Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.451
Filtrar
Más filtros

Intervalo de año de publicación
1.
Neurol Res ; 46(6): 553-560, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38565199

RESUMEN

OBJECTIVES: Inadequate trunk function is the underlying cause of many problems such as impaired balance and mobility. Although there have been trunk-based physiotherapy approaches in recent years, almost all of these approaches focus on motor problems. This study aims to investigate the effects of sensory training combined with trunk-centered Bobath exercises on trunk control and proprioception, balance, gait, and the activity of daily living (ADL). MATERIALS AND METHODS: This study is a randomized controlled trial included with twenty-seven stroke patients. Participants were separated into two groups, Group 1; 'sensory training combined with trunk-centered Bobath exercises' and Group 2; 'trunk-centered Bobath exercises'. Trunk-centered Bobath exercises were used for motor training. Sensory training included transcutaneous electric nerve stimulation and a set of exercises that provide tactile and proprioceptive stimulation. Trunk Impairment Scale, Trunk Reposition Error, Berg Balance Scale, 2-minute walk test, and Barthel Index were used to assess trunk control, trunk proprioception, balance, gait, and ADL respectively. RESULTS: Intra-group analysis results showed that trunk control, trunk proprioception, balance, gait, and ADL improved in both groups after treatment (p < 0.05). The changes in the Trunk Reposition Error values of the participants in Group 1 before and after treatment was found to be significantly higher than Group 2 (p < 0.05). CONCLUSIONS: The findings indicated that the application of trunk-centered motor training is effective in improving trunk proprioception and trunk control, balance, gait, and ADL in stroke patients. Also, sensory training combined with trunk-centered motor training was found more effective in improving trunk proprioception than solely motor training.


Asunto(s)
Terapia por Ejercicio , Equilibrio Postural , Propiocepción , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Torso , Humanos , Masculino , Femenino , Propiocepción/fisiología , Rehabilitación de Accidente Cerebrovascular/métodos , Persona de Mediana Edad , Método Simple Ciego , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/terapia , Accidente Cerebrovascular/complicaciones , Torso/fisiopatología , Terapia por Ejercicio/métodos , Equilibrio Postural/fisiología , Anciano , Actividades Cotidianas , Adulto , Resultado del Tratamiento
2.
PLoS One ; 19(4): e0300242, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38625960

RESUMEN

BACKGROUND: Acupuncture of the governor vessel and Yangming meridian are widely used in the treatment of acute ischemic stroke (AIS). However, the optimal meridian for acupuncture in the treatment of AIS remains uncertain. PURPOSE: This network meta-analysis study aimed to compare the clinical effectiveness of acupuncture at governor vessel and Yangming meridian in the treatment of AIS. METHODS: All relevant studies published in CNKI, WANFANG, VIP, Sinomed, Cochrane Library, Web of Science, Pub Med, and Embase before January 13, 2024 were systematically retrieved. The two researchers independently screened the studies and extracted the data. Cochrane ROB tool was used to evaluate the quality of the studies, and Stata 14.0 software was used to conduct a network meta-analysis of neurological deficit score, activities of daily living (ADL), clinical effective rate and Fugl-meyer motor function evaluation (FMA). RESULTS: A total of 401 studies were obtained, and 17 studies met the inclusion criteria. The surface under the cumulative ranking curve (SUCRA) values of the four outcome indexes were all ranked by "Governor vessel acupuncture + Conventional neurology treatment(GVAc+CT) > Yangming meridian acupuncture + Conventional neurology treatment(YMAc+CT) > Conventional neurology treatment (CT)". Compared to YMAc+CT and CT, GVAc+CT had the best effect in reducing the degree of neurological deficit score (SMD = -0.72, 95%CI = [-1.22,-0.21] and SMD = -1.07,95%CI = [-1.45,-0.69], respectively) and promoting the recovery of ADL((SMD = 0.59,95%CI = [0.31,0.88] and SMD = 0.96,95%CI = [0.70,1.21], respectively). Compared to CT, GVAc+CT also had a better clinical effective rate in the treatment of AIS (RR = 1.14,95%CI = [1.04,1.25]). CONCLUSIONS: Governor vessel acupuncture combined with conventional neurology treatment has the best effect in reducing the degree of neurological deficit score and promoting the recovery of ADL in AIS patientscompared to YMAc+CT and CT. Governor Vessel acupuncture is the most preferable acupoint scheme for clinical acupuncture treatment of AIS.


