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Joachim K. Krauss - One of the best experts on this subject based on the ideXlab platform.
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Effects of pedunculopontine area and pallidal DBS on gait ignition in Parkinson's disease.
Brain Stimulation, 2013Co-Authors: Christoph Schrader, Frank Seehaus, H. Holger Capelle, Anja Windhagen, Henning Windhagen, Joachim K. KraussAbstract:Abstract Background Freezing of gait is a disabling feature of Parkinson's disease, and so far no established treatment exists. Deep brain stimulation of the pedunculopontine area has been proposed to treat refractory gait disorders, yet data on measurable effects, especially in combination with stimulation of other targets, are scarce. Methods Acute effects of either low frequency pedunculopontine stimulation or high frequency stimulation of the posteroventral Lateral Globus Pallidus internus and a combination of both in a 66-year-old man with advanced Parkinson's disease were assessed. Four weeks after the intervention, the gait was examined with patient blinded in each condition using computerized gait analysis. Results Isolated pedunculopontine or pallidal stimulation had a mild impact on gait ignition and freezing of gait, but combined stimulation had a marked effect. Conclusions Combined multifocal stimulation may be a promising option for gait ignition and freezing of gait in advanced Parkinson's disease.
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Deep brain stimulation for treatment of hemichorea-hemiballism after craniopharyngioma resection: long-term follow-up.
Journal of Neurosurgery, 2011Co-Authors: Hans-holger Capelle, Thomas M. Kinfe, Joachim K. KraussAbstract:Hemichorea-hemiballism is a rare movement disorder that has various causes. In treatment-resistant cases, both thalamic and pallidal functional procedures have been shown to yield beneficial results. Until now it has not been clarified whether the thalamus or the pallidum would yield a superior outcome. After resection of a craniopharyngioma in this patient at the age of 49 years, hemichorea-hemiballism developed, with a latency of several weeks. Because the patient was greatly impaired by the movement disorder, she underwent implantation of deep brain stimulation (DBS) electrodes in the thalamic ventralis intermedius nucleus and the posteroventral Lateral Globus Pallidus internus. Although both pallidal and thalamic stimulation could suppress the movement disorder, the voltage needed was clearly less with thalamic than with pallidal stimulation. At the last available follow-up 25 months postoperatively, complete subsidence of hemichorea-hemiballism was achieved with long-term thalamic stimulation. Long-t...
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Chronic stimulation of the Globus Pallidus internus for treatment of non-DYT1 generalized dystonia and choreoathetosis: 2-year follow up
Journal of Neurosurgery, 2003Co-Authors: Joachim K. Krauss, Thomas J. Loher, Sabine Weber, H. Holger Capelle, Ralf Weigel, Jean-marc BurgunderAbstract:Object. The authors studied the long-term efficacy of deep brain stimulation (DBS) of the posteroventral Lateral Globus Pallidus internus up to 2 years postoperatively in patients with primary non-DYT1 generalized dystonia or choreoathetosis. The results are briefly compared with those reported for DBS in DYT1 dystonia (Oppenheim dystonia), which is caused by the DYT1 gene. Methods. Enrollment in this prospective expanded pilot study was limited to adult patients with severely disabling, medically refractory non-DYT1 generalized dystonia or choreoathetosis. Six consecutive patients underwent follow-up examinations at defined intervals of 3 months, 1 year, and 2 years postsurgery. There were five women and one man, and their mean age at surgery was 45.5 years. Formal assessments included both the Burke-Fahn-Marsden dystonia scale and the recently developed Unified Dystonia Rating Scale. Two patients had primary generalized non-DYT1 dystonia, and four suffered from choreoathetosis secondary to infantile cer...
