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Beneficial effect of acupuncture has not been proved in the above chronic intractable epilepsy (Kloster et al buy luvox online from canada anxiety symptoms 89. The effect of acupuncture on health-related quality of life was also assessed in intractable epilepsy in a randomized controlled trail purchase discount luvox on-line anxiety symptoms eye pressure. Thirty-four patients with long- standing drug resistant epilepsy were evaluated in the study with two parallel treatments generic 50mg luvox anxiety 120 bpm. Sham controls were applied using bilateral needling with smaller needles of three points outside the traditional meridians buy discount luvox on line anxiety hypnosis. The quality of life in epilepsy was evaluated with scores of 89-item questionnaire. There was no difference between the acupuncture and sham control groups in score changes, which suggested traditional acupuncture build no significant effect on the health-related quality of life of patients with intractable epilepsy (Stavem et al. Even opposite reports emerged that convulsive syncope was associated with acupuncture in a case study (Cole et al. Convulsive syncope has even never been previously documented as a response to acupuncture until the recent report. The case study describes an episode of convulsive syncope, characterized by irregular clonic-tonic movements while the patient was unconscious. A review concluded directly no strong evidence for acupuncture as a treatment for epilepsy (Cheuk and Wang 2006). Their selection criteria of trails was: include 336 12 Effect of Acupuncture on Epilepsy randomized controlled trials evaluating any type of acupuncture performed on any age of people with any form of epilepsy; include trails comparing acupuncture with placebo, sham treatment, and comparing acupuncture plus other therapies with the same other therapies and exclude trails only comparing different acupuncture methods and comparing acupuncture alone with other therapies. Their resulting data was that only three small trials met their inclusion criteria, which included two studied children in China and one studied adult in Norway. Acupuncture did control seizures in the two Chinese studies but did not inhibit seizure in the Norway study. The authors then pointed out that the description of randomization method in the two Chinese studies was not adequate, so they summarized that the current evidences were not enough to support acupuncture as a therapy for epilepsy and much larger high quality clinical trials with appropriate controls are needed to further prove acupuncture efficacy. From hundreds of thousands of trials, the authors set a sort of criteria, picked up three small trials to analyze and made a conclusion. Actually, ancient acupuncture physicians wrote down their successful cases upon clinical improvement one by one. They focused on controlling seizures and how to control seizure better by comparing different acupuncture methods and comparing acupuncture alone with acupuncture plus other therapies. To some extent, ancient acupuncture physicians were using people to perform their experiments and got precious experiences instead that nowadays scientists use animals to do trials first. It was difficult, almost impossible and unimaginable for them to set sort of controls to compare with sham trials. No doubt, denying acupuncture completely is not a scientific attitude and will lead to the loss of the heritage treasure if it is because ancient trials did not meet modern criteria. Acupuncture was first introduced as a therapy to treat epilepsy in 1972 to the American public although it has been part of China’s medical heritage for over 2000 years. The use of acupuncture for epilepsy depends on precise acupoints, methods of acupuncture administration and the type and extent of a person’s epilepsy. Negative and opposite evidences were minority, a growing number of people with epilepsy are finding that this ancient therapy helps reduce the frequency and severity of seizures and control seizures. In the last two decades, remarkable data have emerged within acupuncture and epilepsy. The abnormal amplification and synchronization of neuronal firing in epilepsy leads to discharge. The discharges of many neurons are manifest as synchronous interictal spike wave, sharp wave, spike plus slow wave complex or sharp plus slow wave complex. Acupuncture on some acupoints could prolong the latency of epileptic seizure besides decreasing epileptic discharge (Zhang 1998a). Note that saline did not affect normal power spectrum array, while the electro convulsive shock evoked epileptiform power spectrum. In the above cases, controls were carried out using electroacupuncture stimulation only. For a dog-case, acupuncture therapy was used for treatment of intractable and 339 Acupuncture Therapy of Neurological Diseases: A Neurobiological View idiopathic epilepsy in five dogs at the Veterinary Hospital of the University of Pennsylvania. Two of the five dogs showed a decrease in seizure frequency but the improvement reverted to their previous seizure pattern 5 months later. Three types of electric pulses, 5 Hz, 40 Hz and 80 Hz, were delivered at wave width 0. Using electroencephalogram and power spectra, different effects of acupunctures performed in different acupoints, different frequencies and