Medline references on MRI and Acupuncture

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Chiu JH, Cheng HC, Tai CH, Hsieh JC, Yeh TC, Cheng H, Lin JG,

Ho LT. | ElectroAP-induced neural activation detected by use of

manganese-enhanced fMRI in rabbits. | Am J Vet Res. 2001

Feb;62(2):178-82. | Institute of Traditional Medicine, National Yang-

Ming University, Taipei, Taiwan, Republic of China. | OBJECTIVE:

To investigate the effects of AP on neural activity detected by use

of manganese-enhanced fMRI and elucidate the relationship

between somatic AP point stimulation and brain activation.

ANIMALS: 40 New Zealand White rabbits. PROCEDURE:

Manganese-enhanced fMRI was performed in anesthetized rabbits

manipulated with electroAP (EA) on Zusanli (ST-36) and

Yanglingquan (GB-34) AP points. Image acquisition was performed

on a 1.5T superconductive clinical scanner with a circular polarized

extremity coil. T1-weighted images were acquired sequentially as

follows: baseline, after mannitol injection, after manganese

infusion, and 5 and 20 minutes after initiation of EA. RESULTS:

Changes in focal neural activity were detected by use of

manganese-enhanced fMRI. Stimulation on Zusanli (ST-36) for 5

minutes resulted in activation of the hippocampus, whereas

stimulation on Yanglingquan (GB-34) resulted in activation of the

hypothalamus, insula, and motor cortex. Activation became less

specific after 20 minutes of EA. Furthermore, stimulation on

ipsilateral AP points led to bilateral brain activation.

CONCLUSIONS AND CLINICAL RELEVANCE: Each AP point has

a corresponding cerebral linkage, and stimulation on these points

resulted in time-dependent neural activation. Understanding the

linkage between peripheral AP point stimulation and central neural

pathways may provide a useful guide for clinical applications of AP.

| PMID: 11212024 [PubMed - indexed for MEDLINE]

 

Chiu JH, Chung MS, Cheng HC, Yeh TC, Hsieh JC, Chang CY,

Kuo WY, Cheng H, Ho LT. | Different central manifestations in

response to electroAP at analgesic and nonanalgesic acupoints in

rats: a manganese-enhanced fMRI study. | Can J Vet Res. 2003

May;67(2):94-101. | Institute of Traditional Medicine, National Yang-

Ming University, Number 155, Section 2, Li-Nong Street, Peitou,

Taipei, 112 Taiwan, Republic of China. chiujh |

AP analgesia is an important issue in veterinary medicine. This

study was designed to elucidate central modulation effects in

response to electroAP (EA) at different AP points. Manganese-

enhanced fMRI was performed in Sprague-Dawley rats after sham

AP, sham EA, or true EA at somatic AP points. The AP points

were divided into 3 groups: group 1, analgesic AP points commonly

used for pain relief, such as Hegu (LI 4); group 2, nonanalgesic AP

points rarely used for analgesic effect such as Neiguan (PC 6); and

group 3, AP points occasionally used for analgesia, such as

Zusanli (ST 36). Image acquisition was performed on a 1.5-T

superconductive clinical scanner with a circular polarized extremity

coil. The results showed that there was no neural activation caused

by EA at a true AP point with shallow needling and no electric

current (sham AP). When EA at a true AP point was applied with

true needling but no electric current (sham EA), there was only a

slight increase in brain activity at the hypothalamus; when EA was

applied at a true AP point with true needling and an electric current

(true EA), the primary response at the hypothalamus was

enhanced. Also, there was a tendency for the early activation of

pain-modulation areas to be prominent after EA at analgesic AP

points as compared with nonanalgesic AP points. In conclusion,

understanding the linkage between peripheral AP point stimulation

and central neural pathways provides not only an evidence-based

approach for veterinary AP but also a useful guide for clinical

applications of AP. | PMID: 12760473 [PubMed - indexed for

MEDLINE]

 

Cho ZH, Chung SC, Jones JP, Park JB, Park HJ, Lee HJ, Wong

EK, Min BI. | New findings of the correlation between acupoints and

corresponding brain cortices using functional MRI. | Proc Natl Acad

Sci U S A. 1998 Mar 3;95(5):2670-3. | Dept of Radiological

Sciences, Psychiatry, and Human Behavior, University of

California, Irvine, CA 92697, USA. zcho | A preliminary

study of the correlation between AP points for the treatment of eye

disorders suggested by ancient Oriental literature and the

corresponding brain localization for vision described by Western

medicine was performed by using functional MRI (fMRI). The vision-

related AP point (VA1) is located in the lateral aspect of the foot,

and when AP stimulation is performed there, activation of occipital

lobes is seen by fMRI. Stimulation of the eye by directly using light

results in similar activation in the occipital lobes by fMRI. The

experiment was conducted by using conventional checkerboard 8-

Hz light-flash stimulation of the eye and observation of the time-

course data. This was followed by stimulation of the VA1 by using

the same time-course paradigm as visual light stimulation. Results

obtained with 12 volunteers yielded very clean data and very close

correlations between visual and AP stimulation. We have also

stimulated non-AP points 2-5 cm away from the vision-related AP

points on the foot as a control, and activation in the occipital lobes

was not observed. The results obtained demonstrate the correlation

between activation of specific areas of brain cortices and

corresponding AP point stimulation predicted by ancient AP

literature. | PMID: 9482945 [PubMed - indexed for MEDLINE]

 

Cho ZH, Oleson TD, Alimi D, Niemtzow RC. | AP: the search for

biologic evidence with fMRI and positron emission tomography

techniques. | J Altern Complement Med. 2002 Aug;8(4):399-401.

