Chen Yilei, Kang Yingjie, Luo Shilei, Liu Shanshan, Wang Bo, Gong Zhigang, Huang Yanwen, Wang Hui, Zhan Songhua, Tan Wenli
Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Department of Acupuncture and Moxibustion, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Front Neurosci. 2022 Jul 19;16:925698. doi: 10.3389/fnins.2022.925698. eCollection 2022.
We explored the dynamic alterations of intrinsic brain activity and effective connectivity after acupuncture treatment to investigate the underlying neurological mechanism of acupuncture treatment in patients with migraine without aura (MwoA). The Functional Magnetic Resonance Imaging (fMRI) scans were separately obtained at baseline, after the first and 12th acupuncture sessions in 40 patients with MwoA. Compared with the healthy controls (HCs), patients with MwoA mostly showed a decreased dynamic amplitude of low-frequency fluctuation (dALFF) variability in the rostral ventromedial medulla (RVM), superior lobe of left cerebellum (Cerebellum_Crus1_L), right precuneus (PCUN.R), and so on. The decreased dALFF variability of RVM, Cerebellum_Crus1_L, and PCUN.R progressively recovered after the first and 12th acupuncture treatment sessions as compared to the baseline. There was gradually increased dynamic effective connectivity (DEC) variability in RVM outflow to the right middle frontal gyrus, left insula, right precentral gyrus, and right supramarginal gyrus, and gradually enhanced DEC variability from the right fusiform gyrus inflow to RVM. Furthermore, the gradually increased DEC variability was found from Cerebellum_Crus1_L outflow to the left middle occipital gyrus and the left precentral gyrus, from PCUN.R outflow to the right thalamus. These dALFF variabilities were positively correlated with the frequency of migraine attacks and negatively correlated with disease duration at baseline. The dynamic Granger causality analysis (GCA) coefficients of this DEC variability were positively correlated with Migraine-Specific Quality of Life Questionnaire scores and negatively correlated with the frequency of migraine attacks and visual analog scale (VAS) scores after 12th acupuncture sessions. Our results were analyzed by a longitudinal fMRI in the absence of a sham acupuncture control group and provided insight into the dynamic alterations of brain activity and effective connectivity in patients with MwoA after acupuncture intervention. Acupuncture might relieve MwoA by increasing the effective connectivity of RVM, Cerebellum_Crus1_L, and PCUN.R to make up for the decreased dALFF variability in these brain areas.
我们探讨了针刺治疗后大脑内在活动和有效连接性的动态变化，以研究无先兆偏头痛（MwoA）患者针刺治疗的潜在神经机制。对40例MwoA患者在基线、首次针刺 session 和第12次针刺 session 后分别进行功能磁共振成像（fMRI）扫描。与健康对照（HCs）相比，MwoA患者大多表现为延髓嘴侧腹内侧（RVM）、左侧小脑上叶（Cerebellum_Crus1_L）、右侧楔前叶（PCUN.R）等区域低频波动动态幅度（dALFF）变异性降低。与基线相比，首次和第12次针刺治疗 session 后，RVM、Cerebellum_Crus1_L和PCUN.R的dALFF变异性降低逐渐恢复。从RVM流出到右侧额中回、左侧岛叶、右侧中央前回和右侧缘上回的动态有效连接（DEC）变异性逐渐增加，从右侧梭状回流入RVM的DEC变异性逐渐增强。此外，还发现从Cerebellum_Crus1_L流出到左侧枕中回和左侧中央前回、从PCUN.R流出到右侧丘脑的DEC变异性逐渐增加。这些dALFF变异性在基线时与偏头痛发作频率呈正相关，与病程呈负相关。第12次针刺 session 后，这种DEC变异性的动态格兰杰因果分析（GCA）系数与偏头痛特异性生活质量问卷评分呈正相关，与偏头痛发作频率和视觉模拟量表（VAS）评分呈负相关。我们的结果是在没有假针刺对照组的情况下通过纵向fMRI分析得出的，为针刺干预后MwoA患者大脑活动和有效连接性的动态变化提供了见解。针刺可能通过增加RVM、Cerebellum_Crus1_L和PCUN.R的有效连接性来缓解MwoA，以弥补这些脑区dALFF变异性的降低。
