Table_1_Sensorimotor Responses in Post-Stroke Hemiplegic Patients Modulated by Acupuncture at Yanglingquan (GB34): A fMRI Study Using Intersubject Functional Correlation (ISFC) Analysis.DOC

Motor dysfunction is common in patients with stroke. Acupuncture has become an acceptable alternative method for stroke rehabilitation. Previous studies have shown various functional connectivity changes activated by acupuncture. We introduced intersubject correlation (ISC) and intersubject functional correlation (ISFC) analyses into the functional magnetic resonance imaging (fMRI) for ischemic stroke to seek a common activation and suppression pattern triggered by acupuncture. In this study, 63 ischemic stroke patients with motor dysfunction and 42 normal controls were analyzed. Three functional scans were conducted during the resting state, motor task, and acupuncture at Yanglingquan (GB34) task. Twenty-two sensory, motor, and movement-imagination cortices in the bilateral hemispheres were selected as the region of interest (ROI). We performed ISC and ISFC analyses among these ROIs in three fMRI runs on patients and controls. Subgroup analyses by course or severity were also conducted. The results showed that acupuncture at GB34 triggered ISFC among upper limb motor, upper limb/hand/face, lower limb, tongue/larynx sensory, and movement imagination regions in the patient group. Subgroup ISC and ISFC analyses showed that patients tended to have increasing responses in the early stage of stroke (within 1 month) and decreasing responses afterward (1–3 months). Patients with mild clinical functional damage (NIHSS 2–4) tended to generate more responses via acupuncture than those with moderate damage (NIHSS 5–15). Our findings may help understand the clinical effects and modulatory features of acupuncture based on the group-level post-stroke neuroplasticity.

脑卒中患者常出现运动功能障碍，针灸已成为脑卒中康复领域被广泛认可的替代疗法。既往研究证实，针灸可引发多种功能连接改变。本研究将受试者间相关性（intersubject correlation, ISC）与受试者间功能相关性（intersubject functional correlation, ISFC）分析引入缺血性脑卒中的功能磁共振成像（functional magnetic resonance imaging, fMRI）研究，旨在探寻针灸触发的共通激活与抑制模式。本研究共纳入63例伴运动功能障碍的缺血性脑卒中患者，以及42名正常对照者进行分析。受试者分别完成静息态、运动任务及阳陵泉（GB34）针刺任务下的3次功能磁共振扫描。研究选取双侧半球共22个感觉、运动及运动想象皮层作为感兴趣区（region of interest, ROI）。针对患者与对照者的3次fMRI扫描，我们对上述感兴趣区开展了ISC与ISFC分析。本研究同时依据病程与病情严重程度进行了亚组分析。结果显示，患者组中针刺GB34可引发上肢运动、上肢/手部/面部、下肢、舌/喉感觉及运动想象脑区间的受试者间功能相关性变化。亚组ISC与ISFC分析结果表明，脑卒中早期（发病1个月内）患者的神经响应呈上升趋势，而发病后1~3个月则呈下降趋势。临床功能损伤较轻的患者（美国国立卫生研究院卒中量表NIHSS评分2~4分）经针刺后产生的神经响应，较中度损伤患者（NIHSS评分5~15分）更为显著。本研究结果有助于基于群体水平的卒中后神经可塑性特征，阐释针灸的临床效应与调控机制。