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Acupuncture, the Limbic System, and the Default Mode Network of the Brain
Tara Sporko and Phoebe ChanHUI LAB
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MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging
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MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging
THEMEN Nr. 2, Mai 2008
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MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging
History of Acupuncture?
(http://www.drmanik.com/chap1.htm)
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MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging
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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
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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.
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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
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MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging
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
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MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging
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
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MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging
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MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging
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
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MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging
Signal Decreases in the Limbic Brain (LI4)
(Hui et al., 2000)
BOLD signal BOLD signal
BOLD signal
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MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging
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)
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MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging
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)
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MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging
Acupuncture Modulates Limbic System(ST36)
Acupuncture Deqi Acupuncture Deqi+Pain Sensory
(Hui et al., 2005)
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MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging
VI
VI VIVIIIA
X = X = X =
N=11 N=4 N=5
Acupuncture Modulates Cerebellum (ST36)
(Hui et al., 2005)
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MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging
Needling Sensation
Predominant Signal Change
Deqi
Pain
Deqi + Pain
Decrease
Increase
Correlation between fMRI Response and Needling Sensations
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MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging
Acupuncture Modulates Limbic System and Cerebellum (LI4, ST36, LV3)
(Hui et al., 2009)
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MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging
Brain Responses to Acupuncture Deqi vs. Sharp Pain (LI4, ST36, LV3)
(Hui et al., 2009)
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MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging
0
20
40
60
80
100
Perc
ent
+/
-SE
Acupuncture, N=286 Sensory, N=88
* p
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MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging
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
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MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging
Acupuncture
Correlations in LPNNCorrelation with BA31
Correlation with HypothalamusAcupuncture
Tactile
Tactile
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Functional Anti-correlated Brain Networks Involved in Acupuncture Action
(Hui et al., 2009)Activated regions (Warm colors)Deactivated regions (Cool colors)
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MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging
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.
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MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging
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.
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MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging
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.
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MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging
Kathleen KS Hui, MD Ming Li, lic. acupuncturist
In commemoration of Kathleen Huis life work and contributions to science and medicine
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MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging
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