Efficacy and mechanism of scalp acupuncture for spastic cerebral palsy / 中国针灸

OBJECTIVE@#To observe the clinical efficacy of scalp acupuncture for spastic cerebral palsy (CP), and to explore its possible mechanism based on brain white matter fiber bundles, nerve growth related proteins and inflammatory cytokines.@*METHODS@#A total of 90 children with spastic CP were randomly divided into a scalp acupuncture group and a sham scalp acupuncture group, 45 cases in each group. The children in the two groups were treated with conventional comprehensive rehabilitation treatment. The children in the scalp acupuncture group were treated with scalp acupuncture at the parietal temporal anterior oblique line, parietal temporal posterior oblique line on the affected side, and parietal midline. The children in the sham scalp acupuncture group were treated with scalp acupuncture at 1 cun next to the above point lines. The needles were kept for 30 min, once a day, 5 days a week, for 12 weeks. Before and after treatment, the diffusion tensor imaging (DTI) indexes of magnetic resonance (FA values of corticospinal tract [CST], anterior limb of internal capsule [ICAL], posterior limb of internal capsule [ICPL], genu of internal capsule [ICGL], genu of corpus callosum [GCC], body of corpus callosum [BCC] and splenium of corpus callosum [SCC]), serum levels of nerve growth related proteins (neuron-specific enolase [NSE], glial fibrillary acidic protein [GFAP], myelin basic protein [MBP], ubiquitin carboxy terminal hydrolase-L1 [UCH-L1]) and inflammatory cytokines (interleukin 33 [IL-33], tumor necrosis factor α [TNF-α]), cerebral hemodynamic indexes (mean blood flow velocity [Vm], systolic peak flow velocity [Vs] and resistance index [RI], pulsatility index [PI] of cerebral artery), surface electromyography (SEMG) signal indexes (root mean square [RMS] values of rectus femoris, hamstring muscles, gastrocnemius muscles, tibialis anterior muscles), gross motor function measure-88 (GMFM-88) score, modified Ashworth scale (MAS) score, ability of daily living (ADL) score were observed in the two groups. The clinical effect of the two groups was compared.@*RESULTS@#After treatment, the FA value of each fiber bundle, Vm, Vs, GMFM-88 scores and ADL scores in the two groups were higher than those before treatment (P<0.05), and the above indexes in the scalp acupuncture group were higher than those in the sham scalp acupuncture group (P<0.05). After treatment, the serum levels of NSE, GFAP, MBP, UCH-L1, IL-33, TNF-α as well as RI, PI, MAS scores and RMS values of each muscle were lower than those before treatment (P<0.05), and the above indexes in the scalp acupuncture group were lower than those in the sham scalp acupuncture group (P<0.05). The total effective rate was 95.6% (43/45) in the scalp acupuncture group, which was higher than 82.2% (37/45) in the sham scalp acupuncture group (P<0.05).@*CONCLUSION@#Scalp acupuncture could effectively treat spastic CP, improve the cerebral hemodynamics and gross motor function, reduce muscle tension and spasticity, and improve the ability of daily life. The mechanism may be related to repairing the white matter fiber bundles and regulating the levels of nerve growth related proteins and inflammatory cytokines.

Structural magnetic resonance imaging and diffusion tensor imaging study on white matter in left-and right-handed adults / 中华行为医学与脑科学杂志

Objective To explore the differences of macrostructural and microstructural and their correlations in brain white matter (WM) between left-and right-handed adults.Methods Structural magnetic resonance imaging (sMRI) and diffusion tensor imaging (DTI) were performed on twenty-three left-handed (LH) and thirty-two right-handed (RH) healthy subjects.The WM volume,fractional anisotropy (FA) and mean diffusivity (MD) were mearsured and compared between the two groups by using the voxel-based morphometry (VBM) and voxel-based analysis (VBA) methods.Results (1) LH adults showed lower WM volume than RH adults in bilateral splenium of corpus callosum (SC) (Left:x=-15,y=-57,z =13.5,t=-5.160;Right:x=18,y=-42,z=12,t=-3.654;P＜0.001).Compared with the RH adults,the FA values in WM of the left postcentral gyrus (PoCG) (x =-24,y =-46,z =54) and the above left insula (INS) (x =-36,y =-12,z =20) increased (P＜ 0.001),as well as the average FA values,the average length and number of streamlines in WM tracts increased (P＜0.05) in LH adults.Compared with the RH adults,the MD values in the right HIP (x=24,y=-34,z=-2) decreased(P＜0.001),as well as the average MD values decreased,and the average length in WM tracts increased (P＜0.05) in LH adults.(2)There was positive correlation between FA and the volume of right splenium of corpus callosum in LH and RH adults (LH:r=0.716,RH:r=0.471,P＜0.05).There was negative correlation between FA and MD in the left PoCG (LH:r=-0.769,RH:r=-0.841),left INS (LH:r=-0.775,RH:r=-0.744) and right HIP (LH:r=-0.842,RH:r=-0.742) in LH and RH adults (all P＜0.05).Conclusion There are differences in both macrostructure and microstructure of white matter in several brain regions and WM tracts between left-handed and right-handed people,and correlations between these measures were also observed.

