Epilepsy & Behavior 31 (2014) 387389

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Epilepsy & Behavior

journal homepage: www.elsevier.com/locate/yebeh

Letter to the Editor

The optimal acupoint for acupuncture stimulation as a complementary therapy in pediatric epilepsy extremity acupoints are not tightly linked to the activity of parasympathetic signals. It is well known that vagus nerve stimulation has exhibited an excellent safety prole for epilepsy treatment. Many studies have shown that the auricular branch of the vagus nerve innervates the auricular concha and so provides noninvasive or minimally invasive access to the vagus nerve [47]. These observations suggest stimulation of the ear acupuncture for the treatment of epilepsy. Wang et al. [48] had demonstrated the use of ear acupuncture for preoperative anxiety by placing a needle in the concha, an area innervated by the vagus nerve. Metaphysical theories of auriculotherapy claim that 168 body points on the ear are connected to various body locations. It is more likely that there is only one physiologically active point in the ear, the concha area innervated by the vagus nerve [11,12]. Similar studies had been conducted by other researchers, such as Ouyang et al. [49] in 2002 and Huang et al. [33] in 2005. Based on the direct parasympathetic neuronal circuits existing in the auricular acupoints, and not in the upper extremity acupoints and lower extremity acupoints, it is postulated that the optimal acupoints for acupuncture stimulation in pediatric epilepsy may be the auricular acupoints and not the extremity acupoints. Promising acupoints need to be investigated further.

To the Editor Several lines of evidence have highlighted the success of acupuncture for the treatment of movement disorders and pain [14], given that conventional treatment has signicant limitations. As a treatment that can be individualized and is fully reversible, acupuncture offers potential advantages as a therapy for intractable epilepsy [5-7]. Acupuncture techniques can be classied in two major categories: one is the noninvasive technique, including acupressure [8,9], auricular acupuncture [10,11], and transcutaneous electrical stimulation [1215] and the other is the invasive technique, including needles and electrical acupuncture (a small electrical impulse adding to the needles) [16,17]. In traditional Chinese medicine, thin, solid, metallic needles are often inserted into specic identiable points of the skin and stimulated by manual manipulation [18], moxibustion (i.e., burning a substance called moxa to produce heat, Fig. 1), pressure, and electricity (i.e., to produce a tingling or vibrating sensation by adding a small electrical impulse) [19,20]. Acupuncture needles are stimulated by manual rotation of the needle to evoke needle sensation (De Qi) [5,21,22]. In clinical practice, it has been thought that acupuncture might serve to wash out metabolic end-products by improving blood circulation in muscles [23,24]. Shinbara et al. [25] demonstrated that the effects of manual acupuncture could increase muscle blood ow locally in a dose-dependent manner and that this increase may be caused by local vasodilators, as well as the axon reex. Data provided from clinical trials support the idea that acupuncture may have anticonvulsant effects. However, the optimal acupoint for acupuncture stimulation is not fully understood. It is well known that three main acupoints for stimulation are used: upper extremity acupoints, lower extremity acupoints, and auricular acupoints. Nevertheless, it is still unclear whether upper extremity acupoints, lower extremity acupoints, or auricular acupoints are tightly linked to the benets of spinal stimulation in intractable epilepsy seen in animal models. There are no standard or optimal acupuncture points (acupoints) of the skin, but there are some appropriate acupoints believed to represent concentration of body energies [26,27], and it is apparent that reproducible neurologic and chemical changes occur in response to acupuncture in these acupoints, such as Shen Men (TF2) point [10] (Fig.1), Hegu (LI 4) [2832], Neiguan (PC6) [8,3335], Zusanli (ST36) [15,17,3640], Lanwei (Extra-37) [36,41], Yin-Tang (Extra-1) [42], and San Yin Jiao (SP6) [4345]. Auricular acupuncture has been used for various autonomic disorders in clinical practice, and it has been theorized that different auricular areas have a distinct inuence on autonomic functions [11]. There is no evidence that the parasympathetic nervous system provides any innervations to limb muscles [46], suggesting that the therapeutic effects of acupuncture stimulation in upper and lower
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Fig. 1. Diagrams of the locations of auricular acupuncture points (Shen Men). It is well known that the auricular branch of the vagus nerve innervates the auricular concha and so provides noninvasive or minimally invasive access to the vagus nerve [47]. Wang et al. [48] had demonstrated the use of ear acupuncture (Shen Men) for preoperative anxiety by placing a needle in the concha, an area innervated by the vagus nerve. Metaphysical theories of auriculotherapy claim that 168 body points on the ear are connected to various body locations.

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Conict of interest statement The work is original, and there is no conict of interest to disclose.

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Tao-Tao Liu1 Department of Anesthesiology and Pain Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China

Qing-Qing Guo1 Department of Pain Management, Wuhan Pu'ai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430034, PR China

These authors contributed equally to this work.

Letter to the Editor

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Ke An Department of Anesthesiology, The First Afliated Hospital of Sun Yat-Sen University, Guangzhou 510080, PR China Yi Zhang Xue-Bi Tian Department of Anesthesiology and Pain Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China Rong-Chun Li Department of Pain Management, Wuhan Pu'ai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430034, PR China

Hong-Bing Xiang Department of Anesthesiology and Pain Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China *Corresponding author. Fax: +86 27 83662853. E-mail address: xianghongbing0204@163.com. Peng Wang Department of Anesthesiology and Pain Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China *Corresponding author. Tel.: +86 27 83663173; Fax: +86 27 83662853. E-mail address: chj@medmail.com.cn (P. Wang).

10 October 2013