연구배경 : 침의 효과와 신경생리학적 기전에 관한 연구가 기능자기공명을 이용하여 활발히 이루어지고 있다. 좌우측 동일한 혈위에 대한 자침이 뇌 기능에 미치는 효과에 대하여 논란이 되고 있다. 그러나 동일한 혈위에 대한 좌측 또는 우측 자침이 뇌기능에 미치는 영향에 대한 연구는 부족한 점이 있다. 목적 : 본 연구의 목적은 좌우측 족삼리 자침에 의한 BOLD (blood oxygen level-dependent) 반응을 살펴보고 비교하는 것이다. 방법 : 14명의 건강한 남자를 대상으로 좌우측 족삼리에 가짜 침과 진짜 침 자극을 하였다. 좌우측 족삼리 자침이 뇌 기능에 미치는 영향을 알아보고 비교하기 위해 4가지 실험 디자인을 선택하였다. 첫째와 셋째 스캔은 우측 족삼리에, 둘째와 넷째 스캔은 좌측 족삼리에 가짜침과 진짜침 자극을 주었다. 또한, 자침은 자극기에 자침 및 자극을 주었으며, 자극기가 끝남과 동시에 발침하기를 반복하였다. 통계분석을 위해 SPM8을 이용하여 one sample T-test와 within-subject the analysis of variance (ANOVA) test 를 실시하였다. 통계 결과 좌측과 우측 족삼리 자침에 의해 BOLD 반응의 차이를 보이는 9개 영역의 ROI (regions of interest)에서 BOLD 신호를 추출하였다. 결과 : 좌측과 우측 족삼리의 자침에 의한 BOLD반응은 서로 다른 방식으로 나타났다. 좌우측 족삼리 자침에 의한 BOLD반응을 비교한 결과, 좌측 족삼리 자침은 우측 족삼리 자침에 비해 주로 해마옆 이랑 (브로드만 영역 28), 배외측 전전두 피질 (브로드만 영역 44), 시상, 소뇌정상과 기저핵의 전장에서 더 높은 활성반응이 나타났다. 좌우측 족삼리 자침에 의한 BOLD반응을 각각 조사한 결과, 우측 족삼리 자침은 주로 대뇌섬과 보조운동영역 그리고 전대상이랑 (브로드만 영역 24)에서 활성화가 나타났으며, 좌측 족삼리 자침은 주로 대뇌섬과 일차 체감각 피질 (브로드만 영역 2) 그리고 배외측 전전두 피질 (브로드만 영역 44)에서 활성화가 나타났다. 결론 : 본 연구는 기능적 자기공명영상을 이용하여 좌측과 우측의 족삼리 자침이 인간의 뇌에 미치는 영향을 알아보고 비교한 최초의 연구이다. 본 연구 결과는 좌측과 우측 족삼리 자침은 통증조절효과에 서로 다른 방식으로 영향을 미칠 수 있다는 것을 의미한다. 또한, 본 연구 결과는 좌측과 우측 자침이 뇌 신경에 미치는 영향의 차이에 대한 증거가 된다.
