J Neurogastroenterol Motil  
Central and Peripheral Effects of Transcutaneous Acupuncture Treatment for Nausea in Patients with Diabetic Gastroparesis
Irene Sarosiek,1 Gengqing Song1, Yan Sun,1 Hugo Sandoval,2 Stephen Sands,2 Jiande Chen,3 and Richard W McCallum1*
1Department of Internal Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX, USA; 2Center of Excellence of Neuroscience, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX, USA; and 3Division of Gastroenterology and Hepatology, Johns Hopkins Center of Neurogastroenterology, Baltimore, MD, USA
Correspondence to: Richard W McCallum, MD, FACP, FRACP (AUST) FACG, AGAF
Department of Internal Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, 4800 Albert Avenue, El Paso, TX 79905, USA
Tel: +1-915-215-5218 (direct office: +1-915-545-6634), Fax: +1-913-706-6746, E-mail: richard.mccallum@ttuhsc.edu
Received: October 23, 2015; Revised: October 12, 2016; Accepted: October 23, 2016; Published online: February 5, 2017.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

cc This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background/Aims
Nausea, an unpleasant symptom of diabetic gastroparesis (DMGP), has been reported to be alleviated by needleless transcutaneous electrical acupuncture (TEA). Our study was designed to utilize electroencephalography (EEG) and electrogastrography (EGG) recordings to investigate the central and peripheral responses of TEA in the treatment of nausea in DMGP patients.
Methods
Eleven DMGP subjects underwent simultaneous EEG and EGG testing while grading the severity of nausea following 30-minute intervals of: (1) baseline, (2) visual stimulation (VS) to provoke more nausea, (3) active VS together with TEA, and (4) TEA alone, and a final 15-minute recording without any intervention.
Results
The nausea score was increased to 5.9 ± 1.5 with VS (P < 0.05, vs 3.5 ± 1.0 at baseline), then reduced to 3.5 ± 1.2 with VS plus TEA, and to 2.5 ± 1.3 with TEA alone, while it continued at a score of 2.9 ± 1.0 post TEA (all significant, P < 0.05, vs VS without TEA). The mean percentage of normal gastric slow waves was decreased to 60.0 ± 5.7% with VS (P < 0.05, vs 66.6 ± 4.5% at baseline), then improved to 69.2 ± 4.8% with VS plus TEA, and maintained at 70 ± 3.6% with TEA alone. During initial VS, EEG signals showed right inferior frontal activity as the prominent finding, but during VS with TEA, left inferior frontal activity predominated.
Conclusions
In DMGP, TEA improves gastric dysrhythmia and ameliorates nausea. TEA treatment of nausea provoked by VS resulted in a change of dominance from right to left inferior frontal lobe activity. These data provide new understandings of peripheral and central mechanisms for nausea, and future directions for DMGP treatment approaches.
Keywords: Acupuncture, Diabetes, Electroencephalogram, Electrogastrogram, Gastroparesis


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