Acupuncture stimulates brain metabolism in dementia patients

CM NEWS – Needling specific acupoints may help patients with dementia, a recently published study shows. The acupoint combo seems to increase cerebral glucose metabolism in the brain, as indicated by cerebral functional imaging.

The study has been published in the January 2007 issue of the Journal of Acupuncture and Tuina Science. Chinese researchers observed the effects of needling three acupoints – Baihui (百會, Hundred Convergences; GV 20), Shuigou (水溝, Water Trough; GV 26) and Shenmen (神門, Spirit Gate; HT 7) – and their effects on cerebral glucose metabolism in patients with vascular dementia.

25 patients with vascular dementia were divided into 5 groups (Group A, B, C, D and E) randomly. Patients in the Group A were treated by needling routine acupoints for hemiplegia (paralysis in the vertical half of a patient’s body), which are acupoints of the three “yang meridians” of the hand and foot.

In addition to the “routine acupoints”, Group B patients received acupuncture to Baihui (GV 20); Group C to Shuigou (GV 26), Group D to Shenmen (HT 7), and Group E to Baihui (GV 20), Shuigou (GV 26), and Shenmen (HT 7).

All the patients were examined by Positron Emission Tomography (PET) to detect cerebral glucose metabolism in the bilateral frontal lobes (orbital gyri), parietal lobes, temporal lobes (hippocampus and hippocampal gyrus), occipital lobes, thalamus, lentiform nucleus, caudate nuclei, cingulate gyms and cerebellum before treatments and after treatments.

Why checking on cerebral glucose metabolism? Studies have linked dementia with the slowing of glucose metabolism in certain parts of the brain. One study indicated that patients with frontotemporal dementia not only showed significant metabolic deficits primarily in frontal cortical areas, but also in the caudate nuclei and the thalami. These findings demonstrate that the clinical progression in patients with frontotemporal dementia is accompanied by a region-specific decline in cerebral glucose metabolism.

Another study found that patients with multi-infarct dementia (MID) had significantly lower glucose metabolism in all the grey matter regions measured and were also characterized by more individuality in metabolic pattern.

The present study shows that after needling the routine acupoints for hemiplegia, glucose metabolism increased in lentiform nucleus and temporal lobe; and:

* patients with Baihui (GV 20) needled showed increased glucose metabolism in the frontal lobe, temporal lobe and lentiform nucleus.
* patients with Shuigou (GV 26) needled showed increased glucose metabolism in the frontal lobe, thalamus and lentiform nucleus;
* patients with Shenmen (HT 7) needled got more glucose metabolism in the parietal lobe and lentiform nucleus;
* patients who recieved needling to all these three acupoints has higher glucose metabolism in the frontal lobe, temporal lobe, thalamus and lentiform nucleus.

The results suggest that needling Baihui (GV 20), Shuigou (GV 26) and Shenmen (HT 7) affect glucose metabolism in different functional regions of the brain. In other words, the three acupoints are closely correlated to different functional regions of the brain.

Dan shen’s effect for stroke patients lacks strong evidence

Health Behavior News Service, by Bruce Sylvester – The traditional Chinese medicine dan shen (丹参, Salviae miltiorrhizae), a standard treatment for ischemic stroke in China, lacks strong scientific evidence to support such use, according a new review of studies.Nevertheless, based on the available data, dan shen treatment showed a tendency to improve short-term neurological deficits in stroke patients, say researchers at Sichuan University in Chengdu, China.

However, the short-term result “should be interpreted cautiously because of the poor methodological quality of included trials and the small numbers of patients,” said review co-author and neurology professor Ming Liu.

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews drawevidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

Obstruction of a blood vessel supplying blood to the brain can result in ischemic stroke, which accounts for about 83% of all strokes.

In China, post-stroke use of herbal medicine is part of standard care in both Western-style hospitals and in traditional Chinese medicine hospitals. Dan shen, in various pill, tablet and injection formulations, is the herb most commonly given for ischemic stroke; its use in that context spans more than three decades.

However, few researchers have tested the herb’s effectiveness in rigorous clinical trials that approach current international standards.

The reviewers found six studies that met inclusion criteria for the review — randomized or quasi-randomized and controlled — involving 494 acute ischemic stroke patients.

