Acupuncture to neck may cause cerebral air embolism

A patient with homolateral cerebral air embolism, probably caused by acupuncture insertion into the left anterior neck, was recently reported in the Journal of Stroke Cerebracardiovascular Diseases.

A 64-year-old male patient with post-stroke hemiplegia had an acupuncture treatment including the needle insertion into the anterior neck, and several hours later he developed subcutaneous emphysema into his left anterior neck and chest wall. He was admitted into the hospital with early seizure followed by unconsciousness and focal neurologic deficits. Initial brain scan showed small, multiple air bubbles in the corticomedullary junction area of the left cerebral hemisphere. The patient regained consciousness 2 days later in hospital.

The second scan, taken 6 days after the event, showed no air bubbles in the cerebral hemisphere but massive cerebral edema. The patient's condition continued to improve during his hospital stay. He was discharged 3 weeks later with minimal neurologic deficits.

The report suggested the unilateral cerebral artery air embolism was thought to be caused by direct infiltration of air to the common carotid artery following acupuncture.

Although this is a rare case report it reminded acupuncture practioners that knowledge of human anatomy and acupuncture technique skill are very important for the safety of patients.

Reference:

Chang DI et al., A case of intracerebral air embolism following acupuncture. J Stroke Cerebrovasc Dis. 1995;5(4):238-40.   http://www.ncbi.nlm.nih.gov/pubmed/26486954

Acupuncture is more effective than anti-inflammatory drug ibuprofen in relieving symptoms in carpal tunnel syndrome

Patients with carpal tunnel syndrome receiving acupuncture felt greater symptomatic relief than those taking ibuprofen according a clinical study published in the Journal of Acupuncture and Meridian Studies.

Recently Dr. Hadi Momeninejad and colleagues in Iran carried out a clinical study to assess the effectiveness of acupuncture treatment in mild to moderate carpal tunnel syndrome. Fifty patients with mild to moderate carpal tunnel syndrome were divided into acupuncture group and ibuprofen group. Patients in the former group were given acupuncture at acupoints PC-7 (Daling), PC-4 (Ximen), PC-6 (Neiguan), PC-8 (Laogong), HT-2 (Qingling), HT-7 (Shengmen), HT-8 (Shaofu), LU-9 (Taiyuan), and LI-11 (Quchi), for 20 min twice a week for 4 weeks. Patients in the latter group were given ibuprofen 400mg, three-time a day for 10 days. The outcome measures include the visual analog scale (VAS) score, the score on the Boston Carpal Tunnel Questionnaire for Functional Status and Symptom Severity (BCTQ FUNCT and SYMPT), and the electrodiagnostic findings at the baseline and end of 4-week treatment.

At the end of treatment, patients with acupuncture had greater improvement in pain, numbness, tingling and performing daily activities e.g. doing house work compared with those treated with ibuprofen. The VAS score, BCTQ FUNCT and SYMPT and electrodiagnostic findings were significantly improved in patients with acupuncture compared with their baseline and drug control group.

The study showed that acupuncture is a very effective and alternative treatment to mild and moderate carpal tunnel syndrome.

Reference

M Hadianfard et al., Efficacies of Acupuncture and Antiinflammatory Treatment for Carpal Tunnel Syndrome. J Acupunct Meridian Stud 2015;8(5):229e235.   http://www.sciencedirect.com/science/article/pii/S200529011400226X

How does acupuncture suppress focal epilepsy and improve epilepsy-induced sleep disruption?

Acupuncture therapy can control focal epilepsy and improve epilepsy-induced sleep disruption through modulation of opioid receptors in the brain, according to an epilepsy model study recently published in Journal of Biomedical Science.

In epilepsy, focal seizure refers to a seizure that starts in, and affects just a part of brain. It might affect a large part of hemisphere or just a small area of one of brain lobes. Symptoms of focal seizure depend on the affected brain area and their function. Some simple focal seizures are sometime called “warnings” or “auras” because for some people simple focal seizure can develop into secondarily generalized seizure. So it is important to have an effective treatment for focal seizure and prevent it develop into more severe generalized seizure. Acupuncture is effective in treat focal epilepsy. However the underlying mechanism is unclear.

Recently scientists in Taiwan, China tried to elucidate the mechanism of acupuncture action on a focal epilepsy model with sleep disruption. Before acupuncture epileptic model showed a focal epilepsy and decreased rapid eye movement sleep and non rapid eye movement sleep. Acupuncture at acupoint BL20 with low-frequency 30 min a day for 3 consecutive days suppressed focal epilepsy and epilepsy-induced sleep disruption. The therapeutic effect of electroacupuncture was blocked by naloxone, an opioids receptor antagonist.

The authors suggest that low-frequency electroacupuncture is beneficial to focal epilepsy and its action is modulated through brain opioid receptors.

Reference:

Yi PL et al., Low-frequency electroacupuncture suppresses focal epilepsy and improves epilepsy-induced sleep disruptions. J Biomed Sci. 2015 Jul 7;22(1):49. doi: 10.1186/s12929-015-0145-z.    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4491875/

How does acupuncture exert long-lasting reduction of blood pressure in patients with hypertension?

Electroacupuncture weekly stimulation alone at specific acupoints had a long-lasting reduction of blood pressure in hypertensive patients who did not receive anti-hypertensive medication. According to a randomized controlled clinical trial that was published in the journal of Medical Acupuncture recently.

Although conventional anti-hypertensive medication is able to reduce blood pressure back to normal range in patients with hypertension, long-term medication of those drugs induce many adverse effects. This has sparked a growing interest in alternative medical treatment such as acupuncture.

Recently a group of clinical doctors led by Professor JC Longhurst in the United State carried out a randomized controlled clinical trial to assess the effectiveness and underlying mechanism of eletroacupuncture on hypertension. Sixty-five patients with mild to moderate hypertension, not receiving any medication, were randomly divided into treatment group (n=33) and control group (n=32). Patients in treatment group were given electroacupuncture at acupoints PC5-6+ST36-37, which are thought to have anti-hypertensive effects, for 30min, once a week for 8 weeks. Patients in control group were given electroacupuncture at acupoints LI6-7+GB37-39 which are thought to be irrelevant to blood pressure. Patients were assessed with 24-hour ambulatory blood pressure monitoring to measure the peak and average systolic BP and diabolic BP. Biochemical studies undertaken to look the changes in plasma levels of norepinephrine, renin and aldosterone before and after 8-week treatment.

At the end of 8-week treatment, patients in treatment group had a significant decrease in systolic BP and diabolic BP compared with control group. Four-week follow up found that long-lasting blood pressure-lowering acupuncture effect was still observed in 14 of 33 patients in treatment group. Biochemical studies showed plasma level of norepinephrine, renin and aldosterone, which were initially elevated, was reduced by 41%, 67% and 21% respectively in those patients.

The study showed that electroacupuncture at specific acupoints alone was able to reduced both systolic BP and diabolic BP. Modulation of renin-aldosterone and sympathetic systems were likely linked to long-lasting actions of electroacupuncture.

Reference

Li P et al., Long-Lasting Reduction of Blood Pressure by Electroacupuncture in Patients with Hypertension: Randomized Controlled Trial. MEDICAL ACUPUNCTURE, Volume 27, Number 4, 2015.    http://online.liebertpub.com/doi/full/10.1089/acu.2015.1106