Comment on: J Altern Complement Med. 2002 Aug;8(4):411-9. | |

| Publication Types: Comment Editorial PMID: 12230898 [PubMed

- indexed for MEDLINE]

 

Fang B, Hayes JC. | Functional MRI explores mysteries of AP. |

Diagn Imaging (San Franc). 1999 Jul;21(7):19-21. | | | PMID:

10539699 [PubMed - indexed for MEDLINE]

 

Fang JL, Krings T, Weidemann J, Meister IG, Thron A. | Functional

MRI in healthy subjects during AP: different effects of needle

rotation in real and false acupoints. | Neuroradiology. 2004

May;46(5):359-62. Epub 2004 Apr 22. | Dept of Radiology, Guang

An Men Hospital, China Academy of TCM, Bei Xian Ge 5, 100053

Peking, China. | The cerebral activation pattern due to AP is not

completely understood. Although the effect of AP on cerebral

haemodynamics has been studied, no previous report has focused

on different puncture and stimulation methods. We used functional

MRI (fMRI) in 15 healthy subjects to investigate cortical activation

during stimulation of two real AP points (Liv3 and G40) and one

sham point, needled in a random and, for the subjects, blinded

order employing rotating and non-rotating methods, using a

blocked paradigm on a 1.5 tesla imager. Compared to the non-

rotating stimulation method, during rotating stimulation of the real

AP points, we observed an increase in activation in both secondary

somatosensory cortical areas, frontal areas, the right side of the

thalamus and the left side of the cerebellum; no such effects of the

needling technique were seen while stimulating the sham point.

The observation that rotating the needle strengthened the effects of

AP only at real AP points suggests that, as claimed in Chinese

traditional medicine, stimulation of these AP points has a specific

effect on cortical neuronal activity, absent with sham AP points.

These specific cerebral activation patterns might explain the

therapeutic effects of AP in certain subjects. Copyright 2004

Springer-Verlag | Publication Types: Clinical Trial Randomized

Controlled Trial PMID: 15103431 [PubMed - indexed for MEDLINE]

 

Gareus IK, Lacour M, Schulte AC, Hennig J. | Is there a BOLD

response of the visual cortex on stimulation of the vision-related

acupoint GB 37? | J Magn Reson Imaging. 2002 Mar;15(3):227-32.

| Dept of Radiology, Section of Medical Physics, University

Hospital Freiburg, Freiburg, Germany. isabel_gareus

| PURPOSE: To determine whether or not AP of guangming (GB

37) produces a significant response of the visual cortex detectable

by means of fMRI. MATERIALS AND METHODS: This study

investigates the activation of the visual cortex elicited by a soft and

an intensified stimulation of GB 37, an AP point documented to

influence vision-related disorders. Three different paradigms were

carried out to detect any possible modulation of the Blood

Oxygenation Level Dependent (BOLD)-response in the visual cortex

to visual stimulation through AP. RESULTS: The percentage signal

changes in the visual stimulation cycles did not significantly differ

before vs. during AP. CONCLUSION: Whereas no BOLD-response

correlating with AP was detected in the visual cortex, BOLD-signal-

changes in response to needle twisting were detected in different

cortical areas. Further studies are necessary to clarify whether

these clusters correlate to inevitable somatosensory stimulation

accompanying AP or represent an AP-specific response. | PMID:

11891966 [PubMed - indexed for MEDLINE]

 

Hennig J, Lacour M. | Hui KK, Liu J, Makris N, Gollub RL, CHen

AJ, Moore CI, Kennedy DN, Rosen BR, [Kwong KK: AP modulates

the limbic system and subcortical gray structures of the human

brain: Evidence from fMRI studies in normal subjects - Article in

German] Hum Brain Mapp 2000; 9: 13-25] | Forsch

Komplementarmed Klass Naturheilkd. 2000 Oct;7(5):251-3. |

Sektion Bildgebende und Funktionelle Medizinphysik,

Radiologische Klinik, Universitatsklinikum, Freiburg.

hennig | | PMID: 11203472 [PubMed -

indexed for MEDLINE]

 

Higuchi T, Fukunaga M, Umeda M, Ebisu T, Tanaka C, Naruse S,

Ueda S. | [Functional brain mapping in motor task and

somatosensory stimulation using echo planar MRI - Article in

Japanese] | Nippon Rinsho. 1997 Jul;55(7):1688-93. | Dept of

Neurosurgery, Kyoto Prefectural University of Medicine. |

Functional brain mapping was performed with a 1.5T clinical MRI

apparatus. Single shot gradient echo echo-planar imaging (EPI)

sequence was employed. Normal volunteers were studied with the

task of grasping hand or opposition of fingers at the frequency of 3

Hz, median nerve electro-stimulation, pure somatosensory

stimulation by roller for AP. Apparent signal increase was observed

at contralateral sensorimotor cortex with motor task. Signal

changes delayed about 5 seconds compared with the start and the

cessation of the task, which may suggest that regional changes of

CBF and blood oxygen level in capillary and/or in venule lag behind

electrical excitation. It was hard to detect the activated area with

median nerve electro-stimulation. On the other hand, roller

stimulation provoked distinct activated areas at contralateral

sensorimotor cortex. The activated areas caused by the roller

stimulation and the motor task coincided entirely, which suggests

the possibility of the intermixed localization of primary areas of

motor and somatosensory. It was also clearly demonstrated that

the activated area was broader with quick (3 Hz) and complicated

motor task (finger opposition) than with slow (1Hz) and simple

motor task (hand grasping). | PMID: 9233010 [PubMed - indexed

for MEDLINE]

 

Hui KK, Liu J, Makris N, Gollub RL, Chen AJ, Moore CI, Kennedy

DN, Rosen BR, Kwong KK. | AP modulates the limbic system and

subcortical gray structures of the human brain: evidence from fMRI

studies in normal subjects. | Hum Brain Mapp. 2000;9(1):13-25. |

MGH-NMR Center, Dept of Radiology, Massachusetts General

Hospital and Harvard Medical School, Boston 02129, USA.

hui | AP, an ancient therapeutic technique,

is emerging as an important modality of complementary medicine

in the United States. The use and efficacy of AP treatment are not

yet widely accepted in Western scientific and medical

communities. Demonstration of regionally specific, quantifiable AP

effects on relevant structures of the human brain would facilitate

acceptance and integration of this therapeutic modality into the

practice of modern medicine. Research with animal models of AP

indicates that many of the beneficial effects may be mediated at

the subcortical level in the brain. We used fMRI to investigate the

effects of AP in normal subjects and to provide a foundation for

future studies on mechanisms of AP action in therapeutic

interventions. AP needle manipulation was performed at Large

Intestine 4 (LI 4, Hegu) on the hand in 13 subjects [stux, 1997].

