Brainmap Chan

Acupuncture, the Limbic System, and the Default Mode Network of the Brain

Tara Sporko and Phoebe ChanHUI LAB

MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging


THEMEN Nr. 2, Mai 2008


History of Acupuncture?

(http://www.drmanik.com/chap1.htm)

1996-1997 200720051998-2000 2009 present

Central effects of acupuncture (ST36) on the cerebellum and limbic system

Concerted signal decrease with deqi vs signal increase in pain

Characterized deqiresponse in acupuncture

Acupuncture (LI4) modulates limbic system and subcorticalgray structures

Significant differences between acupuncture stimulation and sensory stimulation

FIRST abstract published using fMRI to image brain response to acupuncture

Acupuncture (LI4) produces widespread effects on human brain

Signal decreases in some structures

Three acupoints (LI4, ST36, LV3)

Virtual identity of deactivations in LPNN to DMN

Functional connectivity of task-negative LPNN and task-positive SMN

Hui et al. 2000

Hui et al. 2007

Hui et al. 2009a, bHui et al. 2005Hui et al. 1996,1998

Correlation of BOLD signals with sensations Commonality and specificity of the three

pain-relief acupoints

Modulation of brain connections in limbic system during acupuncture (ST36)

Effects of acupuncture at four cardiac-related acupoints on brain activity

Effects of acupuncture on brain activity of patients with psychological disorders

Innovations Timeline

NCCAM CERC Center dedicated as the Kathleen Hui Center of Excellence

Hui KKS, Liu J, Wu MT, Kwong KK. Functional mapping of the human brain during acupuncture with magnetic resonance imaging. Proceedings of the 4th World Conference on Acupuncture 1996; 71.

Hui KKS, Liu J, Kwong KK. Functional mapping of the human brain during acupuncture with magnetic resonance imaging somatosensory cortex activation. World J Acupuncture-Moxibustion1997;7(3):44-49.

1996-1997 200720051998-2000 2009 present

Central effects of acupuncture (ST36) on the cerebellum and limbic system

Concerted signal decrease with deqi vs signal increase in pain

Characterized deqiresponse in acupuncture

Acupuncture (LI4) modulates limbic system and subcorticalgray structures

Significant differences between acupuncture stimulation and sensory stimulation

FIRST abstract published using fMRI to image brain response to acupuncture

Acupuncture (LI4) produces widespread effects on human brain

Signal decreases in some structures

Three acupoints (LI4, ST36, LV3)

Virtual identity of deactivations in LPNN to DMN

Functional connectivity of task-negative LPNN and task-positive SMN

Hui et al. 2000

Hui et al. 2007

Hui et al. 2009a, bHui et al. 2005Hui et al. 1996,1998

Correlation of BOLD signals with sensations Commonality and specificity of the three

pain-relief acupoints

Modulation of brain connections in limbic system during acupuncture (ST36)

Effects of acupuncture at four cardiac-related acupoints on brain activity

Effects of acupuncture on brain activity of patients with psychological disorders

Innovations Timeline

NCCAM CERC Center dedicated as the Kathleen Hui Center of Excellence


Collaborators

Outside MGHNorman Kettner Wendy Qiu Yanping Sun

Center for Morphometric AnalysisDavid Kennedy Nikos Makris Mark Vangel

Athinoula A. Martinos Center for Biomedical ImagingRandy Buckner Gregory Cavanagh Iris ChenJoshua D. Claunch Jiliang Fang Randy GollubJian Kong Kenneth K. Kwong Ming LiFa-hsuan Lin Jing Liu Ovidiu MarinaVitaly Napadow Erika E. Nixon Bruce Rosen


Acupuncture, the Limbic System, and the Default Mode Network of the Brain

1. Acupuncture experiment protocol2. Acupuncture (with deqi) evokes:

deactivation of a limbic-paralimbic-neocortical network (LPNN) (match with default mode network)

deactivation of amygdala and hypothalamus activation of somatosensory network (match with anti-

correlated task-positive network)

3. Commonality and specificity of brain responses to different acupoints

4. Connectivity of the LPNN, amygdala and hypothalamus


Acupuncture Stimulation Paradigm

Time (minutes)

0 2 10974

M1 M2R1 R2 R3

needle in needle out

Scan starts Scan stops

DEQI SENSATIONSAching Soreness Pressure Heaviness FullnessWarm Cool Numbness Tingling Dull Pain

SHARP PAINTactile Stimulation

Acupuncture Stimulation


Signal Decreases in the Limbic Brain (LI4)

(Hui et al., 2000)

