Journal Home > Volume 7 , Issue 2

Anxiety is a common psychiatric symptom with unsatisfactory treatment. Scalp acupuncture is a new type of acupuncture based on the functions of different brain regions. However, recent brain neuroimaging findings have not been well-integrated into scalp acupuncture practice and research since it was developed. In parallel, recently developed brain stimulation methods have also been applied to treat anxiety. In this study, we integrated meta-analysis (using Neurosynth), resting-state functional connectivity, and diffusion tensor imaging (using the amygdala as the region of interest) to identify potential locations of scalp acupuncture/neuromodulation for anxiety. We found that the superior/middle frontal gyrus, middle/superior temporal gyrus, precentral gyrus, supplementary motor area, supramarginal gyrus, angular gyrus, and superior/inferior occipital gyrus are involved in the pathophysiology of anxiety, and, thus, may be used as the target areas of scalp stimulation for alleviating anxiety. Integrating multidisciplinary brain methods to identify key surface cortical areas associated with a certain disorder may shed light on the development of scalp acupuncture/neuromodulation, particularly in the domain of identifying stimulation locations.


menu
Abstract
Full text
Outline
About this article

Identify potential neuroimaging-based scalp acupuncture and neuromodulation targets for anxiety

Show Author's information Jin CaoYiting HuangSierra A. HodgesNathaniel MeshbergJian Kong( )
Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown 02129, MA, USA

Abstract

Anxiety is a common psychiatric symptom with unsatisfactory treatment. Scalp acupuncture is a new type of acupuncture based on the functions of different brain regions. However, recent brain neuroimaging findings have not been well-integrated into scalp acupuncture practice and research since it was developed. In parallel, recently developed brain stimulation methods have also been applied to treat anxiety. In this study, we integrated meta-analysis (using Neurosynth), resting-state functional connectivity, and diffusion tensor imaging (using the amygdala as the region of interest) to identify potential locations of scalp acupuncture/neuromodulation for anxiety. We found that the superior/middle frontal gyrus, middle/superior temporal gyrus, precentral gyrus, supplementary motor area, supramarginal gyrus, angular gyrus, and superior/inferior occipital gyrus are involved in the pathophysiology of anxiety, and, thus, may be used as the target areas of scalp stimulation for alleviating anxiety. Integrating multidisciplinary brain methods to identify key surface cortical areas associated with a certain disorder may shed light on the development of scalp acupuncture/neuromodulation, particularly in the domain of identifying stimulation locations.

Keywords: anxiety, magnetic resonance imaging (MRI), neuroimaging, meta-analysis, scalp acupuncture

References(48)

[1]
Kessler RC, Berglund P, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry 2005, 62(6): 593.
[2]
Ravindran LN, Stein MB. The pharmacologic treatment of anxiety disorders: a review of progress. J Clin Psychiatry 2010, 71(7): 839-854.
[3]
Lu S. Scalp acupuncture therapy and its clinical application. J Tradit Chin Med 1991, 11(4): 272-280.
[4]
He YX, Chen J, Pan ZM, et al. Scalp acupuncture treatment protocol for anxiety disorders: a case report. Glob Adv Health Med 2014, 3(4): 35-39.
[5]
Dong GJ, Cao D, Dong Y, et al. Scalp acupuncture for sleep disorder induced by pre-examination anxiety in undergraduates. World J Acupunct Moxibustion 2018, 28(3): 156-160.
[6]
Dias M, Pagnin D, de Queiroz Pagnin V, et al. Effects of electroacupuncture on stress-related symptoms in medical students: a randomised controlled pilot study. Acupunct Med 2012, 30(2): 89-95.
[7]
Pilkington K. Anxiety, depression and acupuncture: a review of the clinical research. Auton Neurosci 2010, 157(1/2): 91-95.
[8]
Hilbert K, Lueken U, Beesdo-Baum K. Neural structures, functioning and connectivity in Generalized Anxiety Disorder and interaction with neuroendocrine systems: a systematic review. J Affect Disord 2014, 158: 114-126.
[9]
Mochcovitch MD, da Rocha Freire RC, Garcia RF, et al. A systematic review of fMRI studies in generalized anxiety disorder: Evaluating its neural and cognitive basis. J Affect Disord 2014, 167: 336-342.
[10]
Bremner JD. Brain imaging in anxiety disorders. Expert Rev Neurother 2004, 4(2): 275-284.
[11]
Shiozawa P, Leiva AP, Castro CD, et al. Transcranial direct current stimulation for generalized anxiety disorder: a case study. Biol Psychiatry 2014, 75(11): e17-e18.
[12]
Clancy KJ, Baisley SK, Albizu A, et al. Transcranial alternating current stimulation induces long-term augmentation of neural connectivity and sustained anxiety reduction. bioRxiv 2017, .
[13]
Bystritsky A, Kaplan JT, Feusner JD, et al. A preliminary study of fMRI-guided rTMS in the treatment of generalized anxiety disorder. J Clin Psychiatry 2008, 69(7): 1092-1098.
[14]
Diefenbach GJ, Assaf M, Goethe JW, et al. Improvements in emotion regulation following repetitive transcranial magnetic stimulation for generalized anxiety disorder. J Anxiety Disord 2016, 43: 1-7.
[15]
Makovac E, Meeten F, Watson DR, et al. Alterations in amygdala-prefrontal functional connectivity account for excessive worry and autonomic dysregulation in generalized anxiety disorder. Biol Psychiatry 2016, 80(10): 786-795.
[16]
Monk CS, Telzer EH, Mogg K, et al. Amygdala and ventrolateral prefrontal cortex activation to masked angry faces in children and adolescents with generalized anxiety disorder. Arch Gen Psychiatry 2008, 65(5): 568-576.
[17]
Modi S, Kumar M, Kumar P, et al. Aberrant functional connectivity of resting state networks associated with trait anxiety. Psychiatry Res 2015, 234(1): 25-34.
[18]
Yarkoni T, Poldrack RA, Nichols TE, et al. Large-scale automated synthesis of human functional neuroimaging data. Nat Methods 2011, 8(8): 665-670.
[19]
Liu J, Zhang BL, Wilson G, et al. New perspective for non-invasive brain stimulation site selection in mild cognitive impairment: based on meta- and functional connectivity analyses. Front Aging Neurosci 2019, 11: 228.
[20]
Zhang BL, Liu J, Bao TY, et al. Locations for noninvasive brain stimulation in treating depressive disorders: a combination of meta-analysis and resting-state functional connectivity analysis. Aust N Z J Psychiatry 2020, 54(6): 582-590.
[21]
Huang YT, Zhang BL, Cao J, et al. Potential locations for noninvasive brain stimulation in treating autism spectrum disorders-A functional connectivity study. Front Psychiatry 2020, 11: 388.
[22]
Fox MD, Buckner RL, White MP, et al. Efficacy of transcranial magnetic stimulation targets for depression is related to intrinsic functional connectivity with the subgenual cingulate. Biol Psychiatry 2012, 72(7): 595-603.
[23]
Cao J, Huang YT, Meshberg N, et al. Neuroimaging-based scalp acupuncture locations for dementia. J Clin Med 2020, 9(8): 2477.
[24]
Etkin A, Wager TD. Functional neuroimaging of anxiety: a meta-analysis of emotional processing in PTSD, social anxiety disorder, and specific phobia. Am J Psychiatry 2007, 164(10): 1476-1488.
[25]
Phan KL, Fitzgerald DA, Nathan PJ, et al. Association between amygdala hyperactivity to harsh faces and severity of social anxiety in generalized social phobia. Biol Psychiatry 2006, 59(5): 424-429.
[26]
Stein MB, Goldin PR, Sareen J, et al. Increased amygdala activation to angry and contemptuous faces in generalized social phobia. Arch Gen Psychiatry 2002, 59(11): 1027.
[27]
Cutini S, Scatturin P, Zorzi M. A new method based on ICBM152 head surface for probe placement in multichannel fNIRS. Neuroimage 2011, 54(2): 919-927.
[28]
Jung YH, Shin JE, Lee YI, et al. Altered amygdala resting-state functional connectivity and hemispheric asymmetry in patients with social anxiety disorder. Front Psychiatry 2018, 9: 164.
[29]
Dilkov D, Hawken ER, Kaludiev E, et al. Repetitive transcranial magnetic stimulation of the right dorsal lateral prefrontal cortex in the treatment of generalized anxiety disorder: a randomized, double-blind sham controlled clinical trial. Prog Neuropsychopharmacol Biol Psychiatry 2017, 78: 61-65.
[30]
de Bellis MD, Keshavan MS, Shifflett H, et al. Superior temporal gyrus volumes in pediatric generalized anxiety disorder. Biol Psychiatry 2002, 51(7): 553-562.
[31]
Zhao XH, Xi Q, Wang PJ, et al. Altered activity and functional connectivity of superior temporal gyri in anxiety disorders: a functional magnetic resonance imaging study. Korean J Radiol 2014, 15(4): 523-529.
[32]
Besteher B, Gaser C, Langbein K, et al. Effects of subclinical depression, anxiety and somatization on brain structure in healthy subjects. J Affect Disord 2017, 215: 111-117.
[33]
Strawn JR, Wehry AM, Chu WJ, et al. Neuroanatomic abnormalities in adolescents with generalized anxiety disorder: a voxel-based morphometry study. Depress Anxiety 2013, 30(9): 842-848.
[34]
Shang J, Fu YC, Ren ZJ, et al. The common traits of the ACC and PFC in anxiety disorders in the DSM-5: meta-analysis of voxel-based morphometry studies. PLoS One 2014, 9(3): e93432.
[35]
Moon CM, Yang JC, Jeong GW. Explicit verbal memory impairments associated with brain functional deficits and morphological alterations in patients with generalized anxiety disorder. J Affect Disord 2015, 186: 328-336.
[36]
Makovac E, Meeten F, Watson DR, et al. Neurostructural abnormalities associated with axes of emotion dysregulation in generalized anxiety. Neuroimage Clin 2016, 10: 172-181.
[37]
Luu P, Tucker DM, Derryberry D. Anxiety and the motivational basis of working memory. Cogn Ther Res 1998, 22(6): 577-594.
[38]
Lukasik KM, Waris O, Soveri A, et al. The relationship of anxiety and stress with working memory performance in a large non-depressed sample. Front Psychol 2019, 10: 4.
[39]
Cañas A, Juncadella M, Lau R, et al. Working memory deficits after lesions involving the supplementary motor area. Front Psychol 2018, 9: 765.
[40]
Picó-Pérez M, Radua J, Steward T, et al. Emotion regulation in mood and anxiety disorders: a meta-analysis of fMRI cognitive reappraisal studies. Prog Neuropsychopharmacol Biol Psychiatry 2017, 79(Pt B): 96-104.
[41]
Moon CM, Jeong GW. Functional neuroanatomy on the working memory under emotional distraction in patients with generalized anxiety disorder. Psychiatry Clin Neurosci 2015, 69(10): 609-619.
[42]
Coutinho JF, Fernandesl SV, Soares JM, et al. Default mode network dissociation in depressive and anxiety states. Brain Imaging Behav 2016, 10(1): 147-157.
[43]
Stein DJ, Fernandes Medeiros L, Caumo W, et al. Transcranial direct current stimulation in patients with anxiety: current perspectives. Neuropsychiatr Dis Treat 2020, 16: 161-169.
[44]
Clancy KJ, Baisley SK, Albizu A, et al. Lasting connectivity increase and anxiety reduction via transcranial alternating current stimulation. Soc Cogn Affect Neurosci 2018, 13(12): 1305-1316.
[45]
Kar SK, Sarkar S. Neuro-stimulation techniques for the management of anxiety disorders: an update. Clin Psychopharmacol Neurosci 2016, 14(4): 330-337.
[46]
Salatino A, Momo E, Nobili M, et al. Awareness of symptoms amelioration following low-frequency repetitive transcranial magnetic stimulation in a patient with tourette syndrome and comorbid obsessive-compulsive disorder. Brain Stimul 2014, 7(2): 341-343.
[47]
Clemens B, Jung S, Mingoia G, et al. Influence of anodal transcranial direct current stimulation (tDCS) over the right angular gyrus on brain activity during rest. PLoS One 2014, 9(4): e95984.
[48]
Shin LM, Liberzon I. The neurocircuitry of fear, stress, and anxiety disorders. Neuropsychopharmacology 2010, 35(1): 169-191.
Publication history
Copyright
Rights and permissions

Publication history

Received: 25 February 2021
Revised: 20 May 2021
Accepted: 25 May 2021
Published: 05 June 2021
Issue date: June 2021

Copyright

© The authors 2021

Rights and permissions

This article is published with open access at journals.sagepub.com/home/BSA

Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/ en-us/nam/open-access-at-sage).

Return