Needle manipulation on either hand produced prominent decreases

of fMRI signals in the nucleus accumbens, amygdala,

hippocampus, parahippocampus, hypothalamus, ventral tegmental

area, anterior cingulate gyrus (BA 24), caudate, putamen, temporal

pole, and insula in all 11 subjects who experienced AP sensation.

In marked contrast, signal increases were observed primarily in the

somatosensory cortex. The two subjects who experienced pain

instead of AP sensation exhibited signal increases instead of

decreases in the anterior cingulate gyrus (BA 24), caudate,

putamen, anterior thalamus, and posterior insula. Superficial tactile

stimulation to the same area elicited signal increases in the

somatosensory cortex as expected, but no signal decreases in the

deep structures. These preliminary results suggest that AP needle

manipulation modulates the activity of the limbic system and

subcortical structures. We hypothesize that modulation of

subcortical structures may be an important mechanism by which

AP exerts its complex multisystem effects. | PMID: 10643726

[PubMed - indexed for MEDLINE]

 

Irving G, Goli V, Dunteman E. | Novel pharmacologic options in the

treatment of neuropathic pain. | CNS Spectr. 2004 Oct;9(10 Suppl

10):1-11. | Dept of Anesthesia, University of Washington Medical

School, Seattle, WA, USA. | Neuropathic pain is highly prevalent in

the United States, occurring in up to 4 million people. Many

changes affecting the ascending facilitatory system and the

descending inhibitory system occur within the central nervous

system as a result of neuropathy, making successful treatment

difficult. The physiological changes are more complicated in

humans than in animals, and medications which have been shown

to be successful in animal models are often determined to be

failures in phase II or III studies in humans. The concepts of

peripheral and central sensitization help to elucidate the

pathophysiology of neuropathic pain, and fMRI shows promise in

further informing us about the brain's processing of different pains.

Neuropathic pain is commonly treated with anticonvulsant

medications. There are several potential new treatments being

evaluated for neuropathic pain, including N-methyl-D-aspartate

antagonists, cannabinoids, immunomodulatory medications, and

some antidepressants. Given the complexity of neuropathic pain, a

multidisciplinary approach to treatment is preferable to

pharmacologic treatment alone. Treatment goals should target

improving pain and physical function, and reducing psychological

stress. This involves use of behavioral treatments such as cognitive-

behavioral therapy, operant conditioning, and biofeedback;

alternative therapies such as hypnosis and AP; and in some

patients, controversial treatments such as opioids and herbal

medicines, in addition to standard pharmacologic treatment. |

PMID: 15475876 [PubMed - in process]

 

Jellinger KA. | [Principles and application of AP in neurology -

Article in German] | Wien Med Wochenschr. 2000;150(13-14):278-

85. | Ludwig Boltzmann-Institut fur Klinische Neurobiologie, Wien.

kurt.jellinger | AP is a valuable method of

complementary medicine with broad application in neurology. It is

based on the experiences of TCM as well as on experimentally

proven biological (biochemical and neurophysiological) effects. AP-

induced analgesia is mediated by inhibition of pain transmission at

a spinal level and activation of central pain-modulating centers by

release of opioids and other peptides that can be prevented by

opioid antagonists (naloxone). Modern neuroimaging methods

(functional MRI) confirmed the activation of subcortical and cortical

centers, while transcranial Doppler sonography and SPECT

showed an increase of cerebral blood flow and cerebral oxygen

supply in normal subjects. Clinical experience and controlled

studies confirmed the efficacy of AP in various pain syndromes

(tension headache, migraine, trigeminal neuralgia, posttraumatic

pain, lumbar syndrome, ischialgia, etc.) and suggest favorable

effects in the rehabilitation of peripheral facial nerve palsy and after

stroke. Appropriate techniques, hygiene safeguards and knowledge

of contraindications will minimize the risks of rare side effects of

AP which represents a valuable adjunction to the treatment

repertoire in modern neurology. There is sufficient evidence of AP

to expand its use into conventional medicine and to encourage

further studies of its pathophysiology and clinical value. |

Publication Types: Case Reports Review Review, Tutorial PMID:

11075428 [PubMed - indexed for MEDLINE]

 

Jia SW, Wang QS, Xu WG. | [study on influence of acupunctural

signal on energy metabolism of human brain by positron emission

tomography - Article in Chinese] | Zhongguo Zhong Xi Yi Jie He Za

Zhi. 2002 Jul;22(7):508-11. | Dept of Nuclear Medicine, Shenzhen

Hospital of Peking University, Guangdong 518036. | OBJECTIVE:

To study the biologic process of energy metabolism in brain during

AP using positron emission tomography (PET) with 18F-2-

desoxyglucose (18FDG) for further elucidation of the relationship

between acupunctural signal and nerve system. METHODS:

ElectroAP (EA) was applied on right lateral of a healthy volunteer

and paralytic limbs of 4 patients with cerebral infarction at AP

points LI04, LI11, ST36 and SP06 using Hans AP point-nerve

stimulator. PET imaging was conducted on the healthy subject or

patients with the same posture before and during EA with GE

Advance II PET system. RESULTS: PET showed that in the

healthy subject, before EA, the glucose metabolism (GM) in

bilateral cerebral cortex, bilateral thalamus, basal nuclei and

cerebellum was almost symmetrical, but during EA, the GM in

contralateral thalamus, contralateral frontal lobe and parietal lobe

(motor and sensory area) increased obviously. While in the

patients before EA, the GM in the infarcted area was significantly

lower than that in the non-infarcted area, as compared with that

observed with CT and MRI, it showed a similar figure but with

bigger abnormal area. During EA, GM in the infarcted area

increased with apparent reduction of size. Increased GM of focal

area, widened cerebral cortex and decreased edematous area were

shown in patients with larger infarction area. Quantitative analysis

revealed evident change in local/total ratio of glucose and increase

of GM change rate. CONCLUSION: (1) EA on limb AP points of

healthy subject could induce obvious increase of regional GM in

brain and contralateral thalamus, contralateral frontal lobe and

parietal lobe (motor and sensory area). (2) EA on AP points of

paralytic limbs could cause increase of GM in contralateral

thalamus, contralateral frontal lobe and parietal lobe. Besides, GM

also increased in the area with lowered GM before EA,

accompanied with shrinkage or disappearance of lesion. (3) AP

could evoke the function of brain cells and raise the GM in them. |

PMID: 12592684 [PubMed - indexed for MEDLINE]