BOLD signal BOLD signal

BOLD signal


1

2

11

1074

5

3

12

8

9

6

N = 11

1. Frontal pole

2. Ventromedial prefrontal cortex

3. Pregenual cingulate

4. Subgenual cingulate

5. Subgenual Brodmann area 25

6. Septal nuclei

7. Hypothalamus

8. Posterior cingulate

9. Precuneus

10. Substantia nigra

11. Reticular formation

12. Cerebellar vermis

Brain Responses to Acupuncture Deqi(ST36)

(Hui et al., 2005)


Sharp PainDeqi

R RL L

1

2

3

4

1 56

7

8 810

89

Brain Responses to Acupuncture Deqi vs. Sharp Pain (ST36)

(Hui et al., 2010)


Acupuncture Modulates Limbic System(ST36)

Acupuncture Deqi Acupuncture Deqi+Pain Sensory

(Hui et al., 2005)


VI

VI VIVIIIA

X = X = X =

N=11 N=4 N=5

Acupuncture Modulates Cerebellum (ST36)

(Hui et al., 2005)


Needling Sensation

Predominant Signal Change

Deqi

Pain

Deqi + Pain

Decrease

Increase

Correlation between fMRI Response and Needling Sensations


Acupuncture Modulates Limbic System and Cerebellum (LI4, ST36, LV3)

(Hui et al., 2009)


Brain Responses to Acupuncture Deqi vs. Sharp Pain (LI4, ST36, LV3)

(Hui et al., 2009)


0

20

40

60

80

100

Perc

ent

+/

-SE

Acupuncture, N=286 Sensory, N=88

* p


Virtually Identical Patterns ofLimbic-paralimbic Neocortical Network (LPNN)

and Default mode Network (DMN)

Deactivations during acupuncture at LI4, ST36 and LV3

(Hui et al., 2009)

(3D map of DMN from Buckner et al., 2008)

DMN

LPNN


Acupuncture

Correlations in LPNNCorrelation with BA31

Correlation with HypothalamusAcupuncture

Tactile

Tactile

Functional Anti-correlated Brain Networks Involved in Acupuncture Action

(Hui et al., 2009)Activated regions (Warm colors)Deactivated regions (Cool colors)


Summary of Major Findings

Acupuncture evokes extensive deactivation of the LPNN and more limited activation of the SMN and paralimbicstructures. The general brain response is associated with acupuncture sensations (deqi).

LI4 shows the most extensive deactivation response, consistent with its high clinical potency.

The LPNN shows highly correlated activity among different regions, overlapping with DMN.

The amygdala and hypothalamus normally not part of DMN in the literature are deactivated frequently in acupuncture. Their involvement is a unique feature of acupuncture action.


Summary of Major Findings (Cont)

The posterior cingulate and precuneus shows strongest functional connectivity with the rest of the brain may also be the hub of acupuncture deactivation network. This is further demonstrated in the effective connectivity study.

Acupuncture stimulation modulates the interactions among the cortical and subcortical brain regions in LPNN and DMN.


Acupuncture may mobilize the intrinsic functionally anti-correlated systems to maintain a balance of brain functions and mediate its diverse modulatory and analgesic effects.

An analogy between the functionally anti-correlated systems of the brain and the opposing forces of yin and yang in TCM, although speculative, may be worth considering.


Kathleen KS Hui, MD Ming Li, lic. acupuncturist

In commemoration of Kathleen Huis life work and contributions to science and medicine


AcknowledgementsAdministrative colleagues

Carol Barnstead Linda Butler Deedee Correia Karen Dervin Maureen Kelly Stacey Ladieu Monica Langone Mary Roy Janice White

Technical & Computing colleagues David Covin Mary Foley Chris Johnson Sam Mehl Larry White Paul Raines
Acupuncture, the Limbic System, and the Default Mode Network of the BrainSlide Number 2Slide Number 3History of Acupuncture?Slide Number 5Innovations TimelineSlide Number 7Innovations TimelineCollaboratorsAcupuncture, the Limbic System, and the Default Mode Network of the BrainSlide Number 11Slide Number 12Signal Decreases in the Limbic Brain (LI4)Brain Responses to Acupuncture Deqi (ST36)Brain Responses to Acupuncture Deqi vs. Sharp Pain (ST36)Acupuncture Modulates Limbic System(ST36)Acupuncture Modulates Cerebellum (ST36)Correlation between fMRI Response and Needling SensationsAcupuncture Modulates Limbic System and Cerebellum (LI4, ST36, LV3) Brain Responses to Acupuncture Deqi vs. Sharp Pain (LI4, ST36, LV3)Sensations at Acupoints LI4, ST36 and LV3Virtually Identical Patterns ofLimbic-paralimbic Neocortical Network (LPNN)and Default mode Network (DMN)Correlations in LPNNFunctional Anti-correlated Brain Networks Involved in Acupuncture ActionSummary of Major FindingsSummary of Major Findings (Cont)Slide Number 27Slide Number 28Acknowledgements

Brainmap Chan

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