Diffusion tensor imaging study on white matter structure in children with autism spectrum disorder / 中华行为医学与脑科学杂志

Objective To explore the white matter microstructural change between autism spectrum disorder(ASD) children and the healthy controls and it's correlation with the age and the clinical symptoms.Methods Thirty-three patients with ASD and thirty-three healthy controls (HC) matched for sex-,age-and handedness underwent diffusion tensor imaging (DTI) scans.Use the Autism Diagnostic Observation Schedule(ADOS) and the Neuropsychological Development Inventory for Children Aged 0-6 Years Old (SLAS) to assess the clinical symptoms.Use tract-based spatial statistics (TBSS) based on fiber skeleton to analyze the fractional anisotropy (FA) of the whole brain DTI then to identify the differentiated brain regions.And analyze the correlation with age and clinical symptoms.Results (1) FA value of the body of corpus callosum (BCC) (x =-10,y =11,z =26;P=0.0012),left posterior limb of internal capsule (LPLI) (x =-23,y =-11,z =12;P＜0.01),left anterior corona radiata (LACR) (x =-28,y =28,z =16;P＜ 0.01),lift superior corona radiata(LSCR) (x=-27,y=-1,z=21;P=0.0017) was significantly lower in ASD group.(2) There was a positive correlation between the FA value of LPLI and the LACR,LSCR with age among the ASD group(r=0.436,P=0.012;r=0.443,P=0.010;r=0.475,P=0.005).There was a negative correlation between the FA value of the BCC,LPLI and the LACR,LSCR with the age among the HC children.(3) There was a correlation between the LPLI with the score of A DOS (communication:r=0.406,P=0.025;communication+social behavior:r=0.377,P=0.039;restrictive interests and repetitive behaviors:r=0.375,P=0.041) and SLAS (gross motor:r=-0.409,P=0.024),There was a correlation between the LSCR with the score of the SLAS (gross motor:r=-0.539,P=0.002,adaptive capacity:r=-0.373,P=0.041,mental age:r=-0.388,P=0.034).Conclusion The brain white matter microstructure change of BCC,LPLI,LACR,LSCR may be the pathophysiological basis of ASD.The development trend of brain white matter structure varied with age in ASD children is different from that of normal children.Brain white matter microstructure of the LPLI,LSCR is correlation with ASD symptoms.

Diffusion tensor imaging study on white matter structure in children with autism spectrum disorder / 中华行为医学与脑科学杂志

Objective To explore the white matter microstructural change between autism spectrum disorder(ASD) children and the healthy controls and it's correlation with the age and the clinical symptoms.Methods Thirty-three patients with ASD and thirty-three healthy controls (HC) matched for sex-,age-and handedness underwent diffusion tensor imaging (DTI) scans.Use the Autism Diagnostic Observation Schedule(ADOS) and the Neuropsychological Development Inventory for Children Aged 0-6 Years Old (SLAS) to assess the clinical symptoms.Use tract-based spatial statistics (TBSS) based on fiber skeleton to analyze the fractional anisotropy (FA) of the whole brain DTI then to identify the differentiated brain regions.And analyze the correlation with age and clinical symptoms.Results (1) FA value of the body of corpus callosum (BCC) (x =-10,y =11,z =26;P=0.0012),left posterior limb of internal capsule (LPLI) (x =-23,y =-11,z =12;P＜0.01),left anterior corona radiata (LACR) (x =-28,y =28,z =16;P＜ 0.01),lift superior corona radiata(LSCR) (x=-27,y=-1,z=21;P=0.0017) was significantly lower in ASD group.(2) There was a positive correlation between the FA value of LPLI and the LACR,LSCR with age among the ASD group(r=0.436,P=0.012;r=0.443,P=0.010;r=0.475,P=0.005).There was a negative correlation between the FA value of the BCC,LPLI and the LACR,LSCR with the age among the HC children.(3) There was a correlation between the LPLI with the score of A DOS (communication:r=0.406,P=0.025;communication+social behavior:r=0.377,P=0.039;restrictive interests and repetitive behaviors:r=0.375,P=0.041) and SLAS (gross motor:r=-0.409,P=0.024),There was a correlation between the LSCR with the score of the SLAS (gross motor:r=-0.539,P=0.002,adaptive capacity:r=-0.373,P=0.041,mental age:r=-0.388,P=0.034).Conclusion The brain white matter microstructure change of BCC,LPLI,LACR,LSCR may be the pathophysiological basis of ASD.The development trend of brain white matter structure varied with age in ASD children is different from that of normal children.Brain white matter microstructure of the LPLI,LSCR is correlation with ASD symptoms.