 

Jin Z, Zhang WT, Luo F, Zhang KL, Zhang L, Zeng YW, Han JS. |

[Frequency-specific responses of human brain to peripheral

transcutaneous electric nerve stimulation: a fMRI study - Article in

Chinese] | Sheng Li Xue Bao. 2001 Aug;53(4):275-80. | MRI Unit,

Hospital 306, Beijing 100101. | The purpose of the present

investigation was to determine the responses of human brain to

transcutaneous electric nerve stimulation (TENS) at different

frequencies by fMRI examinations covering the whole brain of

eleven healthy volunteers. Each subject received TENS at AP

points ST36 and SP06 of the left leg at the frequencies of 2 and

100 Hz. Frequency-specific responses were found in motor-related

areas, thalamus, limbic system and associated cortex to

stimulation of the two frequencies, while the primary

somatosensory areas were activated by both. Therefore, it appears

that 2 and 100 Hz TENS act through different neuro-pathways in

the central nervous system. | PMID: 11930205 [PubMed - indexed

for MEDLINE]

 

Kaptchuk TJ. | AP: theory, efficacy, and practice. | Ann Intern Med.

2002 Mar 5;136(5):374-83. Comment in: Ann Intern Med. 2002 Oct

15;137(8):702-3; author reply 702-3. | Division of Research and

Education in Complementary and Integrative Medical Therapies,

Beth Israel Deaconess Medical Center, Harvard Medical School,

Boston, Massachusetts 02215, USA. | Traditionally, AP is

embedded in naturalistic theories that are compatible with

Confucianism and Taoism. Such ideas as yin-yang, qi, dampness,

and wind represent East Asian conceptual frameworks that

emphasize the reliability of ordinary, human sensory awareness.

Many physicians who practice AP reject such prescientific notions.

Numerous randomized, controlled trials and more than 25

systematic reviews and meta-analyses have evaluated the clinical

efficacy of AP. Evidence from these trials indicates that AP is

effective for emesis developing after surgery or chemotherapy in

adults and for nausea associated with pregnancy. Good evidence

exists that AP is also effective for relieving dental pain. For such

conditions as chronic pain, back pain, and headache, the data are

equivocal or contradictory. Clinical research on AP poses unique

methodologic challenges. Properly performed AP seems to be a

safe procedure. Basic-science research provides evidence that

begins to offer plausible mechanisms for the presumed physiologic

effects of AP. Multiple research approaches have shown that AP

activates endogenous opioid mechanisms. Recent data, obtained

by using fMRI, suggest that AP has regionally specific, quantifiable

effects on relevant brain structures. AP may stimulate gene

expression of neuropeptides. The training and provision of AP care

in the United States are rapidly expanding. | Publication Types:

Historical Article Review Review, Academic PMID: 11874310

[PubMed - indexed for MEDLINE]

 

Kong J, Ma L, Gollub RL, Wei J, Yang X, Li D, Weng X, Jia F,

Wang C, Li F, Li R, Zhuang D. | A pilot study of fMRI of the brain

during manual and electroAP stimulation of AP point (LI-4 Hegu) in

normal subjects reveals differential brain activation between

methods. | J Altern Complement Med. 2002 Aug;8(4):411-9.

Comment in: J Altern Complement Med. 2002 Aug;8(4):399-401. |

Institute of AP and Moxibustion, China Academy of TCM, Beijing,

People's Republic of China. kongj |

OBJECTIVES: To characterize the brain activation patterns evoked

by manual and electroAP on normal human subjects. DESIGN: We

used fMRI to investigate the brain regions involved in electroAP and

manual AP needle stimulation. A block design was adopted for the

study. Each functional run consists of 5 minutes, starting with 1-

minute baseline and two 1-minute stimulation, the interval between

the two stimuli was 1 minute. Four functional runs were performed

on each subject, two runs for electroAP and two runs for manual

AP. The order of the two modalities was randomized among

subjects. During the experiment, AP needle manipulation was

performed at Large Intestine 4 (LI4, Hegu) on the left hand. For

each subject, before scanning started, the needle was inserted

perpendicular to the skin surface to a depth of approximately 1.0

cm. ElectroAP stimulation was delivered using a continuous

rectangular wave form (pulse width 30 ms) at a frequency of 3 Hz.

For manual AP, the needle was rotated manually clockwise and

counterclockwise at a rate of about 180 times per minute (3 Hz).

SUBJECTS: Eleven right-handed, normal, healthy volunteer adults,

6 male and 5 female, ages 21-64 participated in the experiment.

RESULTS: Results showed that electroAP mainly produced fMRI

signal increases in precentral gyrus, postcentral gyrus/inferior

parietal lobule, and putamen/insula; in contrast, manual needle

manipulation produced prominent decreases of fMRI signals in

posterior cingulate, superior temporal gyrus, putamen/insula.

CONCLUSION: These results indicate that different brain networks

are involved during manual and electroAP stimulation. It suggests

that different brain mechanisms may be recruited during manual

and electroAP. | Publication Types: Clinical Trial Randomized

Controlled Trial PMID: 12230901 [PubMed - indexed for MEDLINE]

 

Lee H, Park HJ, Kim SA, Lee HJ, Kim MJ, Kim CJ, Chung JH, Lee

H. | AP stimulation of the vision-related acupoint (BL67) increases

c-Fos expression in the visual cortex of binocularly deprived rat

pups. | Am J Chin Med. 2002;30(2-3):379-85. | Dept of Oriental

Medical Science, Graduate School of East-West Medical Science,

Kyung Hee University, Yongin, Korea. | Our previous study with

fMRI (MRI) demonstrated that AP stimulation of the vision-related

AP point, BL67, activates the visual cortex of the human brain. As

a further study on the effect of BL67 AP stimulation on the visual

cortex, we examined c-Fos expression in binocularly deprived rat

pups. Binocular deprivation significantly reduced the number of c-

Fos-positive cells in the primary visual cortex, compared with that

of normal control rat pups. Interestingly, AP stimulation of BL67

resulted in a significant increase in the number of c-Fos-positive

cells in the primary visual cortex, while AP stimulation of other AP

points less important for visual function had no significant effect on

c-Fos expression in the primary visual cortex. The results suggest

the possibility of vision-related AP point (BL67) having an influence

over the activity of the primary visual cortex. | PMID: 12230026

[PubMed - indexed for MEDLINE]