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effect of chronic pallidal deep brain stimulation on off period dystonia and sensory symptoms in advanced parkinson s disease
Journal of Neurology Neurosurgery and Psychiatry, 2002Co-Authors: Thomas J. Loher, Jean-marc Burgunder, Sabine Weber, Regine Sommerhalder, Joachim K. KraussAbstract:Objective: To investigate the efficacy of chronic pallidal deep brain stimulation (DBS) on off period dystonia, cramps, and sensory symptoms in advanced Parkinson's disease (PD). Methods: 16 patients (6 women, 10 men; mean age at surgery 65 years) suffering from advanced PD were followed up prospectively for one year after implantation of a monopolar electrode in the posteroventral Lateral Globus Pallidus internus. UniLateral DBS was performed in 9 patients. 10 patients had biLateral procedures (contemporaneous biLateral surgery in 7 and staged biLateral surgery in 3 instances). The decision whether to perform uniLateral or biLateral surgery depended on the clinical presentation of the patient. Patients were formally assessed preoperatively, at 3–5 days, 3 months, and 12 months after surgery. Results: In patients who underwent uniLateral surgery, pain was present in 7 (78%), off dystonia in 5 (56%), cramps in 6 (67%), and dysaesthesia in 4 (44%). In patients who underwent biLateral surgery, pain was present in 7 (70%), off dystonia in 6 (60%), cramps in 7 (70%), and dysaesthesia in 4 (40%). With uniLateral DBS, contraLateral off period dystonia was improved by 100% at 1 year postoperatively, pain by 74%, cramps by 88%, and dysaesthesia by 100%. There was less pronounced amelioration of ipsiLateral off period dystonia and sensory symptoms. With biLateral DBS, total scores for dystonia were improved by 86%, for pain by 90%, for cramps by 90%, and for dysaesthesia by 88%. The benefit appeared early at the first evaluation 3–5 days after surgery and was stable throughout the follow up period. Conclusions: Pallidal DBS yields major improvement of off period dystonia, cramps, and sensory symptoms in patients with advanced PD.
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Effect of chronic pallidal deep brain stimulation on off period dystonia and sensory symptoms in advanced Parkinson’s disease
Journal of Neurology Neurosurgery & Psychiatry, 2002Co-Authors: Jean-marc Burgunder, Weber S, Sommerhalder R, Joachim K. KraussAbstract:Objective: To investigate the efficacy of chronic pallidal deep brain stimulation (DBS) on off period dystonia, cramps, and sensory symptoms in advanced Parkinson's disease (PD). Methods: 16 patients (6 women, 10 men; mean age at surgery 65 years) suffering from advanced PD were followed up prospectively for one year after implantation of a monopolar electrode in the posteroventral Lateral Globus Pallidus internus. UniLateral DBS was performed in 9 patients. 10 patients had biLateral procedures (contemporaneous biLateral surgery in 7 and staged biLateral surgery in 3 instances). The decision whether to perform uniLateral or biLateral surgery depended on the clinical presentation of the patient. Patients were formally assessed preoperatively, at 3–5 days, 3 months, and 12 months after surgery. Results: In patients who underwent uniLateral surgery, pain was present in 7 (78%), off dystonia in 5 (56%), cramps in 6 (67%), and dysaesthesia in 4 (44%). In patients who underwent biLateral surgery, pain was present in 7 (70%), off dystonia in 6 (60%), cramps in 7 (70%), and dysaesthesia in 4 (40%). With uniLateral DBS, contraLateral off period dystonia was improved by 100% at 1 year postoperatively, pain by 74%, cramps by 88%, and dysaesthesia by 100%. There was less pronounced amelioration of ipsiLateral off period dystonia and sensory symptoms. With biLateral DBS, total scores for dystonia were improved by 86%, for pain by 90%, for cramps by 90%, and for dysaesthesia by 88%. The benefit appeared early at the first evaluation 3–5 days after surgery and was stable throughout the follow up period. Conclusions: Pallidal DBS yields major improvement of off period dystonia, cramps, and sensory symptoms in patients with advanced PD.
Norihiro Ohnari - One of the best experts on this subject based on the ideXlab platform.