연구배경 : 침의 효과와 신경생리학적 기전에 관한 연구가 기능자기공명을 이용하여 활발히 이루어지고 있다. 좌우측 동일한 혈위에 대한 자침이 뇌 기능에 미치는 효과에 대하여 논란이 되고 있다. 그러나 동일한 혈위에 대한 좌측 또는 우측 자침이 뇌기능에 미치는 영향에 대한 연구는 부족한 점이 있다. 목적 : 본 연구의 목적은 좌우측 족삼리 자침에 의한 BOLD (blood oxygen level-dependent) 반응을 살펴보고 비교하는 것이다. 방법 : 14명의 건강한 남자를 대상으로 좌우측 족삼리에 가짜 침과 진짜 침 자극을 하였다. 좌우측 족삼리 자침이 뇌 기능에 미치는 영향을 알아보고 비교하기 위해 4가지 실험 디자인을 선택하였다. 첫째와 셋째 스캔은 우측 족삼리에, 둘째와 넷째 스캔은 좌측 족삼리에 가짜침과 진짜침 자극을 주었다. 또한, 자침은 자극기에 자침 및 자극을 주었으며, 자극기가 끝남과 동시에 발침하기를 반복하였다. 통계분석을 위해 SPM8을 이용하여 one sample T-test와 within-subject the analysis of variance (ANOVA) test 를 실시하였다. 통계 결과 좌측과 우측 족삼리 자침에 의해 BOLD 반응의 차이를 보이는 9개 영역의 ROI (regions of interest)에서 BOLD 신호를 추출하였다. 결과 : 좌측과 우측 족삼리의 자침에 의한 BOLD반응은 서로 다른 방식으로 나타났다. 좌우측 족삼리 자침에 의한 BOLD반응을 비교한 결과, 좌측 족삼리 자침은 우측 족삼리 자침에 비해 주로 해마옆 이랑 (브로드만 영역 28), 배외측 전전두 피질 (브로드만 영역 44), 시상, 소뇌정상과 기저핵의 전장에서 더 높은 활성반응이 나타났다. 좌우측 족삼리 자침에 의한 BOLD반응을 각각 조사한 결과, 우측 족삼리 자침은 주로 대뇌섬과 보조운동영역 그리고 전대상이랑 (브로드만 영역 24)에서 활성화가 나타났으며, 좌측 족삼리 자침은 주로 대뇌섬과 일차 체감각 피질 (브로드만 영역 2) 그리고 배외측 전전두 피질 (브로드만 영역 44)에서 활성화가 나타났다. 결론 : 본 연구는 기능적 자기공명영상을 이용하여 좌측과 우측의 족삼리 자침이 인간의 뇌에 미치는 영향을 알아보고 비교한 최초의 연구이다. 본 연구 결과는 좌측과 우측 족삼리 자침은 통증조절효과에 서로 다른 방식으로 영향을 미칠 수 있다는 것을 의미한다. 또한, 본 연구 결과는 좌측과 우측 자침이 뇌 신경에 미치는 영향의 차이에 대한 증거가 된다.
Objectives : There has been some controversy about the modulatory effects on brain function during acupuncture on each side of the same acupoint. This study was designed to investigate and compare the blood oxygen level-dependent(BOLD) responses of acupuncture on each side of ST36. Methods : Fourtee...
Objectives : There has been some controversy about the modulatory effects on brain function during acupuncture on each side of the same acupoint. This study was designed to investigate and compare the blood oxygen level-dependent(BOLD) responses of acupuncture on each side of ST36. Methods : Fourteen healthy subjects were recruited for imaging and received acupuncture or placebo stimulations either on the left or on the right acupoint of ST36 in each scan. For the voxel-wise statistical analysis, one sample T-test and the within-subject analysis of variance(ANOVA) test were performed using SPM8 software. Results : This study showed that acupuncture on each side of ST36 showed different BOLD signal patterns. Higher BOLD responses after acupuncture stimulations at the left ST36 compared to the right were observed mainly in the parahippocampal gyrus(BA 28), dorsolateral prefrontal cortex(DLPFC, BA 44), thalamus, culmen and claustrum. We investigated the different neural responses between rest and activation periods of placebo and acupuncture stimulations on each side of ST36. Acupuncture at the right ST36 elicited activation mainly in the insula, supplementary motor area(SMA) and anterior cingulate cortex(ACC), while acupuncture at the left ST36 elicited activation mainly in the insula, primary somatosensory cortex(SI, BA 2) and DLPFC(BA 44). Conclusions : To our knowledge, this is the first reported functional MRI study directly comparing when needling at the right and at the left side of ST36. This study's preliminary results proved to be evidence of acupuncture's different effects when performed on opposite sides of an acupoint.
Objectives : There has been some controversy about the modulatory effects on brain function during acupuncture on each side of the same acupoint. This study was designed to investigate and compare the blood oxygen level-dependent(BOLD) responses of acupuncture on each side of ST36. Methods : Fourteen healthy subjects were recruited for imaging and received acupuncture or placebo stimulations either on the left or on the right acupoint of ST36 in each scan. For the voxel-wise statistical analysis, one sample T-test and the within-subject analysis of variance(ANOVA) test were performed using SPM8 software. Results : This study showed that acupuncture on each side of ST36 showed different BOLD signal patterns. Higher BOLD responses after acupuncture stimulations at the left ST36 compared to the right were observed mainly in the parahippocampal gyrus(BA 28), dorsolateral prefrontal cortex(DLPFC, BA 44), thalamus, culmen and claustrum. We investigated the different neural responses between rest and activation periods of placebo and acupuncture stimulations on each side of ST36. Acupuncture at the right ST36 elicited activation mainly in the insula, supplementary motor area(SMA) and anterior cingulate cortex(ACC), while acupuncture at the left ST36 elicited activation mainly in the insula, primary somatosensory cortex(SI, BA 2) and DLPFC(BA 44). Conclusions : To our knowledge, this is the first reported functional MRI study directly comparing when needling at the right and at the left side of ST36. This study's preliminary results proved to be evidence of acupuncture's different effects when performed on opposite sides of an acupoint.
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제안 방법
These previous studies suggested that acupoints on opposite sides of the body might have different modulatory effects in the human brain. In order to investigate the neuronal effects of acupuncture on each side of the same acupoint, this study examined the blood oxygen level-dependent (BOLD) response to acupuncture on each side of ST36 and compared needling at the right side of ST36 with that at the left side.
In order to mimic all aspects of the real treatment, the experiment was performed with SHAM on the acupoints in this study. This study revealed that both ACUP and SHAM have some remarkable overlapping activation on limbic and paralimbic structures.
To minimize the effect of the subject’s motion during scans, we performed realignments for two scans separately and a mean image was generated. The co-registration was performed between the realigned BOLD-MRI data and the 3 dimensional T1-weighted anatomical images. After the 3D T1-weighted images were normalized into the Montreal Neurological Institute(MNI) space, the co-registered BOLD-MRI data were also normalized into the standard space and smoothed with a full width of half maximum(FWHM) of 8×8×10 mm.
The experiment was performed with an 8 channel head coil and a 3.0T MRI system(Philips Achieva, Best, The Netherlands). The subject lied down supine in the scanner with a supporting head cushion.
The first major finding of this study was that acupuncture on each side of ST36 showed different BOLD signal patterns. We compared needling on the right side of ST36 to that on the left side.
대상 데이터
Fifteen healthy subjects(all males, age 29.9±5.7 years, mean±SD) participated in this study.
In order to eliminate the possibility of conditioning and long-lasting effects of the acupuncture stimulations, we scheduled SHAM before ACUP. The acupuncture needle used in this study was made of stainless steel and its size was 0.25 mm in diameter and 40 mm in length(Dong Bang Acupuncture Inc. Korea) for ACUP and the blunt, non-penetrating needle of same size which was made by Dong Bang Acupuncture inc. was used for SHAM. The stimulations were performed by an experienced Korean medical doctor at the right or left ST36, which is located in the tibialis anterior muscle, 4 fingerbreadth lateral to the anterior crest of the tibia.
was used for SHAM. The stimulations were performed by an experienced Korean medical doctor at the right or left ST36, which is located in the tibialis anterior muscle, 4 fingerbreadth lateral to the anterior crest of the tibia. The duration of each scan task was 3 minutes 45 seconds.
There was a 1 minute gap between each scan. There were 75 scans for each scan task and a total of 300 scans(2 placebo tasks and 2 acupuncture tasks) for each subject. The total scan time of each subject was about 18 minutes.
데이터처리
We constructed the matrix of activated functional maps in placebo/acupuncture stimulations for each scan. In order to investigate BOLD responses of acupuncture/placebo stimulations at the right and left side of ST36, the data were analyzed using a one sample t-test with a statistical threshold of p<0.001(uncorrected) combined with the spatial extent threshold of 10 contiguous voxels. In order to investigate the differences between needling at the left and right side of ST36(side effect), the data were analyzed using the within subject analysis of variance(ANOVA) test with a statistical threshold of p<0.
001(uncorrected) combined with the spatial extent threshold of 10 contiguous voxels. In order to investigate the differences between needling at the left and right side of ST36(side effect), the data were analyzed using the within subject analysis of variance(ANOVA) test with a statistical threshold of p<0.005(uncorrected) combined with the spatial extent threshold of 10 contiguous voxels. The results were reported using the coordinates of Talairach space.
Pre-processing and statistical analysis were performed using SPM8 software(Statistical Parameter Mapping, version 8, The Wellcome Trust Centre for Neuroimaging). Pre-processing began with slice timing correction to adjust the acquisition time delay between slices of a volume.
The data were analyzed using one sample T-tests.
The data were analyzed using within-subject ANOVA test.
성능/효과
In order to mimic all aspects of the real treatment, the experiment was performed with SHAM on the acupoints in this study. This study revealed that both ACUP and SHAM have some remarkable overlapping activation on limbic and paralimbic structures. According to the result of the within-subject ANOVA test, higher BOLD responses were observed during acupuncture stimulations at the left ST36 than at the right acupoint mainly in the parahippocampal gyrus(BA 28), DLPFC(BA 44), thalamus, culmen and claustrum.
It has been reported that the cerebral cortex and cerebellum as well as basal ganglia are involved in the planning, control, and execution of voluntary motor functions50). This study showed that acupuncture-induced activation was observed in the SMA and claustrum contralaterally as well as in the uvula ipsilaterally. This may due to the effects of acupuncture at different sides of the acupoint as suggested by previous researches.
참고문헌 (52)
Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M et al. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA. 1998 ; 280 : 1569-75.
Lewith GT, White PJ, Pariente J. Investigating acupuncture using brain imaging techniques: the current state of play. Evid Based Complement Alternat Med. 2005 ; 2 : 315-9.
Hui KK, Liu J, Makris N, Gollub RL, Chen AJ, Moore CI et al. Acupuncture modulates the limbic system and subcortical gray structures of the human brain: evidence from fMRI studies in normal subjects. Hum Brain Mapp. 2000 ; 9 : 13-25.
Biella G, Sotgiu ML, Pellegata G, Paulesu E, Castiglioni I, Fazio F. Acupuncture produces central activations in pain regions. Neuroimage. 2001 ; 14 : 60-6.
Hsieh JC, Tu CH, Chen FP, Chen MC, Yeh TC, Cheng HC et al. Activation of the hypothalamus characterizes the acupuncture stimulation at the analgesic point in human: a positron emission tomography study. Neurosci Lett. 2001 ; 307 : 105-8.
Zhang WT, Jin Z, Huang J, Zhang L, Zeng YW, Luo F et al. Modulation of cold pain in human brain by electric acupoint stimulation: evidence from fMRI. Neuroreport. 2003 ; 14 : 1591-6.
Dougherty DD, Kong J, Webb M, Bonab AA, Fischman AJ, Gollub RL. A combined [11C]diprenorphine PET study and fMRI study of acupuncture analgesia. Behav Brain Res. 2008 ; 193 : 63-8.
Kong J, Ma L, Gollub RL, Wei J, Yang X, Li D et al. A pilot study of functional magnetic resonance imaging of the brain during manual and electroacupuncture stimulation of acupuncture point (LI-4 Hegu) in normal subjects reveals differential brain activation between methods. J Altern Complement Med. 2002 ; 8 : 411-9.
Jeun SS, Kim JS, Kim BS, Park SD, Lim EC, Choi GS et al. Acupuncture stimulation for motor cortex activities: a 3T fMRI study. Am J Chin Med. 2005 ; 33 : 573-8.
Chae Y, Lee H, Kim H, Sohn H, Park JH, Park HJ. The neural substrates of verum acupuncture compared to non-penetrating placebo needle: an fMRI study. Neurosci Lett. 2009 ; 450 : 80-4.
Hui KK, Liu J, Marina O, Napadow V, Haselgrove C, Kwong KK et al. The integrated response of the human cerebro-cerebellar and limbic systems to acupuncture stimulation at ST 36 as evidenced by fMRI. Neuroimage. 2005 ; 27 : 479-96.
Napadow V, Makris N, Liu J, Kettner NW, Kwong KK, Hui KK. Effects of electroacupuncture versus manual acupuncture on the human brain as measured by fMRI. Hum Brain Mapp. 2005 ; 24 : 193-205.
Li K, Shan B, Xu J, Liu H, Wang W, Zhi L et al. Changes in FMRI in the human brain related to different durations of manual acupuncture needling. J Altern Complement Med. 2006 ; 12 : 615-23.
Gareus IK, Lacour M, Schulte AC, Hennig J. Is there a BOLD response of the visual cortex on stimulation of the vision-related acupoint GB 37? J Magn Reson Imaging. 2002 ; 15 : 227-32.
Park S. A Study on the Concept of the Right and the Left in Oriental Medicine. Seoul, Republic of Korea: Graduate school of Kyung Hee University. 1998.
Park S, Kim J, Kim M. Effects of hetero-segmental electroacupuncture on formalin induced pain in the rat. J Korean Acupunc Moxibustion Soc. 2000 ; 17 : 231-46.
Moon S, Cho K, Ko C. Effects of opposing-needling on upper limb on cerebral blood flow in Ischemic stroke patients. Kyung- Hee Med. 2000 ; 16 : 94-101.
Wu MT, Sheen JM, Chuang KH, Yang P, Chin SL, Tsai CY et al. Neuronal specificity of acupuncture response: a fMRI study with electroacupuncture. Neuroimage. 2002 ; 16 : 1028-37.
Zhang WT, Jin Z, Cui GH, Zhang KL, Zhang L, Zeng YW et al. Relations between brain network activation and analgesic effect induced by low vs. high frequency electrical acupoint stimulation in different subjects: a functional magnetic resonance imaging study. Brain Res. 2003 ; 982 : 168-78.
Wu MT, Hsieh JC, Xiong J, Yang CF, Pan HB, Chen YC et al. Central nervous pathway for acupuncture stimulation: localization of processing with functional MR imaging of the brain--preliminary experience. Radiology. 1999 ; 212 : 133-41.
Pariente J, White P, Frackowiak RS, Lewith G. Expectancy and belief modulate the neuronal substrates of pain treated by acupuncture. Neuroimage. 2005 ; 25 : 1161-7.
Cho ZH, Hwang SC, Wong EK, Son YD, Kang CK, Park TS et al. Neural substrates, experimental evidences and functional hypothesis of acupuncture mechanisms. Acta Neurol Scand. 2006 ; 113 : 370-7.
Kong J, Kaptchuk TJ, Polich G, Kirsch I, Vangel M, Zyloney C et al. Expectancy and treatment interactions: a dissociation between acupuncture analgesia and expectancy evoked placebo analgesia. Neuroimage. 2009 ; 45 : 940-9.
Frost JA, Binder JR, Springer JA, Hammeke TA, Bellgowan PS, Rao SM et al. Language processing is strongly left lateralized in both sexes. Evidence from functional MRI. Brain. 1999 ; 122 ( Pt 2) : 199-208.
Pujol J, Deus J, Losilla JM, Capdevila A. Cerebral lateralization of language in normal left-handed people studied by functional MRI. Neurology. 1999 ; 52 : 1038-43.
Ahmad Z, Balsamo LM, Sachs BC, Xu B, Gaillard WD. Auditory comprehension of language in young children: neural networks identified with fMRI. Neurology. 2003 ; 60 : 1598-605.
Schonwiesner M, Krumbholz K, Rubsamen R, Fink GR, von Cramon DY. Hemispheric asymmetry for auditory processing in the human auditory brain stem, thalamus, and cortex. Cereb Cortex. 2007 ; 17 : 492-9.
Plante E, Schmithorst VJ, Holland SK, Byars AW. Sex differences in the activation of language cortex during childhood. Neuropsychologia. 2006 ; 44 : 1210-21.
Briellmann RS, Saling MM, Connell AB, Waites AB, Abbott DF, Jackson GD. A high-field functional MRI study of quadri-lingual subjects. Brain Lang. 2004 ; 89 : 531-42.
Woermann FG, Jokeit H, Luerding R, Freitag H, Schulz R, Guertler S et al. Language lateralization by Wada test and fMRI in 100 patients with epilepsy. Neurology. 2003 ; 61 : 699-701.
Anderson DP, Harvey AS, Saling MM, Anderson V, Kean M, Abbott DF et al. FMRI lateralization of expressive language in children with cerebral lesions. Epilepsia. 2006 ; 47 : 998-1008.
Siedentopf CM, Golaszewski SM, Mottaghy FM, Ruff CC, Felber S, Schlager A. Functional magnetic resonance imaging detects activation of the visual association cortex during laser acupuncture of the foot in humans. Neurosci Lett. 2002 ; 327 : 53-6.
Yeo S, Choe IH, van den Noort M, Bosch P, Lim S. Consecutive acupuncture stimulations lead to significantly decreased neural responses. J Altern Complement Med. 2010 ; 16 : 481-7.
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