Functional Movement Disorder Submission to Complementary and Alternative Medicine Journal

This is my submission in reply to a call for papers to the Complementary and Alternative Medicine Journal concerning functional movement disorder.

Acupuncture and Vagal Tone:  Cervical Dystonia and Intention Tremor

Patients with functional movement disorders have lower vagal tone than controls according to a recent study. Lower vagal tone is associated with worse health outcomes in a variety of conditions[ii] [iii]and   correlates with poor mood, sleep, pain levels, immunity and Self Rated Health[iv]  .  Acupuncture may improve vagal tone over time as measured by HRV[v] [vi]. Furthermore, there is some evidence that an improvement in HRV correlates with clinical improvement[vii].  There are many aspects of HRV to explore in conjunction with Acupuncture treatment from best needling protocols, to most relevant HRV parameters, to related modalities such as transauricular vagal nerve stimulation. Here are two cases examining HRV and clinical outcomes.

Patient 1:  60 y.o. female nurse with disabling cervical dystonia characterized by stiffness, pain, and involuntary “pulling” of her head. Wanting to avoid further Botox injections, she sought Acupuncture treatment. Points were used for vagal enhancement[viii] and TH15 for neck pain.  Though the acupuncture helped her sleep better and improved her overall wellbeing, she still requires periodic Botox injections, thus her clinical improvement is only partial.  Her HRV has dramatically improved over the months of her weekly or biweekly treatments, however. At her session 10/5/2015 overall HF (HRV measure of vagal tone) was .25.  On 05/04/2016 HF was .71.

Patient 2: 75 y.o. female retiree with mild to moderate intention tremor.  Points were chosen for vagal enhancement and local points for hand tremor.  She improved within 6 treatments with her tremor rarely in evidence.  Though the patient has continued treatment for over a year there has been no significant increase in her HF over time as was the case in Patient 1.

These case studies illustrate two clinical outcomes treating movement disorders with Acupuncture but do not support the hypothesis that clinical improvement necessarily correlates with improved HRV. ­

[i] Parkinsonism Relat Disord. 2016 Jun 16. Impaired resting vagal tone in patients with functional movement disorders. Maurer CW1, Liu VD2, LaFaver K3, Ameli R4, Wu T5, Toledo R6,

[ii] Psychosom Med. 2015 May;77(4):346-55.Higher vagal activity as related to survival in patients with advanced breast cancer: an analysis of autonomic dysregulation.Giese-Davis J1, Wilhelm FH, Tamagawa R, Palesh O, et al…

[iii]PLoS One. 2014 Sep 10;9(9)  Relationship between vagal tone, cortisol, TNF-alpha, epinephrine and negative affects in Crohn’s disease and irritable bowel syndrome. Pellissier S1, Dantzer C2, Mondillon L3, Trocme C4 et al…

[iv] PLoS One. 2015; 10(2) Investigating the Associations of Self-Rated Health: Heart Rate Variability Is More Strongly Associated than Inflammatory and Other Frequently Used Biomarkers in a Cross Sectional Occupational Sample

Marc N. Jarczok,1 Marcus E. Kleber,1 Julian Koenig,2,* Adrian Loerbroks,3 et al…

[v] Int J Cardiol. 2014 Sep 20;176(2):367-74. A randomized controlled trial of acupuncture in stable ischemic heart disease patients .Mehta PK1, Polk DM2, Zhang X3, Li N4, et al…

[vi] Med Acupunct. 2014 Oct 1;26(5):286-294.Does Acupuncture Reduce Stress Over Time? A Clinical Heart Rate Variability Study in Hypertensive Patients. Sparrow K1, Golianu B2.

[vii]  Clin J Pain. 2008 Feb;24(2):106-15. Acupuncture in migraine: investigation of autonomic effects Bäcker M, Grossman P, Schneider J, Michalsen A, Knoblauch N, Tan L, Niggemeyer C, Linde K, Melchart D, Dobos GJ 

[viii] Points varied but included PC6, Ht7, St36, Sishencong, Yintang , auricular points