 

Lee JD, Chon JS, Jeong HK, Kim HJ, Yun M, Kim DY, Kim DI,

Park CI, Yoo HS. | The cerebrovascular response to traditional AP

after stroke. | Neuroradiology. 2003 Nov;45(11):780-4. Epub 2003

Aug 27. | Division of Nuclear Medicine, Dept of Diagnostic

Radiology, Yonsei University College of Medicine, 134 Shinchon-

dong, Seodaemun-gu, 120-752 Seoul, South Korea.

jdlee | AP is useful in treating the nausea and

vomiting related to chemotherapy, adult postoperative surgery pain

and postoperative dental pain. We obtained single-photon emission

computed tomography (SPECT) brain perfusion images of six

patients with middle cerebral artery occlusion obtained before and

after AP and compared the changes in regional cerebral blood flow

(rCBF) to those in normal control. Images were obtained before and

after AP at six traditional AP points (LI0 4, LI10, LI11, LI15 and

LI16 and TH05) in the affected arm. The baseline image was

subtracted from the postAP image, to produce a subtraction image

displaying only voxels with values >2 SD from the mean and those

voxels were coregistered to the baseline SPECT or T2-weighted

MRI. Similar images were obtained before and after AP of 8 normal

volunteers. Statistical parametric mapping with a threshold of P

=0.001 and a corrected P of 0.05 was performed for group

comparison between postAP and baseline SPECT. Focally

increased CBF was seen in all patients especially in the

hypoperfused zone surrounding the ischaemic lesion, the ipsilateral

or contralateral sensorimotor area, or both. Normal subjects

showed increased rCBF mainly in the parahippocampal gyrus,

premotor area, frontal and temporal areas bilaterally and ipsilateral

globus pallidus. AP stimulation after stroke patients appears to

activate perilesional or use-dependent reorganised sites and might

be a way of looking at brain reorganisation. | PMID: 12942221

[PubMed - indexed for MEDLINE]

 

Li G, Cheung RT, Ma QY, Yang ES. | Visual cortical activations on

fMRI upon stimulation of the vision-implicated acupoints. |

Neuroreport. 2003 Apr 15;14(5):669-73. | The Jockey Club MRI

Engineering Centre, Dept of Electrical and Electronic Engineering,

The University of Hong Kong, Pokfulam, Hong Kong. | We used

fMRI to reveal the visual cortical activations during conventional or

electro-AP over four vision-implicated AP points in 18 healthy

volunteers and compared the results with those obtained during

direct visual stimulation. Positive activations were seen over the

visual cortex during visual stimulation in all subjects, and similar

activations were observed in 10 subjects during conventional AP as

well as in eight and seven subjects during electro-AP at 2 and 20

Hz, respectively. Negative activations were also seen over the

occipital lobes, temporal gyri and frontal gyri bilaterally in 13

subjects during conventional AP. Thus, AP may modulate the

activity of relevant brain sites. Our results also suggest that electro-

AP is useful in future studies. | Publication Types: Clinical Trial

PMID: 12692460 [PubMed - indexed for MEDLINE]

 

Li G, Huang L, Cheung RT, Liu SR, Ma QY, Yang ES. | Cortical

activations upon stimulation of the sensorimotor-implicated

acupoints. | Magn Reson Imaging. 2004 Jun;22(5):639-44. | The

Jockey Club MRI Engineering Centre, Faculty of Engineering, The

University of Hong Kong, Hong Kong. | Sixty-seven healthy right-

handed subjects were studied using a 1.5-T MRI. Activations,

which were absent during stimulation of the adjacent nonacupoints

over the right arm or leg, were consistently seen over the right

premotor area during stimulation of the sensorimotor-implicated AP

points over the left arm or leg. The left premotor area was also

activated during stimulation of the arm or leg AP points. The right

precentral and postcentral gyri showed activations during

stimulation of the arm AP points. The volume and location of

activations vary when different combinations of the arm AP points

were stimulated. Our results indicate the existence of sensorimotor-

implicated AP points as sensitive sites to obtain somatotopic

activations over the sensory cortices with co-activation of the motor

cortices. | PMID: 15172057 [PubMed - indexed for MEDLINE]

 

Li G, Liu HL, Cheung RT, Hung YC, Wong KK, Shen GG, Ma QY,

Yang ES. | An fMRI study comparing brain activation between word

generation and electrical stimulation of language-implicated

acupoints. | Hum Brain Mapp. 2003 Mar;18(3):233-8. | The Jockey

Club MRI Engineering Centre, The University of Hong Kong, Hong

Kong. | We compared the brain activation on fMRI (MRI) during

word generation with the activation during electrical stimulation of

two language-implicated AP points in 17 healthy, Mandarin-

speaking, Chinese male volunteers (age 19-26 years). All subjects

were strongly right handed according to a handedness inventory.

Using a standard functional MRI procedure and a word-generation

paradigm, significant activation was seen in the left and right

inferior frontal gyri (BA 44, 45) as well as the left superior temporal

gyrus (BA 22, 42). Stronger activation with a larger volume was

seen in the left hemisphere. Electrical stimulation of either one of

the two language-implicated AP points, SJ 8 (11 subjects) and Du

15 (6 subjects), without the word-generation paradigm in the same

cohort, produced significant activation in the right inferior frontal

gyrus (BA 44, 46) and in the left and right superior temporal gyri

(BA 22, 42), respectively. Nevertheless, no activation was seen in

the left inferior frontal gyrus. In addition, electrical stimulation of the

adjacent non-AP points did not produce any significant brain

activation. Although our results support the notion of AP point-brain

activation, applying AP at SJ 8 or Du 15 does not activate the

typical language areas in the left inferior frontal cortex. Copyright

2003 Wiley-Liss, Inc. | PMID: 12599282 [PubMed - indexed for

MEDLINE]

 

Litscher G, Rachbauer D, Ropele S, Wang L, Schikora D, Fazekas

F, Ebner F. | AP using laser needles modulates brain function: first

evidence from functional transcranial Doppler sonography and fMRI.

