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Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture.

التفاصيل البيبلوغرافية
العنوان: Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture.
المؤلفون: Maeda Y; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA.; Department of Radiology, Logan University, Chesterfield, MO, 63017, USA., Kim H; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA.; Clinical Research Division, Korean Institute of Oriental Medicine, Daejeon, 34054, South Korea., Kettner N; Department of Radiology, Logan University, Chesterfield, MO, 63017, USA., Kim J; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA.; Clinical Research Division, Korean Institute of Oriental Medicine, Daejeon, 34054, South Korea., Cina S; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA., Malatesta C; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Medford, MA, 02155, USA., Gerber J; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA., McManus C; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Medford, MA, 02155, USA., Ong-Sutherland R; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Medford, MA, 02155, USA., Mezzacappa P; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA., Libby A; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA., Mawla I; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA., Morse LR; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, 02114, USA., Kaptchuk TJ; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA., Audette J; Department of Pain Medicine, Harvard Vanguard Medical Associates, Atrium Health, Boston, MA, 02215, USA., Napadow V; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA.; Department of Radiology, Logan University, Chesterfield, MO, 63017, USA.
المصدر: Brain : a journal of neurology [Brain] 2017 Apr 01; Vol. 140 (4), pp. 914-927.
نوع المنشور: Journal Article; Randomized Controlled Trial
اللغة: English
بيانات الدورية: Publisher: Oxford University Press Country of Publication: England NLM ID: 0372537 Publication Model: Print Cited Medium: Internet ISSN: 1460-2156 (Electronic) Linking ISSN: 00068950 NLM ISO Abbreviation: Brain Subsets: MEDLINE
أسماء مطبوعة: Publication: Oxford : Oxford University Press
Original Publication: London.
مواضيع طبية MeSH: Acupuncture Therapy/*methods , Carpal Tunnel Syndrome/*pathology , Carpal Tunnel Syndrome/*therapy , Electroacupuncture/*methods , Somatosensory Cortex/*pathology, Acupuncture Points ; Adult ; Aged ; Brain Mapping ; Carpal Tunnel Syndrome/physiopathology ; Diffusion Magnetic Resonance Imaging ; Female ; Hand/pathology ; Humans ; Male ; Median Nerve/pathology ; Median Nerve/physiopathology ; Middle Aged ; Neural Conduction ; Pain Measurement ; Treatment Outcome ; White Matter/pathology ; Wrist/pathology ; Young Adult
مستخلص: Carpal tunnel syndrome is the most common entrapment neuropathy, affecting the median nerve at the wrist. Acupuncture is a minimally-invasive and conservative therapeutic option, and while rooted in a complex practice ritual, acupuncture overlaps significantly with many conventional peripherally-focused neuromodulatory therapies. However, the neurophysiological mechanisms by which acupuncture impacts accepted subjective/psychological and objective/physiological outcomes are not well understood. Eligible patients (n = 80, 65 female, age: 49.3 ± 8.6 years) were enrolled and randomized into three intervention arms: (i) verum electro-acupuncture 'local' to the more affected hand; (ii) verum electro-acupuncture at 'distal' body sites, near the ankle contralesional to the more affected hand; and (iii) local sham electro-acupuncture using non-penetrating placebo needles. Acupuncture therapy was provided for 16 sessions over 8 weeks. Boston Carpal Tunnel Syndrome Questionnaire assessed pain and paraesthesia symptoms at baseline, following therapy and at 3-month follow-up. Nerve conduction studies assessing median nerve sensory latency and brain imaging data were acquired at baseline and following therapy. Functional magnetic resonance imaging assessed somatotopy in the primary somatosensory cortex using vibrotactile stimulation over three digits (2, 3 and 5). While all three acupuncture interventions reduced symptom severity, verum (local and distal) acupuncture was superior to sham in producing improvements in neurophysiological outcomes, both local to the wrist (i.e. median sensory nerve conduction latency) and in the brain (i.e. digit 2/3 cortical separation distance). Moreover, greater improvement in second/third interdigit cortical separation distance following verum acupuncture predicted sustained improvements in symptom severity at 3-month follow-up. We further explored potential differential mechanisms of local versus distal acupuncture using diffusion tensor imaging of white matter microstructure adjacent to the primary somatosensory cortex. Compared to healthy adults (n = 34, 28 female, 49.7 ± 9.9 years old), patients with carpal tunnel syndrome demonstrated increased fractional anisotropy in several regions and, for these regions we found that improvement in median nerve latency was associated with reduction of fractional anisotropy near (i) contralesional hand area following verum, but not sham, acupuncture; (ii) ipsilesional hand area following local, but not distal or sham, acupuncture; and (iii) ipsilesional leg area following distal, but not local or sham, acupuncture. As these primary somatosensory cortex subregions are distinctly targeted by local versus distal acupuncture electrostimulation, acupuncture at local versus distal sites may improve median nerve function at the wrist by somatotopically distinct neuroplasticity in the primary somatosensory cortex following therapy. Our study further suggests that improvements in primary somatosensory cortex somatotopy can predict long-term clinical outcomes for carpal tunnel syndrome.
(© The Author (2017). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
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معلومات مُعتمدة: S10 RR021110 United States RR NCRR NIH HHS; P41 RR014075 United States RR NCRR NIH HHS; K24 AT004095 United States AT NCCIH NIH HHS; R01 AT004714 United States AT NCCIH NIH HHS; P01 AT006663 United States AT NCCIH NIH HHS; S10 RR023043 United States RR NCRR NIH HHS
فهرسة مساهمة: Keywords: carpal tunnel syndrome; entrapment neuropathy; nerve conduction studies; neuromuscular disease: imaging; neuropathic pain
تواريخ الأحداث: Date Created: 20170324 Date Completed: 20170425 Latest Revision: 20230814
رمز التحديث: 20231215
مُعرف محوري في PubMed: PMC5837382
DOI: 10.1093/brain/awx015
PMID: 28334999
قاعدة البيانات: MEDLINE
الوصف
تدمد:1460-2156
DOI:10.1093/brain/awx015