Association of Dysphagia With Supratentorial Lesions in Patients With Middle Cerebral Artery Stroke

OBJECTIVE: To determine the supratentorial area associated with poststroke dysphagia, we assessed the diffusion tensor images (DTI) in subacute stroke patients with supratentorial lesions. METHODS: We included 31 patients with a first episode of infarction in the middle cerebral artery territory. Each subject underwent brain DTI as well as a videofluoroscopic swallowing study (VFSS) and patients divided were into the dysphagia and non-dysphagia groups. Clinical dysphagia scale (CDS) scores were compared between the two groups. The corticospinal tract volume (TV), fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were calculated for 11 regions of interest in the supratentorial area—primary motor cortex, primary somatosensory cortex, supplementary motor cortex, anterior cingulate cortex, orbitofrontal cortex, parieto-occipital cortex, insular cortex, posterior limb of the internal capsule, thalamus, and basal ganglia (putamen and caudate nucleus). DTI parameters were compared between the two groups. RESULTS: Among the 31 subjects, 17 were diagnosed with dysphagia by VFSS. Mean TVs were similar across the two groups. Significant inter-group differences were observed in two DTI values: the FA value in the contra-lesional primary motor cortex and the ADC value in the bilateral posterior limbs of the internal capsule (all p<0.05). CONCLUSION: The FA value in the primary motor cortex on the contra-lesional side and the ADC value in the bilateral PLIC can be associated with dysphagia in middle cerebral artery stroke.

The study of diffusion tensor imaging and cognitive function in patients with asymptomatic mild traumat-ic brain injury / 中国神经精神疾病杂志

Objective To explore the features of white matter in DTI in patients with asymptomatic mild traumat?ic brain injury(mTBI)and their correlation with the cognitive features. Methods The DTI data and cognitive function data were obtained from 36 mTBI patients and 36 health controls. The fractional anisotropy (FA) pictures were ana?lyzed by voxel-based analysis. The FA value differences of the two groups were analyzed by using t test. The values of FA were extracted from the abnormal regions of mTBI patients. Correlation analyses were performed on the association of extracted FA value with P300 latency,P300 amplitude,the scores of Montreal Cognitive Assessment (MoCA) Scale, Hamilton Depression Scale, Hamilton Anxiey Scale,age and education(P>0.05). Results Compared with controls, mTBI patients had significant reduction of FA in the right medial frontal gyrus, bilateral postcentral gyrus, left precune?us, right posterior cingutate and right superior temporal gyrus(P<0.01,FDR correction). There were no significant correlations between extracted FA value and all clinical characteristics in mTBI patients. Conclusions Patients with mTBI have white matter microstructural damage and cognitive impairment.

Peritumoral Diffusion Tensor Imaging of High Grade Astrocytoma and Metastasis / 实用放射学杂志

Objective To study the value and clinical significance of diffusion tensor imaging(DTI)in differentiating high-grade astrocytomas and solitary metastatic tumors of brain.Methods 16 patients with intracranial solitary metastasis and 25 patients with high-grade astrocytoma confirmed pathologically were examined with MR DTI.Mean diffusivity(MD)and fractional anisotropy(FA)were measured in the regions of interest(ROI)of peritumor and cerebral parenchyma of the normal side on DTL Fiber tractography was reconstructed and the encountered patterns of tumor-related alteration to cerebral white matter were observed.Results The peritumor were all depicted as hyperintense or isointense signals on DTI.The FA values were 0.227±0.05 and 0.169±0.07 in the peritumor of high-grade astrocytoma and metastasis respectively,which was of significant difference(P＜0.05).Furthermore,fiber tractography could display the course of white matter tracts in three-dimensional space.Conclusion DTI may be help to differential diagnosis of solitary metastasis and high-grade astrocytoma in clinical practice.

