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Chen Z, Liu Y, Lin C, Li Z, Shan J, Duan Z, Rong L, Wei X, Xiao L, Liu H. Aberrant cerebral blood flow and functional connectivity in patients with vestibular migraine: a resting-state ASL and fMRI study. J Headache Pain 2024; 25:84. [PMID: 38773396 PMCID: PMC11107056 DOI: 10.1186/s10194-024-01792-5] [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] [Received: 04/22/2024] [Accepted: 05/15/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Prior neuroimaging studies on vestibular migraine (VM) have extensively certified the functional and structural alterations in multiple brain regions and networks. However, few studies have assessed the cerebral blood flow (CBF) in VM patients using arterial spin labeling (ASL). The present study aimed to investigate CBF and functional connectivity (FC) alterations in VM patients during interictal periods. METHODS We evaluated 52 VM patients and 46 healthy controls (HC) who received resting-state pseudo-continuous ASL and functional magnetic resonance imaging (fMRI) scanning. Comparisons of voxel-based CBF and seed-based FC were performed between the two groups. Brain regions showed significant group differences in CBF analyses were chosen as seeds in FC analyses. Additionally, the associations between abnormal imaging results and clinical features were explored. RESULTS Compared with HC, VM patients showed higher normalized CBF in the right precentral gyrus (PreCG), left postcentral gyrus (PostCG), left superior frontal gyrus and bilateral insular (p < 0.05, FDR corrected). Furthermore, VM patients exhibited increased FC between the right PreCG and areas of the left PostCG, left cuneus and right lingual gyrus (p < 0.05, FDR corrected). In addition, we observed decreased FC between the left insular and regions of the left thalamus and right anterior cingulate cortex, as well as increased FC between the left insular and right fusiform gyrus in VM patients (p < 0.05, FDR corrected). Moreover, these variations in brain perfusion and FC were significantly correlated with multiple clinical features including frequency of migraine symptoms, frequency of vestibular symptoms and disease duration of VM (all p < 0.05). CONCLUSIONS Patients with VM during interictal period showed hyperperfusion and abnormal resting-state FC in brain regions potentially contributed to disrupted multi-sensory and autonomic processing, as well as impaired ocular motor control, pain modulation and emotional regulation. Our study provided novel insights into the complex neuropathology of VM from a CBF perspective.
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Affiliation(s)
- Zhengwei Chen
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Yueji Liu
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Cunxin Lin
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Zhining Li
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Junjun Shan
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Zuowei Duan
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Liangqun Rong
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Xiue Wei
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Lijie Xiao
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China.
| | - Haiyan Liu
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China.
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Shibata Y, Ishiyama S. Neurite Damage in Patients with Migraine. Neurol Int 2024; 16:299-311. [PMID: 38525701 PMCID: PMC10961799 DOI: 10.3390/neurolint16020021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
We examined neurite orientation dispersion and density imaging in patients with migraine. We found that patients with medication overuse headache exhibited lower orientation dispersion than those without. Moreover, orientation dispersion in the body of the corpus callosum was statistically negatively correlated with migraine attack frequencies. These findings indicate that neurite dispersion is damaged in patients with chronic migraine. Our study results indicate the orientation preference of neurite damage in migraine.
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Affiliation(s)
- Yasushi Shibata
- Department of Neurosurgery, Headache Clinic, Mito Medical Center, University of Tsukuba, Mito Kyodo General Hospital, Mito 3100015, Japan
| | - Sumire Ishiyama
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ami 3000394, Japan
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Dobos D, Kökönyei G, Gyebnár G, Szabó E, Kocsel N, Galambos A, Gecse K, Baksa D, Kozák LR, Juhász G. Microstructural differences in migraine: A diffusion-tensor imaging study. Cephalalgia 2023; 43:3331024231216456. [PMID: 38111172 DOI: 10.1177/03331024231216456] [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: 12/20/2023]
Abstract
BACKGROUND Diffusion-tensor imaging can be applied to describe the microstructural integrity of the whole brain. As findings about microstructural alterations in migraine are inconsistent, we aimed to replicate the most frequent results and assess a relationship between migraine parameters and changes in microstructure. METHODS Diffusion-weighted MRI data of 37 migraine patients and 40 controls were collected. Two indices of diffusion of water molecules, fractional anisotropy and mean diffusivity were used in a voxel-wise analysis. Group comparisons were carried out in SPM12 using age and sex as covariates. Statistically significant results survived family-wise error correction (pFWE < 0.05). Migraine intensity, frequency, and duration were self-reported and correlated with mean fractional anisotropy and mean diffusivity values across clusters. RESULTS Migraine patients showed significantly lower fractional anisotropy in occipital regions, and significantly higher fractional anisotropy in thirteen clusters across the brain. Mean diffusivity of migraine patients was significantly decreased in the cerebellum and pons, but it was not increased in any area. Correlation between migraine duration and fractional anisotropy was significantly positive in the frontal cortex and significantly negative in the superior parietal lobule. CONCLUSION We suggest that microstructural integrity of the migraine brain is impaired in visual areas and shows duration-related alterations in regions of the default mode network.
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Affiliation(s)
- Dóra Dobos
- NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- SE NAP 2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Department of Pharmacodynamics, Faculty of Pharmaceutical Sciences, Semmelweis University, Budapest, Hungary
| | - Gyöngyi Kökönyei
- NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- SE NAP 2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Department of Pharmacodynamics, Faculty of Pharmaceutical Sciences, Semmelweis University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Gyula Gyebnár
- Magnetic Resonance Research Centre, Semmelweis University, Budapest, Hungary
| | - Edina Szabó
- SE NAP 2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Natália Kocsel
- SE NAP 2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Attila Galambos
- SE NAP 2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Kinga Gecse
- NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- SE NAP 2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Department of Pharmacodynamics, Faculty of Pharmaceutical Sciences, Semmelweis University, Budapest, Hungary
| | - Dániel Baksa
- NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- SE NAP 2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Department of Pharmacodynamics, Faculty of Pharmaceutical Sciences, Semmelweis University, Budapest, Hungary
- Department of Personality and Clinical Psychology, Institute of Psychology, Faculty of Humanities and Social Sciences, Pazmany Peter Catholic University, Budapest, Hungary
| | - Lajos R Kozák
- Magnetic Resonance Research Centre, Semmelweis University, Budapest, Hungary
| | - Gabriella Juhász
- NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- SE NAP 2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Department of Pharmacodynamics, Faculty of Pharmaceutical Sciences, Semmelweis University, Budapest, Hungary
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Chou BC, Lerner A, Barisano G, Phung D, Xu W, Pinto SN, Sheikh-Bahaei N. Functional MRI and Diffusion Tensor Imaging in Migraine: A Review of Migraine Functional and White Matter Microstructural Changes. J Cent Nerv Syst Dis 2023; 15:11795735231205413. [PMID: 37900908 PMCID: PMC10612465 DOI: 10.1177/11795735231205413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 09/14/2023] [Indexed: 10/31/2023] Open
Abstract
Migraine is a complex and heterogenous disorder whose disease mechanisms remain disputed. This narrative review summarizes functional MRI (fMRI) and diffusion tensor imaging (DTI) findings and interprets their association with migraine symptoms and subtype to support and expand our current understanding of migraine pathophysiology. Our PubMed search evaluated and included fMRI and DTI studies involving comparisons between migraineurs vs healthy controls, migraineurs with vs without aura, and episodic vs chronic migraineurs. Migraineurs demonstrate changes in functional connectivity (FC) and regional activation in numerous pain-related networks depending on migraine phase, presence of aura, and chronicity. Changes to diffusion indices are observed in major cortical white matter tracts extending to the brainstem and cerebellum, more prominent in chronic migraine and associated with FC changes. Reported changes in FC and regional activation likely relate to pain processing and sensory hypersensitivities. Diffuse white matter microstructural changes in dysfunctional cortical pain and sensory pathways complement these functional differences. Interpretations of reported fMRI and DTI measure trends have not achieved a clear consensus due to inconsistencies in the migraine neuroimaging literature. Future fMRI and DTI studies should establish and implement a uniform methodology that reproduces existing results and directly compares migraineurs with different subtypes. Combined fMRI and DTI imaging may provide better pathophysiological explanations for nonspecific FC and white matter microstructural differences.
