World Journal ofAcupuncture-Moxibustion (WJAM)

ELSEVIER Vol. 23, No.3, 30th Sep. 2013

Clinical Research
Impacts of acupuncture on brainstem evoked potentials
in patients with primary depression
It!
LIUYong-hui DUANZhi-gang ZENG Sheng (it JJiY, WANSi (7i
CAO Ya-qiong Cit $1*)2, LIU Tai
39
1. First Affiliated Hospital of Guangxi University of TCM, Nanning 530023, China; 2. Guangxi University
ofTCM ( 1. WIT 530023, 9='00; 2.
ARTICLE INFO
First author: L1U Yong-hui (1982-), male,
attending physician.
Researchfield: clinical and scientific
research of encephalopathy with reM.
E-mail: liuyonghui626@126.com
Accepted on March 6, 2013
ABSTRACT
Objective To observe the impacts of acupuncture on brainstem evoked
potentials in the patients with primary depression. Methods Forty cases
of primary depression were treated by acupuncture at Baihul CJ3 GV 20),
Ylntang GV 29), Dazhul (:*;fl GV 14), bilateral Shenrnen (*,n HT 7),
bilateral Talchong (.:;tj1=p LR 3), bilateral Nelguan Oig *PC 6) and SanyTnjiao c=
13Jj:'\t SP 6). The needles were retained for 30 min. Acupuncture treatment was
given once every two days, three treatments a week. The brainstem auditory
evoked potential (BAEP) and visual evoked potential (VEP) were observed in 6
weeks of treatment. The change in Hamilton depression scale (HAMD) score
was observed before and after treatment in the depression group. Results
After treatment, VEP wave latency was shortened significantly in patients of
depression (P<O.OS), BAEPIII wave latency was shortened significantly (P<O.OS).
The score of HAMDwas decreasedapparently in the depression group (P<O.OS).
Conclusions The stressability of visual and auditory stimuli in the central
nervous system was decreased in the patients of depression. Acupuncture
shortens remarkably the brainstem evoked potentials latency in the patients
of depression and achieves the effective results in the treatment of primary
depression.
KEY WORDS: depression; acupuncture; brainstem auditory evoked potential
(BAEP); visual evoked potential (VEP)
Primary depression is also named depressive
disorder. It is the nervous symptomatic disorder
characterized as persistent depressed mood, commonly
associated with anxiety, physical discomfort and sleep
disorder. Additionally, with the accelerative pace of
life, people have to bear more and more stresses, and
the prevalence of the disease is increasing yearly in
tendency!'! The evoked potentials are abnormal in
the patients of depression and the wave latency was
prolonged significantly in brainstem auditory evoked
potential (BAEP) and visual evokedpotential (YEP) [2].
This research observed the impacts of acupuncture on
brainstem evoked potentials in 40 patients of primary
depression and the report is as follows.
CLINICAL DATA
General data
The patients of depression were enrolled from the
wards and clinics of the Encephalopathy Department
of TCM, the First Affiliated Hospital of Guangxi
University of TCM from February 2011 to September
2012. Of 40 cases, 17 cases were male and 23 cases
female, aged from 20 to 60 years, averagely (3813)
years old; the duration of sickness was in the range
from 2 months to 10 years, averagely (l6.98.3)
40
World Journal ofAcupuncture-Moxibustion (WJAM)
Vol. 23, No.3, 30th Sep. 2013 ELSEVIER
months. The subjects (40 cases) in the control group
were the staffs and students of the First Affiliated
Hospital of Guangxi University of TCM. Of 40 cases,
15 cases were male and 25 cases female, aged from
22 to 58 years, averagely (29 10) years old. In the
enrolment, there were no physical and metal disorder,
no history of drug or food abuse involved.
Inclusive criteria
Aged in the range from 18 to 65 years,
in compliance with the diagnostic standard of
depression issued in Chinese Classification and
Diagnostic Criteria of Mental Disorders in China,
Third-Reversed Edition (CCMD-3), >50 scores in
self-rating depression scale (SDS) and scores
in Hamilton depression scale (HAMD) (24 items);
the first onset, somatic symptoms as the chief
complaints, but without the evidence of corresponding
organic disorder, in the scope of SDS>50 scores and
HAMD>8 scores, diagnosed as primary depression; in
accordance with the diagnostic criteria of traditional
Chinese medicine (TCM), in reference to Internal
Medicine ofTCM, chief complaints: mental depression
and irritability, accompanied symptoms: chest fullness,
distending pain in hypochondriac region, wandering
pain, epigastriac distention, belching, poor appetite,
irregular defecation.
Exclusive criteria
Unstable life physical signs, serious liver and
kidney dysfunctions, auditory disorders or visual
dysfunction, in pregnancy, and inability to cooperate
in the research.
METHODS
Main points: Baihui eEf GV 20), Yintang (Ell
}it GV 29), Dazhui (*fft GV 14), bilateral Shenmen
nHT 7), bilateral Taichong LR 3), bilateral
Neiguan PC 6) and Sanylnjiao SP 6).
Adding Zusanlf (,.@.'::::::ll ST 36) for poor appetite.
The patient was in sitting position. GV 14 was
punctured at first. After the needle sensation arrived,
the even needling manipulation was applied for 30 s
before the needle was withdrawn. Afterwards, the
patient was in lying position, GV 20, GV 29, PC 6,
HT 7, SP 6, LR 3 and the symptomatic points were
inserted. After the arrival of needling sensation, the
needles were retained for 30 min and manipulated
manually with even needling technique once every
15 min, for 5-10 s each time. The treatment was
given once every two days, 3 treatments a week. The
observation was done in 6 weeks of treatment. The
acupuncture physicians were those of acupuncture and
moxibustion specialty and had been participated in
the training of standard acupuncture operation in the
research.
OBSERVATION INDICES AND METHODS
Determination of brain evoked potentials
The assigned person detected the evoked
potentials of all the patients. The subjects were
required to be relaxed physically and mentally and
keep a clear mind and ensure the mind concentrated.
Denmark Keypoint 4-channel EMG/evoked potential
instrument was adopted to detect each item twice and
the mean was calculated. 1) BAEP: the subject lay
down and received the hearing detection to except the
auricular disease. According to the international 10-20
lead method, the recording electrode was attached to
the calvaria of subject (Cz), the reference lead was to
the ear lobe on the same side of sound stimulation and
the forehead was grounding. The clicking sound was
adopted, the stimulation intensity was the auditory
threshold plus 60 dB, the maximal intensity was less
than 120 dB, the stimulation frequency was 10 Hz,
the filtering band pass was in the range from 100 to
2000 Hz, the superposition was 1000-2000 times, the
analyzing time was 10 ms and the record was repeated
twice. 2) YEP detection: the checkerboard pattern
reversal stimulus was adopted. Before the detection,
the subject was required for visual determination and
rectification to 1.0. The subject was in sitting position
1 m far from the screen. The electrodes were placed
after degreasing. The recording electrode was attached
to the central occiput of subject (Oz) and the bilateral
sides of it (01, 02), the reference electrode was to
the frontal pole (Fz) and Fpz was grounding. The
band pass was 1-100 Hz, the stimulation frequency
was 2 Hz, the analyzing time was 300 ms and the
superposition was about 100 times.
HAMD scores were delimited according to Davis
JM. The total scores were delimited as severe
depression, the scores in the range of <35 and
as moderate depression, those <21 and 18 as mild
depression, those <18 and 8 as depressive state and
those <8 as no depressive state.
Statistical method
All of the research data were input in EXCEL
Database. SPSS 17.0 statistical software was
adopted. The t test was used for the assessment of
the measurement data. X- test was applied to the
assessment of enumeration data. P<0.05 indicated the
statistically significant difference.
WorldJournal ofAcupuncture-Moxibustion(WJAM)
ELSEVIER Vol. 23, No.3, 30th Sep. 2013
Table 1 Comparison of BAEP and YEP of the subjects between the two groups before treatment
41
(Xs, ms)
BAEP wave latency BAEP main wave interphase YEP wave latency
Groups Cases
m V I-m m-v N75 PlOO NB5
Depression 40 1.680.1OI) 3.76O.l2
1
) 5.800.24
')
2.230.07
')
2.2l0.26I) 67.651.86I) 93.522.93 I) l29.107.5
')
Control 40 1.56O.l2 3.600.l6 5.47O.17 2.l40.03 1.9l0.05 66.171.92 90.462.66 l25.706.0
Note: compared with the control group, I)P<0.05.
Table 2 Comparison of BAEP and YEP of patients with depression before and after treatment (Xs, ms)
BAEP wave latency BAEP main wave interphase YEP wave latency
Time Cases
m V I-m m-v N75 P100 NB5
Before treatment 40 1.680.10 3.76O.l2 5.800.24 2.230.07 2.2l0.26 67.651.86 93.522.93 l29.l07.5
After treatment 40 1.590.33 3.630.3l
')
5.500.26 2.l90.03 2.030.20 66.801.73
1
) 91.522.50
1
) l25.606.8
1
)
Note: compared with that before treatment I)P<0.05.
RESULTS
Comparison of evoked potentials between
the two groups
In comparison between the two groups before
treatment, I , mand Vmain waves latency and
interphase of BAEP in the depression group were
all prolonged apparently, indicating the statistically
significant difference (P<0.05). PIOO and N1351atency
of YEP were prolonged, indicating the statistically
significant difference (P<O.05, Tablel).
Comparison of evoked potentials before and
after treatment in the depression group
After treatment, mwave latency of BAEP was
shortened apparently as compared with that before
treatment, indicating the statistically significant
difference (P<O.05). I and V latency and interphase
did not change apparently before and after treatment.
N75, P100 and N135 latency ofVEP were shortened
significantly as compared with those before treatment,
indicating the statistically significant difference
(P<O.05). See Table 2.
As compared with the moderate depression level
[(25.803.87)] in HAMD score before treatment,
HAMD score [(15.633.42)] indicated the mild or no
depressive state after treatment. The clinical symptoms
were improved apparently. The score difference was
significant (P<O.05).
DISCUSSION
Depression is the mood disorder syndrome
manifested as mental and motor retardation such as
low mood, loss of interest in activities that they enjoy,
lack of energy, etc. The evoked potential is one of
the research index of neural electrophysiology and is
the bioelectrical activity produced by various internal
and external specific stimuli in the central nervous
system. The evoked potential abnormality indicates
the damage of neural pathways in the patients. The
changes in evoked potentials in the patients of primary
depression are relevant with trouble in sleeping, low
mood, poor concentration and retarded thinking. It is
deduced that YEP changes in primary depression may
be the state index and BAEP be the attitude index [2-3
1

After acupuncture treatment, the main mwave

of BAEP and N75, PIOO and N135 latencies were
shortened significantly and the clinical symptoms
were improved. Acupuncture presents its very large
developing space in practice and deserves to be
promoted because of its characteristics as safety,
effectiveness and less side effects. The impact
mechanism of acupuncture on evoked potentials has
not been clarified yet and needs a further study on it.
REFERENCES
[1] Guo JQ, HuangY, Wang CQ, Chen JQ, Li GL, Wang SX.
Curative effect observation of acupuncture combined with
Paroxethine on primary depression. Mod J Integr Tradit
Chin Med West Med (Chin) 2010; 19(1): 9-10.
[2] Gao CY, Gan JL, Niu F, Yang DD, YangC. Characteristics
of variation of evoked potentials in patients with
depression: two month follow up observation. Chin J Clin
Rehabil (Chin) 2005; 9(4): 36-37,47.
[3] Xie LJ, Tang QS, Huo AR. Impacts of Yinao Jieyu
formula on evoked potentials in the patients with primary
depression. J Tradit Chin Med (Chin) 2007; 48(4): 322-
324.
(Editor: LID Wan-ning Translator: WANGFang)
(Turn to page 45)
World Journal ofAcupuncture-Moxibustion (WJAM)
ELSEVIER Vol. 23, No.3, 30th Sep. 2013
Beijing: People's Medical Publishing House; 2007: 130-
154.
[2] Shi XM. Acupuncture (Chin). 5th Edition. Beijing: China
ABSTRACT IN CHINE SE
45
Press of Traditional Chinese Medicine; 2002.
(Editor: LID Wan-ning Translator: ZHANGYong-mei)
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