Mechanism of acupuncture for limb spasm of post-stroke spasticity based on GABA and BDNF/Trkb-KCC2 signaling pathway

Background:To investigate the effects of acupuncture on post-stroke limb spasm model rats and the underlying mechanism.Methods:A total of 50 Sprague-Dawley rats were randomly divided into three groups,Control group(10),Model group(20)and Zhishen Tiaoxing(ZSTX)acupuncture group(20).Middle cerebral artery occlusion was conducted in SD rats to establish post-stroke limb spasm rats,which were treated with ZSTX acupuncture.Behavioral assays were determined by the Narrow ally test,the limb muscle tension was detected by the BL-420S test system,and infarct volume was assessed after the cerebral infarction by 2,3,5-triphenyltetrazolium chloride staining.Heterogeneous neurotransmitterγ-aminobutyric acid(GABA)and its receptors GABAA and GABAB in the cerebral cortex of the infarct area were determined by immunofluorescence assay.The release of Trkb and K-Cl cotransporter isoform 2 was detected by an immunofluorescence double labeling study.Western Blot was utilized to measure the expression of BDNF and Trkb.Results:The results showed that the behavioral assays in post-stroke limb spasm rats were significantly improved by the treatment of ZSTX acupuncture.14 days of ZSTX acupuncture can effectively inhibit muscle tone and decrease Infarct volume,which was measured with BL-420S biological function experiment system and triphenyltetrazolium chloride.Meanwhile,the results of Double-Label Immunofluorescence Assays showed that ZSTX acupuncture improved the expression of GABA,GABAA,GABAB,BDNF,and K-Cl cotransporter isoform 2.Double-Label Immunofluorescence Assays and WB results showed that 14 days ZSTX acupuncture declined the expression of Trkb.Conclusions:Our results suggest that 14 days of ZSTX acupuncture can significantly improve post-stroke limb spasm.Meanwhile,the pathogenesis of post-stroke limb spasm and the efficacy of ZSTX acupuncture involve metabolic pathways of neurotransmitters,and electro-acupuncture can treat post-stroke limb spasm by regulating BDNF/Trkb-KCC2 signaling pathway.

Warm-needle acupuncture for limb spasticity post-stroke:a systematic review

Background:Warm acupuncture,or warm-needle acupuncture,is a traditional external treatment widely used in China for thousands of years.However,the effects of different treatment times on limb spasticity post-stroke have not been evaluated.Methods:We searched PubMed,Embase,the Cochrane Library,the Web of Science,the China National Knowledge Infrastructure,the Chinese Scientific and Journal Database,the Wanfang database,and the Chinese Biomedical Literature Database from inception to May 21st,2020,to seek information regarding randomized controlled trials studying warm-needle acupuncture for limb spasticity post-stroke.Two authors selected 24 studies fitting the eligibility criteria and developed this systematic review and meta-analysis.Results:Warm-needle acupuncture is shown to be more effective than other treatments used in the control groups(odds ratio(OR)=3.61,95%confidence intervals(CI)(2.51,5.19),P<0.001).This treatment decreased limb spasticity as assessed with the Modified Ashworth Scale(mean differences(MD)=−0.78,95%CI(−1.00,−0.56),P<0.001)and the Clinic Spasticity Index(MD=1.06,95%CI(0.51,1.60),P=0.0002),improved sensorimotor impairments according to the Fugl-Meyer Assessment(MD=9.51,95%CI(6.99,12.03),P<0.001),and improved activities of daily living according to the Barthel Index(MD=9.70,95%CI(6.27,13.12),P<0.001).Subgroup analysis based on the length of the treatment using the Modified Ashworth Scale,Fugl-Meyer Assessment,and Barthel Index showed better outcomes for patients who received more than 20 days of treatments(P<0.001).Conclusion:Warm-needle acupuncture is an effective treatment for limb spasticity post-stroke.A treatment frequency of more than 20 days appears to have better effectiveness than that of less than 20 days.