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Affiliation(s)
- Brendon C. Chou
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alexander Lerner
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Daniel Phung
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Wilson Xu
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Soniya N. Pinto
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Nasim Sheikh-Bahaei
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Goto M, Shibata Y, Ishiyama S, Matsumaru Y, Ishikawa E. Brain Microstructure and Brain Function Changes in Space Headache by Head-Down-Tilted Bed Rest. Aerosp Med Hum Perform 2023; 94:678-685. [PMID: 37587626 DOI: 10.3357/amhp.6177.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
INTRODUCTION: Several astronauts have experienced severe headaches during spaceflight, but no studies have examined the associated brain microstructure and functional changes. Head-down-tilted bed rest (HDBR) is a well-established method for studying the physical effects of microgravity on the ground. In this study, we analyzed the changes in brain microstructure and function during headache caused by HDBR using diffusion tensor imaging (DTI) and resting state functional magnetic resonance imaging (R-fMRI).METHODS: We imaged 28 healthy subjects with DTI and R-fMRI in the horizontal supine position and HDBR. Using Tract-Based Spatial Statistics, fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity were compared between the headache and non-headache groups. Additionally, an analysis of functional connectivity (FC) was performed, followed by a correlation analysis between FC and numerical rating scale.RESULTS: HDBR caused headaches in 21 of 28 subjects. DTI analysis showed no significant change in fractional anisotropy after HDBR, whereas axial diffusivity, radial diffusivity, and mean diffusivity increased significantly. R-fMRI analysis showed a significant decrease in FC in several areas after HDBR. The headache group showed significantly higher FC before HDBR, and both groups showed higher FC after HDBR. Correlation analysis showed a positive correlation between FC and numerical rating scale before HDBR but negative after HDBR.DISCUSSION: We demonstrated the image change in the acute phase of space headache by HDBR using DTI and R-fMRI. Changes in brain microstructure and function specific to patients developing headaches may be evaluated by imaging.Goto M, Shibata Y, Ishiyama S, Matsumaru Y, Ishikawa E. Brain microstructure and brain function changes in space headache by head-down-tilted bed rest. Aerosp Med Hum Perform. 2023; 94(9):678-685.
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Messina R, Rocca MA, Goadsby PJ, Filippi M. Insights into migraine attacks from neuroimaging. Lancet Neurol 2023; 22:834-846. [PMID: 37478888 DOI: 10.1016/s1474-4422(23)00152-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/15/2023] [Accepted: 04/12/2023] [Indexed: 07/23/2023]
Abstract
Migraine is one of the most common neurological diseases and it has a huge social and personal impact. Although head pain is the core symptom, individuals with migraine can have a plethora of non-headache symptoms that precede, accompany, or follow the pain. Neuroimaging studies have shown that the involvement of specific brain areas can explain many of the symptoms reported during the different phases of migraine. Recruitment of the hypothalamus, pons, spinal trigeminal nucleus, thalamus, and visual and pain-processing cortical areas starts during the premonitory phase and persists through the headache phase, contributing to the onset of pain and associated symptoms. Once the pain stops, the involvement of most brain areas ends, although the pons, hypothalamus, and visual cortex remain active after acute treatment intake and resolution of migraine symptoms. A better understanding of the correlations between imaging findings and migraine symptomatology can provide new insight into migraine pathophysiology and the mechanisms of novel migraine-specific treatments.
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Affiliation(s)
- Roberta Messina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Peter J Goadsby
- NIHR King's Clinical Research Facility, King's College, London, UK; Department of Neurology, University of California, Los Angeles, CA, USA
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Di Antonio S, Arendt-Nielsen L, Castaldo M. Cervical musculoskeletal impairments and pain sensitivity in migraine patients. Musculoskelet Sci Pract 2023; 66:102817. [PMID: 37451884 DOI: 10.1016/j.msksp.2023.102817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Currently, examination of migraine patients relies on a clinical interview investigating symptoms characteristics. Despite this, to help identify distinct migraine subtypes and allow a personalized treatment approach, biomarkers to profile distinct migraine subtypes should be utilized in clinical and research settings. Therefore, there is a need to include physical and psychophysical examinations aimed at assessing migraine features quantitatively. PURPOSE This paper aimed to discuss if increased pressure pain sensitivity and impaired cervical musculoskeletal function could be considered 1) as quantitative features of migraine and 2) if they could be used as biomarkers to profile migraine patients in distinct subtypes. IMPLICATION Increased pain sensitivity and cervical musculoskeletal impairments have been suggested as quantitative biomarkers to phenotype and subgroup migraine patients in clinical and research settings. This could provide the first step for a mechanistically-driven and personalized treatment approach according to migraine phenotypes.
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Affiliation(s)
- Stefano Di Antonio
- Department of Health Science and Technology, Center for Pain and Neuroplasticity (CNAP), SMI, School of Medicine, Aalborg University, 9220, Aalborg, Denmark; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, 16132, Genoa, Italy
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Center for Pain and Neuroplasticity (CNAP), SMI, School of Medicine, Aalborg University, 9220, Aalborg, Denmark; Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, 9220, Aalborg, Denmark; Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, 9220, Aalborg, Denmark
| | - Matteo Castaldo
- Department of Health Science and Technology, Center for Pain and Neuroplasticity (CNAP), SMI, School of Medicine, Aalborg University, 9220, Aalborg, Denmark.
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Messina R, Filippi M. What imaging has revealed about migraine and chronic migraine. HANDBOOK OF CLINICAL NEUROLOGY 2023; 198:105-116. [PMID: 38043956 DOI: 10.1016/b978-0-12-823356-6.00011-1] [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
Although migraine pathophysiology is not yet entirely understood, it is now established that migraine should be viewed as a complex neurological disease, which involves the interplay of different brain networks and the release of signaling molecules, instead of a pure vascular disorder. The field of migraine research has also progressed significantly due to the advancement of brain imaging techniques. Numerous studies have investigated the relation between migraine pathophysiology and cerebral hemodynamic changes, showing that vascular changes are neither necessary nor sufficient to cause the migraine pain. Abnormal function and structure of key cortical, subcortical, and brainstem regions involved in multisensory, including pain, processing have been shown to occur in migraine patients during both an acute attack and the interictal phase. Whether brain imaging alterations represent a predisposing trait or are the consequence of the recurrence of headache attacks is still a matter of debate. It is highly likely that brain functional and structural alterations observed in migraine patients derive from the interaction between predisposing brain traits and experience-dependent responses. Neuroimaging studies have also enriched our knowledge of the mechanisms responsible for migraine chronification and have shed light on the mechanisms of actions of acute and preventive migraine treatments.
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Affiliation(s)
- Roberta Messina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Shi M, Yang J, Yang D, Yang X, Zhao H. Microstructural white matter changes in chronic migraine patients with liver-yang hyperactivity and qi-blood deficiency syndrome: a diffusion tensor imaging study. Neuroreport 2022; 33:422-428. [PMID: 35623087 DOI: 10.1097/wnr.0000000000001800] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
White matter alterations in patients with chronic migraine (CM) have been reported. Traditional Chinese medicine (TCM) syndromes are clinical syndromes proposed by TCM doctors based on long-term clinical observation and classification of the clinical symptoms and signs of CM patients. This study aimed to analyze the whole-brain diffusion tensor imaging (DTI) data of CM patients with different types of TCM syndromes. Sixteen CM patients diagnosed with liver-yang hyperactivity (LH) syndrome and 16 CM patients with qi-blood deficiency (QD) syndrome were recruited in this study. Thirty-one healthy controls (HCs) were also enrolled. All subjects underwent DTI and T1-weighted MRI acquisition. Thirty HCs and 30 CM patients (LH group: n = 15; QD group: n = 15) were included in the final analysis. No significant difference was observed in the DTI indexes between CM patients and HCs, including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). The mean FAs of the left tapetum and the mean MD values for the right medial lemniscus and the right inferior cerebellar peduncle were significantly different in the LH and HC groups. The mean AD values for the right cingulate gyrus and the left uncinate fasciculus, as well as the mean RD for the right inferior cerebellar peduncle and the left tapetum, were also significantly different between these two groups. CM patients with LH and QD syndrome showed altered FA and diffusivity in comparison to healthy controls, suggesting that there may be significant white matter microstructural alterations in these patients.