Asunto(s)
Terapia por Acupuntura , Accidente Cerebrovascular Isquémico , Meridianos , Accidente Cerebrovascular , Humanos , Accidente Cerebrovascular Isquémico/terapia , Metaanálisis en Red , Actividades Cotidianas , Accidente Cerebrovascular/terapia
3.
Zhongguo Zhen Jiu ; 44(4): 375-383, 2024 Apr 12.
Artículo en Inglés, Chino | MEDLINE | ID: mdl-38621722

RESUMEN

OBJECTIVES: To observe the effect of acupuncture intervention in the acute phase on functional impairment at 6 months post-onset in patients with first-ever stroke, and provide evidence for selecting optimal acupuncture timing in the real-world setting. METHODS: A total of 601 patients with first-ever stroke were divided into an acute intervention group (onset within 14 days, 256 cases) and a non-acute intervention group (onset between 15 and 90 days, 345 cases) based on whether they received acupuncture treatment in the acute phase. The assessments were conducted at baseline and 6 months post-onset, including modified Rankin scale (mRS) score, total number of acupuncture sessions, total number of combined therapies (moxibustion, cupping, tuina and rehabilitation treatment), recurrence, death events and disability. Logistic regression analysis was used to analyze the association between acupuncture timing and the risk of disability at 6 months post-onset. The mRS transition method was employed to assess the effect of acupuncture timing on functional improvement at 6 months post-onset. RESULTS: Without adjusting for confounding factors, compared with the non-acute intervention group, the patients in the acute intervention group had reduced risk of disability at 6 months post-onset (OR=0.434, 95%CI: 0.309-0.609, P=0.000). After adjusting for variables i.e. severity of illness, number of acupuncture sessions, and number of cupping sessions, compared with the non-acute intervention group, the patients in the acute intervention group had reduced risk of disability at 6 months post-onset (OR=0.588, 95%CI: 0.388-0.890, P=0.012). After adjusting for all confounding factors, including severity of illness, number of acupuncture sessions, number of cupping sessions, gender, smoking and drinking history, comorbidities, and diagnosis, compared with the non-acute intervention group, the patients in the acute intervention group continued to have a reduced risk of disability at 6 months post-onset (OR=0.629, 95%CI: 0.408-0.971, P=0.036). Both groups showed an overall shift towards lower mRS scores at 6 months post-onset compared to baseline, with a more significant shift towards lower scores in the acute intervention group than the non-acute intervention group. CONCLUSIONS: In the real-world setting, acupuncture intervention in the acute phase in patients with first-ever stroke, compared to acupuncture intervention after the acute phase, reduces the risk of disability at 6 months post-onset and improves functional status.


Asunto(s)
Terapia por Acupuntura , Moxibustión , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Humanos , Estudios Prospectivos , Accidente Cerebrovascular/terapia , Terapia por Acupuntura/métodos , Resultado del Tratamiento
4.
Medicine (Baltimore) ; 103(14): e37686, 2024 Apr 05.
Artículo en Inglés | MEDLINE | ID: mdl-38579054

RESUMEN

BACKGROUND: Electroacupuncture (EA) is a promising rehabilitation treatment for upper-limb motor recovery in stroke patients. However, the neurophysiological mechanisms underlying its clinical efficacy remain unclear. This study aimed to explore the immediate modulatory effects of EA on brain network functional connectivity and topological properties. METHODS: The randomized, single-blinded, self-controlled two-period crossover trial was conducted among 52 patients with subacute subcortical stroke. These patients were randomly allocated to receive either EA as the initial intervention or sham electroacupuncture (SEA) as the initial intervention. After a washout period of 24 hours, participants underwent the alternate intervention (SEA or EA). Resting state electroencephalography signals were recorded synchronously throughout both phases of the intervention. The functional connectivity (FC) of the parietofrontal network and small-world (SW) property indices of the whole-brain network were compared across the entire course of the two interventions. RESULTS: The results demonstrated that EA significantly altered ipsilesional parietofrontal network connectivity in the alpha and beta bands (alpha: F = 5.05, P = .011; beta: F = 3.295, P = .047), whereas no significant changes were observed in the SEA group. When comparing between groups, EA significantly downregulated ipsilesional parietofrontal network connectivity in both the alpha and beta bands during stimulation (alpha: t = -1.998, P = .049; beta: t = -2.342, P = .022). Significant differences were also observed in the main effects of time and the group × time interaction for the SW index (time: F = 5.516, P = .026; group × time: F = 6.892, P = .01). In terms of between-group comparisons, the EA group exhibited a significantly higher SW index than the SEA group at the post-stimulation stage (t = 2.379, P = .018). CONCLUSION: These findings suggest that EA downregulates ipsilesional parietofrontal network connectivity and enhances SW properties, providing a potential neurophysiological mechanism for facilitating motor performance in stroke patients.


Asunto(s)
Electroacupuntura , Accidente Cerebrovascular , Humanos , Electroacupuntura/métodos , Estudios Cruzados , Accidente Cerebrovascular/terapia , Encéfalo , Electroencefalografía
5.
J Clin Neurosci ; 123: 186-193, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38599032

