Acupuncture on GB34 activates the precentral gyrus and prefrontal cortex in Parkinson’s disease

BackgroundAcupuncture is increasingly used as an additional treatment for patients with Parkinson’s disease (PD).MethodsIn this functional magnetic resonance imaging study, brain activation in response to acupuncture in a group of 12 patients with PD was compared with a group of 12 healthy participants. Acupuncture was conducted on a specific acupoint, the right GB 34 (Yanglingquan), which is a frequently used acupoint for motor function treatment in the oriental medical field.ResultsAcupuncture stimulation on this acupoint activates the prefrontal cortex, precentral gyrus, and putamen in patients with PD; areas that are known to be impaired in patients with PD. Compared with healthy participants, patients with PD showed significantly higher brain activity in the prefrontal cortex and precentral gyrus, especially visible in the left hemisphere.ConclusionsThe neuroimaging results of our study suggest that in future acupuncture research; the prefrontal cortex as well as the precentral gyrus should be treated for symptoms of Parkinson’s disease and that GB 34 seems to be a suitable acupoint. Moreover, acupuncture evoked different brain activations in patients with Parkinson’s disease than in healthy participants in our study, stressing the importance of conducting acupuncture studies on both healthy participants as well as patients within the same study, in order to detect acupuncture efficacy.Trial registrationKCT0001122 at cris.nih.go.kr (registration date: 20140530)

[1]  Younbyoung Chae,et al.  The neural substrates of verum acupuncture compared to non-penetrating placebo needle: An fMRI study , 2009, Neuroscience Letters.

[2]  R. C. Oldfield The assessment and analysis of handedness: the Edinburgh inventory. , 1971, Neuropsychologia.

[3]  Clifford R Jack,et al.  An fMRI study of somatosensory‐implicated acupuncture points in stable somatosensory stroke patients , 2006, Journal of magnetic resonance imaging : JMRI.

[4]  Kenneth Hugdahl,et al.  A new verbal reports fMRI dichotic listening paradigm for studies of hemispheric asymmetry , 2008, NeuroImage.

[5]  A. Thron,et al.  Functional MRI in healthy subjects during acupuncture: different effects of needle rotation in real and false acupoints , 2004, Neuroradiology.

[6]  B. Choe,et al.  Acupuncture stimulation for motor cortex activities: a 3T fMRI study. , 2005, The American journal of Chinese medicine.

[7]  E. Ernst,et al.  Effectiveness of acupuncture for Parkinson's disease: A systematic review , 2008, Movement disorders : official journal of the Movement Disorder Society.

[8]  John W. Thatcher,et al.  Putamen coactivation during motor task execution , 2008, Neuroreport.

[9]  A. Beck,et al.  Internal consistencies of the original and revised Beck Depression Inventory. , 1984, Journal of clinical psychology.

[10]  Joo-Ho Chung,et al.  Acupuncture prevents 6-hydroxydopamine-induced neuronal death in the nigrostriatal dopaminergic system in the rat Parkinson’s disease model , 2003, Experimental Neurology.

[11]  D. Moher,et al.  [Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): extending the CONSORT statement (Chinese version)]. , 2010, Zhong xi yi jie he xue bao = Journal of Chinese integrative medicine.

[12]  Margit Jehna,et al.  Altered functional organization of the motor system related to ankle movements in Parkinson’s disease: insights from functional MRI , 2011, Journal of Neural Transmission.

[13]  V. Blasi,et al.  Functional brain changes in early Parkinson's disease during motor response and motor inhibition , 2011, Neurobiology of Aging.

[14]  F. Micheli,et al.  Use of complementary and alternative therapies in outpatients with Parkinson's disease in Argentina , 2010, Movement disorders : official journal of the Movement Disorder Society.

[15]  Youlong Zhou,et al.  Effect of acupuncture given at the HT 7, ST 36, ST 40 and KI 3 acupoints on various parts of the brains of Alzheimer' s disease patients. , 2008, Acupuncture & electro-therapeutics research.

[16]  S. Fahn Members of the UPDRS Development Committee. Unified Parkinson's Disease Rating Scale , 1987 .

[17]  G. Koch,et al.  Sensory perception changes induced by transcranial magnetic stimulation over the primary somatosensory cortex in Parkinson's disease , 2011, Movement disorders : official journal of the Movement Disorder Society.

[18]  Kyungmo Park,et al.  Acupuncture modulates resting state connectivity in default and sensorimotor brain networks , 2008, PAIN.

[19]  Xiaomin Wang,et al.  Electro-Acupuncture Stimulation Improves Spontaneous Locomotor Hyperactivity in MPTP Intoxicated Mice , 2013, PloS one.

