate cortex (MCC), and decrease were observed in the left hemisphere of Middle Temporal Cortex (MTC).In the SAG, compared with MG, glucose metabolism increased in the poster cingulate cortex (PCC), insula, inferior temporal gyrus, MTC, superior temporal gyrus, postcentral gyrus, fusiform, inferior parietal lobe, superior parietal lobe, supramarginal gyrus, middle occipital lobe, angular and precuneus; while, decreased in cerebellum, parahippocampus.The pattern of brain glucose metabolism change in acupoint is pertinent and targeted, while in non-acupoint that was disordered and randomized.

View Article: PubMed Central - PubMed

Affiliation: Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China. mingxiaoyang@hotmail.com.

ABSTRACT

Background: Acupuncture has analgesic effect to most pain conditions. Many neuroimaging studies were conducted to explore acupoint specificity in pain and other condition, but till now there is still discrepancy. Based on our previous finding, this study investigated the brain metabolism changes of acupuncture analgesia induced by sub-specific acupoint and non-acupoint stimulation.

Methods: 30 migraineurs were included and randomly assigned to 3 groups: Acupuncture Group (AG), Sham Acupuncture Group (SAG) and Migraine Group (MG). In AG, a combination sub-specific points of Shaoyang meridians, Luxi (TE19), San Yangluo (TE8), and Xi Yangguan (GB33) has been stimulated with electroacupuncture, while non-acupoints for SAG were used and MG received no treatment. Positron emission tomography with computed tomography (PET-CT) was used to identify differences in brain glucose metabolism between groups.

Results: In the AG, brain glucose metabolism increase compared with the MG was observed in the middle frontal gyrus, postcentral gyrus, the precuneus, parahippocampus, cerebellum and middle cingulate cortex (MCC), and decrease were observed in the left hemisphere of Middle Temporal Cortex (MTC).In the SAG, compared with MG, glucose metabolism increased in the poster cingulate cortex (PCC), insula, inferior temporal gyrus, MTC, superior temporal gyrus, postcentral gyrus, fusiform, inferior parietal lobe, superior parietal lobe, supramarginal gyrus, middle occipital lobe, angular and precuneus; while, decreased in cerebellum, parahippocampus.

Conclusions: Acupuncture stimulation at both sub-specific acupoint and non-acupoint yields ameliorating effect to migraine pain, but with evidently differed central mechanism as measured by PET-CT. The pattern of brain glucose metabolism change in acupoint is pertinent and targeted, while in non-acupoint that was disordered and randomized. These finding may provide new perspectives into the validation of acupoint specificity, optimizing acupuncture analgesia and revealing central mechanism of acupuncture analgesia by neuroimaging measurement.

Trial registration: This trial was registered in the Chinese Clinical Trial Registry, with registration no. ChiCTR-TRC-11001813.

No MeSH data available.


Related in: MedlinePlus