Acupuncture Continuing Education

Acupuncture Rivals Drug Therapy For Aphasia Recovery After Stroke

Acupuncture is effective for the treatment of aphasia after a stroke. Acupuncture patients regained the ability to communicate through speech and written language at a similar rate as drug therapy patients. More importantly, a combination of acupuncture with drug therapy produced optimal positive patient outcomes. Acupuncture, as a standalone therapy, produced a 46% total effective rate and donepezfil (a cognition enhancing drug) produced a 50% total effective rate. Significantly, the combination of acupuncture with donepezfil produced a 77% total effective rate. This important discovery finds the combined protocol of acupuncture and drugs an important treatment option for patients having lost the ability to communicate after a stroke.

 

Brain

 

Stroke, also referred to as cerebral infarction, is the second most common cause of death and disability in the world. Aphasia (the inability to communicate through speech or written language) is one of the effects of stroke, occurring in 20–40% of post-stroke patients. These patients experience a significant loss in quality of life due to the inability to express their thoughts or communicate. Early recovery from aphasia is crucial in restoring speech and language capabilities. 

One factor that significantly determines whether or not recovery from aphasia is possible is the ability for the brain’s capillaries to repair, thereby eliminating brain edema and other concerns. There is a 20–30% chance that the stroke patient will spontaneously recover from aphasia on their own, however, the odds are greatly improved through clinical treatment methods. Currently, there are several treatment methods being researched, including hyperbaric oxygen, repeated transcranial magnetic stimulation, donepezfil, speech and language rehabilitation, and TCM (Traditional Chinese Medicine) including acupuncture and moxibustion therapies. 

Research and clinical observations have long shown that acupuncture has the ability to directly dilate the brain’s capillaries, as well as improve the brain blood and oxygen supply to aspects of the brain that have been oxygen deprived, all of which is crucial to the protection and repair of the brain. In particular, scalp acupuncture regulates the plasma and cells of blood by affecting the mechanisms of circulation within the brain’s blood vessels (hemodynamics), and the neural electrical properties (electrophysiology). Because scalp acupuncture regulates hemodynamics and exerts electrophysiological changes, it has the ability to protect the brain for a prolonged period of time.

While there is a plethora of information and research regarding acupuncture clinical treatments for stroke patients compared with control groups, there is little information on integrated approaches and their efficacy. Recently, researchers Li et al. (Neurology Department, Donguan People's Hospital) published a study that was designed to quantify multiple treatment options to get a better understanding of whether or not combined therapies were more effective and specifically which ones proved to be the most successful at treating aphasia. They divided post-stroke patients within one week of having a stroke into 4 groups, all of whom received speech and rehabilitation therapies, but then each group received an additional clinical treatment comprised of varied common approaches.

Group A was the control group receiving only speech and rehabilitation therapy; the other groups were given speech and rehabilitation therapies plus: group B received donepezfil, group C received scalp and body acupuncture, group D received donepezfil and scalp and body acupuncture therapy. The type of speech and rehabilitation therapies delivered across all the groups was determined individually based on the type of aphasia the patient experienced. The speech and rehabilitation therapies included speech production muscle rehabilitation, face-the-mirror rehabilitation, cohesion training, speech repeatability, hearing and recognition, identification of object and word, reading and writing training, visual and logic training, and gesture rehabilitation.

Acupuncture therapy was conducted on groups C and D on a daily basis for four weeks. Scalp acupuncture points included speech zones 1, 2, and 3. Body acupuncture was used bilaterally. The acupuncture points included the following:

  • REN23 (Lianquan)
  • DU24 (Shenting)
  • DU20 (Baihui)
  • DU15 (Yamen)
  • Extra Point Laoguan
  • HT5 (Tongli)
  • KD1 (Youngquan)

Bleeding techniques were conducted with the acupuncture groups C and D and were performed every other day under the tongue on the Jinjin and Yuyue extraordinary points using a tongue clamp to hold the tongue and a three-edged needle to prick the points specifically where the varicose meridians could be seen. Finally, donepezfil was administered orally to groups B and D in 5 mg doses daily for four weeks.

All the patient groups were then analyzed for recovery of aphasia and assessed as percentages for total recovery. Group A, the control group that received only speech and rehabilitation therapy, had a 28% total treatment effectiveness rate, which was the least effective treatment among the four groups. Group B receiving donepezfil had a 50% total effectiveness rate, while group C receiving acupuncture alone had a comparable 46% total effectiveness rate. This means that acupuncture was similarly effective as donepezfil. Group D by far had the best effect at 77%, meaning that the integrative approach of donepezfil, scalp and body acupuncture therapies combined with speech and rehabilitation therapies was by far the most effective treatment protocol for aphasia from ischemic stroke.

The quality of life for stroke patients suffering from aphasia is significantly diminished since it affects their ability to communicate with others. Therefore, it is vital to discover effective clinical treatment methods to not only restore patients’ speech and language capabilities, but also to regain and improve their quality of life. The research (Department of Neurology, Donguan People's Hospital; Guangdong Province, China) demonstrates the importance of an integrative approach for the treatment of post-stroke aphasia, and particularly the significance of including scalp and body acupuncture in the treatment protocol.

 

References:
Massimiliano Di Filippo, Alessandro Tozzi, Cinzia Costa, Vincenzo Belcastro, Michela Tantucci, Barbara Picconi, Paolo Calabresi. (2008). Plasticity and Repair in the Post-Ischemic Brain. Neuropharmacology. 55(3).

Li AP, Xiao WM, Wang YM & Xiong XP. (2013). A follow up study on poststroke aphasiarecovery using acupuncture and donepezfil. Journal of New Medicine. 44(12).

Berthier ML, Green C, Higueras C, et al. (2006) A randomized, placebo-controlled study of donepezil in poststroke aphasia. Neurology. 67(1687-1689).

Cappa SF, Perani D, Grassi F, et al. (1997). A PET follow-up study of recovery after stroke in acute aphasics. Brain and language. (56-67). 

Chen SD, Yu SW & Zhao JF et al. (2012). Repeated transcranial magnetic stimulation combined with donepezfil in treating post stroke aphasia. Chinese journal of physical medicine and rehabilitation. 34(212-215).

Chen Y, Li YS, Wang ZY et al. (2010). Treatment effectiveness of donepezfil in treating post stroke aphasia. Chinese Journal of Internal Medicine. 49(115-118).

 


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