| Lasers Med Sci. 2004;19(1):6-11. Epub 2004 Mar 31. | Dept of

Biomedical Engineering and Research in Anesthesia and Critical

Care, Medical University of Graz, Auenbruggerplatz 29, 8036,

Austria. gerhard.litscher | AP using laser needles

is a new totally painless stimulation method which has been

described for the first time. This paper presents an experimental

double-blind study in AP research in healthy volunteers using a

new optical stimulation method. We investigated 18 healthy

volunteers (mean age +/- SD: 25.4 +/- 4.3 years; range: 21-30

years; 11 female, 7 male) in a randomized controlled cross-over

trial using functional multidirectional transcranial ultrasound

Doppler sonography (fTCD; n = 17) and performed fMRI in one

volunteer. Stimulation of vision-related AP points resulted in an

increase of mean blood flow velocity in the posterior cerebral artery

measured by fTCD [before stimulation (mean +/- SE): 42.2 +/- 2.5;

during stimulation: 44.2 +/- 2.6; after stimulation: 42.3 +/- 2.4

cm/s, n.s.]. Mean blood flow velocity in the middle cerebral artery

decreased insignificantly. Significant changes (p < 0.05) of brain

activity were demonstrated in the occipital and frontal gyrus by

fMRI. Optical stimulation using properly adjusted laser needles has

the advantage that the stimulation cannot be felt by the patient

(painless and no tactile stimulation) and the operator may also be

unaware of whether the stimulation system is active. Therefore true

double-blind studies in AP research can be performed. | PMID:

15316852 [PubMed - in process]

 

Liu WC, Feldman SC, Cook DB, Hung DL, Xu T, Kalnin AJ,

Komisaruk BR. | fMRI study of AP-induced periaqueductal gray

activity in humans. | Neuroreport. 2004 Aug 26;15(12):1937-40. |

Dept of Radiology, Functional Imaging Laboratory, University of

Medicine and Dentistry of New Jersey, New Jersey Medical

School, 150 Bergen Street, Newark, NJ 07103, USA.

wliu | BOLD fMRI was used to study AP-induced

activation (increase in the BOLD signal from undetectable) of the

periaqueductal gray (PAG) and two somatosensory cortical areas

in seven healthy human subjects. Mechanical stimulation (push-

pull) was given to the LI4 (Hoku) AP point or to a non-AP point. The

stimulation paradigm consisted of 5 runs, each consisting of four

30 s On/30 s OFF periods over 30 min. The scan for each ON

period was analyzed individually. The PAG and cortical areas

showed different activity patterns. PAG activity was episodic and

reliably demonstrated after 20-25 min of stimulation; both cortical

areas, however, were active > 90% of the time. Stimulation of a non-

AP point (leg) resulted in reduced levels of PAG and cortical

activity. | PMID: 15305141 [PubMed - in process]

 

Napadow V, Makris N, Liu J, Kettner NW, Kwong KK, Hui KK. |

Effects of electroAP versus manual AP on the human brain as

measured by fMRI. | Hum Brain Mapp. 2004 Oct 21;24(3):193-205

[Epub ahead of print] | Athinoula A. Martinos Center for Biomedical

Imaging, Dept of Radiology, Massachusetts General Hospital and

Harvard Medical School, Charlestown, Massachusetts. | The goal

of this fMRI study was to compare the central effects of electroAP

at different frequencies with traditional Chinese manual AP.

Although not as time-tested as manual AP, electroAP does have

the advantage of setting stimulation frequency and intensity

objectively and quantifiably. Manual AP, electroAP at 2 Hz and 100

Hz, and tactile control stimulation were carried out at AP point ST-

36. Overall, electroAP (particularly at low frequency) produced

more widespread fMRI signal increase than manual AP did, and all

AP stimulations produced more widespread responses than did our

placebo-like tactile control stimulation. AP produced hemodynamic

signal increase in the anterior insula, and decrease in limbic and

paralimbic structures including the amygdala, anterior

hippocampus, and the cortices of the subgenual and retrosplenial

cingulate, ventromedial prefrontal cortex, frontal, and temporal

poles, results not seen for tactile control stimulation. Only

electroAP produced significant signal increase in the anterior

middle cingulate cortex, whereas 2-Hz electroAP produced signal

increase in the pontine raphe area. All forms of stimulation (AP and

control) produced signal increase in SII. These findings support a

hypothesis that the limbic system is central to AP effect

regardless of specific AP modality, although some differences do

exist in the underlying neurobiologic mechanisms for these

modalities, and may aid in optimizing their future usage in clinical

applications. Hum. Brain Mapping 24:193-205, 2005. © 2004

Wiley-Liss, Inc. | PMID: 15499576 [PubMed - as supplied by

publisher]

 

Shen J. | Research on the neurophysiological mechanisms of AP:

review of selected studies and methodological issues. | J Altern

Complement Med. 2001;7 Suppl 1:S121-7. | National Institutes of

Health Clinical Center, Bethesda, Maryland 20892, USA. | This

presentation reviews studies that contribute to an understanding of

the neurophysiological mechanisms of AP. A 1973 study, using

volunteer medical students, looked into AP's analgesic effect on

experimentally induced pain and suggests that humoral factors

may mediate AP-induced analgesia. In a study of the possible role

of the cerebrospinal fluid transmission of pain suppression effects

of AP, cerebrospinal fluid from AP-treated rabbits was infused into

recipient rabbits. The analgesic effect was observed in the recipient

rabbits, suggesting that AP-induced analgesia may be mediated by

substances released in the cerebrospinal fluid. Studies of

electroAP in rats revealed that both low-frequency and high-

frequency stimulation could induce analgesia, but that there are

differential effects of low- and high-frequency AP on the types of

endorphins released. In another study, low-frequency electroAP,

given as median nerve stimulation in cats, was shown to protect

the myocardium by inhibiting sympathetic pressor response and

increasing myocardial oxygen demand. The development of

neuroimaging tools, such as positron emission tomography (PET)

and fMRI, make noninvasive studies of AP's effects on human brain

activity possible. Studies using PET have shown that thalamic

asymmetry present among patients suffering from chronic pain was

reduced after the patients underwent AP treatment. Other studies,

using fMRI, have pointed to relationships between particular AP

points and visual-cortex activation. These powerful new tools open

the possibility to new scientific studies of this ancient therapy. |

Publication Types: Review Review, Tutorial PMID: 11822627

[PubMed - indexed for MEDLINE]

