Auricular Acupuncture for Epilepsy, a Case for Vagal Stim

(No posting due to travel the last two weeks, thought I could do some but I didn't see too much in the news and my schedule chaotic.)
I did a series of posts about Litscher's work here, here and here. The abstract doesn't mention if he's looking at HRV, but I would suspect he is from his previous work. I will try to get a copy of his paper. (Sometimes it isn't possible because the abstract is out before the paper is ready.) More on my acupuncture practice here.

Evid Based Complement Alternat Med. 2012;2012:615476. Epub 2012 Feb 1.

Auricular Acupuncture May Suppress Epileptic Seizures via Activating the Parasympathetic Nervous System: A Hypothesis Based on Innovative Methods.
He W, Rong PJ, Li L, Ben H, Zhu B, Litscher G.
Source

Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China.
Abstract

Auricular acupuncture is a diagnostic and treatment system based on normalizing the body's dysfunction. An increasing number of studies have demonstrated that auricular acupuncture has a significant effect on inducing parasympathetic tone. Epilepsy is a neurological disorder consisting of recurrent seizures resulting from excessive, uncontrolled electrical activity in the brain. Autonomic imbalance demonstrating an increased sympathetic activity and a reduced parasympathetic activation is involved in the development and progress of epileptic seizures. Activation of the parasympathetic nervous system such as vagus nerve stimulation has been used for the treatment of intractable epilepsy. Here, we propose that auricular acupuncture may suppress epileptic seizures via activating the parasympathetic nervous system.

Electroacupuncture, Immunity and Autonomic Nervous System in Rats

We've seen a number of studies on acupuncture and the immune system and its effect on cellular immunity(Nerve growth factor and electroacupuncture), moxabustion and cytokine production, basophils and acupuncture for eczema, and some theoretical studies on stress and immunity but I don't recall seeing a paper drawing the specific connection between the autonomic nervous system and improved immunity. In rats no less... (Information about my practice here.)

Anesthesiology. 2012 Feb;116(2):406-14.
Electroacupuncture improves survival in rats with lethal endotoxemia via the autonomic nervous system.
Song JG, Li HH, Cao YF, Lv X, Zhang P, Li YS, Zheng YJ, Li Q, Yin PH, Song SL, Wang HY, Wang XR.
Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Recent advances have indicated a complex interplay between the autonomic nervous system and the innate immune system. Targeting neural networks for the treatment of sepsis is being developed as a therapeutic strategy. Because electroacupuncture at select acupoints can modulate activities of the autonomic nervous system, we tested the hypothesis that electroacupuncture at specific acupoints could modulate systemic inflammatory responses and improve survival via its impact on the autonomic nervous system in a rat model of sepsis.
METHODS:

Sprague-Dawley male rats received electroacupuncture for 45 min before and at 1, 2, or 4 h after a lethal dose of intraperitoneal lipopolysaccharide injection (6 mg/kg). Outcomes included survival and systemic cytokine responses. Also, the possible roles of neural circuitry, including the hypothalamic-pituitary-adrenal axis and the autonomic nervous system, were evaluated.
RESULTS:
Electroacupuncture pretreatment at the Hegu acupoints significantly attenuate systemic inflammatory responses and improve survival rate from 20% to 80% in rats with lethal endotoxemia. Such a site-specific effect requires the activation of muscarinic receptors in the central nervous system, but not increasing central sympathetic tone. In the periphery synergistic, rather than independent, action of the sympathetic and parasympathetic systems is also necessary.
CONCLUSIONS:
Electroacupuncture pretreatment has a dramatic survival-enhancing effect in rats with lethal endotoxemia, which involves the activation of efferent neural circuits of the autonomic nervous system (e.g., cholinergic antiinflammatory pathway). This approach could be developed as a prophylactic treatment for sepsis or perioperative conditions related to excessive inflammation.

"Broken Hearts" in Women After a Shock

I wanted to cite this article because of the implications in Traditional Chinese Medicine (TCM). In TCM, the heart is the home of the spirit or Shen. So in treating disturbances of the Shen, the practitioner will treat the heart through the heart meridian and through the pericardium meridian. Interestingly, both of these meridians have been found to have a direct effect on the vagus nerve and the autonomic nervous system. So in this article when it explains how a "shock" can affect the heart through adrenaline etc..., TCM has had a way to treat that for millenia.
I've discussed these sort of overlaps before in this blog, here, for example. Of course, data on acupuncture and the autonomic nervous system can be found here, here, and here to name a few. I'd have to think about this further from a TCM standpoint why women would be more susceptible. The fact that women over 55 are more susceptible would suggest a yin/yang issue, but that's speculative...

