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Szabo E, Ashina S, Melo-Carrillo A, Bolo NR, Borsook D, Burstein R. Peripherally acting anti-CGRP monoclonal antibodies alter cortical gray matter thickness in migraine patients: A prospective cohort study. Neuroimage Clin 2023; 40:103531. [PMID: 37866119 PMCID: PMC10623369 DOI: 10.1016/j.nicl.2023.103531] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 10/24/2023]
Abstract
Migraine is underpinned by central nervous system neuroplastic alterations thought to be caused by the repetitive peripheral afferent barrage the brain receives during the headache phase (cortical hyperexcitability). Calcitonin gene-related peptide monoclonal antibodies (anti-CGRP-mAbs) are highly effective migraine preventative treatments. Their ability to alter brain morphometry in treatment-responders vs. non-responders is not well understood. Our aim was to determine the effects of the anti-CGRP-mAb galcanezumab on cortical thickness after 3-month treatment of patients with high-frequency episodic or chronic migraine. High-resolution magnetic resonance imaging was performed pre- and post-treatment in 36 migraine patients. In this group, 19 patients were classified responders (≥50 % reduction in monthly migraine days) and 17 were considered non-responders (<50 % reduction in monthly migraine days). Following cross-sectional processing to analyze the baseline differences in cortical thickness, two-stage longitudinal processing and symmetrized percent change were conducted to investigate treatment-related brain changes. At baseline, no significant differences were found between the responders and non-responders. After 3-month treatment, decreased cortical thickness (compared to baseline) was observed in the responders in regions of the somatosensory cortex, anterior cingulate cortex, medial frontal cortex, superior frontal gyrus, and supramarginal gyrus. Non-responders demonstrated decreased cortical thickness in the left dorsomedial cortex and superior frontal gyrus. We interpret the cortical thinning seen in the responder group as suggesting that reduction in head pain could lead to changes in neural swelling and dendritic complexity and that such changes reflect the recovery process from maladaptive neural activity. This conclusion is further supported by our recent study showing that 3 months after treatment initiation, the incidence of premonitory symptoms and prodromes that are followed by headache decreases but not the incidence of the premonitory symptoms or prodromes themselves (that is, cortical thinning relates to reductions in the nociceptive signals in the responders). We speculate that a much longer recovery period is required to allow the brain to return to a more 'normal' functioning state whereby prodromes and premonitory symptoms no longer occur.
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Affiliation(s)
- Edina Szabo
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Anaesthesiology, Harvard Medical School, Boston, MA 02215, USA
| | - Sait Ashina
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Anaesthesiology, Harvard Medical School, Boston, MA 02215, USA; Comprehensive Headache Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Agustin Melo-Carrillo
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Anaesthesiology, Harvard Medical School, Boston, MA 02215, USA
| | - Nicolas R Bolo
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - David Borsook
- Department of Anaesthesiology, Harvard Medical School, Boston, MA 02215, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02215, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Anaesthesiology, Harvard Medical School, Boston, MA 02215, USA; Comprehensive Headache Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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Puledda F, Viganò A, Sebastianelli G, Parisi V, Hsiao FJ, Wang SJ, Chen WT, Massimini M, Coppola G. Electrophysiological findings in migraine may reflect abnormal synaptic plasticity mechanisms: A narrative review. Cephalalgia 2023; 43:3331024231195780. [PMID: 37622421 DOI: 10.1177/03331024231195780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
BACKGROUND The cyclical brain disorder of sensory processing accompanying migraine phases lacks an explanatory unified theory. METHODS We searched Pubmed for non-invasive neurophysiological studies on migraine and related conditions using transcranial magnetic stimulation, electroencephalography, visual and somatosensory evoked potentials. We summarized the literature, reviewed methods, and proposed a unified theory for the pathophysiology of electrophysiological abnormalities underlying migraine recurrence. RESULTS All electrophysiological modalities have determined specific changes in brain dynamics across the different phases of the migraine cycle. Transcranial magnetic stimulation studies show unbalanced recruitment of inhibitory and excitatory circuits, more consistently in aura, which ultimately results in a substantially distorted response to neuromodulation protocols. Electroencephalography investigations highlight a steady pattern of reduced alpha and increased slow rhythms, largely located in posterior brain regions, which tends to normalize closer to the attacks. Finally, non-painful evoked potentials suggest dysfunctions in habituation mechanisms of sensory cortices that revert during ictal phases. CONCLUSION Electrophysiology shows dynamic and recurrent functional alterations within the brainstem-thalamus-cortex loop varies continuously and recurrently in migraineurs. Given the central role of these structures in the selection, elaboration, and learning of sensory information, these functional alterations suggest chronic, probably genetically determined dysfunctions of the synaptic short- and long-term learning mechanisms.
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Affiliation(s)
- Francesca Puledda
- Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Gabriele Sebastianelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino ICOT, Latina, Italy
| | | | - Fu-Jung Hsiao
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Ta Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Marcello Massimini
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino ICOT, Latina, Italy
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Vucic S, Stanley Chen KH, Kiernan MC, Hallett M, Benninger DH, Di Lazzaro V, Rossini PM, Benussi A, Berardelli A, Currà A, Krieg SM, Lefaucheur JP, Long Lo Y, Macdonell RA, Massimini M, Rosanova M, Picht T, Stinear CM, Paulus W, Ugawa Y, Ziemann U, Chen R. Clinical diagnostic utility of transcranial magnetic stimulation in neurological disorders. Updated report of an IFCN committee. Clin Neurophysiol 2023; 150:131-175. [PMID: 37068329 PMCID: PMC10192339 DOI: 10.1016/j.clinph.2023.03.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/28/2023] [Accepted: 03/09/2023] [Indexed: 03/31/2023]
Abstract
The review provides a comprehensive update (previous report: Chen R, Cros D, Curra A, Di Lazzaro V, Lefaucheur JP, Magistris MR, et al. The clinical diagnostic utility of transcranial magnetic stimulation: report of an IFCN committee. Clin Neurophysiol 2008;119(3):504-32) on clinical diagnostic utility of transcranial magnetic stimulation (TMS) in neurological diseases. Most TMS measures rely on stimulation of motor cortex and recording of motor evoked potentials. Paired-pulse TMS techniques, incorporating conventional amplitude-based and threshold tracking, have established clinical utility in neurodegenerative, movement, episodic (epilepsy, migraines), chronic pain and functional diseases. Cortical hyperexcitability has emerged as a diagnostic aid in amyotrophic lateral sclerosis. Single-pulse TMS measures are of utility in stroke, and myelopathy even in the absence of radiological changes. Short-latency afferent inhibition, related to central cholinergic transmission, is reduced in Alzheimer's disease. The triple stimulation technique (TST) may enhance diagnostic utility of conventional TMS measures to detect upper motor neuron involvement. The recording of motor evoked potentials can be used to perform functional mapping of the motor cortex or in preoperative assessment of eloquent brain regions before surgical resection of brain tumors. TMS exhibits utility in assessing lumbosacral/cervical nerve root function, especially in demyelinating neuropathies, and may be of utility in localizing the site of facial nerve palsies. TMS measures also have high sensitivity in detecting subclinical corticospinal lesions in multiple sclerosis. Abnormalities in central motor conduction time or TST correlate with motor impairment and disability in MS. Cerebellar stimulation may detect lesions in the cerebellum or cerebello-dentato-thalamo-motor cortical pathways. Combining TMS with electroencephalography, provides a novel method to measure parameters altered in neurological disorders, including cortical excitability, effective connectivity, and response complexity.