The Cochrane reviewers found that methods of randomly assigning study subjects to dan shen or placebo were unclear, and that this could have led to results exaggerating a positive treatment effect by 30% to 41%. “It is therefore plausible that dan shen is truly ineffective and the apparent benefits are simply due to bias arising from the methodological weaknesses of the studies,” they say.

Since treatment and follow-up in these studies ranged from 14 to 28 days, it was not possible to assess the long-term effects of dan shen.

“We found no evidence to support the routine use of dan shen agents for ischemic stroke,” Liu said. “However, if the apparently beneficial effects on neurological impairment were confirmed in methodologically rigorous trials, it would lead to a useful treatment for stroke being identified,” she added.

Ted Kaptchuck, O.M.D., associate professor of medicine at Harvard Medical School, said, “in Chinese society, at this time, basic science and laboratory evidence seems to be enough to gain widespread acceptance and adoption for the use herbal and other medications. In the West, we think it is a long shot to go from basic laboratoryevidence to demonstrated clinical efficacy in randomized trials. We are not at the point where it is clear that a traditional Chinese herb has a major role in health care.”

Liu agreed: “The designs of these trials need to be improved in the future research, not only in the clinical trials on dan shen agents, but also in trials on other Chinese herbal medicine.”

[Dan Shen agents for acute ischaemic stroke (Review). Cochrane Database of Systematic Reviews 2007, Issue 2.]

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search forevidence in the form of clinical trials and other studies of interventions.

What is the prognosis (outlook) for patients who get swine flu (H1N1)?

The following is speculation on the prognosis for swine flu (H1N1) because this disease has only been recently diagnosed and the data is changing daily. This section is based on currently available information.

In general, the majority (about 90%-95%) of people who get the disease feel terrible (see symptoms) but recover with no problems, as seen in patients in both Mexico and the U.S. Caution must be taken as the swine flu (H1N1) is still spreading and has become a pandemic. So far, young adults have not done well, and in Mexico, this group currently has the highest mortality rate, but this data could quickly change.

People with depressed immune systems historically have worse outcomes than uncompromised individuals; investigators suspect that as swine flu (H1N1) spreads, the mortality rates may rise and be high in this population. Current data suggest that pregnant individuals, children under 2 years of age, young adults, and individuals with any immune compromise or debilitation are likely to have a worse prognosis. Unfortunately, the problem with the prognosis is still unclear. If the mortality is like the conventional flu that causes mortality rates of about 0.1%, the result would be about 36,000 deaths per year because of the huge number of people who get infected. If the Mexico swine flu (H1N1) ends up with a mortality rate of about 6% and infects the same number of millions of people as conventional flu viruses, the projected numbers could be as high as 2 million deaths in the U.S. alone. This is a bad prognosis for about 2 million people and their families; these potential deaths are major reasons that health officials are so concerned about the spread of this new virus. As of September 2009, the current estimates are that about 90,000 deaths will occur in the U.S. from novel H1N1 swine flu (estimated by the president’s advisory committee). As of October, these estimates have not been revised by the advisory committee or the CDC.

Another confounding problem with the prognosis of swine flu (H1N1) is that the disease is occurring and spreading in high numbers at the usual end of the flu season. Most flu outbreaks happen between November to the following April, with peak activity between late December to March. This outbreak is not following the usual flu pattern since novel H1N1 began its outbreak in April and had spread throughout the world by September. Some scientists think that swine flu (H1N1) will die down but return with many more cases in the fall, and still others speculate the current pandemic will eventually resemble the outcomes similar to the 1918 influenza pandemic. Some suggest it may resemble the SARS (severe acute respiratory syndrome caused by a coronavirus strain) outbreak in 2002-2003 in which the disease spread to about 10 countries with over 7,000 cases, over 700 deaths, and had a 10% mortality rate. Effective isolation of patients was done in this case, and many investigators think the outbreak was stopped due to this measure. Because swine flu (H1N1) is a new virus and does not seem to be following the usual flu disease pattern, any prognosis is speculative, although as of October 2009, the numbers of people with flu-like illness are higher than usual and the illness is affecting a much younger population than the conventional flu. As the pandemic progresses, this article will be updated. The best news about this novel H1N1 swine flu is that the majority of people, as of October 2009, who have caught the flu recover without medical treatment and have an excellent prognosis.