Short- and long-term modulation of upper limb motor-evoked potentials induced by acupuncture.

The aim of this study was to investigate in humans the effects of acupuncture upon upper-limb motor-evoked potentials (MEPs), elicited by transcranial magnetic stimulation of the primary motor cortex. It is known that peripheral sensory stimulation can be used to induce short- and long-term changes in motor cortex excitability. Data show that the simple insertion of the needle is an adequate somatosensory stimulus to induce a significant modulation of MEP amplitude, the sign of which (facilitation or inhibition) is specific to the investigated muscle and to the point of needle insertion. Moreover, MEP changes in upper-limb muscles are also observed following needling of lower-limb sites, revealing the presence of long-distance effects of acupuncture. Finally, the modulation in muscle excitability considerably outlasts the time period of needle application, demonstrating the induction of long-term plastic changes in the central nervous system. In addition, results have shown that the effects on muscle excitability are not restricted to the stimulation of well-coded acupoints, as described in traditional Chinese medicine, but they can also be induced by needling of nonacupoints, normally not used for therapeutic purposes. The possible neuronal mechanisms underlying the observed effects of acupuncture are discussed in relation to the available neurophysiological data regarding the interlimb reflexes and the changes in the representational cortical maps induced in humans by a prolonged somatosensory stimulation.