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Affiliation(s)
- Steve Vucic
- Brain, Nerve Research Center, The University of Sydney, Sydney, Australia.
| | - Kai-Hsiang Stanley Chen
- Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Matthew C Kiernan
- Brain and Mind Centre, The University of Sydney; and Department of Neurology, Royal Prince Alfred Hospital, Australia
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, Bethesda, Maryland, United States
| | - David H Benninger
- Department of Neurology, University Hospital of Lausanne (CHUV), Switzerland
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Paolo M Rossini
- Department of Neurosci & Neurorehab IRCCS San Raffaele-Rome, Italy
| | - Alberto Benussi
- Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli; Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Currà
- Department of Medico-Surgical Sciences and Biotechnologies, Alfredo Fiorini Hospital, Sapienza University of Rome, Terracina, LT, Italy
| | - Sandro M Krieg
- Department of Neurosurgery, Technical University Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Jean-Pascal Lefaucheur
- Univ Paris Est Creteil, EA4391, ENT, Créteil, France; Clinical Neurophysiology Unit, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Yew Long Lo
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, and Duke-NUS Medical School, Singapore
| | | | - Marcello Massimini
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi di Milano, Milan, Italy; Istituto Di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Mario Rosanova
- Department of Biomedical and Clinical Sciences University of Milan, Milan, Italy
| | - Thomas Picht
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Cluster of Excellence: "Matters of Activity. Image Space Material," Humboldt University, Berlin Simulation and Training Center (BeST), Charité-Universitätsmedizin Berlin, Germany
| | - Cathy M Stinear
- Department of Medicine Waipapa Taumata Rau, University of Auckland, Auckland, Aotearoa, New Zealand
| | - Walter Paulus
- Department of Neurology, Ludwig-Maximilians-Universität München, München, Germany
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Japan
| | - Ulf Ziemann
- Department of Neurology and Stroke, Eberhard Karls University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany; Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Otfried-Müller-Straße 27, 72076 Tübingen, Germany
| | - Robert Chen
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital-UHN, Division of Neurology-University of Toronto, Toronto Canada
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Fischer P, Piña-Fuentes D, Kassavetis P, Sadnicka A. Physiology of dystonia: Human studies. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 169:137-162. [PMID: 37482391 DOI: 10.1016/bs.irn.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
In this chapter, we discuss neurophysiological techniques that have been used in the study of dystonia. We examine traditional disease models such as inhibition and excessive plasticity and review the evidence that these play a causal role in pathophysiology. We then review the evidence for sensory and peripheral influences within pathophysiology and look at an emergent literature that tries to probe how oscillatory brain activity may be linked to dystonia pathophysiology.
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Affiliation(s)
- Petra Fischer
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Biomedical Sciences Building, University Walk, Bristol, United Kingdom
| | - Dan Piña-Fuentes
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, The Netherlands; Department of Neurology, OLVG, Amsterdam, The Netherlands
| | | | - Anna Sadnicka
- Motor Control and Movement Disorders Group, St George's University of London, London, United Kingdom; Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom.
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Mignot C, Faria V, Hummel T, Frost M, Michel CM, Gossrau G, Haehner A. Migraine with aura: less control over pain and fragrances? J Headache Pain 2023; 24:55. [PMID: 37198532 DOI: 10.1186/s10194-023-01592-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/04/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Accumulating data emphasizes the importance of olfaction in migraine pathophysiology. However, there are only a few studies evaluating how the migraine brain processes olfactory stimulation, and virtually no studies comparing patients with and without aura in this context. METHODS This cross-sectional study recorded event-related potentials from 64 electrodes during a pure olfactory or pure trigeminal stimulus in females with episodic migraine with aura (n = 13) and without aura (n = 15), to characterize the central nervous processing of these intranasal stimuli. Patients were tested in interictal state only. Data were analyzed in the time domain and in the time-frequency domain. Source reconstruction analysis was also performed. RESULTS Patients with aura had higher event-related potentials amplitudes for left-sided trigeminal and left-sided olfactory stimulations, and higher neural activity for right-sided trigeminal stimulation in brain areas related to trigeminal and visual processing. Following olfactory stimulations patients with aura displayed decreased neural activity in secondary olfactory structures compared to patients without aura. Oscillations in the low frequency bands (< 8 Hz) differed between patient groups. CONCLUSIONS Altogether this may reflect hypersensitivity to nociceptive stimuli in patients with aura relative to patients without aura. Patients with aura have a bigger deficit in engaging secondary olfactory-related structures, possibly leading to distorted attention and judgements towards odors. The cerebral overlap between trigeminal nociception and olfaction might explain these deficits.
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Affiliation(s)
- Coralie Mignot
- Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Smell & Taste Clinic, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Vanda Faria
- Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Smell & Taste Clinic, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- Department of Psychology, Uppsala University, 752 37, Uppsala, Sweden
- Brain and Eye Pain Imaging Lab, Pain and Affective Neuroscience Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, MA 02115, USA
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, MA 02115, USA
| | - Thomas Hummel
- Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Smell & Taste Clinic, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Marie Frost
- Comprehensive Pain Center, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christoph M Michel
- Department of Basic Neurosciences, University of Geneva, CH-1211, Geneva 4, Switzerland
- CIBM Center for Biomedical Imaging, 1015, Lausanne, Switzerland
| | - Gudrun Gossrau
- Comprehensive Pain Center, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Antje Haehner
- Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Smell & Taste Clinic, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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Coppola G, Ambrosini A. What has neurophysiology revealed about migraine and chronic migraine? HANDBOOK OF CLINICAL NEUROLOGY 2023; 198:117-133. [PMID: 38043957 DOI: 10.1016/b978-0-12-823356-6.00003-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Since the first electroencephalographic recordings obtained by Golla and Winter in 1959, researchers have used a variety of neurophysiological techniques to determine the mechanisms underlying recurrent migraine attacks. Neurophysiological methods have shown that the brain during the interictal phase of an episodic migraine is characterized by a general hyperresponsiveness to sensory stimuli, a malfunction of the monoaminergic brainstem circuits, and by functional alterations of the thalamus and thalamocortical loop. All of these alterations vary plastically during the phases of the migraine cycle and interictally with the days following the attack. Both episodic migraineurs recorded during an attack and chronic migraineurs are characterized by a general increase in the cortical amplitude response to peripheral sensory stimuli; this is an electrophysiological hallmark of a central sensitization process that is further reinforced through medication overuse. Considering the large-scale functional involvement and the main roles played by the brainstem-thalamo-cortical network in selection, elaboration, and learning of relevant sensory information, future research should move from searching for one specific primary site of dysfunction at the macroscopic level, to the chronic, probably genetically determined, molecular dysfunctions at the synaptic level, responsible for short- and long-term learning mechanisms.
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Affiliation(s)
- Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino - I.C.O.T., Latina, Italy
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Sebastianelli G, Abagnale C, Casillo F, Cioffi E, Parisi V, Di Lorenzo C, Serrao M, Porcaro C, Schoenen J, Coppola G. Bimodal sensory integration in migraine: A study of the effect of visual stimulation on somatosensory evoked cortical responses. Cephalalgia 2022; 42:654-662. [PMID: 35166155 DOI: 10.1177/03331024221075073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Merging of sensory information is a crucial process for adapting the behaviour to the environment in all species. It is not known if this multisensory integration might be dysfunctioning interictally in migraine without aura, where sensory stimuli of various modalities are processed abnormally when delivered separately. To investigate this question, we compared the effects of a concomitant visual stimulation on conventional low-frequency somatosensory evoked potentials and embedded high-frequency oscillations between migraine patients and healthy volunteers. METHODS We recorded somatosensory evoked potentials in 19 healthy volunteers and in 19 interictal migraine without aura patients before, during, and 5 min after (T2) simultaneous synchronous pattern-reversal visual stimulation. At each time point, we measured amplitude and habituation of the N20-P25 low-frequency-somatosensory evoked potentials component and maximal peak-to-peak amplitude of early and late bursts of high-frequency oscillations. RESULTS In healthy volunteers, the bimodal stimulation significantly reduced low-frequency-somatosensory evoked potentials habituation and tended to reduce early high-frequency oscillations that reflect thalamocortical activity. By contrast, in migraine without aura patients, bimodal stimulation significantly increased low-frequency-somatosensory evoked potentials habituation and early high-frequency oscillations. At T2, all visual stimulation-induced changes of somatosensory processing had vanished. CONCLUSION These results suggest a malfunctioning multisensory integration process, which could be favoured by an abnormal excitability level of thalamo-cortical loops.
