Scalp acupuncture coupled with speech-language therapy modulates the ventral-dorsal structural brain network in patients with post-stroke anomia: a randomized clinical and DTI neuroimaging trial

Abstract Background Scalp acupuncture (SA) is used as adjunctive rehabilitation for post-stroke aphasia, but its effect on naming recovery and structural language-network changes remains unclear. We evaluated SA coupled with speech-language therapy (SLT) in patients with post-stroke anomia and explored diffusion tensor imaging markers of ventral-dorsal structural language networks. Methods This randomized controlled trial recruited 85 patients with post-stroke anomia and randomly assigned them to SA or control. Both groups received conventional stroke treatment and SLT; the SA group additionally received scalp acupuncture synchronously with SLT during needle retention. Treatment was delivered once daily, 5 days/week for 4 weeks. The primary outcome was WAB naming total score. Diffusion tensor imaging assessed white matter integrity and topological properties before and after treatment. Results Compared to the control group, the SA group showed greater improvements in the WAB naming total score ( P = 0.009), object naming, sentence completion, responsive speech, BNT spontaneous naming, and SAQOL-39 communication. In the ventral-dorsal structural network, the SA group showed smaller changes in the area under the curve (AUC) of small-worldness properties ( P = 0.008) and normalized clustering coefficient ( P = 0.017), and greater changes in clustering coefficient and local efficiency. In the SA group, the change in small-worldness was negatively correlated with the change in the WAB naming total score (r = −0.451, P = 0.027). The SA group also showed smaller axial diffusivity (AD) changes in the left uncinate fasciculus ( P = 0.003, Bonferroni corrected), which correlated negatively with the WAB naming total score change (r = −0.440, P = 0.031). Exploratory adjusted regression showed that SA-group assignment was associated with greater naming improvement after adjustment for baseline naming and clinical covariates. Conclusions SA coupled with SLT was associated with greater naming recovery in patients with post-stroke anomia. The benefit was accompanied by changes in structural language-network topology and white matter integrity, particularly involving the left UF. These findings support further evaluation of scalp acupuncture as an adjunct to language rehabilitation and suggest structural network plasticity as a relevant imaging correlate.