[20]  P. Klein,et al.  Taiji for Individuals with Parkinson Disease and their Support Partners: Program Evaluation , 2006, Journal of neurologic physical therapy : JNPT.

[21]  David J. Freedman,et al.  The prefrontal cortex: categories, concepts and cognition. , 2002, Philosophical transactions of the Royal Society of London. Series B, Biological sciences.

[22]  G. Jahng,et al.  Acupuncture Stimulation on GB34 Activates Neural Responses Associated with Parkinson's Disease , 2012, CNS neuroscience & therapeutics.

[23]  R Levy,et al.  [The prefrontal cortex: composer and conductor of voluntary behaviors]. , 2009, Revue neurologique.

[24]  J. Penney,et al.  The functional anatomy of basal ganglia disorders , 1989, Trends in Neurosciences.

[25]  R. Passingham,et al.  Self-initiated versus externally triggered movements. II. The effect of movement predictability on regional cerebral blood flow. , 2000, Brain : a journal of neurology.

[26]  T. Kaptchuk,et al.  Developing a Research Strategy for Acupuncture , 2006, The Clinical journal of pain.

[27]  Sabina Lim,et al.  Neuroprotective Changes of Striatal Degeneration-Related Gene Expression by Acupuncture in an MPTP Mouse Model of Parkinsonism: Microarray Analysis , 2011, Cellular and Molecular Neurobiology.

[28]  Xiao-Min Wang,et al.  Long-term high-frequency electro-acupuncture stimulation prevents neuronal degeneration and up-regulates BDNF mRNA in the substantia nigra and ventral tegmental area following medial forebrain bundle axotomy. , 2002, Brain research. Molecular brain research.

[29]  A. Georgopoulos,et al.  Motor cortical encoding of serial order in a context-recall task. , 1999, Science.

[30]  W. Weiner,et al.  Acupuncture therapy for the symptoms of Parkinson's disease , 2002, Movement disorders : official journal of the Movement Disorder Society.

[31]  R. Passingham,et al.  Self-initiated versus externally triggered movements. I. An investigation using measurement of regional cerebral blood flow with PET and movement-related potentials in normal and Parkinson's disease subjects. , 1996, Brain : a journal of neurology.

[32]  M. Hallett,et al.  Regional homogeneity changes in patients with Parkinson's disease , 2009, Human brain mapping.

[33]  Sabina Lim,et al.  Neuroprotective changes of thalamic degeneration-related gene expression by acupuncture in an MPTP mouse model of parkinsonism: microarray analysis. , 2013, Gene.

[34]  A. Oliviero,et al.  Patterning of globus pallidus local field potentials differs between Parkinson's disease and dystonia. , 2003, Brain : a journal of neurology.

[35]  I. Toni,et al.  Spatial remapping of cortico-striatal connectivity in Parkinson's disease – a resting state fMRI study , 2009, NeuroImage.

[36]  I. Shim,et al.  Combined treatment with acupuncture reduces effective dose and alleviates adverse effect of l-dopa by normalizing Parkinson's disease-induced neurochemical imbalance , 2014, Brain Research.

[37]  A. Bonnet,et al.  [The Unified Parkinson's Disease Rating Scale]. , 2000, Revue neurologique.

[38]  G. E. Alexander,et al.  Preparation for movement: neural representations of intended direction in three motor areas of the monkey. , 1990, Journal of neurophysiology.

[39]  J. T. Massey,et al.  Mental rotation of the neuronal population vector. , 1989, Science.

[40]  X. Zhuang,et al.  Acupuncture treatment of Parkinson's disease--a report of 29 cases. , 2000, Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan.

[41]  T. Kaptchuk,et al.  Acupuncture: Theory, Efficacy, and Practice , 2002, Annals of Internal Medicine.

[42]  Yong He,et al.  Altered Small-World Efficiency of Brain Functional Networks in Acupuncture at ST36: A Functional MRI Study , 2012, PloS one.

[43]  David Moher,et al.  Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): Extending the CONSORT Statement , 2010, PLoS medicine.

[44]  M. Hoehn,et al.  Parkinsonism , 1967, Neurology.

[45]  Chantal E. Stern,et al.  Fronto-striatal deficit in Parkinson's disease during semantic event sequencing , 2008, Neurobiology of Aging.

[46]  S. Chung,et al.  Use of complementary and alternative medicine by Korean patients with Parkinson's disease , 2009, Clinical Neurology and Neurosurgery.

[47]  Yaniv Assaf,et al.  Cluster analysis of resting-state fMRI time series , 2009, NeuroImage.

