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Acupuncture for the t reatment of Epilepsy

Acupuncture for the t reatment of Epilepsy. Hongqi Zhang * , Jianliang Zhang School of Chinese Medicine , Hong Kong Baptist University. Epilepsia G k: = seizure

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Acupuncture for the t reatment of Epilepsy

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  1. Acupuncture for the treatment of Epilepsy Hongqi Zhang*, JianliangZhang School of Chinese Medicine, Hong Kong Baptist University

  2. Epilepsia Gk: = seizure • Paroxysmal transient disturbance of brain function (motor, sensory, consciousness, psychic, or autonomic), due to paroxysmal disturbance of brain electrical activities • one of the most common primary disorder of the brain, affecting 3% of population by age 80 (USA data)

  3. Vagus Nerve Stimulation (VNS) Although many epilepsy patients can be treated by the antiepileptic drugs, intractable epilepsy often requires surgical intervention or other treatments such as VNS • It has been reported in recent 20 years to reduce seizures; • In 1988, the first patient receiving VNS in US; • Since approval by U.S. FDA 1997 for clinical use, more than 35,000 patients received VNS worldwide up to date.

  4. The vagus nerve is the most important autonomic nerve that innervate most organs Not only efferent but also afferent Related to immune function

  5. Questions ? • How does it work? • mechanism unclear!! • Potential complications • High costs ~$US 10,000 • Possible alternatives? • trigeminal nerve stimulation may produce an even better anti-epileptic effect in rat. Fanselow, E. E., A. P. Reid, et al. (2000). "Reduction of pentylenetetrazole-induced seizure activity in awake rats by seizure-triggered trigeminal nerve stimulation." The Journal of Neuroscience

  6. Acupuncture has long been used for the treatment of epilepsy in China, though its efficacy has been quite variable in different reports 啞门 大椎Da-zhui 陶道 Dazhui 大椎 Yaoqi 腰奇

  7. OBJECTIVES 1. To examine the influence of VNS onthecorticaland thalamicepileptiform activities induced by pentylenetetrazole (PTZ); 2. Tocompare the effects of VNS atlow and high intensities; 3.Tocompare the effect of by EA with that by VNS on theepileptiform activities.

  8. Methodology • SD rats were anaesthetized with Ketamine and Xylazine; • Parietal cortex was exposed for recording the cortical activities, or inserting of microelectrode into VB thalamus for recording; • Epilepsy model was made by iv administration of PTZ (60mg/kg); • VNS:The left vagus nerve was stimulated at 30Hz,1mA/3mA, 0.45ms, 5min; • EA: Applied to “Dazhui” acupoint at 30Hz,1mA/3mA, 0.45ms, 5min.

  9. RESULTS

  10. PTZ induced cortical epileptiform activities PTZ Background (BK) 2/min 44/min 100µV 1min 80 Imp count 60 * 40 20 N = 12 P<0.05 * BK PTZ

  11. VNS effect on cortical epileptiform activities A: PTZ induced epileptiform cortical activities;B: 1mA VNS had little effect on the epileptiform cortical activities;C:3mA VNS abolishedthe epileptiform activities. 2/min (BK) 46/min (PTZ) 30/min (VNS 1mA) 26/min (pre VNS) 28/min (post VNS) 4/min (VNS 3mA) 26/min (pre VNS) 12/min (post VNS)

  12. EA effect on cortical epileptiform activities A: PTZ induced epileptiform cortical activities;B: EA 1mA “Dazhui” point slightly inhibited corticalepileptiform activities;C: EA 3mA “Dazhui” produced strong inhibition of theepileptiform activities. PTZ 6/min (BK) 40/min A 22/min (EA 1mA) 30/min (pre EA) B 10/min (EA 3mA) 30/min (pre EA) C

  13. A: PTZ induced epileptiform activities;B: 3 mA VNS produced little effect on the cortical epileptiform activities;C: 3 mA EA abolished the epileptiform activities. Comparison of VNS vs EA on cortical epileptiform activities 16/min (BK) 60/min (PTZ) A 104/min (VNS 3mA) 92/min (pre VNS) 88/min (post VNS) B 0/min (EA 3mA) 78/min (pre EA) 24/min (post EA) C

  14. Effects of VNS and EA on the PTZ induced cortical epileptiform activities ________________________________________ Treatment VNS EA Intensity 1mA 3mA 1mA 3mA _______________________________________________________________________ total 16 18 15 25 Inhibitory 8(50%)7(39%)8(53%)13(52%) Excitatory 1(6%) 2(11%)0 3 (12%) No change7 9 7 9 ________________________________________ Notes: > 10% change in comparison with pre-stimulation control

  15. Cortical recording: inhibition rate summary P<0.05 P<0.05 P<0.05 P<0.01 P>0.05 60 Imp counts 40 12% 20% 16% 31% 20 N=16 N=18 N=15 N=25 0 Pre- post- VNS 1mA Pre- post- VNS 3mA Pre- post- EA 1mA Pre- post- EA 3mA

  16. Thalamic single neuron recording A: PTZ enhanced the neuronal activities; B: EA stimulation of “Dazhui” acupoint inhibited the neuronal activities by 33%; C: VNS inhibited the neuronal activities more strongly (by 67%) than EA. A 80 PTZ 224/min BK 91/min 0 0 300s 600s B 224/min 80 149/min EA-DZ-3mA 0 C 80 VNS 3mA 149/min 49/min 0 0 300s 600s 900s

  17. A 80 PTZ 901/min 54/min (BK) 0 0 600s 300s B 80 901/min 691/min VNS 1mA 0 0 C 80 691/min 23/min EA-DZ-1mA 0 0 900s 300s 600s A: PTZ significantly increased the thalamic neuronal activities; B: 1mA VNS inhibited the neuron; C: 1mA EA stimulation of “Dazhui” acupoint significantly inhibited the neuronal activities;

  18. Effects of EA and VNS on thalamic neuronal activities induced by PTZ EA VNS 1mA 3mA 1mA 3mA total 48 29 44 29 Inhibition 12(41%) 14(48%) 27(56%) 25(56%) Excitation 11(23%) 7(24%) 10(23%) 11(48%) 10 10 9 4 No change

  19. Conclusion • EA (at Da-zhui) has a comparable effect in comparison with VNS on cortical and thalamic epileptiform activities • EA could be a good alternative therapy for epilepsy. • Further studies on different models/subjects should be carried out

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