different amplitudes were compared further. Acupuncture was applied at different acupoints, different frequencies and different amplitudes. Such biological change may be the basis for seizure induction and augmentation of endogenous protective mechanisms. Tiagabine, an anticonvulsant drug, suppresses epileptic seizure via blocking this reuptake. Glutamate metabotropic receptors (mGlu) are likely to be as targets for drug therapy in epilepsy (Moldrich et al. Agonists and antagonists are identified as pro- or anti-convulsant candidates according to these selective 342 12 Effect of Acupuncture on Epilepsy actions on subtypes. Although potential anticonvulsant effect of antagonists exists, there is not yet an antagonist of mGlu for clinical usefulness due to their acute and chronic side effects. Lots of evidences showed that some amino acids were associated with acupuncture anti-convulsion to certain extent. In the following experiments, multiple acupuncture methods were performed on different acupoints. The needle stimulation increased the latency of seizure and reduced the seizure ratio of rats with grade-four epilepsy or more severe (Yan et al. The finding indicated that acupuncture may inhibit epileptic seizure through down-regulating excitatory amino acids and up-regulating inhibitory amino acids relatively in the neural-humoral pathway. However, the change of glutamate acid showed no statistical significance in this study (Wang and Cheng 1994a). In other investigation, amino acids were measured in kainic acid-induced epileptic models before and after acupuncture using push-pull perfusion and high performance liquid chromatography with fluorometric detection. Glutamate acid increased in hippocampus during epilepsy and decreased after administration of acupuncture, but the change was not significant. Collected perfusion fluid from above four brain regions were submitted to high performance liquid chromatography. The resulting data showed that glutamate contents in sensory motor area and visual area of the cerebral cortex decreased slightly after acupuncture treatment but had no statistic changes in comparison with that from pre-treatment.
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For example luvox 100mg anxiety symptoms at night, acupuncture applied at the peak phase may induce an effect that is different from that applied at other phases during the fluctuation of blood pressure discount luvox 100 mg without a prescription anxiety symptoms 4dp3dt. Wang (1989) used acupuncture to treat 21 patients with primary hypertension at different phases with the same approach cheap 50mg luvox with mastercard anxiety 300mg, and observed that the blood pressure declined more at the peak phase than at the non-peak phase buy line luvox anxiety symptoms memory loss, in response to acupuncture treatment, suggesting that cardiovascular sensitivity to acupuncture varies from time to time during the day. At a relatively high level of blood pressure, acupuncture may induce a greater decrease in high blood pressure (Fig. Guo and Ni (2001) observed that in 87 patients, who were subjected to acupuncture therapy for various disorders, the systolic pressure declined in those with hypertension, while the diastolic or systolic pressure showed little change in patients with normal blood pressure. Ni et al (2001) also reported that acupuncture had no appreciable effect on the normal blood pressure in both male and female subjects. These observations demonstrate that acupuncture may adjust “abnormal”, but not “normal” blood pressure. There is also preliminary evidence implying that the efficacy of acupuncture depressurization may vary with genders. For example, Ni et al (2001) showed that acupuncture could lower the systolic pressure, but not the diastolic pressure in women. Owing to the lack of other solid evidence at this stage, there still exists a need to verify the presence of any major gender difference in terms of acupuncture depressurization. In general, the therapeutic effect of acupuncture on hypertension is better at the early and middle stages than at the later stage in hypertensive patients. Yin (1994) analyzed the data of 48 hypertensive patients who underwent acupuncture therapy, and found that acupuncture induced satisfactory depressurization in patients with stage-Ċ hypertension, but had limited effect on those with stage-ċ hypertension (Table 11. Thus, acupuncture may have a therapeutic effect on mild or moderate hypertension, but not on severe hypertension. In contrast, acupuncture has been observed to produce no significant effect on normal blood pressure in either the normal subjects or patients with non-hypertensive diseases. The efficacy of acupuncture depressurization is greatly dependent on the acupoints, stimulation intensity, and applying window. Hypotension can be secondary to hypovolemia (reduced blood volume as seen in excessive use of diuretics), decreased cardiac output, excessive vasodilation, and acute life-threatening allergic reaction. Primary hypotension can also occur, and the cause of low blood pressure is unclear. Hypotension is often associated with cardinal symptoms, such as lightheadedness or dizziness, headache, shortness of breath, chest pain, profound fatigue, loss of consciousness, and seizures. When compared with acupuncture therapy for hypertension, only limited research has