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Affiliation(s)
- Gabriele Sebastianelli
- Sapienza University of Rome Polo Pontino, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
| | - Chiara Abagnale
- Sapienza University of Rome Polo Pontino, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
| | - Francesco Casillo
- Sapienza University of Rome Polo Pontino, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
| | - Ettore Cioffi
- Sapienza University of Rome Polo Pontino, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
| | | | - Cherubino Di Lorenzo
- Sapienza University of Rome Polo Pontino, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
| | - Mariano Serrao
- Sapienza University of Rome Polo Pontino, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
| | - Camillo Porcaro
- Department of Neuroscience and Padova Neuroscience Center (PNC), University of Padova, Padova, Italy.,Institute of Cognitive Sciences and Technologies (ISTC) - National Research Council (CNR), Rome, Italy.,Centre for Human Brain Health and School of Psychology, University of Birmingham, Birmingham, UK
| | - Jean Schoenen
- Headache Research Unit, University Department of Neurology CHR, Citadelle Hospital. University of Liège, Liège, Belgium
| | - Gianluca Coppola
- Sapienza University of Rome Polo Pontino, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
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Diffusion tensor magnetic resonance imaging: is it valuable in the detection of brain microstructural changes in patients having migraine without aura? Pol J Radiol 2021; 86:e548-e556. [PMID: 34820031 PMCID: PMC8607831 DOI: 10.5114/pjr.2021.110645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 08/20/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose The aim of this study is to assess the diagnostic value of diffusion tensor magnetic resonance imaging (MRI) in the detection of brain microstructural changes in patients having migraine without aura. Material and methods Our prospective study included 33 patients having migraine without aura and 15 volunteers with matched age and sex, who underwent brain MRI with diffusion tensor imaging (DTI). The fractional anisotropy (FA) and mean diffusivity (MD) of selected grey and white matter regions on both sides were measured and correlated with the neurological clinical examination. Results Significant differences were detected in MD values in the thalamus, globus pallidus, and hippocampus head on the right side of patients versus controls. Also, significant differences of the FA values were detected in the thalamus, globus pallidus, and hippocampus head on the right side of patients versus controls. Regarding the FA values of the same regions on the left side, a significant difference in the FA value was detected only in the hippocampus head. There was a statistically significant difference in the FA values on both sides of the white matter of the frontal lobes, posterior limbs of the internal capsules, and cerebellar hemispheres in patients compared to controls. There was a statistically significant difference in MD values in the white matter of both frontal lobes, posterior limb of the right internal capsule, and both cerebellar hemispheres in patients compared to controls. Conclusions DTI can detect microstructural changes of the grey and white matter in patients having migraine without aura that could not be detected by conventional MRI.
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Clinical and Neurophysiological Effects of Botulinum Neurotoxin Type A in Chronic Migraine. Toxins (Basel) 2021; 13:toxins13060392. [PMID: 34072379 PMCID: PMC8229748 DOI: 10.3390/toxins13060392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 12/13/2022] Open
Abstract
Chronic pain syndromes present a subversion of both functional and structural nociceptive networks. We used transcranial magnetic stimulation (TMS) to evaluate changes in cortical excitability and plasticity in patients with chronic migraine (CM) treated with botulinum neurotoxin type A (BoNT/A). We enrolled 11 patients with episodic migraine (EM) and 11 affected by CM. Baseline characteristics for both groups were recorded using single- and paired-pulse TMS protocols. The same TMS protocol was repeated in CM patients after four cycles of BoNT/A completed in one year. At baseline, compared with EM patients, patients with CM had a lower threshold in both hemispheres (right hemisphere: 46% ± 7.8 vs. 52% ± 4.28, p = 0.03; left hemisphere: 52% ± 4.28 vs. 53.54% ± 6.58, p = 0.02). In EM, paired-pulse stimulation elicited a physiologically shaped response, whereas in CM, physiological intracortical inhibition (ICI) between 1 and 3 ms intervals was absent at baseline. On the contrary, increasing intracortical facilitation (ICF) was observed for all interstimulus intervals (ISIs). In CM, cortical excitability was partially reduced after BoNT/A treatment, along with a significant decrease observed in MIDAS score (from 20.7 to 9.8; p = 0.008). The lower motor threshold in CM reflects a higher cortical hyperexcitability. The lack of physiological ICI in CM could indicate sensitisation of the trigeminovascular system. Although reduced, this type of response is still observable after treatment, despite a marked clinical improvement. Our study suggests a long-term alteration of cortical plasticity due to chronic pain.
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Impaired short-term visual paired associative plasticity in patients with migraine between attacks. Pain 2021; 162:803-810. [PMID: 33136981 DOI: 10.1097/j.pain.0000000000002085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 09/16/2020] [Indexed: 01/11/2023]
Abstract
ABSTRACT A common experimental neurophysiological method to study synaptic plasticity is pairing activity of somatosensory afferents and motor cortical circuits, so-called paired associative stimulation (PAS). Dysfunctional inhibitory and excitatory PAS mechanisms within the sensorimotor system were described in patients with migraine without aura (MO) between attacks. We have recently observed that the same bidirectional PAS rules also apply to the visual system. Here, we have tested whether dysfunctioning associative plasticity might characterize the visual system of patients with MO. In 14 patients with MO between attacks and in 15 healthy volunteers, we performed a previously validated visual PAS (vPAS) protocol by coupling 90 black-and-white checkerboard reversals with low-frequency transcranial magnetic stimulation pulses over the occipital cortex at 2 interstimulus intervals of -25/+25 ms around the visual-evoked potential (VEP) P1 latency. We recorded VEPs (600 sweeps) before, immediately after, and 10 min after each vPAS session. We analysed VEP N1-P1 amplitude and delayed habituation. Although vPAS-25 significantly enhanced and vPAS + 25 reduced VEP amplitude habituation in healthy volunteers, the same protocols did not significantly change VEP amplitude habituation in MO between attacks. We provide evidence for lack of habituation enhancing and habituation suppressing visual PAS mechanisms within the visual system in interictal migraine. This finding, in combination with those previously obtained studying the sensorimotor system, leads us to argue that migraine disease-related dysrhythmic thalamocortical activity prevents the occurrence of physiological bidirectional synaptic plasticity induced by vPAS.
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Korai SA, Ranieri F, Di Lazzaro V, Papa M, Cirillo G. Neurobiological After-Effects of Low Intensity Transcranial Electric Stimulation of the Human Nervous System: From Basic Mechanisms to Metaplasticity. Front Neurol 2021; 12:587771. [PMID: 33658972 PMCID: PMC7917202 DOI: 10.3389/fneur.2021.587771] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 01/04/2021] [Indexed: 12/19/2022] Open
Abstract
Non-invasive low-intensity transcranial electrical stimulation (tES) of the brain is an evolving field that has brought remarkable attention in the past few decades for its ability to directly modulate specific brain functions. Neurobiological after-effects of tES seems to be related to changes in neuronal and synaptic excitability and plasticity, however mechanisms are still far from being elucidated. We aim to review recent results from in vitro and in vivo studies that highlight molecular and cellular mechanisms of transcranial direct (tDCS) and alternating (tACS) current stimulation. Changes in membrane potential and neural synchronization explain the ongoing and short-lasting effects of tES, while changes induced in existing proteins and new protein synthesis is required for long-lasting plastic changes (LTP/LTD). Glial cells, for decades supporting elements, are now considered constitutive part of the synapse and might contribute to the mechanisms of synaptic plasticity. This review brings into focus the neurobiological mechanisms and after-effects of tDCS and tACS from in vitro and in vivo studies, in both animals and humans, highlighting possible pathways for the development of targeted therapeutic applications.
