Digital archive of theses discussed at the University of Pisa


Thesis etd-06222017-172634

Thesis type
Tesi di specializzazione (5 anni)
Thesis title
Neuromodulatory effects of acupuncture on consciousness disorders: state of the art and a neurophysiological pilot study
Course of study
relatore Prof.ssa Carboncini, Maria Chiara
relatore Prof. Andre, Paolo
  • sistema nervoso autonomo
  • variabilità cardiaca
  • neuromodulazione
  • neuromodulation
  • EEG
  • hearth rate variability
  • coscienza
  • consciousness
  • autonomic nervous system
  • agopuntura
  • acupuncture
Graduation session start date
Release date
Background - Disorders of consciousness (DOCs) due to severe acquired brain injuries represent one of the greatest challenges that modern medicine faces today, causing the highest degree of disability often in young and working-age people.
Besides steady progress has been made toward prolonging patients’ survival, and several pharmacologic and neuromodulating strategies have been proposed, results on functional recovery are still scarce.
Moreover, patients with DOCs, presenting motor, sensory, cognitive and/or behavioural significant impairment, are prone to important infections and to autonomous nervous system (ANS) imbalance, thus any medicament needs to be carefully considered for the potential interactions and side effects.
Purpose - The present work aims to study, through a clinical and neurophysiological evaluation, the effects of a developing medical science derived from an ancient oriental therapeutic tradition, i.e. acupuncture, in subjects affected by DOCs. Employed throughout the world mainly as analgesic technique, acupuncture has been shown to act at various levels (local dermis, spinal cord, midbrain, thalamus, limbic system) and to modulate the ANS. It is demonstrably safe and free of side effects or drug interactions, therefore indicated for such fragile subjects.
Patients and Methods - Six subjects (5 males and 1 female) affected by DOCs of various origin (2 traumatic, 3 anoxic, 1 from brain haemorrhage), under treatment at Severe Acquired brain Injury Unit of Cisanello Hospital, were enrolled.
Obtained the informed consent of the family members, the patients underwent a neurophysiological evaluation through a 30 minutes resting state 64-channel electroencephalogram (EEG), also monitoring eyeblink (EOG) and hearth activity (ECG), using a Micromed device, followed by acustic event-related potential (ERP), with Ates system.
They were then treated with a specific 6-points acupuncture protocol established on the basis of scientific literature, for 30 minutes. After removing the needle, a new ERP and EEG sessions were recorded.
Hearth rate variability (HRV) was analysed by Kubios software; a comparison between the parameters extracted before and after acupuncture was performed by a Wilcoxon Test.
Brain electrical activity was assessed using Eeglab software running under Matlab environment.
For 2 of 6 subjects, who were hospitalised, the treatment was carried on for 15 consecutive daily sessions, followed by a new neurophysiological assessment.
Results - Clinically, a light increase in blinking rate was reported in all the subjects, and a fast progressive rise in responsiveness was shown in one of the patients treated chronically, since the second session.
As regards the effects on ANS assessed through HRV spectral analysis, due to the small sample size, few variables resulted significantly changed after acupuncture, but a trend towards parasympathetic activation and increased HRV indexes were reported, both in rest and during ERPs.
EEG spectrum analysis showed an increased power in the alpha and beta bands in the midline channels; the ERP P300 waveforms exhibited a rise in amplitude and/or a reduction in latency.
Conclusions - Given its safety and the absence of drug interactions, acupuncture could represent a neuromodulation technique able to influence brain activity and ANS. Further studies are required to establish the most appropriate therapeutic protocol.