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ZhangZhang -Jin Zhang (), Associate Professor School of Chinese Medicine, HKU September 14, 2012, Hong Kong
Dense cranial electroacupuncture stimulation for neuropsychiatric disorders: rationale and clinical application
What is NAU
When an acupuncture needle is inserted into a designated point on the body and mechanical or electrical stimulation is delivered, a variety of neural and neuroactive Free nerve endings components are activated. Merkel disc ending Meissners corpuscle A collection of the Ruffinis corpuscle activated neural and neuroactive components Pacinian corpuscle ending distributed in the skin, Muscle spindles muscle, and connective tissues surrounding the inserted needle is defined as a neural acupuncture unit (NAU).
Tou-Lin-Qi (GB15)
Neural and neuroactive components are much richer in forehead acupointacupoint -based NAUs than other acupointacupointbased NAUs.
Enhancing antidepressant efficacy in MDD and PSD. Improve mild depression. Improve sleep and other comorbide symptoms. Reduce adverse effects.
Inclusion criteria
1.
2.
3.
4.
Aged 2565 yrs DSMDSM -IV diagnosis of MDD; HAMDHAMD -17 score >18 Clinical Global ImpressionImpression-Severity (CGI(CGI -S) score 4 (moderately ill).
Clinical assessment:
HAMD-17 HAMDClinical Global ImpressionImpression-severity (CGI(CGI-S), SelfSelf -rating Depression Scale (SDS) Clinical response: > 50% reduction in HAMDHAMD-17 Remission rate: <7 in score on HAMDHAMD-17.
Withdrew prematurely (n = 3): Lost to follow-up (n =1); Other medical emergency (n = 1) Severe headache (n = 1) Completed treatment (n = 32, 91.4%)
Withdrew prematurely (n = 7): Lost to follow-up (n = 2) Other medical emergencies (n = 3) Intolerance of acupuncture (n = 2) Completed treatment (n = 31, 81.6%)
DCEAS (n = 36) 25 (69.4) 46.3 9.9 7.9 8.0 4.9 6.1 2 (5.5) 7 (19.4) 13 (36.1) 24 (66.7) 7 (19.4) 3 1 1 2 23.9 3.8 4.4 0.5 41.9 14.0
P values (t or
2
(n = 34) 33 (97.1) 48.2 9.8 7.3 7.1 3.6 4.4 3 (8.8) 8 (23.5) 9 (26.5) 22 (64.7) 6 (17.6) 3 1 1 2
a d
test) 0.006 0.414 0.744 0.332 0.669 0.901 0.800 0.937 0.909
No. (%) of patients with first-onset MDD No. (%) of patients with previous psychiatric admission No. (%) of patients with family members having mental illnesses. No. (%) of patients with previous b acupuncture treatment No. (%) of patients receiving psychotropic medications at study c entry SSRIs SNRIs Mood stabilizers Benzodiazepines Baseline HAMD-17 score Baseline CGI-S
a a
Efficacy
DCEASDCEAS-treated group had significantly greater improvement on both HAMDHAMD-17 and SDS. There were significant differences in HAMDHAMD -17 between the two groups at Day 3 through Day 21 and in SDS at Day 3 and Day 21. DCEAS produced a higher clinical response rate compared to sham group (19.4% vs. 8.8%), but similar in remission rate (2.7% (2.7% vs. 2.9%).
0 -2
HAMD-17
* * * *
Mean changes from baseline in score on HAMD-17, CGI-S, and SDS over time
CGI-S
-5
SDS
-10
-15
14
21
Days of treatment
P value 0.354 0.412 0.910 0.236 0.894 0.892 0.877 0.159 0.706 0.266 0.266
a a a
11 (30.6) 15 (41.7) 10 (27.8) 6 (16.7) 10 (27.8) 9 (25.0) 9 (25.0) 14 (38.9) 3 (8.3) 6 (16.7) 6 (16.7)
Results of credibility
45.5% (15/33) of patients in sham EA perceived to have received DCEAS, while 23.5% (8/34) of patients in DCEAS believed to have control treatment. It was not significantly different (P = 0.103).
12 MDD patients received 12 sessions of DCEAS treatment in 3 weeks. PET scanning was conducted at baseline and endpoint. 6 healthy volunteers were included to serve as PET scan control. The four regions displaying significant response were identified: dorsolateral prefrontal cortex (DLPFC), anterior cingulate cortex (ACC), caudate nucleus, and posterior cerebellar cortex.
Conclusions
DCEAS is effective in reducing OCD, depression, and insomnia symptoms. DCEAS also could improve neuroimagingneuroimaging -measured brain activity in depressed patients.
Acknowledgements
The study was supported by Health and Health Services Research Fund (HHSRF) from Food and Health Bureau of Hong Kong (ref. no.: 06070831) and GRF/RGC (ref no.: 786611). We thank Dr. Roger Ng, Marksman Man, Jade Li, Wendy Wong in coordination and conduct of the study. We thank the following colleagues at Department of Psychiatry of Kowloon Hospital for help recruit MDD patients: Ka-Lik Kwan, Chun-Ting Chan, Man-Lui Chan, Chi-Kwan Cheung, Janice Chik, Lung-Kit Hui, Man-Man Kwan, Chee-Kin Lee, Kwok-Chuen Ng, Yin-Ting Ng, Ting-Keung Poon, Fu-Yin Tong, Wai-Ching Yan, Kam-Hing Yeung, Tin-Yan Yeung, Mei-Kuen Frieda Shiu, CheukKin Tang, Pui-Shan Tse, Ngar-Fong Lam,See-Cheuk Fu, Chui-Lin Carol Ching, Ka-Fai Ho, Sau-Lai Tai, Sau-Ming Chan, Yiu-Kwun Law, Yuk-Kwan Yvonne Kwong. We thank Professor Yong Huang in Guangzhou Nanfang Medical University for PET study.
Thank you!