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Affiliation(s)
- Sohaib Ali Korai
- Division of Human Anatomy - Laboratory of Neuronal Networks, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Federico Ranieri
- Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Vincenzo Di Lazzaro
- Neurology, Neurophysiology and Neurobiology Unit, University Campus Bio-Medico, Rome, Italy
| | - Michele Papa
- Division of Human Anatomy - Laboratory of Neuronal Networks, University of Campania "Luigi Vanvitelli", Naples, Italy.,ISBE Italy, SYSBIO Centre of Systems Biology, Milan, Italy
| | - Giovanni Cirillo
- Division of Human Anatomy - Laboratory of Neuronal Networks, University of Campania "Luigi Vanvitelli", Naples, Italy.,Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Coppola G, Di Lenola D, Abagnale C, Ferrandes F, Sebastianelli G, Casillo F, Di Lorenzo C, Serrao M, Evangelista M, Schoenen J, Pierelli F. Short-latency afferent inhibition and somato-sensory evoked potentials during the migraine cycle: surrogate markers of a cycling cholinergic thalamo-cortical drive? J Headache Pain 2020; 21:34. [PMID: 32299338 PMCID: PMC7164277 DOI: 10.1186/s10194-020-01104-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/07/2020] [Indexed: 12/21/2022] Open
Abstract
Background Short-latency afferent inhibition (SAI) consists of motor cortex inhibition induced by sensory afferents and depends on the excitatory effect of cholinergic thalamocortical projections on inhibitory GABAergic cortical networks. Given the electrophysiological evidence for thalamo-cortical dysrhythmia in migraine, we studied SAI in migraineurs during and between attacks and searched for correlations with somatosensory habituation, thalamocortical activation, and clinical features. Methods SAI was obtained by conditioning the transcranial magnetic stimulation-induced motor evoked potential (MEP) with an electric stimulus on the median nerve at the wrist with random stimulus intervals corresponding to the latency of individual somatosensory evoked potentials (SSEP) N20 plus 2, 4, 6, or 8 ms. We recruited 30 migraine without aura patients, 16 between (MO), 14 during an attack (MI), and 16 healthy volunteers (HV). We calculated the slope of the linear regression between the unconditioned MEP amplitude and the 4-conditioned MEPs as a measure of SAI. We also measured SSEP amplitude habituation, and high-frequency oscillations (HFO) as an index of thalamo-cortical activation. Results Compared to HV, SAI, SSEP habituation and early SSEP HFOs were significantly reduced in MO patients between attacks, but enhanced during an attack. There was a positive correlation between degree of SAI and amplitude of early HFOs in HV, but not in MO or MI. Conclusions The migraine cycle-dependent variations of SAI and SSEP HFOs are further evidence that facilitatory thalamocortical activation (of GABAergic networks in the motor cortex for SAI), likely to be cholinergic, is reduced in migraine between attacks, but increased ictally.
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Affiliation(s)
- Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy.
| | - Davide Di Lenola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | - Chiara Abagnale
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | - Fabio Ferrandes
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | - Gabriele Sebastianelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | - Francesco Casillo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | - Cherubino Di Lorenzo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | - Maurizio Evangelista
- Università Cattolica del Sacro Cuore/CIC, Istituto di Anestesiologia, Rianimazione e Terapia del Dolore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Jean Schoenen
- Headache Research Unit, University Department of Neurology CHR, Citadelle Hospital. University of Liège, Boulevard du Douzième de Ligne 1, 4000, Liège, Belgium
| | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy.,IRCCS - Neuromed, via Atinense, 18, 86077, Pozzilli, IS, Italy
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Plasticity and dystonia: a hypothesis shrouded in variability. Exp Brain Res 2020; 238:1611-1617. [PMID: 32206849 PMCID: PMC7413892 DOI: 10.1007/s00221-020-05773-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/07/2020] [Indexed: 12/19/2022]
Abstract
Studying plasticity mechanisms with Professor John Rothwell was a shared highlight of our careers. In this article, we discuss non-invasive brain stimulation techniques which aim to induce and quantify plasticity, the mechanisms and nature of their inherent variability and use such observations to review the idea that excessive and abnormal plasticity is a pathophysiological substrate of dystonia. We have tried to define the tone of our review by a couple of Professor John Rothwell's many inspiring characteristics; his endless curiosity to refine knowledge and disease models by scientific exploration and his wise yet humble readiness to revise scientific doctrines when the evidence is supportive. We conclude that high variability of response to non-invasive brain stimulation plasticity protocols significantly clouds the interpretation of historical findings in dystonia research. There is an opportunity to wipe the slate clean of assumptions and armed with an informative literature in health, re-evaluate whether excessive plasticity has a causal role in the pathophysiology of dystonia.
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Coppola G, Parisi V, Di Renzo A, Pierelli F. Cortical pain processing in migraine. J Neural Transm (Vienna) 2019; 127:551-566. [DOI: 10.1007/s00702-019-02089-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/28/2019] [Indexed: 12/17/2022]
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Coppola G, Di Lorenzo C, Parisi V, Lisicki M, Serrao M, Pierelli F. Clinical neurophysiology of migraine with aura. J Headache Pain 2019; 20:42. [PMID: 31035929 PMCID: PMC6734510 DOI: 10.1186/s10194-019-0997-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/16/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The purpose of this review is to provide a comprehensive overview of the findings of clinical electrophysiology studies aimed to investigate changes in information processing of migraine with aura patients. MAIN BODY Abnormalities in alpha rhythm power and symmetry, the presence of slowing, and increased information flow in a wide range of frequency bands often characterize the spontaneous EEG activity of MA. Higher grand-average cortical response amplitudes, an increased interhemispheric response asymmetry, and lack of amplitude habituation were less consistently demonstrated in response to any kind of sensory stimulation in MA patients. Studies with single-pulse and repetitive transcranial magnetic stimulation (TMS) have reported abnormal cortical responsivity manifesting as greater motor evoked potential (MEP) amplitude, lower threshold for phosphenes production, and paradoxical effects in response to both depressing or enhancing repetitive TMS methodologies. Studies of the trigeminal system in MA are sparse and the few available showed lack of blink reflex habituation and abnormal findings on SFEMG reflecting subclinical, probably inherited, dysfunctions of neuromuscular transmission. The limited studies that were able to investigate patients during the aura revealed suppression of evoked potentials, desynchronization in extrastriate areas and in the temporal lobe, and large variations in direct current potentials with magnetoelectroencephalography. Contrary to what has been observed in the most common forms of migraine, patients with familial hemiplegic migraine show greater habituation in response to visual and trigeminal stimuli, as well as a higher motor threshold and a lower MEP amplitude than healthy subjects. CONCLUSION Since most of the electrophysiological abnormalities mentioned above were more frequently present and had a greater amplitude in migraine with aura than in migraine without aura, neurophysiological techniques have been shown to be of great help in the search for the pathophysiological basis of migraine aura.
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Affiliation(s)
- Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Corso della Repubblica, 79–04100 Latina, Italy
| | | | | | - Marco Lisicki
- Headache Research Unit, University of Liège, Department of Neurology-Citadelle Hospital, Boulevard du Douzième de Ligne, 1-400 Liège, Belgium
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Corso della Repubblica, 79–04100 Latina, Italy
| | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Corso della Repubblica, 79–04100 Latina, Italy
- IRCCS – Neuromed, Via Atinense, 18-86077 Pozzilli, (IS) Italy
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Szabó N, Faragó P, Király A, Veréb D, Csete G, Tóth E, Kocsis K, Kincses B, Tuka B, Párdutz Á, Szok D, Tajti J, Vécsei L, Kincses ZT. Evidence for Plastic Processes in Migraine with Aura: A Diffusion Weighted MRI Study. Front Neuroanat 2018; 11:138. [PMID: 29387002 PMCID: PMC5776127 DOI: 10.3389/fnana.2017.00138] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 12/26/2017] [Indexed: 01/03/2023] Open
Abstract
Background: Formerly white matter abnormalities in a mixed group of migraine patients with and without aura were shown. Here, we aimed to explore white matter alterations in a homogeneous group of migraineurs with aura and to delineate possible relationships between white matter changes and clinical variables. Methods: Eighteen patients with aura, 25 migraine patients without aura and 28 controls were scanned on a 1.5T MRI scanner. Diffusivity parameters of the white matter were estimated and compared between patients’ groups and controls using whole-brain tract-based spatial statistics. Results: Decreased radial diffusivity (p < 0.036) was found bilaterally in the parieto-occipital white matter, the corpus callosum, and the cingular white matter of migraine with aura (MwA) patients compared to controls. Migraine without aura (MwoA) patients showed no alteration compared to controls. MwA compared to MwoA showed increased fractional anisotropy (p < 0.048) in the left parieto-occipital white matter. In MwA a negative correlation was found between axial diffusivity and disease duration in the left superior longitudinal fascicle (left parieto-occipital region) and in the left corticospinal tract (p < 0.036) and with the number of the attacks in the right superior longitudinal fascicle (p < 0.048). Conclusion: We showed for the first time that there are white matter microstructural differences between these two subgroups of migraine and hence it is important to handle the two groups separately in further researches. We propose that degenerative and maladaptive plastic changes coexist in the disease and the diffusion profile is a result of these processes.