'Broken heart syndrome' hits women harder

Marilynn Marchione, Associated Press

Thursday, November 17, 2011

Orlando --

A woman's heart breaks more easily than a man's.

Women are seven to nine times more likely to suffer "broken heart syndrome," when sudden or prolonged stress such as an emotional breakup or death causes overwhelming heart failure or heart attack-like symptoms, the first nationwide study of this finds. Patients usually recover with no lasting damage.

Japanese doctors first recognized this syndrome around 1990 and named it Takotsubo cardiomyopathy - tako tsubo are octopus traps that resemble the shape of the stricken heart.

It happens when a big shock triggers a rush of adrenaline and other stress hormones that cause the heart's main chamber to balloon suddenly. Tests show dramatic changes in rhythm and blood substances typical of a heart attack, but no artery blockages that typically cause one. ..

"I was very curious why only women were having this," said Dr. Abhishek Deshmukh of the University of Arkansas, who did the first large study of the problem and reported results Wednesday at an American Heart Association conference in Florida.

Using a federal database with 1,000 hospitals, Deshmukh found 6,229 cases in 2007. Only 671 involved men. After adjusting for high blood pressure, smoking and other factors that can affect heart problems, women were 7.5 times more likely to suffer the syndrome than men.

It was three times more common in women over 55 than in younger women.

Info on my practice here.

HRV in Post Stroke Patients Teleacupuncture Analysis

This study is from the same group I've linked to and discussed here, here and here. This is Part 1, so I'll be looking forward to their further studies coming up. There is the added advantage that you can view the entire journal article online.
What they found is that using acupuncture on one single point, pericardium 5, on one side lowered increased HRV. (For further information about my practice and research .)

Results. Acupuncture does not change heart rate in the post-stroke patients; however, total HRV increased significantly (P < .05) during and 5–10 minutes after acupuncture. In addition, balance between sympathetic and parasympathetic activity (low frequency/high frequency HRV ratio) changes markedly during treatment. Conclusions. Based on innovative HRV analysis, it could be demonstrated that teleacupuncture between China/Harbin and Austria/Graz over a distance of about 8,500 km is no longer a future vision; it has become reality."

Is polycystic ovary syndrome associated with high sympathetic nerve activity and size at birth?

This article is back up information about PCOS and high sympathetic tone. They were measuring sympathetic nerve activity to the muscle vascular bed (MSNA.) They found that the heightened MSNA may account for the higher cardiovascular risk in PCOS patients, and postulate that the higher sympathetic tone may account for many of the abnormalities encountered in PCOS. They cite one previous study that explored HRV and PCOS, which I will try to track down. I'm excerpting almost in its entirety for those who might be as interested as I am in this topic.
(For more information about my practice, please click here.)

Yrsa Bergmann Sverrisdo´ttir,1 Tove Mogren,1 Josefin Kataoka,1 Per Olof Janson,2
and Elisabet Stener-Victorin Institute of Neuroscience and Physiology, Department of Physiology, and 2Department of Obstetrics and Gynecology,Sahlgrenska Academy, Go¨teborg University, Go¨teborg, Sweden
Am J Physiol Endocrinol Metab 294: E576–E581, 2008.

Is polycystic ovary syndrome associated with high sympathetic
nerve activity and size at birth?
Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disturbance among women ofreproductive age and is proposed to be linked with size at birth and
increased prevalence of cardiovascular disease. A disturbance in the
sympathetic nervous system may contribute to the etiology of PCOS.
This study evaluates sympathetic outflow in PCOS and its relation to
size at birth. Directly recorded sympathetic nerve activity to the
muscle vascular bed (MSNA) was obtained in 20 women with PCOS
and in 18 matched controls. Ovarian ultrasonographic evaluation,
biometric, hormonal, and biochemical parameters were measured, and
birth data were collected. Women with PCOS had increased MSNA compared with
controls. MSNA was positively related to testosterone and cholesterol levels in PCOS, which, in turn, were not related to each other. Testosterone level was a stronger predictor of MSNA than cholesterol. Birth size did not differ between the study groups. This is the first study to directly address sympathetic nerve activity in women with PCOS and shows that PCOS is associated with high MSNA. Testosterone and cholesterol levels are identified as independent predictors of MSNA in PCOS, although testosterone has a stronger impact. The increased MSNA in PCOS may contribute to the increased cardiovascular risk and etiology of the condition. In this study, PCOS was not related to size at birth.

Polycystic Ovary Syndrome and Acupuncture

There is a review article in the most recent issue of the American Journal of Physiological Endocrinology looking at Complementary Medical methods of approaching Polycystic Ovarian Syndrome. The authors postulate that acupuncture is useful through its "modulation of the activity in the somatic and autonomic nervous system may modulate endocrine and metabolic functions in PCOS." As readers of this blog are aware, the autonomic nervous system is of utmost interest to me, so am always heartened when other researchers and practitioners acknowledge the autonomic nervous system's role in acupuncture effectiveness. They were wary of endorsing herbal treatment for PCOS, because they were unstudied and unproven.
I was also directed to a study from 2008 concerning the evidence and physiology behind acupuncture and Polycystic Ovary Syndrome by the same author Elisabet Stener-Victorin. Stener-Vitorin has established herself as an authority on OB GYN and Acupuncture. (I shared a cab with her after the last Society for Acupuncture Research meeting a year ago and we shared our enthusiasm for the "Girl with the Dragon Tatoo" series. In Swedish the name of the first book is "Men Who Hate Women" instead of "Girl with the Dragon Tatoo." She mused that Swedes are quite realistic and dark compared to Americans. Apparently so, since would guess very few Americans would pick up a book called "Men who Hate Women.")
Excerpts from the two studies follow.
(For more information about my practice please click here.)

The Physiological Basis of Complementary and Alternative Medicine for Polycystic Ovary Syndrome.
Am J Physiol Endocrinol Metab. 2011 Apr 12. [Epub ahead of print]

Raja-Khan N, Stener-Victorin E, Wu X, Legro R.

1Penn State College of Medicine.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder that is characterized by chronic hyperandrogenic anovulation leading to symptoms of hirsutism, acne, irregular menses and infertility. Multiple metabolic and cardiovascular risk factors are associated with PCOS, including insulin resistance, obesity, type 2 diabetes, hypertension, inflammation, and subclinical atherosclerosis. However, current treatments for PCOS are only moderately effective at controlling symptoms and preventing complications. This article describes how the physiological effects of major complementary and alternative medicine (CAM) treatments could reduce the severity of PCOS and its complications. Acupuncture reduces hyperandrogenism and improves menstrual frequency in PCOS. Acupuncture's clinical effects are mediated via activation of somatic afferent nerves innervating the skin and muscle, which via modulation of the activity in the somatic and autonomic nervous system may modulate endocrine and metabolic functions in PCOS. ..

Acupuncture in polycystic ovary syndrome: current experimental and clinical evidence.
J Neuroendocrinol. 2008 Mar;20(3):290-8.
Stener-Victorin E, Jedel E, Mannerås L.

Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden. elisabet.stener-victorin@neuro.gu.se

This review describes the aetiology and pathogenesis of polycystic ovary syndrome (PCOS) and evaluates the use of acupuncture to prevent and reduce symptoms related with PCOS. PCOS is the most common female endocrine disorder and it is strongly associated with hyperandrogenism, ovulatory dysfunction and obesity...The syndrome is associated with peripheral and central factors that influence sympathetic nerve activity. Thus, the sympathetic nervous system may be an important factor in the development and maintenance of PCOS. Many women with PCOS require prolonged treatment. Current pharmacological approaches are effective but have adverse effects. Therefore, nonpharmacological treatment strategies need to be evaluated. Clearly, acupuncture can affect PCOS via modulation of endogenous regulatory systems, including the sympathetic nervous system, the endocrine and the neuroendocrine system. Experimental observations in rat models of steroid-induced polycystic ovaries and clinical data from studies in women with PCOS suggest that acupuncture exert long-lasting beneficial effects on metabolic and endocrine systems and ovulation.

Autonomic activation in insomnia: the case for acupuncture.

I hope I'll be able to get a copy of this article. If I do, I'll post again on the details. Here are the money quotes: "Acupuncture may represent a unique avenue of treatment for poor sleep by virtue of its direct effects on peripheral nerves and muscles, which, in turn, modulate autonomic tone and central activation. In this review, we summarize both basic and clinical research indicating that acupuncture exerts profound influences via a wide variety of potential neural and/or hormonal mechanisms that have great relevance for the modulation of sleep and wakefulness."
I would add that acupuncture is often helpful for a wide variety of psychological conditions because it provides that link between the physical and the mental through augmentation of the autonomic nervous system, hence decreasing stress and its related maladies.

(To read further about acupuncture, HRV, and my practice please click here.)

Autonomic activation in insomnia: the case for acupuncture.

Huang W, Kutner N, Bliwise DL. J Clin Sleep Med 2011;7(1):95-102.
Current conceptualizations of the biological basis for insomnia typically invoke central nervous system and/or autonomic nervous system arousal. Acupuncture may represent a unique avenue of treatment for poor sleep by virtue of its direct effects on peripheral nerves and muscles, which, in turn, modulate autonomic tone and central activation. In this review, we summarize both basic and clinical research indicating that acupuncture exerts profound influences via a wide variety of potential neural and/or hormonal mechanisms that have great relevance for the modulation of sleep and wakefulness. We illustrate principles of acupuncture intervention applied to cases of otherwise intractable insomnia that document successful application of this component of Traditional Chinese Medicine to the treatment of poor sleep. Our review indicates the necessity for further research in the relationship between the effects of acupuncture on insomnia and autonomic regulation, which might guide better selective use of this treatment modality for insomnia. CITATION: Huang W; Kutner N; Bliwise DL. Autonomic activation in insomnia: the case for acupuncture. J Clin Sleep Med 2011;7(1):95-102.

Monitoring the Autonomic Nervous System and HRV in rats after Acupuncture

I often don't know what to make of these studies, but find them super interesting nonetheless, and somehow can't help but incorporate their findings into my practice for better or for worse. What I love about this study is that they actually saw a difference between electroacupuncture on Stomach 36 and Pericardium 6, both in pain reduction and autonomic response as measured by heart rate, LF(low frequency portion of HRV) and LF/HR (low frequency to high frequency ratio-a common measure of stress response.) They saw no reduction when using Liver 3 nor the sham, non-acupoint. I wish we had more studies like this, comparing one set of points and another. For one, it helps get away from the ever present placebo problem in research, and for two it might help inform our practice!!
The study model is 4 groups, sham point, Stomach 36, Pericardium 6, Liver 3, 9 rats in each group. They used alternating 2Hz/15Hz electro, (got to haul out my alternating device again...)
The abstract for the study follow. The emphases are mine. Poor rats...

(To read more about acupuncture, HRV, and my practice, please click here.

Zhen Ci Yan Jiu. 2010 Oct;35(5):335-41.
[Effects of electroacupuncture of different acupoints on changes of blood pressure and autonomic nerve system after colorectal distension in rats].

Chen SP, Gao YH, Yu XC, Liu JL.
Institute of Acu-moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China.
Abstract

OBJECTIVE: To observe the influence of electroacupuncture (EA) of different acupoints on changes of mean arterial pressure (MAP), heart rate (HR) and heart rate variability (HRV) in colorectal distension (CRD) rats, so as to analyze the specificity of actions of acupoints in relieving visceral pain and regulating activities of the autonomic nerve system.

METHODS: Forty-five Wistar rats were randomized into control, Zusanli (ST 36), non-acupoint, Neiguan (PC 6) and Taichong (LR 3) groups (n = 9/group). Under anesthesia, CRD was given to the rats by using an aerostat for 5 min. EA (2 Hz/15 Hz, 2 mA) was applied to bilateral ST 36, non-acupoint (1.0 cm lateral to ST 36), PC 6 and LR 3 for 15 min, respectively. Electrocardiogram of the cervico-chest lead was recorded by using a bioelectric amplifier, and MAP recorded by using a pressure transducer and an amplifier. Low frequency and high frequency of HRV were analyzed by Chart 5.0.

RESULTS: Following CRD, the HR, MAP, LF and LF/HF levels increased significantly in all the 5 groups (P <> 0.05). Compared with the control group, 5 min and 15 min after EA ,and 10 min after ceasing EA, MAP values of ST 36 and PC 6 groups were decreased obviously (P < style="font-weight: bold;">The LF levels of both ST 36 and PC 6 groups at 5 min after EA, and those of ST 36, PC 6 and LR 3 at 15 min after EA were significantly lower than those of control group (P <> 0.05).

CONCLUSION: EA of ST 36 and PC 6 can suppress CRD-induced increase of MAP, HR and LF/HF, suggesting beneficial effects of EA in relieving visceral pain and mediating autonomic nerve system. The aforementioned effects of EA of LR 3 and non-acupoint are not obvious.

Good results with Acupuncture for a patient with High Blood Pressure

On a more anecdotal basis, I saw a patient today who has been coming to me for about 6 months to treat high blood pressure. He had no desire to take medications, and so was seeking some other alternatives. He is 67 and works in a stressful job as a taxi cab dispatcher. He had spent some time in Asia earlier in his working life so was open to acupuncture as an alternative.
He came twice weekly for 6 weeks and then weekly for 2 months. I treated him with classic points for decreasing rising yang, and also points that have been shown to calm the autonomic nervous system in studies, like sishencong and 6MC. We added daily herbal supplements in addition to the acupuncture treatments. In his particular case a Yin tonic was key. He now comes in once a month and has maintained his blood pressure in a healthy range. Here is a chart of his BP ( bit blurry, sorry!) It may not look super dramatic, but it's the difference between taking medications and not.

(To read more about acupuncture and my practice, please click here.)