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Affiliation(s)
- Min Shi
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, P.R. China
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Microstructural white matter alterations associated with migraine headaches: a systematic review of diffusion tensor imaging studies. Brain Imaging Behav 2022; 16:2375-2401. [PMID: 35710680 PMCID: PMC9581876 DOI: 10.1007/s11682-022-00690-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 11/04/2022]
Abstract
The pathophysiology of migraine as a headache disorder is still undetermined. Diffusion tensor imaging (DTI) has significantly improved our knowledge about brain microstructure in this disease. Here, we aimed to systematically review DTI studies in migraine and survey the sources of heterogeneity by investigating diffusion parameter changes associated with clinical characteristics and migraine subtypes. Microstructural changes, as revealed by widespread alteration of diffusion metrics in white matter (WM) tracts, subcortical and cortical regions, were reported by several migraine DTI studies. Specifically, we reported changes in the corpus callosum, thalamic radiations, corona radiata, and brain stem. These alterations showed high variability across migraine cycle phases. Additionally, migraine associated with depressive/anxiety symptoms revealed significant changes in the corpus callosum, internal capsule, and superior longitudinal fasciculus. No significant WM microstructural differences were observed between migraine patients with and without aura. Overall, differences between chronic and episodic migraine showed inconsistency across studies. Migraine is associated with microstructural changes in widespread regions including thalamic radiations, corpus callosum, and brain stem. These alterations can highlight neuronal damage and neuronal plasticity mechanisms either following pain stimulations occurring in migraine cycle or as a compensatory response to pain in chronic migraine. Longitudinal studies applying advanced modalities may shed new light on the underlying microstructural changes in migraine subtypes.
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Simonetta I, Riolo R, Todaro F, Tuttolomondo A. New Insights on Metabolic and Genetic Basis of Migraine: Novel Impact on Management and Therapeutical Approach. Int J Mol Sci 2022; 23:ijms23063018. [PMID: 35328439 PMCID: PMC8955051 DOI: 10.3390/ijms23063018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 12/12/2022] Open
Abstract
Migraine is a hereditary disease, usually one-sided, sometimes bilateral. It is characterized by moderate to severe pain, which worsens with physical activity and may be associated with nausea and vomiting, may be accompanied by photophobia and phonophobia. The disorder can occur at any time of the day and can last from 4 to 72 h, with and without aura. The pathogenic mechanism is unclear, but extensive preclinical and clinical studies are ongoing. According to electrophysiology and imaging studies, many brain areas are involved, such as cerebral cortex, thalamus, hypothalamus, and brainstem. The activation of the trigeminovascular system has a key role in the headache phase. There also appears to be a genetic basis behind the development of migraine. Numerous alterations have been identified, and in addition to the genetic cause, there is also a close association with the surrounding environment, as if on the one hand, the genetic alterations may be responsible for the onset of migraine, on the other, the environmental factors seem to be more strongly associated with exacerbations. This review is an analysis of neurophysiological mechanisms, neuropeptide activity, and genetic alterations that play a fundamental role in choosing the best therapeutic strategy. To date, the goal is to create a therapy that is as personalized as possible, and for this reason, steps forward have been made in the pharmacological field in order to identify new therapeutic strategies for both acute treatment and prophylaxis.
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Affiliation(s)
- Irene Simonetta
- Internal Medicine and Stroke Care Ward, Department of Promoting Health, Maternal-Infant Excellence and Internal and Specialized Medicine (ProMISE) G. D’Alessandro, University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (I.S.); (R.R.); (F.T.)
- Molecular and Clinical Medicine PhD Programme, University of Palermo, P.zza delle Cliniche n.2, 90127 Palermo, Italy
| | - Renata Riolo
- Internal Medicine and Stroke Care Ward, Department of Promoting Health, Maternal-Infant Excellence and Internal and Specialized Medicine (ProMISE) G. D’Alessandro, University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (I.S.); (R.R.); (F.T.)
| | - Federica Todaro
- Internal Medicine and Stroke Care Ward, Department of Promoting Health, Maternal-Infant Excellence and Internal and Specialized Medicine (ProMISE) G. D’Alessandro, University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (I.S.); (R.R.); (F.T.)
| | - Antonino Tuttolomondo
- Internal Medicine and Stroke Care Ward, Department of Promoting Health, Maternal-Infant Excellence and Internal and Specialized Medicine (ProMISE) G. D’Alessandro, University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (I.S.); (R.R.); (F.T.)
- Molecular and Clinical Medicine PhD Programme, University of Palermo, P.zza delle Cliniche n.2, 90127 Palermo, Italy
- Correspondence:
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Stankewitz A, Schulz E. Intrinsic network connectivity reflects the cyclic trajectory of migraine attacks. NEUROBIOLOGY OF PAIN 2022; 11:100085. [PMID: 35243179 PMCID: PMC8861450 DOI: 10.1016/j.ynpai.2022.100085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/28/2022] [Accepted: 02/05/2022] [Indexed: 11/06/2022]
Abstract
Migraineurs undergo cyclic cortical changes, already detectable in pain-free phase. Increasing magnitudes of intrinsic network connectivity towards the next attack. Network decoupling was observed during the ictal phase. Network alterations can explain the variety of ictal and pre-ictal migraine symptoms. Need for early therapeutic approaches during the pain-free interval.
Background Episodic migraine is considered to be cyclic in nature, triggered by the hypothalamus. To assess the natural trajectory of intrinsic networks over an entire migraine cycle, we designed a longitudinal intra-individual study using functional magnetic resonance imaging (fMRI). Methods Intrinsic network connectivity was assessed for 12 migraineurs in 82 sessions including spontaneous, untriggered headache attacks and follow-up recordings towards the next attack. Results We found cyclic changes in the visual, auditory, and somatosensory networks, in limbic networks (e.g. thalamo-insular, parahippocampal), and in the salience network (anterior insula and dorsal anterior cingulate cortex). Connectivity changes also extended to further cortical networks, such as the central executive network, the default mode network, as well as subcortical networks. Almost all of these network connectivity changes followed the trajectory of a linear increase over the pain-free interval that peaked immediately prior to the headache, and “dropped” to the baseline level during the headache. These network alterations are associated with a number of cortical functions that may explain the variety of ictal and pre-ictal physiological and psychological migraine symptoms. Conclusion Our results suggest that migraine disease is associated with widespread cyclic alterations of intrinsic networks that develop before the headache is initiated, i.e. during the interictal and premonitory phase. The increasing magnitude of connectivity within these networks towards the next attack may reflect an increasing effort to maintain network integrity.