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Affiliation(s)
- Nikoletta Szabó
- Neuroimaging Research Group, Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.,Central European Institute of Technology, Brno, Czechia
| | - Péter Faragó
- Neuroimaging Research Group, Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.,Central European Institute of Technology, Brno, Czechia
| | - András Király
- Neuroimaging Research Group, Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.,Central European Institute of Technology, Brno, Czechia
| | - Dániel Veréb
- Neuroimaging Research Group, Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Gergő Csete
- Neuroimaging Research Group, Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Eszter Tóth
- Neuroimaging Research Group, Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Krisztián Kocsis
- Neuroimaging Research Group, Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Bálint Kincses
- Neuroimaging Research Group, Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | | | - Árpád Párdutz
- Neuroimaging Research Group, Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Délia Szok
- Neuroimaging Research Group, Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - János Tajti
- Neuroimaging Research Group, Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - László Vécsei
- Neuroimaging Research Group, Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.,MTA-SZTE Neuroscience Research Group, Szeged, Hungary
| | - Zsigmond T Kincses
- Neuroimaging Research Group, Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
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Nyholt DR, Borsook D, Griffiths LR. Migrainomics — identifying brain and genetic markers of migraine. Nat Rev Neurol 2017; 13:725-741. [DOI: 10.1038/nrneurol.2017.151] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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18
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Suppa A, Quartarone A, Siebner H, Chen R, Di Lazzaro V, Del Giudice P, Paulus W, Rothwell J, Ziemann U, Classen J. The associative brain at work: Evidence from paired associative stimulation studies in humans. Clin Neurophysiol 2017; 128:2140-2164. [DOI: 10.1016/j.clinph.2017.08.003] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/20/2017] [Accepted: 08/03/2017] [Indexed: 12/25/2022]
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The sensorimotor network dysfunction in migraineurs without aura: a resting-state fMRI study. J Neurol 2017; 264:654-663. [PMID: 28154971 DOI: 10.1007/s00415-017-8404-4] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 01/13/2017] [Accepted: 01/23/2017] [Indexed: 01/03/2023]
Abstract
Migraine is a common recurrent neurological disorder combining nausea, vomiting, and hypersensitivities to visual, auditory, olfactory and somatosensory stimuli. However, the dysfunction of the sensorimotor network in migraineurs has not been well clarified. In the present study, we evaluated the dysfunction of the sensorimotor network in 30 migraineurs without aura and in 31 controls by combining regional homogeneity (ReHo), amplitudes of low-frequency fluctuation (ALFF) and degree centrality (DC) analysis methods based on resting-state fMRI. A seed-based functional connectivity (FC) analysis was used to investigate whether the dysfunctional areas within the sensorimotor network exhibited abnormal FC with other brain areas. Compared to the controls, the migraineurs without aura exhibited significantly smaller ReHo, ALFF and DC values in the primary somatosensory cortex (S1) and right premotor cortex (PMC). The migraineurs showed weaker FC between the S1 and brain areas within the pain intensity and spatial discrimination pathways and trigemino-thalamo-cortical nociceptive pathway. We proposed that the dysfunction of the S1 and PMC and the decreased FC between the S1 and brain areas in migraineurs without aura may disrupt the discrimination of sensory features of pain and affect nociception pathways, and would be involved in the dysfunctional mechanism in migraine.
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Faragó P, Tuka B, Tóth E, Szabó N, Király A, Csete G, Szok D, Tajti J, Párdutz Á, Vécsei L, Kincses ZT. Interictal brain activity differs in migraine with and without aura: resting state fMRI study. J Headache Pain 2017; 18:8. [PMID: 28124204 PMCID: PMC5267588 DOI: 10.1186/s10194-016-0716-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/20/2016] [Indexed: 01/03/2023] Open
Abstract
Background Migraine is one of the most severe primary headache disorders. The nature of the headache and the associated symptoms during the attack suggest underlying functional alterations in the brain. In this study, we examined amplitude, the resting state fMRI fluctuation in migraineurs with and without aura (MWA, MWoA respectively) and healthy controls. Methods Resting state functional MRI images and T1 high-resolution images were acquired from all participants. For data analysis we compared the groups (MWA-Control, MWA-MWoA, MWoA-Control). The resting state networks were identified by MELODIC. The mean time courses of the networks were identified for each participant for all networks. The time-courses were decomposed into five frequency bands by discrete wavelet decomposition. The amplitude of the frequency-specific activity was compared between groups. Furthermore, the preprocessed resting state images were decomposed by wavelet analysis into five specific frequency bands voxel-wise. The voxel-wise amplitudes were compared between groups by non-parametric permutation test. Results In the MWA-Control comparison the discrete wavelet decomposition found alterations in the lateral visual network. Higher activity was measured in the MWA group in the highest frequency band (0.16–0.08 Hz). In case of the MWA-MWoA comparison all networks showed higher activity in the 0.08–0.04 Hz frequency range in MWA, and the lateral visual network in in higher frequencies. In MWoA-Control comparison only the default mode network revealed decreased activity in MWoA group in the 0.08–0.04 Hz band. The voxel-wise frequency specific analysis of the amplitudes found higher amplitudes in MWA as compared to MWoA in the in fronto-parietal regions, anterior cingulate cortex and cerebellum. Discussion The amplitude of the resting state fMRI activity fluctuation is higher in MWA than in MWoA. These results are in concordance with former studies, which found cortical hyperexcitability in MWA.
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Affiliation(s)
- Péter Faragó
- Department of Neurology, Neuroimaging Research Group, Albert Szent-Györgyi, Clinical Center, University of Szeged, Semmelweis u. 6, H-6725, Szeged, Hungary
| | - Bernadett Tuka
- Department of Neurology, Neuroimaging Research Group, Albert Szent-Györgyi, Clinical Center, University of Szeged, Semmelweis u. 6, H-6725, Szeged, Hungary.,MTA-SZTE Neuroscience Research Group, Szeged, Hungary
| | - Eszter Tóth
- Department of Neurology, Neuroimaging Research Group, Albert Szent-Györgyi, Clinical Center, University of Szeged, Semmelweis u. 6, H-6725, Szeged, Hungary
| | - Nikoletta Szabó
- Department of Neurology, Neuroimaging Research Group, Albert Szent-Györgyi, Clinical Center, University of Szeged, Semmelweis u. 6, H-6725, Szeged, Hungary.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - András Király
- Department of Neurology, Neuroimaging Research Group, Albert Szent-Györgyi, Clinical Center, University of Szeged, Semmelweis u. 6, H-6725, Szeged, Hungary
| | - Gergő Csete
- Department of Neurology, Neuroimaging Research Group, Albert Szent-Györgyi, Clinical Center, University of Szeged, Semmelweis u. 6, H-6725, Szeged, Hungary
| | - Délia Szok
- Department of Neurology, Neuroimaging Research Group, Albert Szent-Györgyi, Clinical Center, University of Szeged, Semmelweis u. 6, H-6725, Szeged, Hungary
| | - János Tajti
- Department of Neurology, Neuroimaging Research Group, Albert Szent-Györgyi, Clinical Center, University of Szeged, Semmelweis u. 6, H-6725, Szeged, Hungary
| | - Árpád Párdutz
- Department of Neurology, Neuroimaging Research Group, Albert Szent-Györgyi, Clinical Center, University of Szeged, Semmelweis u. 6, H-6725, Szeged, Hungary
| | - László Vécsei
- Department of Neurology, Neuroimaging Research Group, Albert Szent-Györgyi, Clinical Center, University of Szeged, Semmelweis u. 6, H-6725, Szeged, Hungary.,MTA-SZTE Neuroscience Research Group, Szeged, Hungary
| | - Zsigmond Tamás Kincses
- Department of Neurology, Neuroimaging Research Group, Albert Szent-Györgyi, Clinical Center, University of Szeged, Semmelweis u. 6, H-6725, Szeged, Hungary. .,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.
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Cortese F, Coppola G, Di Lenola D, Serrao M, Di Lorenzo C, Parisi V, Pierelli F. Excitability of the motor cortex in patients with migraine changes with the time elapsed from the last attack. J Headache Pain 2017; 18:2. [PMID: 28063106 PMCID: PMC5218956 DOI: 10.1186/s10194-016-0712-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/09/2016] [Indexed: 12/03/2022] Open
Abstract
Background Motor-evoked potentials (MEPs) produced by single-pulse transcranial magnetic stimulation (TMS) of the motor cortex can be an objective measure of cortical excitability. Previously, MEP thresholds were found to be normal, increased, or even reduced in patients with migraine. In the present study, we determined whether the level of cortical excitability changes with the time interval from the last migraine attack, thereby accounting for the inconsistencies in previous reports. Methods Twenty-six patients with untreated migraine without aura (MO) underwent a MEP study between attacks. Their data were then compared to the MEP data collected from a group of 24 healthy volunteers (HVs). During the experiment, the TMS figure-of-eight coil was positioned over the left motor area. After identifying the resting motor threshold (RMT), we delivered 10 single TMS pulses (rate: 0.1 Hz, intensity: 120% of the RMT) and averaged the resulting MEP amplitudes. Results The mean RMTs and MEP amplitudes were not significantly different between the MO and HV groups. In patients with MO, the RMTs were negatively correlated with the number of days elapsed since the last migraine attack (rho = -0.404, p = 0.04). Conclusion Our results suggest that the threshold for evoking MEPs is influenced by the proximity of an attack; specifically, the threshold is lower when a long time interval has passed after an attack, and is higher (within the range of normative values) when measured close to an attack. These dynamic RMT variations resemble those we reported previously for visual and somatosensory evoked potentials and may represent time-dependent plastic changes in brain excitability in relation to the migraine cycle.
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Affiliation(s)
- Francesca Cortese
- Department of Medico-Surgical Sciences and Biotechnologies, 'Sapienza' University of Rome Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy.
| | - Gianluca Coppola
- G. B. Bietti Foundation IRCCS, Research Unit of Neurophysiology of Vision and Neuro-Ophthalmology, Rome, Italy
| | - Davide Di Lenola
- Department of Medico-Surgical Sciences and Biotechnologies, 'Sapienza' University of Rome Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, 'Sapienza' University of Rome Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | | | - Vincenzo Parisi
- G. B. Bietti Foundation IRCCS, Research Unit of Neurophysiology of Vision and Neuro-Ophthalmology, Rome, Italy
| | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, 'Sapienza' University of Rome Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy.,INM Neuromed IRCCS, Pozzilli, (IS), Italy
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Parker RS, Lewis GN, Rice DA, McNair PJ. Is Motor Cortical Excitability Altered in People with Chronic Pain? A Systematic Review and Meta-Analysis. Brain Stimul 2016; 9:488-500. [DOI: 10.1016/j.brs.2016.03.020] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 03/02/2016] [Accepted: 03/30/2016] [Indexed: 01/18/2023] Open
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Cosentino G, Brighina F, Talamanca S, Paladino P, Vigneri S, Baschi R, Indovino S, Maccora S, Alfonsi E, Fierro B. Reduced threshold for inhibitory homeostatic responses in migraine motor cortex? A tDCS/TMS study. Headache 2016; 54:663-74. [PMID: 24822247 DOI: 10.1111/head.12249] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Neurophysiological studies in migraine have reported conflicting findings of either cortical hyper- or hypoexcitability. In migraine with aura (MwA) patients, we recently documented an inhibitory response to suprathreshold, high-frequency repetitive transcranial magnetic stimulation (hf-rTMS) trains applied to the primary motor cortex, which is in contrast with the facilitatory response observed in the healthy subjects. The aim of the present study was to support the hypothesis that in migraine, because of a condition of basal increased cortical responsivity, inhibitory homeostatic like mechanisms of cortical excitability could be induced by high magnitude stimulation. For this purpose, the hf-rTMS trains were preconditioned by transcranial direct current stimulation (tDCS), a noninvasive brain stimulation technique able to modulate the cortical excitability state. METHODS Twenty-two MwA patients and 20 patients with migraine without aura (MwoA) underwent trains of 5-Hz repetitive transcranial magnetic stimulation at an intensity of 130% of the resting motor threshold, both at baseline and after conditioning by 15 minutes of cathodal or anodal tDCS. Motor cortical responses to the hf-rTMS trains were compared with those of 14 healthy subjects. RESULTS We observed abnormal inhibitory responses to the hf-rTMS trains given at baseline in both MwA and MwoA patients as compared with the healthy subjects (P < .00001).The main result of the study was that cathodal tDCS, which reduces the cortical excitability level, but not anodal tDCS, which increases it, restored the normal facilitatory response to the hf-rTMS trains in both MwA and MwoA. CONCLUSIONS The present findings strengthen the notion that, in migraine with and without aura, the threshold for inducing inhibitory mechanisms of cortical excitability might be lower in the interictal period. This could represent a protective mechanism counteracting cortical hyperresponsivity. Our results could be helpful to explain some conflicting neurophysiological findings in migraine and to get insight into the mechanisms underlying recurrence of the migraine attacks.
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Maleki N, Barmettler G, Moulton EA, Scrivani S, Veggeberg R, Spierings ELH, Burstein R, Becerra L, Borsook D. Female migraineurs show lack of insular thinning with age. Pain 2016; 156:1232-1239. [PMID: 25775358 DOI: 10.1097/j.pain.0000000000000159] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Gray matter loss in cortical regions is a normal ageing process for the healthy brain. There have been few studies on the process of ageing of the brain in chronic neurological disorders. In this study, we evaluated changes in the cortical thickness by age in 92 female subjects (46 patients with migraine and 46 healthy controls) using high-field magnetic resonance imaging. The results indicate that in contrast to healthy subjects, migraineurs show a lack of thinning in the insula by age. The functional significance of the lack of thinning is unknown, but it may contribute to the overall cortical hyperexcitability of the migraine brain because the region is tightly involved in a number of major brain networks involved in interoception, salience, nociception, and autonomic function, including the default mode network.
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Affiliation(s)
- Nasim Maleki
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA Center for Pain and the Brain and PAIN Group, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA Department of Psychiatry, PAIN Group, Brain Imaging Center, McLean Hospital, Harvard Medical School, Belmont, MA, USA Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Xiang J, Leiken K, Degrauw X, Kay B, Fujiwara H, Rose DF, Allen JR, Kacperski JE, O'Brien HL, Kabbouche MA, Powers SW, Hershey AD. Spatial Heterogeneity of Cortical Excitability in Migraine Revealed by Multifrequency Neuromagnetic Signals. THE JOURNAL OF PAIN 2016; 17:694-706. [PMID: 26970516 DOI: 10.1016/j.jpain.2016.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 12/23/2015] [Accepted: 02/11/2016] [Indexed: 01/03/2023]
Abstract
UNLABELLED To investigate the spatial heterogeneity of cortical excitability in adolescents with migraine, magnetoencephalography (MEG) recordings at a sampling rate of 6,000 Hz were obtained from 35 adolescents with an acute migraine and 35 age- and sex-matched healthy control participants during an auditory-motor task. Neuromagnetic activation from low- to high-frequency ranges (5-1,000 Hz) was measured at sensor and source levels. The heterogeneity of cortical excitability was quantified within each functional modality (auditory vs motor) and hemispherical lateralization. MEG data showed that high-frequency, not low-frequency neuromagnetic signals, showed heterogeneous cortical activation in migraine subjects compared with control participants (P < .001). The alteration of the heterogeneity of cortical excitability in migraine subjects was independent of age and sex. The degree of the neuromagnetic heterogeneity of cortical activation was significantly correlated with headache frequency (r = .71, P < .005). The alteration of cortical excitability in migraine subjects was spatially heterogeneous and frequency dependent, which previously has not been reported. The finding may be critical for developing spatially targeted therapeutic strategies for normalizing cortical excitability with the purpose of reducing headache attacks. PERSPECTIVE This article presents a new approach to quantitatively measure the spatial heterogeneity of cortical excitability in adolescents with migraine using MEG signals in a frequency range of 5 to 1,000 Hz. The characteristics of the location and degree of cortical excitability may be critical for spatially targeted treatment for migraine.
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Affiliation(s)
- Jing Xiang
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio.
| | - Kimberly Leiken
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Xinyao Degrauw
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Benjamin Kay
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Hisako Fujiwara
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Douglas F Rose
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Janelle R Allen
- MEG Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joanne E Kacperski
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Hope L O'Brien
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Marielle A Kabbouche
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Scott W Powers
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio; MEG Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Andrew D Hershey
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
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Zhang Y, Li KS, Liu HW, Fu CH, Chen S, Tan ZJ, Ren Y. Acupuncture treatment modulates the resting-state functional connectivity of brain regions in migraine patients without aura. Chin J Integr Med 2015; 22:293-301. [PMID: 25847772 DOI: 10.1007/s11655-015-2042-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the modulatory effect of acupuncture treatment on the resting-state functional connectivity of brain regions in migraine without aura (MWoA) patients. METHODS Twelve MWoA patients were treated with standard acupuncture treatment for 4 weeks. All MWoA patients received resting-state functional magnetic resonance imaging (fMRI) scanning before and after acupuncture treatment. Another 12 normal subjects matched in age and gender were recruited to serve as healthy controls. The changes of restingstate functional connectivity in MWoA patients before and after the acupuncture treatment and those with the healthy controls were compared. RESULTS Before acupuncture treatment, the MWoA patients had significantly decreased functional connectivity in certain brain regions within the frontal and temporal lobe when compared with the healthy controls. After acupuncture treatment, brain regions showing decreased functional connectivity revealed significant reduction in MWoA patients compared with before acupuncture treatment. CONCLUSIONS Acupuncture treatment could increase the functional connectivity of brain regions in the intrinsic decreased brain networks in MWoA patients. The results provided further insights into the interpretation of neural mechanisms of acupuncture treatment for migraine.
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Affiliation(s)
- Yong Zhang
- Department of Neurology and Stroke Center, Dongzhimen Hospital, the First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Kuang-shi Li
- Department of Neurology and Stroke Center, Dongzhimen Hospital, the First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Hong-wei Liu
- Department of Neurology and Stroke Center, Dongzhimen Hospital, the First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Cai-hong Fu
- Department of Neurology and Stroke Center, Dongzhimen Hospital, the First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Sheng Chen
- Department of Acupuncture, Dongzhimen Hospital, the First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Zhong-jian Tan
- Department of Magnetic Resonance Imaging, Dongzhimen Hospital, the First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Yi Ren
- Department of Neurology and Stroke Center, Dongzhimen Hospital, the First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100700, China.
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Coppola G, Di Renzo A, Tinelli E, Iacovelli E, Lepre C, Di Lorenzo C, Di Lorenzo G, Di Lenola D, Parisi V, Serrao M, Pauri F, Fiermonte G, Bianco F, Pierelli F. Evidence for brain morphometric changes during the migraine cycle: a magnetic resonance-based morphometry study. Cephalalgia 2014; 35:783-91. [PMID: 25414472 DOI: 10.1177/0333102414559732] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 10/15/2014] [Indexed: 01/09/2023]
Abstract
Neurophysiological investigations have demonstrated that there are unique fluctuations in the migraine brain functional activity between the ictal and interictal periods. Here we investigated the possibility that there are fluctuations over time also in whole brain morphometry of patients affected by episodic migraine without aura (MO).Twenty-four patients with untreated MO underwent 3T MRI scans during (n = 10) or between attacks (n = 14) and were compared to a group of 15 healthy volunteers (HVs). We then performed voxel-based-morphometry (VBM) analysis of structural T1-weighted MRI scans to determine if changes in brain structure were observed over the course of the migraine cycle.Interictally, MO patients had a significantly lower gray matter (GM) density within the right inferior parietal lobule, right temporal inferior gyrus, right superior temporal gyrus, and left temporal pole than did HVs. Ictally, GM density increased within the left temporal pole, bilateral insula, and right lenticular nuclei, but no areas exhibited decreased GM density.These morphometric GM changes between ictal and interictal phases suggest that abnormal structural plasticity may be an important mechanism of migraine pathology. Given the functional neuroanatomy of these areas, our findings suggest that migraine is a condition associated with global dysfunction of multisensory integration and memory processing.
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Affiliation(s)
- Gianluca Coppola
- G.B. Bietti Foundation IRCCS, Department of Neurophysiology of Vision and Neurophthalmology, Italy
| | - Antonio Di Renzo
- G.B. Bietti Foundation IRCCS, Department of Neurophysiology of Vision and Neurophthalmology, Italy
| | - Emanuele Tinelli
- "Sapienza" University of Rome, Department of Neurology and Psychiatry, Neuroradiology Section, Italy
| | - Elisa Iacovelli
- "Sapienza" University of Rome, Department of Medico-Surgical Sciences and Biotechnologies, Neurology Section, Italy
| | - Chiara Lepre
- "Sapienza" University of Rome, Department of Medico-Surgical Sciences and Biotechnologies, Neurology Section, Italy
| | | | - Giorgio Di Lorenzo
- University of Rome "Tor Vergata," Laboratory of Psychophysiology, Psychiatric Clinic, Department of Systems Medicine, Italy
| | - Davide Di Lenola
- "Sapienza" University of Rome Polo Pontino, Department of Medico-Surgical Sciences and Biotechnologies, Italy
| | - Vincenzo Parisi
- G.B. Bietti Foundation IRCCS, Department of Neurophysiology of Vision and Neurophthalmology, Italy
| | - Mariano Serrao
- "Sapienza" University of Rome Polo Pontino, Department of Medico-Surgical Sciences and Biotechnologies, Italy
| | - Flavia Pauri
- "Sapienza" University of Rome, Department of Medico-Surgical Sciences and Biotechnologies, Neurology Section, Italy
| | - Giancarlo Fiermonte
- "Sapienza" University of Rome, Department of Medico-Surgical Sciences and Biotechnologies, Neurology Section, Italy
| | - Federico Bianco
- "Sapienza" University of Rome, Department of Medico-Surgical Sciences and Biotechnologies, Neurology Section, Italy
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Sadnicka A, Hamada M, Bhatia KP, Rothwell JC, Edwards MJ. A reflection on plasticity research in writing dystonia. Mov Disord 2014; 29:980-7. [DOI: 10.1002/mds.25908] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 03/21/2014] [Accepted: 04/11/2014] [Indexed: 12/24/2022] Open
Affiliation(s)
- Anna Sadnicka
- Sobell Department of Motor Neuroscience and Movement Disorders; University College London; London UK
| | - Masashi Hamada
- Sobell Department of Motor Neuroscience and Movement Disorders; University College London; London UK
- Department of Neurology; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Kailash P. Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders; University College London; London UK
| | - John C. Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders; University College London; London UK
| | - Mark J. Edwards
- Sobell Department of Motor Neuroscience and Movement Disorders; University College London; London UK
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Abstract
Metaplasticity refers to the modification of plasticity induction (direction, magnitude, duration) by previous activity of the same postsynaptic neuron or neuronal network. In recent years evidence from animal studies has been accumulated that metaplasticity significantly contributes to network function and behavior. Here, we review the evidence for metaplasticity at the system level of the human cortex as investigated by non-invasive brain stimulation. These studies support the notion that metaplasticity is also operative in the human brain and is mostly homeostatic in nature, that is, keeping network activity within a physiological range. However, non-homeostatic metaplasticity has also been described, which can increase non-invasive brain stimulation-induced aftereffects on cortical excitability, or learning. Current evidence further suggests that aberrant metaplasticity may underlie some neurological and psychiatric diseases. Finally, first proof-of-principle studies show that the concept of metaplasticity can be harnessed for treatment of patients suffering from brain diseases.
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Affiliation(s)
| | - Ulf Ziemann
- Department of Neurology and Stroke, Eberhard-Karls University Tübingen, Tübingen, Germany
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Brighina F, Cosentino G, Vigneri S, Fierro B. Letter to the Editor. Pain 2014; 155:643-644. [DOI: 10.1016/j.pain.2013.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 11/15/2013] [Accepted: 11/19/2013] [Indexed: 11/15/2022]
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de Tommaso M, Ambrosini A, Brighina F, Coppola G, Perrotta A, Pierelli F, Sandrini G, Valeriani M, Marinazzo D, Stramaglia S, Schoenen J. Altered processing of sensory stimuli in patients with migraine. Nat Rev Neurol 2014; 10:144-55. [PMID: 24535465 DOI: 10.1038/nrneurol.2014.14] [Citation(s) in RCA: 209] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Migraine is a cyclic disorder, in which functional and morphological brain changes fluctuate over time, culminating periodically in an attack. In the migrainous brain, temporal processing of external stimuli and sequential recruitment of neuronal networks are often dysfunctional. These changes reflect complex CNS dysfunction patterns. Assessment of multimodal evoked potentials and nociceptive reflex responses can reveal altered patterns of the brain's electrophysiological activity, thereby aiding our understanding of the pathophysiology of migraine. In this Review, we summarize the most important findings on temporal processing of evoked and reflex responses in migraine. Considering these data, we propose that thalamocortical dysrhythmia may be responsible for the altered synchronicity in migraine. To test this hypothesis in future research, electrophysiological recordings should be combined with neuroimaging studies so that the temporal patterns of sensory processing in patients with migraine can be correlated with the accompanying anatomical and functional changes.
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Affiliation(s)
| | - Anna Ambrosini
- Headache Clinic, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Via Atinense 18, Pozzilli, 86077 Isernia, Italy
| | | | | | - Armando Perrotta
- Headache Clinic, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Via Atinense 18, Pozzilli, 86077 Isernia, Italy
| | - Francesco Pierelli
- Headache Clinic, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Via Atinense 18, Pozzilli, 86077 Isernia, Italy
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Pierelli F, Iacovelli E, Bracaglia M, Serrao M, Coppola G. Response to letter to the editor. Pain 2013; 155:644-645. [PMID: 24333950 DOI: 10.1016/j.pain.2013.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 12/09/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Francesco Pierelli
- IRCCS Neuromed, Pozzilli (IS), Italy "Sapienza" University of Rome, Department of Medico-surgical Sciences and Biotechnologies, Neurology Section, Rome, Italy "Sapienza" University of Rome, Department of Medico-surgical Sciences and Biotechnologies, Latina, Italy G.B. Bietti Foundation-IRCCS, Department of Neurophysiology of Vision and Neurophthalmology, Rome, Italy
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Restuccia D, Vollono C, Virdis D, Piero ID, Martucci L, Zanini S. Patterns of habituation and clinical fluctuations in migraine. Cephalalgia 2013; 34:201-10. [DOI: 10.1177/0333102413508241] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Habituation deficit, suggesting a deregulation of cortical excitability, represents a typical hallmark of interictal stages of migraine. We previously demonstrated that several neurophysiological markers of altered cortical excitability are significantly correlated to spontaneous clinical fluctuations of migraine. We therefore aimed at verifying whether clinical fluctuations are correlated to specific patterns of somatosensory evoked potential (SEP) habituation. Methods We analyzed habituation after median nerve stimulation of both high-frequency oscillations (HFOs) and N20 SEP in 25 migraine patients and 18 healthy volunteers. Subjects underwent six consecutive series of 500 stimuli. Results Migraine patients as a whole showed a significant habituation deficit of the N20 response. Moreover, spontaneously worsening patients show a clear potentiation of this wave in the last block of stimuli, whereas in spontaneously improving patients the N20 amplitude remained stable. Presynaptic HFOs were smaller in worsening patients and larger in improving ones, but they did not undergo habituation in patients as well as in healthy subjects. Conclusions Potentiation of the N20 response in spontaneously worsening migraineurs confirms that the reduction of the thalamocortical drive plays a major role in migraine pathogenesis. Moreover, the stable pattern we observed in spontaneously improving patients suggests that compensatory mechanisms can also play an important role. The normal response to repeated stimuli of HFOs in migraineurs might indicate that, although its initial amount depends on clinical conditions, high-frequency thalamocortical drive remains stable during the stimulation and probably reflects the activity of a buffer mechanism.
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Coppola G, Di Lorenzo C, Schoenen J, Pierelli F. Habituation and sensitization in primary headaches. J Headache Pain 2013; 14:65. [PMID: 23899115 PMCID: PMC3733593 DOI: 10.1186/1129-2377-14-65] [Citation(s) in RCA: 160] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 07/21/2013] [Indexed: 11/20/2022] Open
Abstract
The phenomena of habituation and sensitization are considered most useful for studying the neuronal substrates of information processing in the CNS. Both were studied in primary headaches, that are functional disorders of the brain characterized by an abnormal responsivity to any kind of incoming innocuous or painful stimuli and it's cycling pattern over time (interictal, pre-ictal, ictal). The present review summarizes available data on stimulus responsivity in primary headaches obtained with clinical neurophysiology. In migraine, the majority of electrophysiological studies between attacks have shown that, for a number of different sensory modalities, the brain is characterised by a lack of habituation of evoked responses to repeated stimuli. This abnormal processing of the incoming information reaches its maximum a few days before the beginning of an attack, and normalizes during the attack, at a time when sensitization may also manifest itself. An abnormal rhythmic activity between thalamus and cortex, namely thalamocortical dysrhythmia, may be the pathophysiological mechanism subtending abnormal information processing in migraine. In tension-type headache (TTH), only few signs of deficient habituation were observed only in subgroups of patients. By contrast, using grand-average responses indirect evidence for sensitization has been found in chronic TTH with increased nociceptive specific reflexes and evoked potentials. Generalized increased sensitivity to pain (lower thresholds and increased pain rating) and a dysfunction in supraspinal descending pain control systems may contribute to the development and/or maintenance of central sensitization in chronic TTH. Cluster headache patients are characterized during the bout and on the headache side by a pronounced lack of habituation of the brainstem blink reflex and a general sensitization of pain processing. A better insight into the nature of these ictal/interictal electrophysiological dysfunctions in primary headaches paves the way for novel therapeutic targets and may allow a better understanding of the mode of action of available therapies.
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Affiliation(s)
- Gianluca Coppola
- Department of Neurophysiology of Vision and Neurophthalmology, G.B. Bietti Foundation IRCCS, Via Livenza 3, 00198, Rome, Italy
| | | | - Jean Schoenen
- Headache Research Unit, University Department of Neurology & GIGA-Neurosciences, Liège University, Liège, Belgium
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Esposito M, Parisi L, Gallai B, Marotta R, Di Dona A, Lavano SM, Roccella M, Carotenuto M. Attachment styles in children affected by migraine without aura. Neuropsychiatr Dis Treat 2013; 9:1513-9. [PMID: 24124370 PMCID: PMC3794987 DOI: 10.2147/ndt.s52716] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND In recent years, great attention has been given to the presence of psychological problems and psychiatric comorbidity that are also present in children affected by primary headaches. The relationship between pain and attachment has been identified, and it may be that pain perception may change in relation with specific attachment styles. The aim of the present study was to assess the prevalent attachment style and verify its putative relationship and correlation with the main characteristics of migraine attacks, in school-aged children affected by migraine without aura (MoA). MATERIALS AND METHODS The study population consisted of 219 children (103 males, 116 females) aged between 6 and 11 years (mean 8.96 ± 2.14 years), consecutively referred for MoA compared with 381 healthy controls (174 males, 207 females; mean age 9.01 ± 1.75 years) randomly selected from schools. All the children were classified according to the attachment typologies of the Italian modified version of the Separation Anxiety Test; monthly headache frequency and mean headache duration were assessed from daily headache diaries kept by all the children. Headache intensity was assessed on a visual analog scale. The chi-square test and t-test, where appropriate, were applied, and the Spearman rank correlation test was applied to explore the relationship between the types of attachment style and clinical aspects of MoA. RESULTS The MoA group showed a significantly higher prevalence of type A (avoidant) attachment (P<0.001) and a significantly lower prevalence of type B (secure) attachment (P<0.001) compared with the control group. Moreover, the Spearman rank correlation analysis showed a significant relationship between MoA characteristics and the attachment style of MoA children. CONCLUSION The main findings of the present study were the higher prevalence among MoA children of the avoidant attachment style (type A) and the significantly lower prevalence of the secure style attachment (type B) compared with the normal controls, suggesting that the study of psychiatric comorbidity in pediatric headache may be enriched by this new aspect of analysis.
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Affiliation(s)
- Maria Esposito
- Center for Childhood Headache, Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy
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