Monday, January 27, 2014

The Brain on Acupuncture: New Imaging Yields Insight for Stroke Recovery

Researchers have figured out how to study electroacupuncture inside an MRI machine, enabling new investigation into stroke rehabilitation.

Acupuncturist places needles in watermelon
Watermelon tests helped researchers develop a new way to study acupuncture with advanced imaging.

The breakthrough came in giving acupuncture to a watermelon.

The melon lay inside the giant mouth of a magnetic resonance imaging (MRI) machine at the University of Washington. Steel needles poked into its rind, connected to wires that ran outside the room and into a small box in the hands of acupuncturist Kathleen Lumiere, DAOM ('08), MAc, LAc.

Dr. Lumiere used controls to send mild electric currents into the melon. The technique, electroacupuncture, seeks to stimulate the body's own electrical currents to promote healing. Dr. Lumiere has seen it help stroke patients make significant recoveries at Bastyr Center for Natural Health, where she is a clinical faculty member.

The melon in the imaging lab didn't do anything, just as researchers hoped. It didn't heat up or vibrate in response to the needles, which were specially designed to work inside a magnetic machine. The discovery brings researchers closer to showing it is safe to study electroacupuncture on humans inside an MRI machine. That, in turn, brings them closer to understanding how electroacupuncture works — and how it could become a widely accepted stroke therapy.

The project is a classic example of what researcher Leanna Standish PhD, ND, LAc, FABNO, calls "translational medicine" — translating a time-tested therapy of one culture (traditional Chinese medicine) into the vocabulary of another (modern Western medicine).

"What does acupuncture actually do to the brain tissue? Nobody knows," says Dr. Standish, a research professor in the Bastyr University School of Naturopathic Medicine and an affiliate research professor at the University of Washington School of Medicine. "We think it works, from Chinese studies, but we don't know how it works."

By studying electroacupuncture through functional magnetic resonance imaging (fMRI), her team hopes to gain insight into how exactly the therapy alters blood flow in the brain.

The Electrical Brain

Kathleen Lumiere in clinic hallwayThat may be especially important for victims of strokes. The most common form of stroke occurs when a blockage stops the flow of blood to part of the brain, starving cells of oxygen. Restoring blood flow to the affected areas is thought to be crucial for helping patients recover the ability to do things like speak, walk and use their hands.

"We're looking for a way to show that acupuncture, especially scalp electroacupuncture, can support stroke rehabilitation," says Dr. Lumiere.

Electroacupuncture is common for stroke patients in China, where traditional medicine rests on the notion of qi (pronounced "chee"), the body's underlying life force. Healers seek to restore the flow of qi through the body — some acupuncturists describe needle points as "gates" that needles can reopen. Electroacupuncture uses the same points, introducing mild currents as a more potent therapy for pain, muscle spasms or neurological issues.

As a clinician at Bastyr Center, Dr. Lumiere uses an electrotherapy standard well-studied in China. For stroke patients, she places two needles in the scalp near the motor cortex, which controls body movement. One needle sends a current of 2 hertz (two beats per second), mimicking the brain at sleep. The other needle sends a frequency of 100 hertz, a faster "invigorating" frequency. Patients often describe a tingling sensation, but rarely pain.

"The body acts like it's sleeping," Dr. Lumiere says. "It regenerates tissue, removes waste products, and facilitates healing rather profoundly."

Mariluz Adler, a student in Bastyr’s Post-Baccalaureate Program in Naturopathic Medicine, worked on the study by reviewing published research on electroacupuncture, most of it conducted in China and Japan. She found strong evidence the therapy improves paralysis, speech impairment and other stroke symptoms.

“It has so many positive results, it just makes sense for us to move forward with the study,” she says.

Electroacupuncture has been slow to spread in the U.S. But using electricity to stimulate the brain makes sense to Dr. Standish, who earned a doctorate in neuroscience before completing degrees in acupuncture and naturopathic medicine.

"Qi has never been translated into physics," she says. "But the very basis of brain activity is the electrical firing of a neuron. So our biology is electromagnetic in a very essential way."

Imaging Puzzle

Image scans from watermelon testsAs a translation tool, magnetic resonance imaging has unique potential to shed light on therapies that seem to resist measurement. By reacting to the iron content in blood, machines are able to map changes in neural activity inside a subject's brain. Dr. Standish and colleagues at Bastyr and UW have used functional MRI technology to map the effect of qigong, a Chinese movement therapy, on a healer's brain, with promising preliminary results.

But acupuncture poses a new challenge. MRI machines are essentially giant magnets whose power would yank regular steel needles out of a subject. Dr. Standish worked with medical-imaging specialists to find acupuncture needles that would not react to magnetism. In a paper published last year, her team documented how austenitic stainless steel, a processed, nonmagnetic material, would enable MRI studies. (Gold needles work for some methods but are too soft for scalp acupuncture.)

That finding enabled the watermelon test, which Dr. Lumiere led through a faculty research grant from the Bastyr University Research Institute. She found the needles provided electroacupuncture without producing heat that could harm a patient. Another test of the needles in gelatin found the needles wouldn't create "noise" that would obscure results.

She presented her results in April 2013 to the Society for Acupuncture Research, emphasizing that these methods could allow a multitude of studies.

"The equipment research we've been doing this past year enables all kinds of electroacupuncture and fMRI research, because we've found the right tools," she says.

Next comes a study of healthy human participants. Their proposal is currently awaiting approval from Bastyr and UW internal review boards (which review safety on all studies of human subjects). The team plans to begin early this year.

After that, the group will seek funding for a larger clinical trial of stroke patients. For stroke recovery, researchers will look at two key indicators, says imaging specialist Clark Johnson, PhD, a UW research associate professor emeritus. The first measurement is the change in blood flow in the damaged area. The second is changes in metabolic activity — energy flowing into brain cells affected by the stroke.

"Both of these would be indicators of successful treatment," says Dr. Johnson. "You want blood to get there and you want brain activity to change. It's clearly just a question: Does the use of this technique allow the neurons in the area of the stroke to become reactivated? I don't know if it's going to be true, but it's a good question."

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