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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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Schading S, Pohl H, Gantenbein A, Luechinger R, Sandor P, Riederer F, Freund P, Michels L. Tracking tDCS induced grey matter changes in episodic migraine: a randomized controlled trial. J Headache Pain 2021; 22:139. [PMID: 34800989 PMCID: PMC8605508 DOI: 10.1186/s10194-021-01347-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/27/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Occipital transcranial direct current stimulation (tDCS) is an effective and safe treatment for migraine attack prevention. Structural brain alterations have been found in migraineurs in regions related to pain modulation and perception, including occipital areas. However, whether these structural alterations can be dynamically modulated through tDCS treatment is understudied. OBJECTIVE To track longitudinally grey matter volume changes in occipital areas in episodic migraineurs during and up to five months after occipital tDCS treatment in a single-blind, and sham-controlled study. METHODS 24 episodic migraineurs were randomized to either receive verum or sham occipital tDCS treatment for 28 days. To investigate dynamic grey matter volume changes patients underwent structural MRI at baseline (prior to treatment), 1.5 months and 5.5 months (after completion of treatment). 31 healthy controls were scanned with the same MRI protocol. Morphometry measures assessed rate of changes over time and between groups by means of tensor-based morphometry. RESULTS Before treatment, migraineurs reported 5.6 monthly migraine days on average. A cross-sectional analysis revealed grey matter volume increases in the left lingual gyrus in migraineurs compared to controls. Four weeks of tDCS application led to a reduction of 1.9 migraine days/month and was paralleled by grey matter volume decreases in the left lingual gyrus in the treatment group; its extent overlapping with that seen at baseline. CONCLUSION This study shows that migraineurs have increased grey matter volume in the lingual gyrus, which can be modified by tDCS. Tracking structural plasticity in migraineurs provides a potential neuroimaging biomarker for treatment monitoring. TRIAL REGISTRATION ClinicalTrials.gov , NCT03237754 . Registered 03 August 2017 - retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03237754 .
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Affiliation(s)
- Simon Schading
- Spinal Cord Injury Centre Balgrist, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Heiko Pohl
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas Gantenbein
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland.,ZURZACH Care, Bad Zurzach, Switzerland
| | - Roger Luechinger
- Institute for Biomedical Engineering, ETH Zurich and University of Zurich, Zurich, Switzerland
| | - Peter Sandor
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland.,ZURZACH Care, Bad Zurzach, Switzerland
| | - Franz Riederer
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland.,Neurological Center Rosenhügel and Karl Landsteiner Institute for Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Patrick Freund
- Spinal Cord Injury Centre Balgrist, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Wellcome Centre for Human Neuroimaging, Institute of Neurology, University College London, London, UK.,Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Lars Michels
- Department of Neuroradiology, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
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Valenzuela-Fuenzalida JJ, Suazo-Santibañez A, Semmler MG, Cariseo-Avila C, Santana-Machuca E, Orellana-Donoso M. The structural and functional importance of the thalamus in migraine processes with and without aura. A literature review. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2021.100130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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16
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Chen Z, Xiao L, Liu H, Zhang Q, Wang Q, Lv Y, Zhai Y, Zhang J, Dong S, Wei X, Rong L. Altered thalamo-cortical functional connectivity in patients with vestibular migraine: a resting-state fMRI study. Neuroradiology 2021; 64:119-127. [PMID: 34374821 DOI: 10.1007/s00234-021-02777-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/26/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore the functional connectivity (FC) between the bilateral thalamus and the other brain regions in patients with vestibular migraine (VM). METHODS Resting-state fMRI and 3D-T1 data were collected from 37 patients with VM during the interictal period and 44 age-, gender-, and years of education-matched healthy controls (HC). The FC of the bilateral thalamus was analyzed using a standard seed-based whole-brain correlation method. Furthermore, the correlations between thalamus FC and clinical characteristics of patients were investigated using Pearson's partial correlation. RESULTS Compared with HC, VM patients showed decreased FC between the left thalamus and the left anterior cingulate cortex (ACC), bilateral insular and right supplementary motor cortex. We also observed decreased FC between the right thalamus and the left insular and ACC in VM patients. Furthermore, patients with VM also exhibited increased FC between the left thalamus and the right precuneus and middle frontal gyrus, between the right thalamus and superior parietal lobule. FC between the right thalamus and the left insular was negatively correlated with disease duration (p = 0.019, r = - 0.399), FC between the left thalamus and the left ACC was negatively correlated with HIT-6 score (p = 0.004, r = - 0.484). CONCLUSION VM patients showed altered FC between thalamus and brain regions involved in pain, vestibular and visual processing, which are associated with specific clinical features. Specifically, VM patients showed reduced thalamo-pain and thallamo-vestibular pathways, while exhibited enhanced thalamo-visual pathway, which provided first insight into the underlying functional brain connectivity in VM patients.
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Affiliation(s)
- Zhengwei Chen
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, 221006, Jiangsu, China
| | - Lijie Xiao
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, 221006, Jiangsu, China
| | - Haiyan Liu
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, 221006, Jiangsu, China
| | - Qingxiu Zhang
- Department of Neurology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321, Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Quan Wang
- Medical Imaging Department, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, 221006, Jiangsu, China
| | - You Lv
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, 221006, Jiangsu, China
| | - Yujia Zhai
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, 221006, Jiangsu, China
| | - Jun Zhang
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, 221006, Jiangsu, China
| | - Shanshan Dong
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, 221006, Jiangsu, China
| | - Xiue Wei
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, 221006, Jiangsu, China
| | - Liangqun Rong
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, 221006, Jiangsu, China.
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17
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Nowaczewska M, Straburzyński M, Meder G, Kaźmierczak W. Changes in Cerebral Blood Flow after Erenumab Treatment in Good and Non-Responders-A Pilot Study of Migraine Patients. J Clin Med 2021; 10:jcm10112523. [PMID: 34200202 PMCID: PMC8201252 DOI: 10.3390/jcm10112523] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/06/2021] [Accepted: 06/04/2021] [Indexed: 12/17/2022] Open
Abstract
Erenumab showed efficacy in migraine prevention, however we cannot identify which patients to treat by predicting efficacy response. The aim of this study was to compare changes in cerebral blood flow (CBF) reflected by transcranial Doppler (TCD) in erenumab good responders (GR) and non-responders, in order to identify a parameter that could predict the treatment response. In this study, migraineurs treated with erenumab underwent clinical and TCD evaluations before and 6 weeks after the treatment, including data on migraine type, monthly migraine days (MMD), medication overuse headache (MOH) presence, mean blood flow velocity (Vm) and pulsatility index (PI) in cerebral arteries (CA). GR were defined as reporting ≥50% reduction in MMD. Thirty women were enrolled, of mean age 40.53 years, 20 with chronic migraine, 14 with MOH, and 19 were GR. Baseline Vm values in right CA and basilar artery (BA) were significantly lower in GR as compared with non-responders. Vm values in all arteries significantly increased after the treatment as compared with corresponding baseline values, but only in GR. A significant negative correlation was observed between baseline Vm in right CA and treatment effectiveness. Baseline Vm in right CA and basilar artery is reduced in erenumab GR as compared with non-responders. This asymmetry normalizes after the treatment with significant Vm increase in CA which may reflect CBF increase in GR only. Lower baseline Vm in right CA may predict erenumab efficacy; however, these results should be replicated in a larger cohort.
