Background Acupuncture involving the limb region may be effective for stroke rehabilitation clinically, but the visualised and explanatory evidence is limited. Our objectives were to assess the specific effects of acupuncture for ischaemic stroke (IS) patients with hemiparesis and investigate its therapy-driven modification in functional connectivity. Methods IS patients were randomly assigned (2:1) to receive 10 sessions of hand-foot 12 needles acupuncture (HA, n=30) or non-acupoint (NA) acupuncture (n=16), enrolling gender-matched and age-matched healthy controls (HCs, n=34). The clinical outcomes were the improved Fugl-Meyer Assessment scores including upper and lower extremity (ΔFM, ΔFM-UE, ΔFM-LE). The neuroimaging outcome was voxel-mirrored homotopic connectivity (VMHC). Static and dynamic functional connectivity (sFC, DFC) analyses were used to study the neuroplasticity reorganisation. Results 46 ISs (mean(SD) age, 59.37 (11.36) years) and 34 HCs (mean(SD) age, 52.88 (9.69) years) were included in the per-protocol analysis of clinical and neuroimaging. In clinical, ΔFM scores were 5.00 in HA group and 2.50 in NA group, with a dual correlation between ΔFM and ΔVMHC (angular: r=0.696, p=0.000; cerebellum: r=−0.716, p=0.000) fitting the linear regression model (R2=0.828). In neuroimaging, ISs demonstrated decreased VMHC in bilateral postcentral gyrus and cerebellum (Gaussian random field, GRF corrected, voxel p<0.001, cluster p<0.05), which fitted the logistic regression model (AUC=0.8413, accuracy=0.7500). Following acupuncture, VMHC in bilateral superior frontal gyrus orbital part was increased with cerebro-cerebellar changes, involving higher sFC between ipsilesional superior frontal gyrus orbital part and the contralesional orbitofrontal cortex as well as cerebellum (GRF corrected, voxel p<0.001, cluster p<0.05). The coefficient of variation of VMHC was decreased in bilateral posterior cingulate gyrus (PPC) locally (GRF corrected, voxel p<0.001, cluster p<0.05), with integration states transforming into segregation states overall (p<0.05). There was no acupuncture-related adverse event. Conclusions The randomised clinical and neuroimaging trial demonstrated acupuncture could promote the motor recovery and modified cerebro-cerebellar VMHC via bilateral static and dynamic reorganisations for IS patients with hemiparesis. Data are available upon reasonable request. Not applicable.

中文翻译：

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针刺对缺血性中风偏瘫患者大脑和小脑的双侧影响：一项随机临床和神经影像学试验

背景 临床上涉及肢体区域的针灸可能对中风康复有效，但可视化和解释性证据有限。我们的目标是评估针灸对缺血性中风（IS）偏瘫患者的具体效果，并研究其治疗驱动的功能连接改变。方法 IS 患者被随机分配 (2:1) 接受 10 次手足 12 针针灸 (HA, n=30) 或非穴位 (NA) 针灸 (n=16), 纳入性别、年龄相匹配的患者。匹配的健康对照（HC，n=34）。临床结果是 Fugl-Meyer 评估评分的改善，包括上肢和下肢（ΔFM、ΔFM-UE、ΔFM-LE）。神经影像结果是体素镜像同伦连接（VMHC）。使用静态和动态功能连接（sFC、DFC）分析来研究神经可塑性重组。结果 46 名 IS（平均（SD）年龄，59.37（11.36）岁）和 34 名 HC（平均（SD）年龄，52.88（9.69）岁）被纳入临床和神经影像的符合方案分析。临床上，HA组ΔFM评分为5.00，NA组为2.50，ΔFM和ΔVMHC之间具有双重相关性（角度：r=0.696，p=0.000；小脑：r=-0.716，p=0.000）拟合线性回归模型（R2=0.828）。在神经影像学中，ISs 表现出双侧中央后回和小脑的 VMHC 减少（高斯随机场，GRF 校正，体素 p<0.001，聚类 p<0.05），符合逻辑回归模型（AUC=0.8413，准确性=0.7500）。针刺后，双侧额上回眶部的VMHC随着脑小脑的变化而增加，涉及同病额上回眶部和对侧眶额皮质以及小脑之间更高的sFC（GRF校正，体素p<0.001，簇p< 0.05）。双侧后扣带回 (PPC) 的 VMHC 变异系数局部降低（GRF 校正，体素 p<0.001，簇 p<0.05），整体整合状态转变为分离状态（p<0.05）。没有出现与针灸相关的不良事件。结论 随机临床和神经影像学试验表明，针灸可以促进偏瘫 IS 患者的运动恢复，并通过双侧静态和动态重组来改善脑小脑 VMHC。数据可根据合理要求提供。不适用。