been carried out on acupuncture effect on hypotension at bedside. As modern modalities provide relatively quick and effective treatment for hypovolemia, allergic reaction, and other disorders, there are only limited clinical studies on the application of acupuncture therapy for secondary hypotension. However, several published reports suggest that acupuncture could significantly improve primary hypotension. As the control, 110 patients were exposed to Chinese herbal medicine without acupuncture. They daily received “Bazhen Soup” containing “Decoction of Eight Ingredients”, which comprised angelicae sinensis radix, paeoniae alba radix, rehmannia glutinosa, ligustici rhizome, Codonopsis pilosula, poria cocos, atractylodes macrocephala, and glycyrrhizae radix. Wang (2000) reported similar results in support of this observation, although using different acupoints, e. These available data suggest that acupuncture may induce a therapeutic effect on hypotension; however, more scientific testing with strict control is needed to determine the clinical efficacy and long-term effect of acupuncture. Although the nature of the acupoints is not yet fully understood, considerable studies have shown that the local afferent nerves play an important role in the signal transmission of the acupoints. This suggests the importance of neural regulation in acupuncture therapy for hypertension, though multiple mechanisms are believed to be involved. Acupuncture signals are presumed to be transmitted through the afferent nerves and processed in the central nervous system, and might subsequently regulate the blood pressure through the nerve output signals, along with the humoral and endocrine regulation and balance of the electrolyte. Consequently, the integrated modulation decreases the peripheral resistance and blood viscosity, leading to a decrease in the blood pressure. However, in the normal animals, acupuncture caused an instantaneous and temporary increase in blood pressure, which could be attributed to the pain stimulation when the needles penetrate the skin (Research group at Anhui Medical College, 1960). These results show that acupuncture could induce a pro- found and long-lasting decrease in the blood pressure in animals with hypertension, although it may not affect the normal blood pressure in a major way. All these observations suggest that acupuncture may regulate blood pressure in two ways (decrease or increase), depending on the states of blood pressure. The antihypertensive effect was observed to be owing to blood vessel vasodilation. They observed that the systolic blood 301 Acupuncture Therapy of Neurological Diseases: A Neurobiological View Figure 11. Note that the acupuncture significantly reduced the blood pressure in the hypertensive rats (p<0. The results suggest that the acupuncture-induced depressurization is mainly through lowering the peripheral resistance of small arteries, but not by influencing the compliance of large and middle arteries and cardiac output. On the other hand, Zhou (1993) showed that the blood viscosity of patients with hypertension was higher than that of the healthy persons, and that acupuncture could decrease high blood pressure as well as blood viscosity. Indeed, there has been evidence showing that acupuncture could promote tonicity of the micrangium and reduce peripheral resistance, thus improving microcirculation (Qi 1994). However, neural regulation may play a more important role in the modulation of peripheral resistance of the blood flow. The central sites responsible for the control of blood pressure are located at multiple levels of the brain, with the medulla oblongata playing a critical role. In an experimental animal model, the animal exhibited critical hypertension, when its brain was cut at the level of medulla oblongata. In contrast, no major change was observed in the animal’s blood pressure, when the brain was cut at the level above the brainstem (Reis and Dobs 1974). Thus, the brainstem is essential for the 302 11 Acupuncture Therapy for Hypertension and Hypotension maintenance of normal blood pressure. Indeed, a change in the function of the brainstem is observed to significantly affect the blood pressure. Acupuncture is observed to induce nerve signal inputs to the central nervous system, and thus, regulate the blood pressure. Early studies demonstrated that the brain stimulation altered the neural activity and increased the blood pressure, while simulated acupuncture, e. In other work, Yao (1993) specifically described the relationship between acupuncture and somatic nerve stimulation in the regulation of cardiovascular and renal activities. The process of depressurization involves the activation of small myelinated fibers in the muscles, transmission of afferent nerve signals, and regulation of various kinds of neurotransmitters and neuropeptides (Wang et al. Yao et al (1982) showed that a prolonged stimulation of the somatic afferents with low-frequency currents significantly affected the cardiovascular function and sympathetic nerve activity. In unanesthetized spontaneously hyper- tensive rats, an elevation of blood pressure, heart rate, and splanchnic nerve outflow were elicited during a 30-min period of sciatic nerve stimulation. Following the cessation of the stimulation, depressor response and bradycardia slowly developed and lasted for up to 12 h.