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Affiliation(s)
- Magdalena Nowaczewska
- Department of Otolaryngology, Head and Neck Surgery, and Laryngological Oncology, Ludwik, Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, M. Skłodowskiej-Curie 9, 85-090 Bydgoszcz, Poland
- Athleticomed—Pain & Sport Injury Centre with Headache & Migraine Treatment Divsion, Fordonska 144, 85-357 Bydgoszcz, Poland
- Correspondence:
| | - Marcin Straburzyński
- Headache Clinic—Terapia Neurologiczna ‘Samodzielni’, Mochnackiego 10, 02-042 Warsaw, Poland;
| | - Grzegorz Meder
- Department of Interventional Radiology, Jan Biziel University Hospital No. 2, Ujejskiego 75 Street, 85-168 Bydgoszcz, Poland;
| | - Wojciech Kaźmierczak
- Department of Sensory Organs Examination, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, M. Skłodowskiej-Curie 9, 85-090 Bydgoszcz, Poland;
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18
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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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19
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Liu J, Li M, Luo Y, Yang S, Li W, Bi Y. Alzheimer's disease detection using depthwise separable convolutional neural networks. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 203:106032. [PMID: 33713959 DOI: 10.1016/j.cmpb.2021.106032] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 02/25/2021] [Indexed: 05/02/2023]
Abstract
To diagnose Alzheimer's disease (AD), neuroimaging methods such as magnetic resonance imaging have been employed. Recent progress in computer vision with deep learning (DL) has further inspired research focused on machine learning algorithms. However, a few limitations of these algorithms, such as the requirement for large number of training images and the necessity for powerful computers, still hinder the extensive usage of AD diagnosis based on machine learning. In addition, large number of training parameters and heavy computation make the DL systems difficult in integrating with mobile embedded devices, for example the mobile phones. For AD detection using DL, most of the current research solely focused on improving the classification performance, while few studies have been done to obtain a more compact model with less complexity and relatively high recognition accuracy. In order to solve this problem and improve the efficiency of the DL algorithm, a deep separable convolutional neural network model is proposed for AD classification in this paper. The depthwise separable convolution (DSC) is used in this work to replace the conventional convolution. Compared to the traditional neural networks, the parameters and computing cost of the proposed neural network are found greatly reduced. The parameters and computational costs of the proposed neural network are found to be significantly reduced compared with conventional neural networks. With its low power consumption, the proposed model is particularly suitable for embedding mobile devices. Experimental findings show that the DSC algorithm, based on the OASIS magnetic resonance imaging dataset, is very successful for AD detection. Moreover, transfer learning is employed in this work to improve model performance. Two trained models with complex networks, namely AlexNet and GoogLeNet, are used for transfer learning, with average classification rates of 91.40%, 93.02% and a less power consumption.
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Affiliation(s)
- Junxiu Liu
- School of Electronic Engineering, Guangxi Normal University, Guilin, 541004, China
| | - Mingxing Li
- School of Electronic Engineering, Guangxi Normal University, Guilin, 541004, China
| | - Yuling Luo
- School of Electronic Engineering, Guangxi Normal University, Guilin, 541004, China.
| | - Su Yang
- School of Computing and Engineering, University of West London, London, United Kingdom
| | - Wei Li
- Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Yifei Bi
- College of Foreign Languages, University of Shanghai for Science and Technology, Shanghai, China
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20
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Chong CD, Berisha V, Ross K, Kahn M, Dumkrieger G, Schwedt TJ. Distinguishing persistent post-traumatic headache from migraine: Classification based on clinical symptoms and brain structural MRI data. Cephalalgia 2021; 41:943-955. [PMID: 33926241 DOI: 10.1177/0333102421991819] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Persistent post-traumatic headache most commonly has symptoms that overlap those of migraine. In some cases, it can be clinically difficult to differentiate persistent post-traumatic headache with a migraine phenotype from migraine. The objective of this study was to develop a classification model based on questionnaire data and structural neuroimaging data that distinguishes individuals with migraine from those with persistent post-traumatic headache. METHODS Questionnaires assessing headache characteristics, sensory hypersensitivities, cognitive functioning, and mood, as well as T1-weighted magnetic resonance imaging and diffusion tensor data from 34 patients with migraine and 48 patients with persistent post-traumatic headache attributed to mild traumatic brain injury were included for analysis. The majority of patients with persistent post-traumatic headache had a migraine/probable migraine phenotype (77%). A machine-learning leave-one-out cross-validation algorithm determined the average accuracy for distinguishing individual migraine patients from individual patients with persistent post-traumatic headache. RESULTS Based on questionnaire data alone, the average classification accuracy for determining whether an individual person had migraine or persistent post-traumatic headache was 71.9%. Adding imaging data features to the model improved the classification accuracy to 78%, including an average accuracy of 97.1% for identifying individual migraine patients and an average accuracy of 64.6% for identifying individual patients with persistent post-traumatic headache. The most important clinical features that contributed to the classification accuracy included questions related to anxiety and decision making. Cortical brain features and fibertract data from the following regions or tracts most contributed to the classification accuracy: Bilateral superior temporal, inferior parietal and posterior cingulate; right lateral occipital, uncinate, and superior longitudinal fasciculus. A post-hoc analysis showed that compared to incorrectly classified persistent post-traumatic headache patients, those who were correctly classified as having persistent post-traumatic headache had more severe physical, autonomic, anxiety and depression symptoms, were more likely to have post-traumatic stress disorder, and were more likely to have had mild traumatic brain injury attributed to blasts. DISCUSSION A classification model that included a combination of questionnaire data and structural imaging parameters classified individual patients as having migraine versus persistent post-traumatic headache with good accuracy. The most important clinical measures that contributed to the classification accuracy included questions on mood. Regional brain structures and fibertracts that play roles in pain processing and pain integration were important brain features that contributed to the classification accuracy. The lower classification accuracy for patients with persistent post-traumatic headache compared to migraine may be related to greater heterogeneity of patients in the persistent post-traumatic headache cohort regarding their traumatic brain injury mechanisms, and physical, emotional, and cognitive symptoms.
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Affiliation(s)
- Catherine D Chong
- Mayo Clinic Arizona, Phoenix, Arizona, USA.,Arizona State University, Phoenix Arizona, USA
| | | | | | - Mazher Kahn
- Arizona State University, Phoenix Arizona, USA
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21
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Altamura C, Corbelli I, de Tommaso M, Di Lorenzo C, Di Lorenzo G, Di Renzo A, Filippi M, Jannini TB, Messina R, Parisi P, Parisi V, Pierelli F, Rainero I, Raucci U, Rubino E, Sarchielli P, Li L, Vernieri F, Vollono C, Coppola G. Pathophysiological Bases of Comorbidity in Migraine. Front Hum Neurosci 2021; 15:640574. [PMID: 33958992 PMCID: PMC8093831 DOI: 10.3389/fnhum.2021.640574] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/23/2021] [Indexed: 12/12/2022] Open
Abstract
Despite that it is commonly accepted that migraine is a disorder of the nervous system with a prominent genetic basis, it is comorbid with a plethora of medical conditions. Several studies have found bidirectional comorbidity between migraine and different disorders including neurological, psychiatric, cardio- and cerebrovascular, gastrointestinal, metaboloendocrine, and immunological conditions. Each of these has its own genetic load and shares some common characteristics with migraine. The bidirectional mechanisms that are likely to underlie this extensive comorbidity between migraine and other diseases are manifold. Comorbid pathologies can induce and promote thalamocortical network dysexcitability, multi-organ transient or persistent pro-inflammatory state, and disproportionate energetic needs in a variable combination, which in turn may be causative mechanisms of the activation of an ample defensive system with includes the trigeminovascular system in conjunction with the neuroendocrine hypothalamic system. This strategy is designed to maintain brain homeostasis by regulating homeostatic needs, such as normal subcortico-cortical excitability, energy balance, osmoregulation, and emotional response. In this light, the treatment of migraine should always involves a multidisciplinary approach, aimed at identifying and, if necessary, eliminating possible risk and comorbidity factors.
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Affiliation(s)
- Claudia Altamura
- Headache and Neurosonology Unit, Neurology, Campus Bio-Medico University Hospital, Rome, Italy
| | - Ilenia Corbelli
- Clinica Neurologica, Dipartimento di Medicina, Ospedale S.M. Misericordia, Università degli Studi di Perugia, Perugia, Italy
| | - Marina de Tommaso
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Bari Aldo Moro University, Policlinico General Hospital, Bari, Italy
| | - Cherubino Di Lorenzo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Giorgio Di Lorenzo
- Laboratory of Psychophysiology and Cognitive Neuroscience, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,IRCCS-Fondazione Santa Lucia, Rome, Italy
| | | | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Tommaso B Jannini
- Laboratory of Psychophysiology and Cognitive Neuroscience, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Roberta Messina
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Pasquale Parisi
- Child Neurology, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine & Psychology, c/o Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | | | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy.,Headache Clinic, IRCCS-Neuromed, Pozzilli, Italy
| | - Innocenzo Rainero
- Neurology I, Department of Neuroscience "Rita Levi Montalcini," University of Torino, Torino, Italy
| | - Umberto Raucci
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Rome, Italy
| | - Elisa Rubino
- Neurology I, Department of Neuroscience "Rita Levi Montalcini," University of Torino, Torino, Italy
| | - Paola Sarchielli
- Clinica Neurologica, Dipartimento di Medicina, Ospedale S.M. Misericordia, Università degli Studi di Perugia, Perugia, Italy
| | - Linxin Li
- Nuffield Department of Clinical Neurosciences, Centre for Prevention of Stroke and Dementia, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Fabrizio Vernieri
- Headache and Neurosonology Unit, Neurology, Campus Bio-Medico University Hospital, Rome, Italy
| | - Catello Vollono
- Department of Neurology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Catholic University, Rome, Italy
| | - Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
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22
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Chamanzar A, Haigh SM, Grover P, Behrmann M. Abnormalities in cortical pattern of coherence in migraine detected using ultra high-density EEG. Brain Commun 2021; 3:fcab061. [PMID: 34258580 PMCID: PMC8269966 DOI: 10.1093/braincomms/fcab061] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/28/2021] [Indexed: 11/13/2022] Open
Abstract
Individuals with migraine generally experience photophobia and/or phonophobia during and between migraine attacks. Many different mechanisms have been postulated to explain these migraine phenomena including abnormal patterns of connectivity across the cortex. The results, however, remain contradictory and there is no clear consensus on the nature of the cortical abnormalities in migraine. Here, we uncover alterations in cortical patterns of coherence (connectivity) in interictal migraineurs during the presentation of visual and auditory stimuli and during rest. We used a high-density EEG system, with 128 customized electrode locations, to compare inter- and intra-hemispheric coherence in the interictal period from 17 individuals with migraine (12 female) and 18 age- and gender-matched healthy control subjects. During presentations of visual (vertical grating pattern) and auditory (modulated tone) stimulation which varied in temporal frequency (4 and 6 Hz), and during rest, participants performed a colour detection task at fixation. Analyses included characterizing the inter- and intra-hemisphere coherence between the scalp EEG channels over 2-s time intervals and over different frequency bands at different spatial distances and spatial clusters. Pearson's correlation coefficients were estimated at zero-lag. Repeated measures analyses-of-variance revealed that, relative to controls, migraineurs exhibited significantly (i) faster colour detection performance, (ii) lower spatial coherence of alpha-band activity, for both inter- and intra-hemisphere connections, and (iii) the reduced coherence occurred predominantly in frontal clusters during both sensory conditions, regardless of the stimulation frequency, as well as during the resting-state. The abnormal patterns of EEG coherence in interictal migraineurs during visual and auditory stimuli, as well as at rest (eyes open), may be associated with the cortical hyper-responsivity that is characteristic of abnormal sensory processing in migraineurs.
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Affiliation(s)
- Alireza Chamanzar
- Department of Electrical and Computer Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
- Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Sarah M Haigh
- Department of Psychology, University of Nevada, Reno, NV 89557, USA
- Institute for Neuroscience, University of Nevada, Reno, NV 89557, USA
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Pulkit Grover
- Department of Electrical and Computer Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
- Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Marlene Behrmann
- Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA 15213, USA
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA
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Coppola G, Di Lorenzo C, Di Lenola D, Serrao M, Pierelli F, Parisi V. Visual Evoked Potential Responses after Photostress in Migraine Patients and Their Correlations with Clinical Features. J Clin Med 2021; 10:jcm10050982. [PMID: 33801187 PMCID: PMC7957878 DOI: 10.3390/jcm10050982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 11/16/2022] Open
Abstract
In the past few years, researchers have detected subtle macular vision abnormalities using different psychophysical experimental tasks in patients with migraine. Recording of visual evoked potential (VEP) after photostress (PS) represents an objective way to verify the integrity of the dynamic properties of macular performance after exposure to intense light. VEPs were recorded before and after PS in 51 patients with migraine (19 with aura (MA) and 22 without aura (MO) between attacks, and 10 recorded during an attack (MI)) and 14 healthy volunteers. All study participants were exposed to 30 s of PS through the use of a 200-watt bulb lamp. The P100 implicit time and N75-P100 amplitude of the baseline VEP were compared with those collected every 20 s up to 200 s after PS. VEP parameters recorded at baseline did not differ between groups. In all groups, the VEP recordings exhibited a significant increase in implicit times and a reduction in amplitude at 20 s after the PS. In migraine, the percentage decrease in amplitudes observed at 20 s after photostress was significantly lower than in healthy volunteers, in both MO and MA patients, but not in MI patients. When data for MO and MA patients were combined, the percentage of amplitude change at 20 s was negatively correlated with the number of days that had elapsed since the last migraine attack, and positive correlated with attack frequency. We showed dynamic changes of recovery of VEP after PS depending on the migraine cycle. This finding, in conjunction with those previously attained with other neuromodulatory interventions using VEPs, leads us to argue that migraine-disease-related dysrhythmic thalamocortical activity precludes amplitude suppression by PS.
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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; (C.D.L.); (D.D.L.); (M.S.); (F.P.)
- Correspondence: ; Tel.: +39-0773-6513337; Fax: +39-0773-651230
| | - Cherubino Di Lorenzo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Corso della Repubblica 79, 04100 Latina, Italy; (C.D.L.); (D.D.L.); (M.S.); (F.P.)
| | - Davide Di Lenola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Corso della Repubblica 79, 04100 Latina, Italy; (C.D.L.); (D.D.L.); (M.S.); (F.P.)
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Corso della Repubblica 79, 04100 Latina, Italy; (C.D.L.); (D.D.L.); (M.S.); (F.P.)
| | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Corso della Repubblica 79, 04100 Latina, Italy; (C.D.L.); (D.D.L.); (M.S.); (F.P.)
- IRCCS—Neuromed, Headache Center, Via Atinense 18, 86077 Pozzilli, IS, Italy
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Masson R, Demarquay G, Meunier D, Lévêque Y, Hannoun S, Bidet-Caulet A, Caclin A. Is Migraine Associated to Brain Anatomical Alterations? New Data and Coordinate-Based Meta-analysis. Brain Topogr 2021; 34:384-401. [PMID: 33606142 DOI: 10.1007/s10548-021-00824-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/05/2021] [Indexed: 11/25/2022]
Abstract
A growing number of studies investigate brain anatomy in migraine using voxel- (VBM) and surface-based morphometry (SBM), as well as diffusion tensor imaging (DTI). The purpose of this article is to identify consistent patterns of anatomical alterations associated with migraine. First, 19 migraineurs without aura and 19 healthy participants were included in a brain imaging study. T1-weighted MRIs and DTI sequences were acquired and analyzed using VBM, SBM and tract-based spatial statistics. No significant alterations of gray matter (GM) volume, cortical thickness, cortical gyrification, sulcus depth and white-matter tract integrity could be observed. However, migraineurs displayed decreased white matter (WM) volume in the left superior longitudinal fasciculus. Second, a systematic review of the literature employing VBM, SBM and DTI was conducted to investigate brain anatomy in migraine. Meta-analysis was performed using Seed-based d Mapping via permutation of subject images (SDM-PSI) on GM volume, WM volume and cortical thickness data. Alterations of GM volume, WM volume, cortical thickness or white-matter tract integrity were reported in 72%, 50%, 56% and 33% of published studies respectively. Spatial distribution and direction of the disclosed effects were highly inconsistent across studies. The SDM-PSI analysis revealed neither significant decrease nor significant increase of GM volume, WM volume or cortical thickness in migraine. Overall there is to this day no strong evidence of specific brain anatomical alterations reliably associated to migraine. Possible explanations of this conflicting literature are discussed. Trial registration number: NCT02791997, registrated February 6th, 2015.
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Affiliation(s)
- Rémy Masson
- Lyon Neuroscience Research Center (CRNL), INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France.
| | - Geneviève Demarquay
- Lyon Neuroscience Research Center (CRNL), INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Neurological Hospital Pierre Wertheimer, Functional Neurology and Epilepsy Department, Hospices Civils de Lyon and Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - David Meunier
- Lyon Neuroscience Research Center (CRNL), INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Yohana Lévêque
- Lyon Neuroscience Research Center (CRNL), INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Salem Hannoun
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Aurélie Bidet-Caulet
- Lyon Neuroscience Research Center (CRNL), INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Anne Caclin
- Lyon Neuroscience Research Center (CRNL), INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
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25
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Sheng L, Ma H, Shi Y, Dai Z, Zhong J, Chen F, Pan P. Cortical Thickness in Migraine: A Coordinate-Based Meta-Analysis. Front Neurosci 2021; 14:600423. [PMID: 33488349 PMCID: PMC7815689 DOI: 10.3389/fnins.2020.600423] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/25/2020] [Indexed: 11/13/2022] Open
Abstract
Cortical thickness (CTh) via surface-based morphometry analysis is a popular method to characterize brain morphometry. Many studies have been performed to investigate CTh abnormalities in migraine. However, the results from these studies were not consistent and even conflicting. These divergent results hinder us to obtain a clear picture of brain morphometry regarding CTh alterations in migraine. Coordinate-based meta-analysis (CBMA) is a promising technique to quantitatively pool individual neuroimaging studies to identify consistent brain areas involved. Electronic databases (PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure, WanFang, and SinoMed) and other sources (bioRxiv and reference lists of relevant articles and reviews) were systematically searched for studies that compared regional CTh differences between patients with migraine and healthy controls (HCs) up to May 15, 2020. A CBMA was performed using the Seed-based d Mapping with Permutation of Subject Images approach. In total, we identified 16 studies with 17 datasets reported that were eligible for the CBMA. The 17 datasets included 872 patients with migraine (average sample size 51.3, mean age 39.6 years, 721 females) and 949 HCs (average sample size 59.3, mean age 44.2 years, 680 females). The CBMA detected no statistically significant consistency of CTh alterations in patients with migraine relative to HCs. Sensitivity analysis and subgroup analysis verified this result to be robust. Metaregression analyses revealed that this CBMA result was not confounded by age, gender, aura, attack frequency per month, and illness duration. Our CBMA adds to the evidence of the replication crisis in neuroimaging research that is increasingly recognized. Many potential confounders, such as underpowered sample size, heterogeneous patient selection criteria, and differences in imaging collection and methodology, may contribute to the inconsistencies of CTh alterations in migraine, which merit attention before planning future research on this topic.
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Affiliation(s)
- LiQin Sheng
- Department of Neurology, Kunshan Hospital of Traditional Chinese Medicine, Suzhou, China
| | - HaiRong Ma
- Department of Neurology, Kunshan Hospital of Traditional Chinese Medicine, Suzhou, China
| | - YuanYuan Shi
- Department of Central Laboratory, School of Medicine, Affiliated Yancheng Hospital, Southeast University, Yancheng, China
| | - ZhenYu Dai
- Department of Radiology, School of Medicine, Affiliated Yancheng Hospital, Southeast University, Yancheng, China
| | - JianGuo Zhong
- Department of Neurology, School of Medicine, Affiliated Yancheng Hospital, Southeast University, Yancheng, China
| | - Fei Chen
- Department of Radiology, School of Medicine, Affiliated Yancheng Hospital, Southeast University, Yancheng, China
| | - PingLei Pan
- Department of Central Laboratory, School of Medicine, Affiliated Yancheng Hospital, Southeast University, Yancheng, China
- Department of Neurology, School of Medicine, Affiliated Yancheng Hospital, Southeast University, Yancheng, China
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26
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Alternative Microstructural Measures to Complement Diffusion Tensor Imaging in Migraine Studies with Standard MRI Acquisition. Brain Sci 2020; 10:brainsci10100711. [PMID: 33036306 PMCID: PMC7599963 DOI: 10.3390/brainsci10100711] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/29/2020] [Accepted: 10/02/2020] [Indexed: 01/03/2023] Open
Abstract
The white matter state in migraine has been investigated using diffusion tensor imaging (DTI) measures, but results using this technique are conflicting. To overcome DTI measures, we employed ensemble average diffusion propagator measures obtained with apparent measures using reduced acquisitions (AMURA). The AMURA measures were return-to-axis (RTAP), return-to-origin (RTOP) and return-to-plane probabilities (RTPP). Tract-based spatial statistics was used to compare fractional anisotropy, mean diffusivity, axial diffusivity and radial diffusivity from DTI, and RTAP, RTOP and RTPP, between healthy controls, episodic migraine and chronic migraine patients. Fifty healthy controls, 54 patients with episodic migraine and 56 with chronic migraine were assessed. Significant differences were found between both types of migraine, with lower axial diffusivity values in 38 white matter regions and higher RTOP values in the middle cerebellar peduncle in patients with a chronic migraine (p < 0.05 family-wise error corrected). Significantly lower RTPP values were found in episodic migraine patients compared to healthy controls in 24 white matter regions (p < 0.05 family-wise error corrected), finding no significant differences using DTI measures. The white matter microstructure is altered in a migraine, and in chronic compared to episodic migraine. AMURA can provide additional results with respect to DTI to uncover white matter alterations in migraine.
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27
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Porcaro C, Di Renzo A, Tinelli E, Di Lorenzo G, Parisi V, Caramia F, Fiorelli M, Di Piero V, Pierelli F, Coppola G. Haemodynamic activity characterization of resting state networks by fractal analysis and thalamocortical morphofunctional integrity in chronic migraine. J Headache Pain 2020; 21:112. [PMID: 32928129 PMCID: PMC7490862 DOI: 10.1186/s10194-020-01181-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/08/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Chronic migraine (CM) can be associated with aberrant long-range connectivity of MRI-derived resting-state networks (RSNs). Here, we investigated how the fractal dimension (FD) of blood oxygenation level dependent (BOLD) activity may be used to estimate the complexity of RSNs, reflecting flexibility and/or efficiency in information processing in CM patients respect to healthy controls (HC). METHODS Resting-state MRI data were collected from 20 untreated CM without history of medication overuse and 20 HC. On both groups, we estimated the Higuchi's FD. On the same subjects, fractional anisotropy (FA) and mean diffusivity (MD) values of bilateral thalami were retrieved from diffusion tensor imaging and correlated with the FD values. RESULTS CM showed higher FD values within dorsal attention system (DAS) and the anterior part of default-mode network (DMN), and lower FD values within the posterior DMN compared to HC. Although FA and MD were within the range of normality, both correlated with the FD values of DAS. CONCLUSIONS FD of DAS and DMN may reflect disruption of cognitive control of pain in CM. Since the normal microstructure of the thalamus and its positive connectivity with the cortical networking found in our CM patients reminds similar results obtained assessing the same structures but with the methods of neurophysiology, in episodic migraine during an attack, this may be yet another evidence in supporting CM as a never-ending migraine attack.
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Affiliation(s)
- Camillo Porcaro
- Institute of Cognitive Sciences and Technologies (ISTC), National Research Council (CNR), Via Palestro 32, I-00185, Rome, Italy.
- Centre for Human Brain Health and School of Psychology, University of Birmingham, Birmingham, UK.
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), Crotone, Italy.
- Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy.
