A systematic review and coordinate-based meta-analysis of fMRI studies on acupuncture at LR 3

A systematic review of resting-state functional-MRI studies in the diagnosis, comorbidity and treatment of postpartum depression

BACKGROUND

Postpartum depression (PPD) is a common and serious mental health problem that affects many new mothers and their families worldwide. In recent years, there has been an increasing number of studies using magnetic resonance techniques (MRI), particularly functional MRI (fMRI), to explore the neuroimaging biomarker of this disease.

METHODS

PubMed database was used to search for English literature focusing on resting-state fMRI and PPD published up to June 2024.

RESULTS

After screening, 17 studies were finally identified, among which all 17 studies reported abnormal regions or connectivity compared to health controls (HC), 4 studies reported results considering the differences between PPD and PPD with anxiety (PPD-A), and 2 studies reported biomarkers for the treatment of PPD. The existing studies indicate that PPD is characterized by functional impairments in multiple brain regions, especially the medial prefrontal cortex (MPFC), precentral gyrus and cerebellum. Abnormal functional connectivity has been widely reported in the dorsomedial prefrontal cortex (dmPFC), anterior cingulate cortex (ACC) and the orbitofrontal cortex (OFC). However, none of the four comorbidity studies identified overlapping discriminative biomarkers between PPD and PPD-A. Additionally, the two treatment-related studies consistently reported functional improvements in the amygdala after effective treatment.

CONCLUSION

The affected brain regions were highly overlapped with major depressive disorder (MDD), suggesting that PPD may be categorized as a potential subtype of MDD. Considering the negative effects of medication on PPD, future efforts should focus on developing non-pharmacological therapies, such as transcranial magnetic stimulation (TMS) and acupuncture, to support women with PPD in overcoming this unique and important phase.

Does acupuncture at motor-related acupoints affect corticospinal excitability? A systematic review and meta-analysis

BACKGROUND

Acupuncture is widely used in modulating brain excitability and motor function, as a form of complementary and alternative medicine. However, there is no existing meta-analysis evaluating the effectiveness and safety of acupuncture on corticospinal excitability (CSE), and the credibility of the evidence has yet to be quantified.

OBJECTIVE

This study was designed to assess the efficacy and safety of electroacupuncture (EA) and manual acupuncture (MA) in enhancing brain excitability, specifically focusing on CSE as measured by transcranial magnetic stimulation (TMS).

SEARCH STRATEGY

This study followed a systematic approach, searching 9 databases up to August 2024 and examining grey literature, in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

INCLUSION CRITERIA

Studies were included if they compared the clinical efficacy of EA or MA with sham acupuncture, no treatment or usual training.

DATA EXTRACTION AND ANALYSIS

Three investigators independently conducted literature screening, data extraction, and risk of bias assessment. The primary outcome focused on motor-evoked potentials as measured by TMS, with treatment effects quantified using mean differences or standardized mean differences between pre- and post-treatment. Subgroup analyses were conducted using mixed-effects models, while random-effects or fixed-effects models were used to estimate average treatment differences across studies.

RESULTS

Based on 34 studies involving 1031 adults, acupuncture techniques significantly enhanced CSE. EA had a greater impact than MA, with effect sizes of 0.53 mV vs 0.43 mV (95% confidence interval [CI]: [0.30, 0.76], P < 0.00001 vs 95% CI: [0.28, 0.59], P < 0.00001). The 5 most frequently used acupoints were LI4 (Hegu, 32 times), ST36 (Zusanli, 10 times), LI11 (Quchi, 7 times), TE5 (Waiguan, 6 times), and GB34 (Yanglingquan, 5 times).

CONCLUSION

This systematic review indicates that both EA and MA could effectively and safely enhance CSE, bringing the corticospinal pathway closer to the threshold for firing, which may ultimately improve motor function. LI4, ST36, LI11, TE5 and GB34 are the most commonly used acupoints. Please cite this article as: Liu R, Moe AAK, Liu W, Zoghi M, Jaberzadeh S. Does acupuncture at motor-related acupoints affect corticospinal excitability? A systematic review and meta-analysis. J Integr Med. 2025; 23(2): 113-125.

Graded exercise with motion style acupuncture therapy for a patient with failed back surgery syndrome and major depressive disorder: a case report and literature review

Effective treatment of failed back surgery syndrome (FBSS) remains challenging despite urgent medical attention requirements. Depression is a contributing factor to the development and poor prognosis of FBSS, and vice versa. We report the case of a patient with FBSS and major depressive disorder (MDD) treated with graded exercise combined with motion-style acupuncture therapy (MSAT). A 53-year-old male veteran who had undergone lumbar discectomy and laminectomy with instrumented fusion was admitted to the hospital with re-current back pain and radiative pain in the left leg. The effects of failed surgery triggered MDD as a comorbidity. After a six-week routine treatment without remarkable improvement, a three-week program of graded exercise with MSAT was applied. The numeric rating scale (NRS) and short form-36 (SF-36) were used to assess low back pain with radiating leg pain, and daily functioning levels, respectively. The voluntary walking distance of the patients was measured. To analyze the therapeutic effects and other applications of the intervention, we surveyed clinical trials using MSAT or graded exercise therapy (GET). Three weeks of graded exercise with MSAT reduced physical and mental functional disabilities (SF-36, physical component: 15.0 to 37.2, mental component: 21.9 to 30.1) as well as the intensity of low back pain and/or radiative leg pain (NRS: 50 to 30). Furthermore, as the therapeutic intensity gradually increased, there was a significant corresponding increase in daily walking distance (mean daily walking distance, the first week vs. baseline, second, and third week, 3.05 ± 0.56: 2.07 ± 0.79, 4.27 ± 0.96, and 4.72 ± 1.04 km, p = 0.04, p = 0.02, and p = 0.003, respectively). Three randomized controlled trials of GET were included, all showing statistically significant antidepressant effects in the diseased population. Graded exercise with MSAT may be an effective rehabilitative therapy for patients with FBSS and MDD who have impaired daily routines.