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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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Eikermann-Haerter K, Dileköz E, Kudo C, Savitz SI, Waeber C, Baum MJ, Ferrari MD, van den Maagdenberg AM, Moskowitz MA, Ayata C. Genetic and hormonal factors modulate spreading depression and transient hemiparesis in mouse models of familial hemiplegic migraine type 1. J Clin Invest 2009; 119:99-109. [PMID: 19104150 PMCID: PMC2613474 DOI: 10.1172/jci36059] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Accepted: 10/08/2008] [Indexed: 11/17/2022] Open
Abstract
Familial hemiplegic migraine type 1 (FHM1) is an autosomal dominant subtype of migraine with aura that is associated with hemiparesis. As with other types of migraine, it affects women more frequently than men. FHM1 is caused by mutations in the CACNA1A gene, which encodes the alpha1A subunit of Cav2.1 channels; the R192Q mutation in CACNA1A causes a mild form of FHM1, whereas the S218L mutation causes a severe, often lethal phenotype. Spreading depression (SD), a slowly propagating neuronal and glial cell depolarization that leads to depression of neuronal activity, is the most likely cause of migraine aura. Here, we have shown that transgenic mice expressing R192Q or S218L FHM1 mutations have increased SD frequency and propagation speed; enhanced corticostriatal propagation; and, similar to the human FHM1 phenotype, more severe and prolonged post-SD neurological deficits. The susceptibility to SD and neurological deficits is affected by allele dosage and is higher in S218L than R192Q mutants. Further, female S218L and R192Q mutant mice were more susceptible to SD and neurological deficits than males. This sex difference was abrogated by ovariectomy and senescence and was partially restored by estrogen replacement, implicating ovarian hormones in the observed sex differences in humans with FHM1. These findings demonstrate that genetic and hormonal factors modulate susceptibility to SD and neurological deficits in FHM1 mutant mice, providing a potential mechanism for the phenotypic diversity of human migraine and aura.
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Affiliation(s)
- Katharina Eikermann-Haerter
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Ergin Dileköz
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Chiho Kudo
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Sean I. Savitz
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Christian Waeber
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Michael J. Baum
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Michel D. Ferrari
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Arn M.J.M. van den Maagdenberg
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Michael A. Moskowitz
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Cenk Ayata
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
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