 

Siedentopf CM, Golaszewski SM, Mottaghy FM, Ruff CC, Felber

S, Schlager A. | FMRI detects activation of the visual association

cortex during laser AP of the foot in humans. | Neurosci Lett. 2002

Jul 12;327(1):53-6. | Dept of Radiology II, University Hospital of

Innsbruck, Innsbruck, Austria. | The aim of this study was to

investigate the effect of laser AP on cerebral activation. Using fMRI

cortical activations during laser AP at the left foot (Bladder 67) and

dummy AP, were compared employing a block design in ten

healthy male volunteers. All experiments were done on a 1.5 Tesla

MRI scanner equipped with a circular polarized head coil. During

laser AP, we found activation in the cuneus corresponding to

Brodmann Area (BA) 18 and the medial occipital gyrus (BA 19) of

the ipsilateral visual cortex. Placebo stimulation did not show any

activation. We could demonstrate that laser AP of a specific AP

point, empirically related to ophthalmic disorders, leads to

activation of visual brain areas, whereas placebo AP does not.

These results indicate that fMRI has the potential to elucidate

effects of AP on brain activity. | Publication Types: Clinical Trial

Controlled Clinical Trial PMID: 12098499 [PubMed - indexed for

MEDLINE]

 

Wu MT, Hsieh JC, Xiong J, Yang CF, Pan HB, Chen YC, Tsai G,

Rosen BR, Kwong KK. | Central nervous pathway for AP

stimulation: localization of processing with functional MR imaging

of the brain--preliminary experience. | Radiology. 1999

Jul;212(1):133-41. | Dept of Radiology, Kaohsiung Veterans

General Hospital, Taiwan. | PURPOSE: To characterize the central

nervous system (CNS) pathway for AP stimulation in the human

brain by using fMRI. MATERIALS AND METHODS: Functional MR

imaging of the whole brain was performed in two groups of nine

healthy subjects during four stimulation paradigms: real AP at

ST.36 (on the leg) and LI.4 (on the hand) and control stimulations

(minimal AP and superficial pricking on the leg). Stimulations were

performed in semirandomized, balanced order nested within two

experiments. Psychophysical responses (pain, De-Qi effect

[characteristic AP effect of needle-manipulation sensation],

anxiety, and unpleasantness) and autonomic responses were

assessed. Talairach coordinates-transformed imaging data were

averaged for a group analysis. RESULTS: AP at LI.4 and ST.36

resulted in significantly higher scores for De-Qi and in substantial

bradycardia. AP at both AP points resulted in activation of the

hypothalamus and nucleus accumbens and deactivation of the

rostral part of the anterior cingulate cortex, amygdala formation,

and hippocampal complex; control stimulations did not result in

such activations and deactivations. CONCLUSION: Functional MR

imaging can demonstrate the CNS pathway for AP stimulation. AP

at ST.36 and LI.4 activates structures of descending

antinociceptive pathway and deactivates multiple limbic areas

subserving pain association. These findings may shed light on the

CNS mechanism of AP analgesia and form a basis for future

investigations of endogenous pain modulation circuits in the human

brain. | Publication Types: Clinical Trial Randomized Controlled

Trial PMID: 10405732 [PubMed - indexed for MEDLINE]

 

Wu MT, Sheen JM, Chuang KH, Yang P, Chin SL, Tsai CY, Chen

CJ, Liao JR, Lai PH, Chu KA, Pan HB, Yang CF. | Neuronal

specificity of AP response: a fMRI study with electroAP. |

Neuroimage. 2002 Aug;16(4):1028-37. | Dept of Radiology,

Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan,

Republic of China. | Recently, neuronal correlates of AP stimulation

in human brain have been investigated by functional neuroimaging.

The preliminary findings suggest that AP at analgesic points

involves the pain-related neuromatrix and may have AP point-brain

correlation. Although multiple models of control stimulations have

been applied to address the specificity of the needling effect

clinically, their impacts have not been evaluated by functional

neuroimaging. With the advantage of objective parameter setting,

electroAP (EA) was used in this study to devise three distinct

controls for real EA, i.e., mock EA (no stimulation), minimal EA

(superficial and light stimulation), and sham EA (same stimulation

as real EA) applied at nonmeridian points. Fifteen healthy

volunteers received real EA at analgesic point Gallbladder 34

(Yanglinquan), sham EA, and one of either mock EA or minimal

EA over the left leg in counter-balanced orders. Multisubject

analysis showed that sham EA and real EA both activated the

reported distributed pain neuromatrix. However, real EA elicited

significantly higher activation than sham EA over the hypothalamus

and primary somatosensory-motor cortex and deactivation over the

rostral segment of anterior cingulate cortex. In the comparison of

minimal EA versus mock EA, minimal EA elicited significantly

higher activation over the medial occipital cortex. Single-subject

analysis showed that superior temporal gyrus (encompassing the

auditory cortex) and medial occipital cortex (encompassing the

visual cortex) frequently respond to minimal EA, sham EA, or real

EA. We concluded that the hypothalamus-limbic system was

significantly modulated by EA at AP points rather than at

nonmeridian points, while visual and auditory cortical activation was

not a specific effect of treatment-relevant AP points and required

further investigation of the underlying neurophysiological

mechanisms. | PMID: 12202090 [PubMed - indexed for MEDLINE]

 

Yoo SS, Teh EK, Blinder RA, Jolesz FA. | Modulation of cerebellar

activities by AP stimulation: evidence from fMRI study. |

Neuroimage. 2004 Jun;22(2):932-40. | Dept of Radiology, Brigham

and Women's Hospital, Harvard Medical School, Boston, MA

02115, USA. yoo | Recent neuroimaging studies

have revealed that AP stimulation modulates human central

nervous system including cerebral limbic/paralimbic and

subcortical structures. Due to the wide and intricate connections

with cerebrum, we hypothesized that anatomically specific areas in

human cerebellum are also modulated by AP stimulation beyond

classical involvement of cerebellum in motor coordination.