RESUMEN

BACKGROUND: Clay art therapy can be used as part of rehabilitation for chronic stroke patients. OBJECTIVE: The objective of this study is to examine the effect of clay therapy on hopelessness and depression levels in chronic stroke patients who receive physical therapy and compare them to patients who only receive physical therapy. METHODS: This randomized controlled study was conducted between August 1st - September 28th, 2022 in Turkiye, with 60 patients who agreed to participate in the study and met the inclusion criteria, which were chronic stroke patients who received physical therapy. The patients were divided into two groups (30 in the experimental group, 30 in the control group) with the control group receiving only their routine physical therapy and rehabilitation (5 days a week, 40 sessions in total), while the experimental group received their routine physical therapy and rehabilitation program as well as clay therapy twice a week, 60 min per session, for 8 weeks. Demographic information of all the participants was recorded, and the Beck Depression Inventory and Beck Hopelessness Scale were administered before and after treatment. RESULTS: The patients' depression posttest scores (t(58) = -11.386; p = 0.000 < 0,05), and hopelessness posttest scores (t(58) = -10.247; p = 0.000 < 0,05) differed significantly based on their groups. The control group's depression posttest scores (x¯ =25,033) and hopelessness posttest scores (x¯ =15,000) were higher than the experimental group's depression posttest scores (x¯ =9,067) and hopelessness posttest scores (x¯ =8,000). The control group's feeling about the future posttest scores (x¯ =2,967) were higher than the experimental group's posttest scores (x¯ =0,967). The control group's loss of motivation posttest scores (x¯ =6,400) were higher than the experimental group's posttest scores (x¯ =2,667). CONCLUSION: It was seen that clay therapy, in addition to physical therapy, was effective in reducing depression and hopelessness in chronic stroke patients.


Asunto(s)
Arcilla , Depresión , Esperanza , Modalidades de Fisioterapia , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Humanos , Masculino , Femenino , Persona de Mediana Edad , Depresión/psicología , Depresión/etiología , Depresión/terapia , Rehabilitación de Accidente Cerebrovascular/métodos , Rehabilitación de Accidente Cerebrovascular/psicología , Accidente Cerebrovascular/psicología , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/terapia , Anciano , Enfermedad Crónica , Silicatos de Aluminio , Arteterapia/métodos , Resultado del Tratamiento
6.
J Affect Disord ; 354: 82-88, 2024 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-38452937

RESUMEN

BACKGROUND: It is a well-established fact that post-stroke depression (PSD) is a prevalent condition that affects a significant proportion of individuals who have suffered a stroke. Hence, our research endeavors to explore the safety, efficacy and the potential molecular mechanism of transcutaneous auricular vagus nerve stimulation (ta-VNS) for the treatment of depression in PSD patients by conducting a double-blind, sham-controlled, randomized trial. METHODS: Patients who had experienced strokes and exhibited depressive symptoms, with a Hamilton Depression Scale (HAMD-17) score of ≥8 and met the DSM-IV criteria, were diagnosed with PSD. A volunteer sample of participants (N = 80) were randomly divided into either the ta-VNS group (which received ta-VNS in addition to conventional treatment) or the control group (which received conventional treatment only), in a 1:1 ratio. The effectiveness of the interventions was evaluated using the 17-item Hamilton Rating Scale for Depression (HAMD-17), Zung Self-Rating Depression Scale (SDS), and Barthel Index (BI) scores. Furthermore, Plasma BDNF, CREB1, and 5-HT levels were measured before and after treatment. RESULTS: The concomitant application of ta-VNS demonstrated a remarkable reduction in HAMD-17 and SDS scores, leading to noteworthy enhancements in patients' daily functioning, as evidenced by improved activities of daily living, at all assessed time points, in contrast to the control group (p < 0.0001). Notably, the ta-VNS group exhibited superior effects in modulating the measured neurotrophic biomarkers when compared to the control group (p < 0.05). CONCLUSIONS: The synergistic approach of combining ta-VNS with conventional treatment has demonstrated remarkable efficacy and tolerability in managing depression following a stroke.


Asunto(s)
Accidente Cerebrovascular , Estimulación Eléctrica Transcutánea del Nervio , Estimulación del Nervio Vago , Humanos , Depresión/etiología , Depresión/terapia , Estimulación del Nervio Vago/efectos adversos , Actividades Cotidianas , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/terapia , Método Doble Ciego , Nervio Vago , Resultado del Tratamiento
7.
Neuroscience ; 545: 185-195, 2024 May 03.
Artículo en Inglés | MEDLINE | ID: mdl-38522660

RESUMEN

Post-stroke cognitive impairment is a significant challenge with limited treatment options. Electroacupuncture (EA) has shown promise in improving cognitive function after stroke. Our study explores the underlying mechanism of EA in alleviating cognitive impairment through the inhibition of autophagy. We utilized a rat model of stroke induced by middle cerebral artery occlusion (MCAO) to evaluate the efficacy of EA. Treatment with EA was observed to markedly improve cognitive function and reduce inflammation in MCAO rats, as evidenced by decreased neurological deficit scores, shorter latencies in the water maze test, and diminished infarct volumes. EA also attenuated tissue damage in the hippocampus and lowered the levels of pro-inflammatory cytokines and oxidative stress markers. Although autophagy was upregulated in MCAO rats, EA treatment suppressed this process, indicated by a reduction in autophagosome formation and alteration of autophagy-related protein expression. The protective effects of EA were reversed by the autophagy activator rapamycin. EA treatment elevated the levels of microRNA (miR)-135a-5p expression, and suppression of this elevation attenuated the remedial efficacy of EA in addressing cognitive impairment and inflammation. MiR-135a-5p targeted mammalian target of rapamycin (mTOR)/NOD-like receptor protein 3 (NLRP3) signaling to repress autophagy. EA treatment inhibits autophagy and alleviates cognitive impairment in post-stroke rats. It exerts its beneficial effects by upregulating miR-135a-5p and targeting the mTOR/NLRP3 axis.


