Acupuncture Improves MRI Brain Microstructure with Postconcussion Symptoms in Mild TBI: A Randomized Controlled Trial

Background Mild traumatic brain injury (mTBI) accounts for 80%-90% of all traumatic brain injury cases, with the heterogeneity of postconcussion syndrome (PCS) limiting effective interventions. With minimal invasiveness and few adverse effects, acupuncture is emerging as a potential treatment option. Purpose To evaluate the efficacy of acupuncture in managing acute PCS symptoms and long-term neurologic impairments. Materials and Methods This prospective, randomized, controlled trial enrolled patients with mTBI from August 2016 to September 2020, and participants were stratified into three groups: verum acupuncture, sham acupuncture, and waiting-list controls. Acupuncture therapy was provided in 14 sessions over 4 weeks. PCS was assessed at baseline, after therapy, and at 6-12-month follow-up. MRI scans were acquired both at baseline and after therapy. Healthy controls were included and scanned twice for comparison. Repeated-measures analysis of variance was performed to assess changes in PCS ratings and imaging metrics. Correlations between imaging metrics and PCS scores were conducted. Results Sixty-six participants (mean age, 41.2 years ± 12.7 [SD]; 32 [48%] male and 34 [52%] female) were included in the study. The PCS score was reduced in the verum acupuncture group (n = 22; -5.2 ± 6.9; P = .002) but not in the sham acupuncture (n = 22; -1.2 ± 6.4) or waiting-list control (n = 22; -1.5 ± 5.0) (both P > .05) groups. After 6-12 months of therapy, a stable effect was observed only in the verum acupuncture group (-8.1 ± 8.6; P < .001). Compared with the waiting-list control group, all participants with mTBI had decreased fractional anisotropy in the right cerebral peduncle, anterior limb of the internal capsule, posterior corona radiata (PCR), and cingulum-hippocampus. Greater improvements in the fractional anisotropy of the right PCR after verum acupuncture were correlated with persistent therapeutic effects of acupuncture at 6-12-month follow-up (r = 0.723; P < .001). Conclusion In this sample of participants with mTBI, acupuncture improved the white matter integrity at MRI, which was associated with relief of long-term postconcussion symptoms. Clinical trial registration no. NCT02868671 Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Narayana in this issue.