Relação entre degeneração do trato córtico-espinhal através de ressonância magnética e escala funcional (ALSFRS) em pacientes com esclerose lateral amiotrófica / Correlation between corticospinal tract degeneration through magnetic resonance imaging, and functional scale (ALSFRS) in patients whit amyotrophic lateral sclerosis

A esclerose lateral amiotrófica (ELA) é doença neurodegenerativa que afeta o trato córtico-espinhal. A escala funcional de avaliação em ELA (ALSFRS) é um questionário que quantifica clinicamente as perdas motoras, enquanto a imagem por tensor de difusão (DTI) avalia a integridade das fibras através da fração de anisiotropia (FA). No presente estudo, sete pacientes com ELA definida foram avaliados pela ALSFRS e imediatamente submetidos à DTI, obtendo valores de FA nas regiões: pedúnculo cerebral (PC), cápsula interna (CI) e substância barnca subjacente às áreas motora primária (M1), motora secundária (M2) e somestésica (SI). Um grupo controle foi constituído de doze indivíduos saudáveis. Os pacientes apresentaram valores de FA significativamente menores que os controles, com tendência à maior redução à direita e nas regiões mais caudais. Curiosamente, os valores de FA estavam reduzidos na área somestésica. Não foi observada correlação entre a duração dos sintomas e os valores de FA. Apesar da correlação entre os valores da ALSFRS e a degeneração em PC e CI, nossos resultados sugerem que essa escala subjetiva não é um bom parâmetro para a avaliação do dano estrutural nas porções encefálicas do trato corticoespinhal.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that affects the corticospinal tract. ALS functional rating scale (ALSFRS) is a questionnaire that quantifies motor deficits, while diffusion tensor imaging (DTI) evaluates the integrity of fibers through the fractional anisotropy (FA). In the present study, seven ALS patients were evaluated by ALSFRS and immediately submitted to DTI, getting FA values in the following regions: cerebral peduncle (PC), internal capsule (CI) and the white matter under the primary motor cortex (M1), secondary motor cortex (M2) and somestetic cortex (SI). A control group was constituted by twelve healthy individuals. FA values in patients were significantly lower when compared with controls, with a tendency to higher reductions in the right hemisphere and more inferior regions. Interestingly, FA values were reduced in somestetic area. No correlation was observed between symptoms duration and FA values. Despite the correlation observed between ALSFRS scores and degeneration in PC and CI, our results suggest that this subjective scale is not a good parameter for the evaluation of the structural damage in encephalic portions of the corticospinal tract.

Diffusion Tensor Imaging in Acute Ischemic Stroke: Usefulness of Fractional Anisotropy

BACKGROUND: Progressing stroke (PS) variably develops from initially the same size and severity, and is most frequently observed in lacunar infarctions. We investigated fractional anisotrophy (FA), mean diffusivity (MD) and infarct volume by using diffusion tensor imaging during the acute phase of ischemic stroke to determine whether these parameters are useful in characterizing and predicting PS. METHODS: In this study, 55 consecutive patients admitted within 24 hours of the onset of their first ischemic stroke were included. NIH stroke scale (NIHSS) and Canadian Neurological scale (CNS) were performed upon admission, twice a day, and at discharge. Modified Rankin scale and Barthel index were also evaluated. PS was defined as a 2-point drop in NIHSS and a 1-point drop in CNS from admission to day 3. A correlation analysis was performed between clinical scale scores and imaging parameters, and the distribution of those values was compared between the two groups with and without PS. RESULTS: Significant correlations were observed between clinical scale scores and infarct volumes. The FA ratio in 14 patients with PS was lower than the patients without PS (p=0.004). Other characteristics including infarct volume and MD ratio were not different. The FA ratio remained as an independent predictor of PS (OR, 1.055; p=0.011). CONCLUSIONS: In acute ischemic stroke within the first 24 hours, only infarct volume was correlated with clinical status. However, patients with PS showed lower FA values, which accounts for rapid and severe vasogenic edema involving the disruption of the cell membrane and axonal fibers. Moreover, FA may be a predictor of PS.

MR-DTI Study on Wallerian Degeneration of the Optic Radiation after Occipital Lobe Chronic Infarction / 实用放射学杂志

Objective To evaluate the possibility of diffusion tensor imaging(DTI)in detecting and quantifying the Wallerian degeneration of optic radiation in occipital lobe chronic infarction.Methods 20 patients with unilateral occipital chronic infarction were undergone DTI.Quantitative fractional anisotropy(FA)and mean diffusivity(MD)were obtained from the ipsilateral optic radiation of the occipital lobe infarction and compared with that of contralateral region using the independent samples t-test.Results On the three dimensional color-coding tensor fractional anisotropic map,the regions of occipital lobe chronic infarction were markedly low signal intensity,the FA value and MD value were 0.274?0.062 and(1.226?0.372)?10-3mm2/s,while in the contralateral region of optic radiation,FA and MD values were 0.495?0.035 and(0.775?0.070)?10-3mm2/s respectively,there was significant difference in FA and MD values in comparing both side(P〈0.01).Conclusion DTI can detect and quantify the Wallerian degeneration in optic radiation after occipital lobe chronic infarction.