Altered centrality and connectivity in motor networks following Xingnao Kaiqiao acupuncture for acute ischemic stroke: a randomized controlled, exploratory fMRI study

Xingnao Kaiqiao (XNKQ) acupuncture is recommended as an adjunctive intervention for motor dysfunction after acute ischemic stroke (AIS), yet its neuroplastic mechanisms remain unclear. In this randomized, exploratory study, 28 AIS patients were randomly assigned to XNKQ acupuncture plus medication (n = 14) or medication-only (n = 14) to receive 10 sessions of treatment over 14 days. Clinical assessments and resting-state fMRI scanning were conducted before and after the intervention, with brain reorganization analyzed using voxel-wise degree centrality (DC) and seed-based functional connectivity (FC). We found that better recovery in the XNKQ group, reflected by more improvements in NIHSS, total and upper-extremity FMA scores, was correlated with reduced DC in the ipsilesional primary motor cortex (iM1) concurrent with attenuated FC to the contralesional supplementary motor area (cSMA), alongside increased DC in the bilateral SMA and preserved FC between SMA and cerebellar regions. Further exploratory mediation analysis suggested that change in iM1-cSMA FC potentially mediated the relationship between iM1 DC normalization and motor recovery. These preliminary findings suggest that XNKQ acupuncture may facilitate early motor recovery after AIS through normalization of ipsilesional M1 hub centrality and modulation of M1-SMA cross-hemispheric connectivity, providing candidate network markers for acupuncture-associated neuroplasticity.