Functional MRI (fMRI) was used to investigate neural substrates

responding to the AP stimulation of Pericardium 6 (PC6, Neiguan),

an AP point relevant for the management of nausea including

vestibular-related motion sickness. Sham stimulation near the AP

point and tactile stimulation on the skin of the AP point were given

as separate conditions. Psychophysical scores as well as the

heart and respiratory rates were measured during each condition.

AP manipulation on PC6, in comparison to the sham AP and

tactile stimulation conditions, selectively activated left superior

frontal gyrus, anterior cingulate gyrus, and dorsomedial nucleus of

thalamus. AP-specific neural substrates in cerebellum were also

evident in declive, nodulus, and uvula of vermis, quadrangular

lobule, cerebellar tonsil, and superior semilunar lobule. Negative

MR signal changes, often seen during the AP of analgesic points,

were not observed in the present study. Our data suggest that

cerebellum serves as important activation loci during the AP

stimulation of PC6, and clinical efficacy of PC6 may be mediated

by the cerebellar vestibular neuromatrix. | PMID: 15193624

[PubMed - indexed for MEDLINE]

 

Yoshida T, Tanaka C, Umeda M, Higuchi T, Fukunaga M, Naruse

S. | Non-invasive measurement of brain activity using functional

MRI: toward the study of brain response to AP stimulation. | Am J

Chin Med. 1995;23(3-4):319-25. | Dept of Neurosurgery, Meiji

College of Oriental Medicine, Kyoto, Japan. | We studied functional

MRI in 15 male and 13 female normal volunteers on a clinical MRI

system using gradient echo sequence. During the experiments,

brain activation was induced by grasping the unilateral hand once

or twice a second for motor tasks. A localized increase of MRI

signal in the contralateral motor cortex was observed in 17 out of

21 cases (81%) under right hand motor task and 11 out of 21

cases (52%) under left hand motor task. The application of this

method may be useful to evaluate brain response to AP. | PMID:

8571929 [PubMed - indexed for MEDLINE]

 

Zhang WT, Jin Z, Cui GH, Zhang KL, Zhang L, Zeng YW, Luo F,

Chen AC, Han JS. | Relations between brain network activation and

analgesic effect induced by low vs. high frequency electrical

acupoint stimulation in different subjects: a fMRI study. | Brain

Res. 2003 Aug 29;982(2):168-78. | Neuroscience Research

Institute, Peking University, 38 Xue Yuan Rd, Beijing 100083,

China. | Two- or 100-Hz electrical AP point stimulation (EAS) can

induce analgesia via distinct central mechanisms. It has long been

known that the extent of EAS analgesia showed tremendous

difference among subjects. Functional MRI (fMRI) studies were

performed to allocate the possible mechanisms underlying the

frequency specificity as well as individual variability of EAS

analgesia. In either frequencies, the averaged fMRI activation levels

of bilateral secondary somatosensory area and insula, contralateral

anterior cingulate cortex and thalamus were positively correlated

with the EAS-induced analgesic effect across the subjects. In 2-Hz

EAS group, positive correlations were observed in contralateral

primary motor area, supplementary motor area, and ipsilateral

superior temporal gyrus, while negative correlations were found in

bilateral hippocampus. In 100-Hz EAS group, positive correlations

were observed in contralateral inferior parietal lobule, ipsilateral

anterior cingulate cortex, nucleus accumbens, and pons, while

negative correlation was detected in contralateral amygdala. These

results suggest that functional activities of certain brain areas

might be correlated with the effect of EAS-induced analgesia, in a

frequency-dependent dynamic. EAS-induced analgesia with low

and high frequencies seems to be mediated by different, though

overlapped, brain networks. The differential activations/de-

activations in brain networks across subjects may provide a

neurobiological explanation for the mechanisms of the induction

and the individual variability of analgesic effect induced by EAS, or

that of manual AP as well. | Publication Types: Clinical Trial

Randomized Controlled Trial PMID: 12915252 [PubMed - indexed

for MEDLINE]

 

Zhang WT, Jin Z, Huang J, Zhang L, Zeng YW, Luo F, Chen AC,

Han JS. | Modulation of cold pain in human brain by electric

acupoint stimulation: evidence from fMRI. | Neuroreport. 2003 Aug

26;14(12):1591-6. | Dept of Neurobiology, Peking University,

Beijing, China. | The purpose of this study is to investigate the

modulation of pain responses in the human brain by electric AP

point stimulation (EAS). Eight healthy subjects were enrolled; each

received real or mock EAS treatment in separate sessions. Cool

(18 degrees C) and cold (2 degrees C) stimuli were delivered,

during which fMRI scans were performed, before and after

treatment. Real EAS specifically increased the pain-specific

activation in bilateral secondary somatosensory area, medial

prefrontal cortex, and Brodmann area (BA) 32, while it decreased

the activation in contralateral primary somatosensory area, BA7,

and BA24. We suggest that EAS may induce an analgesic effect

via modulation of both the sensory and the emotional aspect of

pain processing. | PMID: 14502082 [PubMed - indexed for

MEDLINE]

 

Zhang WT, Jin Z, Luo F, Zhang L, Zeng YW, Han JS. | Evidence

from brain imaging with fMRI supporting functional specificity of

acupoints in humans. | Neurosci Lett. 2004 Jan 2;354(1):50-3. |

Neuroscience Research Institute, Peking University, 38 Xue Yuan

Rd, Beijing 100083, China. | We tested whether the stimulation of

AP points in the same spinal segments could induce different

central responses with fMRI study. Stimulation of AP points

ST36/SP6 (Zusanli/Sanyinjiao) or GB34/BL57

(Yanglingquan/Chengshan) both activated primary and secondary

somatosensory area, insula, ventral thalamus, parietal Brodmann

Area 40, temporal lobe, putamen, and cerebellum, while de-

activated amygdala. Nevertheless, ST36/SP6 stimulation

specifically activated orbital frontal cortex and de-activated

hippocampus. Alternatively, stimulation of GB34/BL57 activated

dorsal thalamus and inhibited those of primary motor area and

premotor cortex. Thus, stimulation of AP points in the same spinal

segments induced distinct though overlapped cerebral response

patterns, which indicated the existence of AP point specificity. |

PMID: 14698480 [PubMed - indexed for MEDLINE]

 

 

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