Electrophysiologic Study of Acupuncture's Effect on the Peripheral Nervous System

描述（由申请人提供）：本项目的总体目标是：1)将Alexandra Dimitrova博士培养为一名独立的补充和替代医师研究者，2)进行针灸的临床研究，评估其对周围神经的影响。Dimitrova博士将通过指导培训，在5个关键领域发展她的知识基础、经验和技能：1)肌电图/神经传导研究和定量感觉测试；2)临床研究：方法学、生物统计学、流行病学、拨款和论文准备；3)针灸；4)体感诱发电位；5)微神经摄影。研究训练计划的长期目标是掌握电生理技术，用于评估针灸对周围和中枢神经系统的作用，从而表征和量化针灸的作用及其作用机制。作为第一步，本研究将评估三种广泛使用的针刺方式对手臂（正中神经和尺神经）和腿部（胫骨神经和腓深神经）两种解剖上不同的神经的局部影响。我们的中心假设是，针刺周围神经上的穴位只会在神经传导研究（NCS）和定量感觉测试（QST）中引起神经特异性变化，因为针刺对周围神经组织产生机械和电刺激。我们期望在患病神经中观察到比健康神经更大的生理变化，因为它们的基线异常。在一项针刺机制研究中，36名腕管综合征患者将被随机分为手动针刺组、低频率电针组和高频电针组。在基线测量正中神经和尺神经的NCS和QST后，每组间隔一周针刺正中神经（心包经络点）和尺神经（心经络点），顺序平衡，然后重复NCS和QST测量。类似的研究将在小腿胫骨神经（使用肾通道点）和腓深神经（使用胃通道点）中进行。具体目的是：1：表征针刺对正中神经和尺神经QST（冷和振动感觉阈值）和神经传导参数的影响。2：比较针灸对患病神经（正中神经）和健康神经（尺神经）的影响，使用QST（冷和振动感觉阈值）和NCS参数。3：比较手针与低频、高频电针的效果。4：使用NCS和QST进行类似研究，评估针刺对周围神经病变受试者腿部胫骨和腓深神经的局部影响。这项研究有望增加我们对针灸作用机制的理解，并在某种程度上捕捉、表征和量化其作用，这是迄今为止尚未完成的。

DESCRIPTION (provided by applicant): The overall goals of this proposed project are 1) to develop Dr. Alexandra Dimitrova into an independent complementary and alternative physician researcher~ and 2) To conduct a clinical research study of acupuncture, assessing its effects on the peripheral nerves. Dr. Dimitrova will develop her knowledge base, experience and skills in 5 key areas through mentored training:1) EMG/Nerve Conduction Studies and Quantitative Sensory Testing~ 2) Clinical research: methodology, biostatistics, epidemiology, grant and paper preparation~ 3) Acupuncture~ 4) Somatosensory Evoked Potentials~ 5) Microneurography. The long-term goal of the research training plan is to master electrophysiologic techniques which will be used in the assessment of acupuncture's effect on the peripheral and central nervous system and thus characterize and quantify acupuncture's effect and its mechanism of action. As a first step, the proposed research study will serve to assess the local effects of three widely-used acupuncture modalities on two anatomically distinct nerves in the arm (Median and Ulnar) and two nerves in the leg (Tibial and Deep Peroneal). Our central hypothesis is that acupuncture to points overlying a peripheral nerve causes nerve-specific changes in nerve conduction studies (NCS) and quantitative sensory testing (QST) only in that nerve, as the needles deliver mechanical and electrical stimulation on the peri-neural tissues. We expect to observe greater physiologic changes in diseased nerves, compared to healthy ones, due to their baseline abnormalities. In a mechanistic study of acupuncture, 36 subjects with carpal tunnel syndrome will be randomized to manual acupuncture, low-and high-frequency electroacupuncture groups. Following baseline measurements of NCS and QST of the Median and Ulnar nerves, each group will undergo acupuncture to the Median nerve (Pericardium channel points) and to the Ulnar nerve (Heart channel points), one week apart, order counterbalanced, followed by repeat NCS and QST measurements. An analogous study will be performed in the Tibial nerve (using Kidney channel points) and Deep Peroneal nerve (using Stomach channel points) in the leg. The specific aims are to 1: Characterize the effects of acupuncture on QST (cold and vibration sensation thresholds) and nerve conduction parameters in the Median and Ulnar nerves. 2: Compare the effects of acupuncture on a diseased nerve (Median) to those of a healthy nerve (Ulnar), using QST (cold and vibration sensation thresholds) and NCS parameters. 3: Compare the effects of manual acupuncture to those of low-frequency and high-frequency electroacupuncture. 4: Conduct an analogous study using NCS and QST to assess the local effects of acupuncture on the Tibial and Deep Peroneal Nerves in the leg, in subjects with peripheral neuropathy. This research is expected to increase our understanding of acupuncture's mechanism of action and capture, characterize and quantify its effect in a way, which has not been accomplished to-date.