Asunto(s)
Autofagia , Disfunción Cognitiva , Electroacupuntura , MicroARNs , Proteína con Dominio Pirina 3 de la Familia NLR , Serina-Treonina Quinasas TOR , Animales , Masculino , Ratas , Autofagia/fisiología , Disfunción Cognitiva/etiología , Disfunción Cognitiva/terapia , Disfunción Cognitiva/metabolismo , Modelos Animales de Enfermedad , Electroacupuntura/métodos , Hipocampo/metabolismo , Infarto de la Arteria Cerebral Media/terapia , Infarto de la Arteria Cerebral Media/complicaciones , Infarto de la Arteria Cerebral Media/metabolismo , MicroARNs/metabolismo , Proteína con Dominio Pirina 3 de la Familia NLR/metabolismo , Ratas Sprague-Dawley , Transducción de Señal/fisiología , Accidente Cerebrovascular/metabolismo , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/terapia , Serina-Treonina Quinasas TOR/metabolismo
9.
Medicine (Baltimore) ; 103(11): e37464, 2024 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-38489710

RESUMEN

BACKGROUND: Swallowing rehabilitation behavioral therapy and traditional Chinese acupuncture therapy are widely used in the treatment of post-stroke dysphagia (PSD). This study investigated the therapeutic effect of electro-acupuncture combined with exercise-based swallowing rehabilitation on PSD and its effect on brainstem auditory evoked potential (BAEP) and cerebral blood flow. METHODS: The 120 PSD patients were divided into 2 groups (n = 60 each) by simple random grouping method, that is, an experimental and control group, receiving routine swallowing training, or additional intervention with electro-acupuncture at a frequency of 5 times/week. Data in swallowing function, BAEP, and cerebrovascular color Doppler ultrasound parameters were collected before treatment, as well as after treatment. An intergroup comparison was conducted using an independent sample t-test, and an intra-group comparison was conducted among different time points using a paired t-test. The data were analyzed using the SPSS Statistics 22.0 software; P < .05 was considered statistically significant. RESULTS: The therapeutic effects were significantly better in the experimental group compared with the control group (P < .05). The standard swallowing function assessment scores were significantly lower in both groups after treatment (P < .05), and the score in the observation group was lower than in the control group (P < .05). The peak latency of BAEP waves III and IV, and the inter-peak latency between peaks III to V and I to V in the 2 groups changed significantly (P < .05). The peak systolic velocity (PSV), end-diastolic velocity (EDV), and mean velocity (MV) were significantly increased in both groups after treatment (P < .05). The pulsatility index decreased significantly in both groups (P < .05), and the PSV, EDV, and MV were higher in the experimental group than in the control group (P < .05). CONCLUSION: Electro-acupuncture, combined with swallowing training in the treatment of Post-stroke Dysphagia, effectively improved cerebral microcirculation and conduction velocity, enhanced the motor function of swallowing muscles, and promoted the recovery of swallowing function.


Asunto(s)
Terapia por Acupuntura , Trastornos de Deglución , Accidente Cerebrovascular , Humanos , Trastornos de Deglución/etiología , Trastornos de Deglución/terapia , Deglución/fisiología , Potenciales Evocados Auditivos del Tronco Encefálico , Resultado del Tratamiento , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/terapia , Circulación Cerebrovascular
10.
Zhongguo Zhen Jiu ; 44(3): 251-254, 2024 Mar 12.
Artículo en Inglés, Chino | MEDLINE | ID: mdl-38467497

RESUMEN

OBJECTIVES: To observe the effect of motor evoked potential (MEP)-oriented scalp acupuncture combined with transcranial magnetic stimulation (TMS) on limb motor ability in patients with ischemic stroke hemiplegia. METHODS: A total of 60 patients with ischemic stroke hemiplegia were randomized into an observation group and a control group, 30 cases in each one. In addition to the medication treatment of internal medicine and comprehensive training of hemiplegic limbs, MEP-oriented scalp acupuncture combined with TMS was applied in the observation group, conventional scalp acupuncture at bilateral anterior oblique line of parietal and temporal regions combined with TMS was applied in the control group. The treatment was given once a day, 5 days a week for 4 weeks totally in the two groups. Before and after treatment, the scores of Fugl-Meyer assessment (FMA), modified Ashworth scale (MAS) and modified Barthel index (MBI) were observed in the two groups. RESULTS: After treatment, the FMA and MBI scores were increased compared with those before treatment in the two groups (P<0.001), and the FMA and MBI scores in the observation group were higher than those in the control group (P<0.05). After treatment, the MAS scores of upper and lower limbs in the observation group were decreased compared with those before treatment (P<0.01, P<0.001), the MAS score of lower limb in the control group was decreased compared with that before treatment (P<0.05). CONCLUSIONS: MEP-oriented scalp acupuncture combined with TMS can effectively improve the limb motor ability, daily living ability and limb spasticity in patients with ischemic stroke hemiplegia.