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Internal structures of the Globus Pallidus in patients with Parkinson’s disease: evaluation with quantitative susceptibility mapping (QSM)
European Radiology, 2015Co-Authors: Satoru Ide, Shingo Kakeda, Issei Ueda, Keita Watanabe, Yu Murakami, Junji Moriya, Atsushi Ogasawara, Koichiro Futatsuya, Toru Sato, Norihiro OhnariAbstract:Objectives The aim of this study was to assess the susceptibility change in medial and Lateral Globus Pallidus (GPm and GPl) related to age separately, using quantitative susceptibility mapping (QSM) and to determine whether QSM can depict GPm in Parkinson’s disease (PD) patients. Methods QSM was performed in 19 PD patients and in 41 normal control (NC) subjects. First, we quantitatively analysed age-related changes in QSM value in NC for GPl and GPm by a manual region of interest (ROI) technique. Then, in PD patients and age-matched NC subjects, we evaluated the depiction of GPm on QSM images qualitatively. Results In NC, the QSM value within GPl significantly increased gradually with age ( r = 0.32, p = 0.04), whereas it did not change with age in GPm. The average QSM value was significantly larger for GPl than for GPm (205 vs 191, p
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Internal structures of the Globus Pallidus in patients with Parkinson’s disease: evaluation with quantitative susceptibility mapping (QSM)
European Radiology, 2014Co-Authors: Satoru Ide, Shingo Kakeda, Issei Ueda, Keita Watanabe, Yu Murakami, Junji Moriya, Atsushi Ogasawara, Koichiro Futatsuya, Toru Sato, Norihiro OhnariAbstract:Objectives The aim of this study was to assess the susceptibility change in medial and Lateral Globus Pallidus (GPm and GPl) related to age separately, using quantitative susceptibility mapping (QSM) and to determine whether QSM can depict GPm in Parkinson’s disease (PD) patients.
Kiyofumi Yamada - One of the best experts on this subject based on the ideXlab platform.
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Therapeutic potential of nicotine for methamphetamine-induced impairment of sensorimotor gating: involvement of pallidotegmental neurons
Psychopharmacology, 2009Co-Authors: Hiroyuki Mizoguchi, Sawako Arai, Hiroyuki Koike, Daisuke Ibi, Hiroyuki Kamei, Toshitaka Nabeshima, Hyoung-chun Kim, Kazuhiro Takuma, Kiyofumi YamadaAbstract:Introduction We have previously found that a disruption to prepulse inhibiton (PPI) induced by methamphetamine (METH) is associated with impaired functioning of pallidotegmental neurons, which play a crucial role in PPI of the startle reflex, through the activation of gamma-aminobutyric acid type B receptors in pedunculopontine tegmental neurons in mice. Objectives Here, we examined the effect of nicotine on METH-induced impairment of PPI of the startle reflex focusing on dysfunctional pallidotegmental neurons and the neural system. Results Nicotine (0.15–0.5 mg/kg) ameliorated the deficit in PPI induced by acute METH, and the ameliorating effect of nicotine was antagonized by nicotinic receptor antagonists such as methyllycaconitine and dihydro-β-erythroidine. The acute METH-induced disruption of PPI was accompanied by suppression of c-Fos expression in the Lateral Globus Pallidus (LGP) as well as its induction in the caudal pontine reticular nucleus (PnC) in mice subjected to the PPI test. Nicotine-induced amelioration of PPI deficits in METH-treated mice was accompanied by a reversal of the changes in c-Fos expression in both the LGP and PnC to the basal level. Conclusions Nicotine is effective in ameliorating the impairment of PPI caused by METH, which may be associated with normalization of the pallidotegmental neurons.
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Therapeutic potential of nicotine for methamphetamine-induced impairment of sensorimotor gating: involvement of pallidotegmental neurons
Psychopharmacology, 2009Co-Authors: Hiroyuki Mizoguchi, Sawako Arai, Hiroyuki Koike, Daisuke Ibi, Hiroyuki Kamei, Toshitaka Nabeshima, Hyoung-chun Kim, Kazuhiro Takuma, Kiyofumi YamadaAbstract:We have previously found that a disruption to prepulse inhibiton (PPI) induced by methamphetamine (METH) is associated with impaired functioning of pallidotegmental neurons, which play a crucial role in PPI of the startle reflex, through the activation of gamma-aminobutyric acid type B receptors in pedunculopontine tegmental neurons in mice. Here, we examined the effect of nicotine on METH-induced impairment of PPI of the startle reflex focusing on dysfunctional pallidotegmental neurons and the neural system. Nicotine (0.15–0.5 mg/kg) ameliorated the deficit in PPI induced by acute METH, and the ameliorating effect of nicotine was antagonized by nicotinic receptor antagonists such as methyllycaconitine and dihydro-β-erythroidine. The acute METH-induced disruption of PPI was accompanied by suppression of c-Fos expression in the Lateral Globus Pallidus (LGP) as well as its induction in the caudal pontine reticular nucleus (PnC) in mice subjected to the PPI test. Nicotine-induced amelioration of PPI deficits in METH-treated mice was accompanied by a reversal of the changes in c-Fos expression in both the LGP and PnC to the basal level. Nicotine is effective in ameliorating the impairment of PPI caused by METH, which may be associated with normalization of the pallidotegmental neurons.
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Involvement of Pallidotegmental Neurons in Methamphetamine- and MK-801-Induced Impairment of Prepulse Inhibition of the Acoustic Startle Reflex in Mice: Reversal by GABA_B Receptor Agonist Baclofen
Neuropsychopharmacology, 2008Co-Authors: Sawako Arai, Hiroyuki Mizoguchi, Daisuke Ibi, Hiroyuki Kamei, Toshitaka Nabeshima, Kazuhiro Takuma, Kenji Takahashi, Taku Nagai, Kiyofumi YamadaAbstract:We have previously demonstrated that pallidotegmental GABAergic neurons play a crucial role in prepulse inhibition (PPI) of the startle reflex in mice through the activation of GABA_B receptors in pedunculopontine tegmental neurons. In this study, we investigated whether PPI disruption induced by methamphetamine (METH) or MK-801 is associated with the dysfunction of pallidotegmental neurons. Furthermore, we examined the effects of baclofen, a GABA_B receptor agonist, on METH- and MK-801-induced PPI impairment. Acute treatment with METH (3 mg/kg, subcutaneouly (s.c.)) and MK-801 (>0.3 mg/kg, s.c.) significantly disrupted PPI, accompanied by the suppression of c-Fos expression in Lateral Globus Pallidus induced by PPI. Furthermore, acute treatment with METH and MK-801 stimulated c-Fos expression in the caudal pontine reticular nucleus (PnC) in mice subjected to the PPT test, although PPI alone had no effect on c-Fos expression. Repeated treatment with 1 mg/kg METH for 7 days, which did not affect PPI acutely, showed similar effects on PPI and c-Fos expression to acute treatment with METH (3 mg/kg). Baclofen dose-dependently ameliorated PPI impairment induced by acute treatment with METH (3 mg/kg) and MK-801 (1 mg/kg), and decreased METH- and MK-801-stimulated c-Fos expression in PnC to the basal level. These results suggest that dysfunction of pallidotegmental neurons is involved in PPI disruption caused by METH and MK-801 in mice. GABA_B receptor may constitute a putative target in treating neuropsychiatric disorders with sensorimotor gating deficits, such as schizophrenia and METH psychosis.
Kazuhiro Takuma - One of the best experts on this subject based on the ideXlab platform.
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Therapeutic potential of nicotine for methamphetamine-induced impairment of sensorimotor gating: involvement of pallidotegmental neurons
Psychopharmacology, 2009Co-Authors: Hiroyuki Mizoguchi, Sawako Arai, Hiroyuki Koike, Daisuke Ibi, Hiroyuki Kamei, Toshitaka Nabeshima, Hyoung-chun Kim, Kazuhiro Takuma, Kiyofumi YamadaAbstract:Introduction We have previously found that a disruption to prepulse inhibiton (PPI) induced by methamphetamine (METH) is associated with impaired functioning of pallidotegmental neurons, which play a crucial role in PPI of the startle reflex, through the activation of gamma-aminobutyric acid type B receptors in pedunculopontine tegmental neurons in mice. Objectives Here, we examined the effect of nicotine on METH-induced impairment of PPI of the startle reflex focusing on dysfunctional pallidotegmental neurons and the neural system. Results Nicotine (0.15–0.5 mg/kg) ameliorated the deficit in PPI induced by acute METH, and the ameliorating effect of nicotine was antagonized by nicotinic receptor antagonists such as methyllycaconitine and dihydro-β-erythroidine. The acute METH-induced disruption of PPI was accompanied by suppression of c-Fos expression in the Lateral Globus Pallidus (LGP) as well as its induction in the caudal pontine reticular nucleus (PnC) in mice subjected to the PPI test. Nicotine-induced amelioration of PPI deficits in METH-treated mice was accompanied by a reversal of the changes in c-Fos expression in both the LGP and PnC to the basal level. Conclusions Nicotine is effective in ameliorating the impairment of PPI caused by METH, which may be associated with normalization of the pallidotegmental neurons.
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Therapeutic potential of nicotine for methamphetamine-induced impairment of sensorimotor gating: involvement of pallidotegmental neurons
Psychopharmacology, 2009Co-Authors: Hiroyuki Mizoguchi, Sawako Arai, Hiroyuki Koike, Daisuke Ibi, Hiroyuki Kamei, Toshitaka Nabeshima, Hyoung-chun Kim, Kazuhiro Takuma, Kiyofumi YamadaAbstract:We have previously found that a disruption to prepulse inhibiton (PPI) induced by methamphetamine (METH) is associated with impaired functioning of pallidotegmental neurons, which play a crucial role in PPI of the startle reflex, through the activation of gamma-aminobutyric acid type B receptors in pedunculopontine tegmental neurons in mice. Here, we examined the effect of nicotine on METH-induced impairment of PPI of the startle reflex focusing on dysfunctional pallidotegmental neurons and the neural system. Nicotine (0.15–0.5 mg/kg) ameliorated the deficit in PPI induced by acute METH, and the ameliorating effect of nicotine was antagonized by nicotinic receptor antagonists such as methyllycaconitine and dihydro-β-erythroidine. The acute METH-induced disruption of PPI was accompanied by suppression of c-Fos expression in the Lateral Globus Pallidus (LGP) as well as its induction in the caudal pontine reticular nucleus (PnC) in mice subjected to the PPI test. Nicotine-induced amelioration of PPI deficits in METH-treated mice was accompanied by a reversal of the changes in c-Fos expression in both the LGP and PnC to the basal level. Nicotine is effective in ameliorating the impairment of PPI caused by METH, which may be associated with normalization of the pallidotegmental neurons.
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Involvement of Pallidotegmental Neurons in Methamphetamine- and MK-801-Induced Impairment of Prepulse Inhibition of the Acoustic Startle Reflex in Mice: Reversal by GABA_B Receptor Agonist Baclofen
Neuropsychopharmacology, 2008Co-Authors: Sawako Arai, Hiroyuki Mizoguchi, Daisuke Ibi, Hiroyuki Kamei, Toshitaka Nabeshima, Kazuhiro Takuma, Kenji Takahashi, Taku Nagai, Kiyofumi YamadaAbstract:We have previously demonstrated that pallidotegmental GABAergic neurons play a crucial role in prepulse inhibition (PPI) of the startle reflex in mice through the activation of GABA_B receptors in pedunculopontine tegmental neurons. In this study, we investigated whether PPI disruption induced by methamphetamine (METH) or MK-801 is associated with the dysfunction of pallidotegmental neurons. Furthermore, we examined the effects of baclofen, a GABA_B receptor agonist, on METH- and MK-801-induced PPI impairment. Acute treatment with METH (3 mg/kg, subcutaneouly (s.c.)) and MK-801 (>0.3 mg/kg, s.c.) significantly disrupted PPI, accompanied by the suppression of c-Fos expression in Lateral Globus Pallidus induced by PPI. Furthermore, acute treatment with METH and MK-801 stimulated c-Fos expression in the caudal pontine reticular nucleus (PnC) in mice subjected to the PPT test, although PPI alone had no effect on c-Fos expression. Repeated treatment with 1 mg/kg METH for 7 days, which did not affect PPI acutely, showed similar effects on PPI and c-Fos expression to acute treatment with METH (3 mg/kg). Baclofen dose-dependently ameliorated PPI impairment induced by acute treatment with METH (3 mg/kg) and MK-801 (1 mg/kg), and decreased METH- and MK-801-stimulated c-Fos expression in PnC to the basal level. These results suggest that dysfunction of pallidotegmental neurons is involved in PPI disruption caused by METH and MK-801 in mice. GABA_B receptor may constitute a putative target in treating neuropsychiatric disorders with sensorimotor gating deficits, such as schizophrenia and METH psychosis.
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Neural circuits containing pallidotegmental GABAergic neurons are involved in the prepulse inhibition of the startle reflex in mice.
Biological Psychiatry, 2007Co-Authors: Kenji Takahashi, Hiroyuki Mizoguchi, Sawako Arai, Hiroyuki Kamei, Toshitaka Nabeshima, Taku Nagai, Kenji Maeda, Takahiro Matsuya, Yukio Yoneda, Kazuhiro TakumaAbstract:Background Prepulse inhibition (PPI) of the startle response is a measure of the inhibitory function and time-linked information processing by which a weak sensory stimulus (the prepulse) inhibits the startle response caused by a sudden intense stimulus. We attempted to clarify the neuronal circuits underlying the control of PPI of the startle reflex in mice. Methods c-Fos immunohistochemistry was used to detect neurons activated by startle pulse and/or prepulse trials. Behavioural pharmacology and tracing studies were also conducted. Results The Lateral Globus Pallidus (LGP) was activated by prepulses. Activation of the caudal pontine reticular nucleus (PnC) evoked by the startle pulses was inhibited under PPI conditions. Double-immunostaining revealed that c-Fos-positive cells in the LGP following prepulse trials were GABAergic neurons. BiLateral microinjections of lidocaine into the LGP resulted in an impairment of PPI. Fluoro-gold infusion into the PnC and the pedunculopontine tegmental nucleus (PPTg) retrogradely labeled neurons in the PPTg and LGP, respectively. Microinjections of phaclofen into the PPTg significantly impaired PPI. Conclusions These results suggest that GABAergic neurons in the LGP which project to the PPTg play a crucial role through the activation of GABA B receptors in the regulation of PPI of the startle reflex in mice.
Peggy Bosch - One of the best experts on this subject based on the ideXlab platform.
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A study of the effects of 8-week acupuncture treatment on patients with Parkinson's disease
Medicine, 2018Co-Authors: Maurits Van Den Noort, Peggy BoschAbstract:Background: Parkinson's disease (PD) is a degenerative brain disorder, resulting in decreased neural responses in the supplementary motor area, putamen, and thalamus. Previous research showed that acupuncture was able to improve the motor dysfunction. The primary aim of this study is to assess the efficacy of longer acupuncture treatment for preventing brain degeneration in patients with PD. Methods: Ten outpatients with PD were recruited from Kyung Hee Medical Hospital. Behavioral and neural responses were examined before and after 8 weeks of acupuncture treatment. A semi-individualized treatment approach was used; patients were treated for 15 minutes with 120-Hz electro-acupuncture at the right GB34 and Taechung (LR3), followed by manual acupuncture based on the individual symptoms of the patient. Results: Immediately after 8 weeks of acupuncture treatment, the Unified Parkinson's Disease Rating Scale (UPDRS) sub-scores and the depression scores for the patients had statistically decreased compared to the scores before acupuncture treatment; moreover, 8 weeks later, these scores remained stable. Compared to the neural responses before the acupuncture stimulation, those after the acupuncture treatment were significantly higher in the thalamus, cingulate gyrus, anterior cingulate, lingual gyrus, parahippocampal gyrus, Lateral Globus Pallidus, mammillary body, middle temporal gyrus, cuneus, and fusiform gyrus. Finally, a positive correlation was found between the UPDRS and the mean magnetic resonance signal change for the thalamus. Conclusion: This study found beneficial clinical effects of 8-week acupuncture treatment in the brains of patients with PD.
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ipsiLateral putamen and insula activation by both left and right gb34 acupuncture stimulation an fmri study on healthy participants
Evidence-based Complementary and Alternative Medicine, 2016Co-Authors: Maurits Van Den Noort, Peggy BoschAbstract:The modulatory effects on the brain during right versus left side acupuncture stimulation of the same acupuncture point have been a subject of controversy. For clarification of this important methodological issue, the present study was designed to compare the blood oxygen level-dependent responses of acupuncture stimulation on the right versus left Yanglingquan (GB34). Twenty-two healthy subjects received right or left GB34 acupuncture. Our results show that acupuncture on the left GB34 induced neural responses in the left putamen, caudate body, insula, postcentral gyrus, claustrum, right and left thalamus, right middle frontal gyrus, hypothalamus, and subthalamic nucleus. Acupuncture on the right GB34 induced neural responses in the right middle frontal gyrus, inferior parietal lobule, thalamus, putamen, Lateral Globus Pallidus, medial Globus Pallidus, and insula. Interestingly, the putamen and insula were ipsiLaterally activated by acupuncture on either the left or right GB34; therefore, they seem to be the main target areas affected by GB34 acupuncture. This is the first reported functional magnetic resonance imaging study directly comparing needling on the right and left GB34. Although more replication studies are needed, our preliminary results prove that acupuncture has different modulatory effects on the brain when performed on the right versus left side.
