Sustained Effects of Acupuncture Stimulation Investigated with Centrality Mapping Analysis

Xiangyu Long, Wenjing Huang, Vitaly Napadow, Fanrong Liang, Burkhard Pleger, Arno Villringer, Claudia M Witt, Till Nierhaus, Daniel Pach, Xiangyu Long, Wenjing Huang, Vitaly Napadow, Fanrong Liang, Burkhard Pleger, Arno Villringer, Claudia M Witt, Till Nierhaus, Daniel Pach

Abstract

Acupuncture can have instant and sustained effects, however, its mechanisms of action are still unclear. Here, we investigated the sustained effect of acupuncture by evaluating centrality changes in resting-state functional magnetic resonance imaging after manually stimulating the acupuncture point ST36 at the lower leg or two control point locations (CP1 same dermatome, CP2 different dermatome). Data from a previously published experiment evaluating instant BOLD effects and S2-seed-based resting state connectivity was re-analyzed using eigenvector centrality mapping and degree centrality mapping. These data-driven methods might add new insights into sustained acupuncture effects on both global and local inter-region connectivity (centrality) by evaluating the summary of connections of every voxel. We found higher centrality in parahippocampal gyrus and middle temporal gyrus after ST36 stimulation in comparison to the two control points. These regions are positively correlated to major hubs of the default mode network, which might be the primary network affected by chronic pain. The stronger integration of both regions within the whole-brain connectome after stimulation of ST36 might be a potential contributor to pain modulation by acupuncture. These findings highlight centrality mapping as a valuable analysis for future imaging studies investigating clinically relevant outcomes associated with physiological response to acupuncture stimulation.

Clinical trial registration: NCT01079689, ClinicalTrials.gov.

Keywords: acupuncture; centrality; functional connectivity; pain; resting-state fMRI.

Figures

FIGURE 1
FIGURE 1
Locations of acupuncture point ST36 and the control points on the right leg [view from the front and from the back, figure adapted (Drake et al., 2009)]. ST36 is located on the anterior aspect of the right leg, on the line connecting ST35 with ST41, 3 B-cun inferior to ST35. The location of ST36 belongs to the dermatome L5. Control point 1 (CP1) is located lateral to ST36, at the middle line between Bladder meridian and Gallbladder meridian, in the same dermatome L5. Control point 2 (CP2) is located 2 B-cun dorsally of GB31, the location of CP2 belongs to the dermatome L2 (Nierhaus et al., 2015).
FIGURE 2
FIGURE 2
The paradigm of the experiment included needle interventions and resting-state scans. The upper part represents the needle stimulation sequence. The lower part represents the whole run of the experiment. Four resting-state scans including one baseline resting-state scan and three scans after needle stimulation were performed. For the Interventions I1/I2/I3 the sequence of the stimulated points (ST36/CP1/CP2) was randomized across participants (Nierhaus et al., 2015).
FIGURE 3
FIGURE 3
The centrality changes of the post-stimulation of all three points against each other. L means the left hemisphere. The warm color means increased centrality and the cold color means decreased centrality. All images were in the Talairach space. P < 0.05, corrected. The average centrality value (mean ± SEM) of the related centrality measures from each resting-state scan within the selected ROIs which were detected in the conjunction analysis were displayed. No significant result was found in the comparison between CP1 and CP2 for both ECM and DCM analysis. Abbreviations: PHG, parahippocampus gyrus; MTG, middle temporal gyrus.

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