Asunto(s)
Terapia por Acupuntura , Accidente Cerebrovascular Isquémico , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Humanos , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/terapia , Hemiplejía/etiología , Hemiplejía/terapia , Estimulación Magnética Transcraneal , Cuero Cabelludo , Potenciales Evocados Motores , Resultado del Tratamiento , Extremidad Superior
11.
Phys Med Rehabil Clin N Am ; 35(2): 369-382, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38514224

RESUMEN

Neural stimulation technology aids stroke survivors in regaining lost motor functions. This article explores its applications in upper and lower limb stroke rehabilitation. The authors review various methods to target the corticomotor system, including transcranial direct current stimulation, repetitive transcranial magnetic stimulation, and vagus nerve stimulation. In addition, the authors review the use of peripheral neuromuscular electrical stimulation for therapeutic and assistive purposes, including transcutaneous electrical nerve stimulation, neuromuscular electrical stimulation, and functional electrical stimulation. For each, the authors examine the potential benefits, limitations, safety considerations, and FDA status.


Asunto(s)
Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Estimulación Transcraneal de Corriente Directa , Estimulación Eléctrica Transcutánea del Nervio , Humanos , Accidente Cerebrovascular/terapia , Estimulación Magnética Transcraneal , Extremidad Superior
12.
Eur J Phys Rehabil Med ; 60(2): 225-232, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38502557

RESUMEN

INTRODUCTION: Spasticity is a common problem in stroke patients. Treatments of spasticity often have side effects or are insufficiently effective. Dry needling (DN) has been proposed as a potential additional option to consider in the multimodal treatment of post-stroke spasticity, although questions about its safety remain. The goal of this study is to assess the safety of DN in stroke patients. EVIDENCE ACQUISITION: A systematic search in Medline, Embase, The Cochrane Library, Web of Science, CIHNAL and PEDro was conducted in June 2023. Two reviewers independently screened abstracts according to the eligibility criteria. EVIDENCE SYNTHESIS: Twenty-five articles were included in this review. Only six studies reported adverse events, all of which were considered minor. None of the included studies reported any serious adverse events. In four of the included studies anticoagulants were regarded as contra-indicative for DN. Anticoagulants were not mentioned in the other included studies. CONCLUSIONS: There is a paucity of literature concerning the safety of DN in stroke patients. This review is the first to investigate the safety of DN in stroke patients and based on the results there is insufficient evidence regarding the safety of DN in stroke patients. CLINICAL REHABILITATION IMPACT: Although DN could be a promising treatment in post-stroke spasticity, further research is indicated to investigate its mechanism of action and its effect on outcome. However, before conducting large clinical trials to assess outcome parameters, the safety of DN in stroke patients must be further investigated.


Asunto(s)
Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Humanos , Inducción Percutánea del Colágeno , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/terapia , Rehabilitación de Accidente Cerebrovascular/métodos , Espasticidad Muscular/terapia , Espasticidad Muscular/rehabilitación , Anticoagulantes
13.
Circ Res ; 134(6): 770-790, 2024 03 15.
Artículo en Inglés | MEDLINE | ID: mdl-38484031

RESUMEN

Time-of-day significantly influences the severity and incidence of stroke. Evidence has emerged not only for circadian governance over stroke risk factors, but also for important determinants of clinical outcome. In this review, we provide a comprehensive overview of the interplay between chronobiology and cerebrovascular disease. We discuss circadian regulation of pathophysiological mechanisms underlying stroke onset or tolerance as well as in vascular dementia. This includes cell death mechanisms, metabolism, mitochondrial function, and inflammation/immunity. Furthermore, we present clinical evidence supporting the link between disrupted circadian rhythms and increased susceptibility to stroke and dementia. We propose that circadian regulation of biochemical and physiological pathways in the brain increase susceptibility to damage after stroke in sleep and attenuate treatment effectiveness during the active phase. This review underscores the importance of considering circadian biology for understanding the pathology and treatment choice for stroke and vascular dementia and speculates that considering a patient's chronotype may be an important factor in developing precision treatment following stroke.


Asunto(s)
Relojes Circadianos , Demencia Vascular , Accidente Cerebrovascular , Humanos , Ritmo Circadiano , Sueño/fisiología , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/terapia , Relojes Circadianos/fisiología
14.
CNS Neurosci Ther ; 30(2): e14574, 2024 02.
Artículo en Inglés | MEDLINE | ID: mdl-38421088

RESUMEN

RATIONALE: Numerous epidemiological studies have reported a link between low testosterone levels and an increased risk of cerebrovascular disease in men. However, there is ongoing controversy surrounding testosterone replacement therapy due to potential side effects. PBMT has been demonstrated to improve cerebrovascular function and promote testosterone synthesis in peripheral tissues. Despite this, the molecular mechanisms that could connect PBMT with testosterone and vascular function in the brain of photothrombosis (PT)-induced stroke rats remain largely unknown. METHODS: We measured behavioral performance, cerebral blood flow (CBF), vascular permeability, and the expression of vascular-associated and apoptotic proteins in PT-induced stroke rats treated with flutamide and seven consecutive days of PBM treatment (350 mW, 808 nM, 2 min/day). To gain further insights into the mechanism of PBM on testosterone synthesis, we used testosterone synthesis inhibitors to study their effects on bEND.3 cells. RESULTS: We showed that PT stroke caused a decrease in cerebrovascular testosterone concentration, which was significantly increased by 7-day PBMT (808 nm, 350 mW/cm2 , 42 J/cm2 ). Furthermore, PBMT significantly increased cerebral blood flow (CBF) and the expression of vascular-associated proteins, while inhibiting vascular permeability and reducing endothelial cell apoptosis. This ultimately mitigated behavioral deficits in PT stroke rats. Notably, treatment with the androgen receptor antagonist flutamide reversed the beneficial effects of PBMT. Cellular experiments confirmed that PBMT inhibited cell apoptosis and increased vascular-associated protein expression in brain endothelial cell line (bEnd.3) subjected to oxygen-glucose deprivation (OGD). However, these effects were inhibited by flutamide. Moreover, mechanistic studies revealed that PBMT-induced testosterone synthesis in bEnd.3 cells was partly mediated by 17ß-hydroxysteroid dehydrogenase 5 (17ß-HSD5). CONCLUSIONS: Our study provides evidence that PBMT attenuates cerebrovascular injury and behavioral deficits associated with testosterone/AR following ischemic stroke. Our findings suggest that PBMT may be a promising alternative approach for managing cerebrovascular diseases.


Asunto(s)
Terapia por Luz de Baja Intensidad , Accidente Cerebrovascular , Humanos , Masculino , Ratas , Ratones , Animales , Testosterona/metabolismo , Andrógenos/metabolismo , Receptores Androgénicos/metabolismo , Células Endoteliales/metabolismo , Flutamida/farmacología , Flutamida/uso terapéutico , Flutamida/metabolismo , Accidente Cerebrovascular/terapia
15.
CNS Neurosci Ther ; 30(2): e14618, 2024 02.
Artículo en Inglés | MEDLINE | ID: mdl-38334061

RESUMEN

AIMS: We investigated the potential mechanisms underlying the therapeutic efficacy of electroacupuncture (EA) at the Shuigou (GV26) and Baihui (GV20) acupoints in the treatment of ischemic stroke. METHODS: We assessed the therapeutic effects of EA on MCAO mice through behavioral studies and TTC staining. Various techniques, such as RT-PCR, immunofluorescence, and Western blots, were employed to evaluate the activation and polarization of microglia/macrophages, and changes in the TRPV4 ion channel. We used the TRPV4 antagonist GSK2193874 (GSK219) to verify the involvement of TRPV4 in the therapeutic effects of EA. RESULTS: EA effectively improved neurological impairments and reduced cerebral infarction volume in MCAO mice. It suppressed activated microglia/macrophages and inhibited their polarization toward the M1 phenotype post-MCAO. EA also downregulated the expression of pro-inflammatory cytokines, including Tnf-α, Il-6, Il-1ß, and Ccl-2 mRNA. Furthermore, EA reduced the elevated expression of TRPV4 following MCAO. Treatment with the TRPV4 antagonist GSK219 mirrored the effects of EA in MCAO mice. Notably, the combination of EA and GSK219 did not demonstrate an additive or synergistic effect. CONCLUSION: EA may inhibit neuroinflammation and exhibit a protective effect against ischemic brain injury by suppressing TRPV4 and the subsequent M1 polarization of microglia/macrophages.


Asunto(s)
Isquemia Encefálica , Electroacupuntura , Accidente Cerebrovascular Isquémico , Daño por Reperfusión , Accidente Cerebrovascular , Animales , Ratones , Isquemia Encefálica/terapia , Isquemia Encefálica/metabolismo , Electroacupuntura/métodos , Infarto de la Arteria Cerebral Media/terapia , Infarto de la Arteria Cerebral Media/metabolismo , Enfermedades Neuroinflamatorias , Daño por Reperfusión/metabolismo , Accidente Cerebrovascular/terapia , Accidente Cerebrovascular/metabolismo , Canales Catiónicos TRPV/genética
16.
NeuroRehabilitation ; 54(2): 185-197, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38306066

RESUMEN

BACKGROUND: Electrical stimulation techniques are widely utilized for rehabilitation management in individuals with stroke patients. OBJECTIVES: This review aims to summarize the rehabilitative effects of electrical stimulation therapy on gait performance in stroke patients. METHODS: This review included randomized controlled trials (RCT) investigating the therapeutic effects of electrical stimulation in stroke patients throughout five databases. This review qualitatively synthesized 20 studies and quantitatively analyzed 11 RCTs. RESULTS: Functional electrical stimulation (FES) was the most commonly used electrical stimulation type to improve postural stability and gait performance in stroke patients. The clinical measurement tools commonly used in the three studies to assess the therapeutic effects of FES were Berg balance scale (BBS), 10-meter walk test (10MWT), 6-minute walk test (6mWT), and gait velocity. The BBS score and gait velocity had positive effects in the FES group compared with the control group, but the 10MWT and 6mWT showed the same effects between the two groups. The heterogeneity of BBS scores was also high. CONCLUSION: The results of this review suggest that electrical stimulation shows little evidence of postural stability and gait performance in stroke patients, although some electrical stimulations showed positive effects on postural stability and gait performance.


Asunto(s)
Terapia por Estimulación Eléctrica , Trastornos Neurológicos de la Marcha , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Humanos , Accidente Cerebrovascular/terapia , Marcha/fisiología , Modalidades de Fisioterapia , Terapia por Estimulación Eléctrica/métodos , Equilibrio Postural/fisiología
17.
BMJ Open ; 14(2): e075218, 2024 Feb 13.
Artículo en Inglés | MEDLINE | ID: mdl-38351113

RESUMEN

OBJECTIVE: To demonstrate that acupuncture is beneficial for decreasing the risk of ischaemic stroke in patients with rheumatoid arthritis (RA). DESIGN: A propensity score-matched cohort study. SETTING: A nationwide population-based study. PARTICIPANTS: Patients with RA diagnosed between 1 January 1997 and 31 December 2010, through the National Health Insurance Research Database in Taiwan. INTERVENTIONS: Patients who were administered acupuncture therapy from the initial date of RA diagnosis to 31 December 2010 were included in the acupuncture cohort. Patients who did not receive acupuncture treatment during the same time interval constituted the no-acupuncture cohort. PRIMARY OUTCOME MEASURES: A Cox regression model was used to adjust for age, sex, comorbidities, and types of drugs used. We compared the subhazard ratios (SHRs) of ischaemic stroke between these two cohorts through competing-risks regression models. RESULTS: After 1:1 propensity score matching, a total of 23 226 patients with newly diagnosed RA were equally subgrouped into acupuncture cohort or no-acupuncture cohort according to their use of acupuncture. The basic characteristics of these patients were similar. A lower cumulative incidence of ischaemic stroke was found in the acupuncture cohort (log-rank test, p<0.001; immortal time (period from initial diagnosis of RA to index date) 1065 days; mean number of acupuncture visits 9.83. In the end, 341 patients in the acupuncture cohort (5.95 per 1000 person-years) and 605 patients in the no-acupuncture cohort (12.4 per 1000 person-years) experienced ischaemic stroke (adjusted SHR 0.57, 95% CI 0.50 to 0.65). The advantage of lowering ischaemic stroke incidence through acupuncture therapy in RA patients was independent of sex, age, types of drugs used, and comorbidities. CONCLUSIONS: This study showed the beneficial effect of acupuncture in reducing the incidence of ischaemic stroke in patients with RA.


Asunto(s)
Terapia por Acupuntura , Artritis Reumatoide , Isquemia Encefálica , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Humanos , Estudios de Cohortes , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/terapia , Accidente Cerebrovascular/etiología , Puntaje de Propensión , Isquemia Encefálica/epidemiología , Isquemia Encefálica/etiología , Isquemia Encefálica/terapia , Terapia por Acupuntura/efectos adversos , Artritis Reumatoide/complicaciones , Artritis Reumatoide/terapia , Accidente Cerebrovascular Isquémico/complicaciones , Incidencia , Taiwán/epidemiología , Factores de Riesgo , Estudios Retrospectivos
18.
PLoS One ; 19(2): e0298547, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38394111

RESUMEN

BACKGROUND: The probability of motor deficits after stroke is relatively high. At the same time many studies have reported that acupuncture and rehabilitation therapy have a significant effect on the treatment of stroke. OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the clinical value of acupuncture and rehabilitation therapy on brain eloquent areas and neurological function in ischemic stroke. METHODS: Seven databases were electronically searched to screen randomized controlled trials (RCTs) of different intervention methods (acupuncture, rehabilitation) in the treatment of ischemic stroke. The search time is from January 1, 2000 to April 20, 2023, and the search languages are limited to Chinese and English. Two researchers independently screened literature and extracted data. The methodological quality of the studies was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: A total of 17 randomized controlled studies were included, including 699 patients, with a maximum sample size of 144 cases and a minimum sample size of 11 cases. Among them, 3 studies reported the brain function in SM1 area. The effective rate of the experimental group was higher than that of the control group [relative risk (OR) = 3.24, 95%CI: 1.49 to 7.05, P < 0.05]. The FMA score of patients in the experimental group was higher than that in the control group [mean difference (MD) = 4.79, 95% CI: 3.86 to 5.71, P < 0.00001]. The NIHSS score of patients in the experimental group was lower than that in the control group [mean difference (MD) = -4.12, 95% CI: -6.99 to -1.26, P < 0.05].None of studies reported adverse events. CONCLUSIONS: Acupuncture rehabilitation for ischemic stroke can activate corresponding brain functional areas and improve neurological deficits. The therapeutic effect of acupuncture rehabilitation treatment is better than that of basic western medicine treatment, and it is more effective in improving neurological deficits. At the same time, clinical research needs to use high-quality randomized double-blind controlled trials with more detailed and larger sample designs, long-term efficacy evaluation and evidence-based research methods.


Asunto(s)
Terapia por Acupuntura , Accidente Cerebrovascular Isquémico , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Humanos , Rehabilitación de Accidente Cerebrovascular/métodos , Terapia por Acupuntura/métodos , Accidente Cerebrovascular/terapia , Encéfalo , Ensayos Clínicos Controlados Aleatorios como Asunto
19.
PLoS One ; 19(2): e0298537, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38408100

RESUMEN

BACKGROUND: Constipation is one of the common gastrointestinal complications after stroke. It not only aggravates the condition of stroke, but also brings huge medical burden to patients, and has a negative impact on the quality of life of patients. Auricular therapy, as a part of Chinese traditional acupuncture and moxibustion, has been found to be effective in the clinical treatment of constipation. However, no systematic review has investigated the efficacy and safety of auricular therapy in the treatment of post-stroke constipation. Therefore, the aim of this systematic review is to assess the effectiveness and safety of auricular therapy for post-stroke constipation. METHODS AND ANALYSIS: Eight electronic databases including PubMed, Cochrane Library/Cochrane Central Register of Controlled Trials, Web of Science, Embase, China National Knowledge Internet, Chinese Biomedical Literature Database, Wanfang, and VIP databases, will be searched for relevant studies published from inception to February 2023. Two reviewers will independently conduct research selection, data extraction, and evaluation of research quality. Only randomized controlled trials (RCTs) that assess the efficacy and safety of auricular therapy for the treatment of post-stroke constipation will be included in this study. We will use the Cochrane risk of bias assessment tool to evaluate the methodological qualities (including bias risk). If possible, a meta-analysis will be performed after screening. RESULTS: This study may provide high-quality evidence for the efficacy and safety of auricular therapy in treating post-stroke constipation. CONCLUSION: The conclusions of our study will provide an evidence to judge whether auricular therapy is an effective and safe intervention for patients with post-stroke constipation. ETHICS AND DISSEMINATION: Ethical approval is not required, as this study was based on a review of published research. This review will be published in a peer-reviewed journal and disseminated electronically and in print. TRIAL REGISTRATION: Registration number: PROSPERO CRD42023402242.


Asunto(s)
Terapia por Acupuntura , Moxibustión , Accidente Cerebrovascular , Humanos , Revisiones Sistemáticas como Asunto , Metaanálisis como Asunto , Moxibustión/métodos , Estreñimiento/etiología , Estreñimiento/terapia , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/terapia , Proyectos de Investigación , Literatura de Revisión como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto
20.
BMC Complement Med Ther ; 24(1): 102, 2024 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-38409065

RESUMEN

BACKGROUND: The refractory and disabling nature of sensory disorders after stroke seriously affects patients' daily lives and reduces hospital turnover. Acupuncture, as an alternative therapy, is commonly used in combination with rehabilitation training to improve sensory disorders. To compare the effects of different acupuncture-related treatments combined with rehabilitation training on sensory impairment and the daily living ability of patients with stroke, we conducted a network meta-analysis to provide evidence-based findings for clinical practice. METHODS: Randomized controlled trials on the treatment of sensory disorders in patients with stroke were systematically retrieved from several databases, including China National Knowledge Infrastructure (CNKI), China Science and Technology Journal(VIP), Wanfang Database, Chinese Biological Medical (CBM), PubMed, Embase, Web of Science, Cochrane Library, and Clinical trials. The retrieval period ranged from January 2012 to December 2023. Two independent reviewers screened the included literature, extracted the data, and assessed the risk quality using Cochrane Handbook 5.1.0 and ReviewManager 5.4.1. Stata16.0 software was employed for data analysis. The study protocol was registered in PROSPERO: CRD42023389180. RESULTS: After screening, 20 studies were included, involving a total of 1999 subjects. The network meta-analysis results indicate that, compared to standard rehabilitation, acupuncture plus massage plus rehabilitation showed the most significant reduction in Numbness Syndrome Scores (MD = -0.71(-1.11,-0.31)). Acupuncture combined with rehabilitation demonstrated the most substantial improvement in Sensory Impairment Scores (MD = -0.59,(-0.68,-0.51)) and daily living ability of patients (MD = 17.16,(12.20,22.12)). CONCLUSIONS: In comparison to standard rehabilitation, the combination of acupuncture-related treatments and modern rehabilitation training not only improves the symptoms of sensory impairment and numbness after stroke but also enhances the daily living ability of patients, especially when acupuncture is combined with rehabilitation. However, further demonstration is required to strengthen these conclusions.


Asunto(s)
Terapia por Acupuntura , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Humanos , Hipoestesia , Metaanálisis en Red , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/terapia , Terapia por Acupuntura/métodos , Rehabilitación de Accidente Cerebrovascular/métodos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA