Assessor- and participant-blinded, randomized controlled trial of dense cranial electroacupuncture stimulation plus body acupuncture for neuropsychiatric sequelae of stroke

Zhang-Jin Zhang, Hong Zhao, Gui-Xing Jin, Sui-Cheung Man, Yi-Si Wang, Ying Wang, Hai-Rong Wang, Meng-Han Li, Lo-Lo Yam, Zong-Shi Qin, Kim-Kam Teresa Yu, Jing Wu, Fung-Leung Bacon Ng, Tat-Chi Eric Ziea, Pei-Jing Rong, Zhang-Jin Zhang, Hong Zhao, Gui-Xing Jin, Sui-Cheung Man, Yi-Si Wang, Ying Wang, Hai-Rong Wang, Meng-Han Li, Lo-Lo Yam, Zong-Shi Qin, Kim-Kam Teresa Yu, Jing Wu, Fung-Leung Bacon Ng, Tat-Chi Eric Ziea, Pei-Jing Rong

Abstract

Aim: Acupuncture has benefits in the rehabilitation of neuropsychiatric sequelae of stroke. This study was aimed to evaluate the effectiveness of dense cranial electroacupuncture stimulation plus body acupuncture (DCEAS+BA) in treating poststroke depression (PSD), functional disability, and cognitive deterioration.

Methods: In this assessor- and participant-blinded, randomized controlled trial, 91 stroke patients who initially had PSD were randomly assigned to either DCEAS+BA (n = 45) or minimum acupuncture stimulation as controls (n = 46) for three sessions per week over 8 consecutive weeks. The primary outcome was baseline-to-end-point change in score of the 17-item Hamilton Depression Rating Scale. Secondary outcomes included the Montgomery-Åsberg Depression Rating Scale for depressive symptoms, the Barthel Index for functional disability, and the Montreal Cognitive Assessment for cognitive function.

Results: DCEAS+BA-treated patients showed strikingly greater end-point reduction than MAS-treated patients in scores of the three symptom domains. The clinical response rate, defined as an at least 50% baseline-to-end-point reduction in 17-item Hamilton Depression Rating Scale score, was markedly higher in the DCEAS+BA-treated group than that of controls (40.0% vs 17.4%, P = 0.031). Incidence of adverse events was not different in the two groups. Subgroup analysis revealed that DCEAS+BA with electrical stimulation on forehead acupoints was more apparent in reducing Barthel-Index-measured disability than that without electrical stimulation.

Conclusion: DCEAS+BA, particularly with electrical stimulation on forehead acupoints, reduces PSD, functional disability, and cognitive deterioration of stroke patients. It can serve as an effective rehabilitation therapy for neuropsychiatric sequelae of stroke.

Keywords: acupuncture; cognitive impairment; dense cranial electroacupuncture stimulation (DCEAS); functional disability; poststroke depression.

© 2019 The Authors. Psychiatry and Clinical Neurosciences © 2019 Japanese Society of Psychiatry and Neurology.

References

    1. Ferro JM, Caeiro L, Figueira ML. Neuropsychiatric sequelae of stroke. Nat. Rev. Neurol. 2016; 12: 269-280.
    1. Yang Y, Shi YZ, Zhang N et al. The disability rate of 5-year post-stroke and its correlation factors: A national survey in China. PLoS One 2016; 11: e0165341.
    1. Douiri A, Rudd AG, Wolfe CD. Prevalence of poststroke cognitive impairment: South London Stroke Register 1995-2010. Stroke 2013; 44: 138-145.
    1. Aichner F, Adelwöhrer C, Haring HP. Rehabilitation approaches to stroke. J. Neural Transm. Suppl. 2002; 63: 59-73.
    1. Wu P, Mills E, Moher D, Seely D. Acupuncture in poststroke rehabilitation: A systematic review and meta-analysis of randomized trials. Stroke 2010; 41: e171-e179.
    1. Zhang ZJ, Chen HY, Yip KC, Ng R, Wong VT. The effectiveness and safety of acupuncture therapy in depressive disorders: Systematic review and meta-analysis. J. Affect. Disord. 2010; 124: 9-21.
    1. Zhang JH, Wang D, Liu M. Overview of systematic reviews and meta-analyses of acupuncture for stroke. Neuroepidemiology 2014; 42: 50-58.
    1. Zhang ZJ, Wang XM, McAlonan GM. Neural acupuncture unit: A new concept for interpreting effects and mechanisms of acupuncture. Evid. Based Complement. Alternat. Med. 2012; 2012: 429412.
    1. Zhang ZJ, Ng R, Man SC et al. Dense cranial electroacupuncture stimulation for major depressive disorder: A single-blind, randomized, controlled study. PLoS One 2012; 7: e29651.
    1. Chung KF, Yeung WF, Zhang ZJ et al. Randomized placebo-controlled pilot trial of electroacupuncture for postpartum depression. J. Affect. Disord. 2012; 142: 115-121.
    1. Zhang ZJ, Wang XY, Tan QR, Jin GX, Yao SM. Electroacupuncture for refractory obsessive-compulsive disorder: A pilot waitlist-controlled trial. J. Nerv. Ment. Dis. 2009; 197: 619-622.
    1. Man SC, Hung BH, Ng RM et al. A pilot controlled trial of a combination of dense cranial electroacupuncture stimulation and body acupuncture for post-stroke depression. BMC Complement. Altern. Med. 2014; 14: 255.
    1. Hamilton M. A rating scale for depression. J. Neurol. Neurosurg. Psychiatry 1960; 23: 56-62.
    1. Han JS. Acupuncture: Neuropeptide release produced by electrical stimulation of different frequencies. Trends Neurosci. 2003; 26: 17-22.
    1. Montgomery SA, Åsberg M. A new depression scale designed to be sensitive to change. Br. J. Psychiatry 1979;134:382-389.
    1. Mahoney FI, Barthel DW. Functional evaluation: Barthel Index. Md. State Med. J. 1965; 14: 61-65.
    1. Nasreddine ZS, Phillips NA, Bédirian V et al. The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. J. Am. Geriatr. Soc. 2005; 53: 695-699.
    1. Guy W. ECDEU Assessment Manual for Psychopharmacology, Revised. Bethesda, MD, US Department of Health, Education, and Welfare, 1976.
    1. Arbab MA, Delgado T, Wiklund L, Svendgaard NA. Brain stem terminations of the trigeminal and upper spinal ganglia innervation of the cerebrovascular system: WGA-HRP transganglionic study. J. Cereb. Blood Flow Metab. 1988; 8: 54-63.
    1. Kubota K, Narita N, Ohkubo K et al. Central projection of proprioceptive afferents arising from maxillo-facial regions in some animals studied by HRP-labeling technique. Anat. Anz. 1988; 165: 229-251.
    1. Simpson KL, Waterhouse BD, Lin RC. Origin, distribution, and morphology of galaninergic fibers in the rodent trigeminal system. J. Comp. Neurol. 1999; 411: 524-534.
    1. Takahashi T, Shirasu M, Shirasu M et al. The locus coeruleus projects to the mesencephalic trigeminal nucleus in rats. Neurosci. Res. 2010; 68: 103-106.
    1. Dhond RP, Kettner N, Napadow V. Neuroimaging acupuncture effects in the human brain. J. Altern. Complement. Med. 2007; 13: 603-616.
    1. Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Prog. Neurobiol. 2008; 85: 355-375.
    1. Qu SS, Huang Y, Zhang ZJ et al. A 6-week randomized controlled trial with 4-week follow-up of acupuncture combined with paroxetine in patients with major depressive disorder. J. Psychiatr. Res. 2013; 47: 726-732.
    1. Schrader LM, Cook IA, Miller PR, Maremont ER, DiGiorgio CM. Trigeminal nerve stimulation in major depressive disorder: First proof of concept in an open pilot trial. Epilepsy Behav. 2011; 22: 475-478.
    1. Cook IA, Abrams M, Leuchter AF. Trigeminal nerve stimulation for comorbid posttraumatic stress disorder and major depressive disorder. Neuromodulation 2016; 19: 299-305.
    1. DeGiorgio CM, Soss J, Cook IA et al. Randomized controlled trial of trigeminal nerve stimulation for drug-resistant epilepsy. Neurology 2013; 80: 786-791.
    1. McGough JJ, Sturm A, Cowen J et al. Double-blind, sham-controlled, pilot study of trigeminal nerve stimulation for attention-deficit/hyperactivity disorder. J. Am. Acad. Child Adolesc. Psychiatry 2019; 58: 403-411.
    1. Ulett GA, Han S, Han JS. Electroacupuncture: Mechanisms and clinical application. Biol. Psychiatry 1998; 44: 129-138.
    1. He W, Tong Y, Zhao Y et al. Review of controlled clinical trials on acupuncture versus sham acupuncture in Germany. J. Tradit. Chin. Med. 2013; 33: 403-407.
    1. Hammerschlag R. Methodological and ethical issues in clinical trials of acupuncture. J. Altern. Complement. Med. 1998; 4: 159-171.
    1. Witt CM, Aickin M, Baca T et al. Effectiveness guidance document (EGD) for acupuncture research: A consensus document for conducting trials. BMC Complement. Altern. Med. 2012; 12: 148.
    1. Yang A, Wu HM, Tang JL, Xu L, Yang M, Liu GJ. Acupuncture for stroke rehabilitation. Cochrane Database Syst. Rev. 2016; 8: CD004131.
    1. Huang Y, Chen JQ, Lai XS et al. Lateralisation of cerebral response to active acupuncture in patients with unilateral ischaemic stroke: An fMRI study. Acupunct. Med. 2013; 31: 290-296.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel