Presentation summary

1/ Neurodegenerative diseases (NDDs) refer to a group of conditions that affect the survival and function of brainneurons. They primarily manifest as a progressive loss of cognitive and/or motor function. The most common NDDs are Parkinson’s disease (PD) and Alzheimer’s disease (AD), but they also encompass a growing number of diseases such as amyotrophic lateral sclerosis (ALS) and other types of dementia (1).
With population growth and longer life expectancy, the burden of people with NDDs will undoubtedly continueto increase.

Currently, medications are the primary therapeutic strategy for neurodegenerative disorders. However, these therapies present numerous problems, such as poor tolerance, insufficient efficacy, and various side effects.Therefore, other therapeutic strategies must be explored. As an effective traditional Chinese medicine method with few side effects, acupuncture is considered a non-drug therapy. It has been used for many years as a complementary therapy for PD and AD. Among the point stimulation modalities, electroacupuncture (EA) is themost commonly chosen to treat neurological problems.

It is therefore necessary to better understand the mechanisms of action of acupuncture that have been demonstrated to explain its therapeutic benefits in NDDs.
Furthermore, does the use of EA offer a significant advantage given current data?
And what is the current state of the art regarding the clinical application of EA in NDDs?

In this presentation, we attempt to answer these questions by reviewing the scientific literature, both experimental (2) and clinical, on the treatment of NDDs such as PD (3) or AD (4) with EA.

We conclude by highlighting the limitations of current studies and examining avenues for future research. Theultimate goal will be to propose an optimal EA protocol for each of these NDDs.

2/ In EA, the specificity of the acupoint is linked to its capacity to generate a significantly greater quantity of nervous information than a non-point (1). In addition, depending on the electro-stimulation parameters (frequencies, waveform, pulse width) we can preferentially stimulate certain nerve pathways and the specific brain areas that they activate. Finally, recent studies demonstrate that ultrasound guidance of the needle to the fascia present at the acupuncture point allows for optimization of both neuro-stimulation and safety, probably by stimulating the numerous afferents present there.

We are apparently far from the concepts of Traditional Chinese Medicine in choosing the points and how to stimulate them.

However, functional neuroimaging studies allow us to identify brain activation patterns in response to EA. These patterns correspond to brain circuits involved in maintaining and restoring general homeostasis, such as the hypothalamic-pituitary-adrenal axis, the ortho- and parasympathetic regulatory nuclei, or even our emotions (5). Finally, neuroimaging demonstrates that the intensity of this activation is greatest when using traditional methods of point identification (search for deqi) and needle manipulation (twisting/rotation) before initiating EA.

Thus, through its action on the main brain circuits regulating homeostasis, this modern and neurophysiological way of stimulating the acupuncture point that is EA therefore joins the traditional conception of acupuncture by contributing to restoring balance where it is disturbed.