[48]  Apostolos P. Georgopoulos,et al.  Participation of primary motor cortical neurons in a distributed network during maze solution: representation of spatial parameters and time-course comparison with parietal area 7a , 2004, Experimental Brain Research.

[49]  Z. Bian,et al.  Efficacy and safety of herbal medicines for idiopathic Parkinson's disease: A systematic review , 2006, Movement disorders : official journal of the Movement Disorder Society.

[50]  V. Napadow,et al.  Neuroimaging acupuncture effects in the human brain. , 2007, Journal of alternative and complementary medicine.

[51]  Leonard S. W. Li,et al.  An fMRI study showing the effect of acupuncture in chronic stage stroke patients with aphasia. , 2010, Journal of acupuncture and meridian studies.

[52]  C. Davie A review of Parkinson's disease. , 2008, British medical bulletin.

[53]  F. Chollet,et al.  Cortical motor reorganization in akinetic patients with Parkinson's disease: a functional MRI study. , 2000, Brain : a journal of neurology.

[54]  Hackjin Kim,et al.  Parsing brain activity associated with acupuncture treatment in Parkinson's diseases , 2009, Movement disorders : official journal of the Movement Disorder Society.

[55]  S. Reich,et al.  The use of alternative therapies by patients with Parkinson’s disease , 2001, Neurology.

[56]  R. Mailman,et al.  Task specific influences of Parkinson’s disease on the striato-thalamo-cortical and cerebello-thalamo-cortical motor circuitries , 2007, Neuroscience.

[57]  Y. S. Kim,et al.  Acupuncture inhibits microglial activation and inflammatory events in the MPTP-induced mouse model , 2007, Brain Research.

[58]  S. Fahn Unified Parkinson's Disease Rating Scale , 1987 .

[59]  K. Zilles,et al.  Neural activity in human primary motor cortex areas 4a and 4p is modulated differentially by attention to action. , 2002, Journal of neurophysiology.

[60]  Min Xu,et al.  Efficacy and safety of acupuncture for idiopathic Parkinson's disease: a systematic review. , 2008, Journal of alternative and complementary medicine.

[61]  T. Joh,et al.  Proteomic analysis of the neuroprotective mechanisms of acupuncture treatment in a Parkinson's disease mouse model , 2008, Proteomics.

[62]  G. Jahng,et al.  An fMRI study of neuronal specificity of an acupoint: Electroacupuncture stimulation of Yanglingquan (GB34) and its sham point , 2009, Neuroscience Letters.

[63]  Hua-guang Zheng,et al.  Functional Magnetic Resonance Imaging Activation of the Brain in Children: Real Acupoint Versus Sham Acupoint , 2010, Journal of child neurology.

[64]  M. Denman Review: Evidence for the effectiveness of acupuncture for pain is mixed , 2011, Annals of Internal Medicine.

[65]  C. Marsden,et al.  Recent Developments in Parkinson's Disease , 1986 .

[66]  Anthony Campbell,et al.  Point Specificity of Acupuncture in the Light of Recent Clinical and Imaging Studies , 2006, Acupuncture in medicine : journal of the British Medical Acupuncture Society.

[67]  L. Tan,et al.  Use of complementary therapies in patients with Parkinson's disease in Singapore , 2006, Movement disorders : official journal of the Movement Disorder Society.

[68]  Oury Monchi,et al.  Dysfunction of the default mode network in Parkinson disease: a functional magnetic resonance imaging study. , 2009, Archives of neurology.

[69]  Hong Yu,et al.  Role of hyperactive cerebellum and motor cortex in Parkinson's disease , 2007, NeuroImage.

[70]  Ted J. Kaptchuk,et al.  Expectancy and treatment interactions: A dissociation between acupuncture analgesia and expectancy evoked placebo analgesia , 2008, NeuroImage.

[71]  C. Marsden,et al.  Self-initiated versus externally triggered movements. I. An investigation using measurement of regional cerebral blood flow with PET and movement-related potentials in normal and Parkinson's disease subjects. , 1995, Brain : a journal of neurology.

[72]  Hun-Kuk Park,et al.  fMRI review on brain responses to acupuncture: the limitations and possibilities in traditional Korean acupuncture , 2007, Neurological research.

[73]  The validity and reliability of a Computerized Dementia Screening Test developed in Korea , 2002, Journal of the Neurological Sciences.

[74]  A P Georgopoulos,et al.  Role of basal ganglia in limb movements. , 1984, Human neurobiology.

[75]  Jan-Ray Liao,et al.  Neuronal Specificity of Acupuncture Response: A fMRI Study with Electroacupuncture , 2002, NeuroImage.