Stroke is the second most common cause of death preceded only by heart attacks and the major cause of disability in the western societies. Stroke occurs when the blood supply to part of the brain is cut off and is mainly caused by ischemic or hemorrhagic. Ischemic stroke is the most common subtype of stroke, accounting for about 80% of all strokes. Treatment of stroke depends on the type of stroke and which part of brain is affected. Conventional approaches include medication to prevent and dissolve the blood clots and reduce blood pressure, and surgery to remove blood clots, treat brain swelling and reduce the risk of further bleeding in case of hemorrhagic stroke. However, people who survived stroke are often left with long-term problems caused by injury to their brains.

Scalp acupuncture is a modern acupuncture technique in which needles are penetrated the specific area of the scalp or lines on the scalp, and differs significantly from classic acupuncture in that it has its own theoretical basis and its acupoints are quite different from traditional acupoints. Scalp acupuncture has integrated traditional Chinese needling methods with western medical knowledge of representative areas of the cerebral cortex. This modern system of acupuncture, although explored since 1930s, has really been developed since 1970s and standardized in 1991 when the World Health Organization announced the International Standard Nomenclature for Scalp Acupuncture Points (WHO, 1991).

Despite its relatively short history, scalp acupuncture has been used to treat a wide range of conditions in many countries. Scalp acupuncture has proven effective for the treatment of cerebrovascular diseases and neurodegenerative disorders (Hao et al., 2013; Li et al., 2014; Wang et al., 2009). Furthermore, a number of clinical trials have reported therapeutic effects of scalp acupuncture for the treatment of stroke (Chen et al., 2014; Lee et al., 2014). Here, recent research developments of scalp acupuncture treatment on stroke are summarized.

 

Preclinical studies

Acupoint Baihui (GV20) is located on the highest point of the head and is an intersecting point of the Governing Vessel, Bladder, Gall Bladder, Triple Heater and Liver meridians. According theory of traditional Chinese medicine, acupuncture stimulation at Baihui can clear the mind, lift the spirits, tonify yang, strengthening the ascending function of spleen, eliminate interior wind and promote resuscitation. Indeed, Baihui acupoint has been used to effectively treat neurological disorders such as stroke in China for thousand years.

A systematic review and meta-analysis to assess the current evidence for the effect of Baihui (GV20)-based scalp acupuncture in animal models of focal cerebral ischemia was conducted by Wang et al., (2014). Meta-analysis results showed that of 54 studies 12 reported significant effects of GV20-based scalp acupuncture for improving infarct volume compared with middle cerebral artery occlusion group, and 32 studies reported significant effects of GV20-based scalp acupuncture for improving the neurological function score when compared with the control group. It was concluded that GV20-based scalp acupuncture could improve infarct volume and neurological function score and exert potential neuroprotective role in experimental ischemic stroke.

Recently effect and mechanisms of scalp acupuncture on neurological dysfunction of intracerebral hemorrhage stroke rat model was investigated (Liu et al., 2017). Rat model of intracerebral hemorrhage (ICH) received scalp acupuncture at acupoint DU20 through GB7 on the lesion side, for 30 mins, twice a day, from day one of surgery for consecutive 7 days. A group of intracerebral hemorrhage model not receiving scalp acupuncture and a group of sham surgery and a group of naïve were used as controls. Behavioral tests included a composite neurological scale, corner turn test, forelimb placing test, wire hang task and beam walking were conducted at days 3 and 7, followed by biochemical studies, such as western blot analysis and histopathologic examine. The data showed that at day 3 after intracerebral hemorrhage, there was no significant difference of behavioral tests between scalp acupuncture group and ICH. However, at day 7 after surgery, there was a significant improvement of neurological deficits in scalp acupuncture treated group compared with ICH. Biochemical studies showed that brain content of tumour necrosis factor alpha and nuclear factor KappaB protein expression, inflammatory markers, was markedly decreased in scalp acupuncture group compared with ICH and sham groups.  The results demonstrated that improved behavioral effects by scalp acupuncture were associated with decreased markers of inflammation in rat model of intracerebral hemorrhage.

Together, the studies above showed that scalp acupuncture improved neurological functions in both ischemic and hemorrhage models of stroke.

 

Clinical studies

Patients with ischemic stroke of subacute stage recovered better following combination of body acupuncture and scalp acupuncture treatment compared to conventional therapy. It is believed that subacute stage of stroke occurs between 1-6 months after onset of stroke. Better recovery in the subacute stage of stroke is crucial for patient’s long-term revival. Chen et al., (2014) carried out a randomized controlled clinical trial to assess the efficacy of combination of body acupuncture and scalp acupuncture in patients of subacute stroke. One hundred twenty-six patients were divided into acupuncture treatment group (n=61) and conventional treatment group (n=65). Acupuncture was given 5 times a week for total 8 weeks. The Fugl-Meyer scale and NIHSS scale and Barthel index were used to evaluate the motor functioning, balance, sensation, joint functioning and activity of daily living before and during and after acupuncture treatment and follow-up. Assessment after 4-week acupuncture showed a very good improvement compared to baseline judged by all parameters but did not show significant difference from conventional treatment group. At the end of 8-week acupuncture patients demonstrated markedly improvement in all assessments compared to baseline. Acupuncture showed a significant functional improvement compared to conventional group at the end of 8-week treatment and 3-month follow-up assessment (Chen et al., 2014). Authors conclude that combination of body acupuncture and scalp acupuncture achieved better clinical efficacy in stroke recovery compared to conventional treatment.

Recently, the study of the influence of scalp acupuncture on levels of inflammation in patients with acute cerebral infarction (ACl) was conducted to investigate its mechanism underlying improvement of ACI (Wang et al., 2016). A total of 61 patients with ACI were randomly allocated to scalp acupuncture group (n = 31) and control (medication) group (n = 30). Scalp acupuncture stimulation of bilateral Dingnieqianxiexian (MS 6) and Dingniehouxiexian (MS 7) was performed daily plus medication for 7 days, while patients in control group were given medication only. Clinical neurological dysfunction scales such as NDS, 0-45 points for consciousness, gazing, facial palsy, speech, myodynamia, walking-ability were monitored at the baseline and at the end of scalp acupuncture. Serum levels of inflammation markers, such as high-sensitivity C-reactive protein (hs-CRP), TNF-α, IL-6, and IL-1β, were assessed at the baseline and 3 and 7-day after scalp acupuncture. At the end of 7-day scalp acupuncture, patients showed a significant improvement of the neurological deficits compared with the baseline scores, and there was marked improvement in neurological dysfunction compared with control group. The levels of all inflammation markers were significantly decreased at both 3 and 7-day scalp acupuncture compared with baseline levels. The levels of inflammation makers were significantly lower in scalp acupuncture compared with control group. There was a correlation between the improved neurological deficits scores and decreased serum inflammation markers (Wang et al., 2016).

 

Conclusion

The results from the brief review study showed that scalp acupuncture is effective in improving neurological deficits of patients with stroke, and it could be an important part of rehabilitation program for stroke recovery.

 

Reference

Grateful acknowledgements are due to Drs. Chen LF, Hao JJ, Lee SJ, Li SK, Liu H, Wang JH, Wang S and Wang WW, and colleagues (This paper was based on their articles cited in above Reference section), as well as to Drs. Hui Nie and Bai-Yun Zeng for their work in preparing this briefing paper.