- Research Center for Motor Control and Neuroplasticity, KU Leuven, Leuven, Belgium.
| | | | - Emanuele Tinelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Giorgio Di Lorenzo
- Laboratory of Psychophysiology and Cognitive Neuroscience, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | | | - Francesca Caramia
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Marco Fiorelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Vittorio Di Piero
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
- IRCCS - Neuromed, Pozzilli, (IS), Italy
| | - Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
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28
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Coppola G, Di Renzo A, Tinelli E, Petolicchio B, Di Lorenzo C, Parisi V, Serrao M, Calistri V, Tardioli S, Cartocci G, Caramia F, Di Piero V, Pierelli F. Patients with chronic migraine without history of medication overuse are characterized by a peculiar white matter fiber bundle profile. J Headache Pain 2020; 21:92. [PMID: 32682393 PMCID: PMC7368770 DOI: 10.1186/s10194-020-01159-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/13/2020] [Indexed: 12/13/2022] Open
Abstract
Background We investigated intracerebral fiber bundles using a tract-based spatial statistics (TBSS) analysis of diffusion tensor imaging (DTI) data to verify microstructural integrity in patients with episodic (MO) and chronic migraine (CM). Methods We performed DTI in 19 patients with MO within interictal periods, 18 patients with CM without any history of drug abuse, and 18 healthy controls (HCs) using a 3 T magnetic resonance imaging scanner. We calculated diffusion metrics, including fractional anisotropy (FA), axial diffusion (AD), radial diffusion (RD), and mean diffusion (MD). Results TBSS revealed no significant differences in the FA, MD, RD, and AD maps between the MO and HC groups. In comparison to the HC group, the CM group exhibited widespread increased RD (bilateral superior [SCR] and posterior corona radiata [PCR], bilateral genu of the corpus callosum [CC], bilateral posterior limb of internal capsule [IC], bilateral superior longitudinal fasciculus [LF]) and MD values (tracts of the right SCR and PCR, right superior LF, and right splenium of the CC). In comparison to the MO group, the CM group showed decreased FA (bilateral SCR and PCR, bilateral body of CC, right superior LF, right forceps minor) and increased MD values (bilateral SCR and right PCR, right body of CC, right superior LF, right splenium of CC, and right posterior limb of IC). Conclusion Our results suggest that chronic migraine can be associated with the widespread disruption of normal white matter integrity in the brain.
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Affiliation(s)
- Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Antonio Di Renzo
- IRCCS - Fondazione Bietti, Research Unit of Neurophysiology of Vision and Neuro-Ophthalmology, Via Livenza 3, 00198, Rome, Italy
| | - Emanuele Tinelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Cherubino Di Lorenzo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Vincenzo Parisi
- IRCCS - Fondazione Bietti, Research Unit of Neurophysiology of Vision and Neuro-Ophthalmology, Via Livenza 3, 00198, Rome, Italy.
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Valentina Calistri
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Stefano Tardioli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Gaia Cartocci
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Francesca Caramia
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Vittorio Di Piero
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy.,IRCCS - Neuromed, Pozzilli, IS, Italy
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29
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Qin ZX, Su JJ, He XW, Zhu Q, Cui YY, Zhang JL, Wang MX, Gao TT, Tang W, Hu Y, Liu YS, Qiao Y, Liu JR, Li JQ, Du XX. Altered resting-state functional connectivity between subregions in the thalamus and cortex in migraine without aura. Eur J Neurol 2020; 27:2233-2241. [PMID: 32562320 DOI: 10.1111/ene.14411] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/14/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE Migraine is a complex and disabling neurological disorder, the exact neurological mechanisms of which remain unclear. The thalamus is considered to be the hub of the central processing and integration of nociceptive information, as well as the modulation of these processes. METHODS A total of 48 migraineurs without aura (MWoAs) during the interictal phase and 48 age- and sex-matched healthy controls underwent resting-state functional magnetic resonance imaging scans. We utilized masked independent component analysis and seed-based functional connectivity (FC) to investigate whether MWoAs exhibited abnormal FC between subregions in the thalamus and the cortex regions. RESULTS The MWoAs showed significantly weaker FC between the anterior dorsal thalamic nucleus and left precuneus. Additionally, MWoAs exhibited significantly reduced FC between the ventral posterior nucleus (VPN) and left precuneus, right inferior parietal lobule (R-IPL) and right middle frontal gyrus. Furthermore, the FC Z-scores between the VPN and R-IPL were negatively correlated with pain intensity in MWoAs. The disease duration of patients was negatively correlated with the FC Z-scores between the VPN and R-IPL. CONCLUSION These altered thalamocortical connectivity patterns may contribute to multisensory integration abnormalities, deficits in pain attention, cognitive evaluation and pain modulation. Pain sensitivity and disease duration are closely tied to abnormal FC between the VPN and R-IPL. Remarkably, recurrent headache attacks might contribute to this maladaptive functional plasticity closely related to pain intensity.
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Affiliation(s)
- Z X Qin
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, Shanghai
| | - J J Su
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - X W He
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Q Zhu
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, Shanghai
| | - Y Y Cui
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, Shanghai
| | - J L Zhang
- Clinical Science, Philips Healthcare, Shanghai
| | - M X Wang
- College of Medical Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - T T Gao
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, Shanghai
| | - W Tang
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, Shanghai
| | - Y Hu
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Y S Liu
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Y Qiao
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - J R Liu
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - J Q Li
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, Shanghai
| | - X X Du
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, Shanghai
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30
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David MCMM, Santos BSD, Barros WMA, Silva TRLD, Franco CIF, Matos RJBD. Neuroimaging investigation of memory changes in migraine: a systematic review. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:370-379. [PMID: 32609194 DOI: 10.1590/0004-282x20200025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 02/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Individuals with migraine usually complain about lower memory performance. Diagnostic methods such as neuroimaging may help in the understanding of possible morphologic and functional changes related to the memory of those individuals. Therefore, the aim of this review is to analyze the available literature on neuroimaging changes related to memory processing in migraine. METHODS We searched the following databases: Pubmed/Medline, Psycinfo, Science Direct, Cochrane and Web of Science. We used articles without restriction of year of publication. The combination of descriptors used for this systematic review of literature were Neuroimaging OR Imaging OR Brain AND Migraine OR Chronic Migraine AND Memory. RESULTS Of the 306 articles found, nine were selected and all used magnetic resonance imaging (MRI). The studies used structural and functional MRI techniques with a predominance of 3 Tesla equipment and T1-weighted images. According to the results obtained reported by these studies, migraine would alter the activity of memory-related structures, such as the hippocampus, insula and frontal, parietal and temporal cortices, thereby suggesting a possible mechanism by which migraine would influence memory, especially in relation to the memory of pain. CONCLUSIONS Migraine is associated to global dysfunction of multisensory integration and memory processing. This condition changes the activity of structures in various regions related to memory of pain, prospective memory, as well as in short- and long-term verbal and visuospatial memories. However, it is necessary to perform studies with larger samples in association with cognitive tests, and without the interference of medications to verify possible alterations and to draw more concrete conclusions.
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Affiliation(s)
| | | | - Waleska Maria Almeida Barros
- Universidade Federal de Pernambuco, Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento, Recife PE, Brazil
| | | | | | - Rhowena Jane Barbosa de Matos
- Universidade Federal de Pernambuco, Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento, Recife PE, Brazil
- Universidade Federal de Pernambuco, Centro Acadêmico de Vitória, Núcleo de Educação Física e Ciências do Esporte, Vitória de Santo Antão PB, Brazil
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31
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Shepherd AJ. Tracking the Migraine Cycle Using Visual Tasks. Vision (Basel) 2020; 4:vision4020023. [PMID: 32365776 PMCID: PMC7355979 DOI: 10.3390/vision4020023] [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: 01/31/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 12/14/2022] Open
Abstract
There are a number of reports that perceptual, electrophysiological and imaging measures can track migraine periodicity. As the electrophysiological and imaging research requires specialist equipment, it has few practical applications. This study sought to track changes in performance on four visual tasks over the migraine cycle. Coherence thresholds were measured for two motion and two orientation tasks. The first part of the study confirmed that the data obtained from an online study produced comparable results to those obtained under controlled laboratory conditions. Thirteen migraine with aura, 12 without aura, and 12 healthy controls participated. The second part of the study showed that thresholds for discriminating vertical coherent motion varied with the migraine cycle for a majority of the participants who tested themselves multiple times (four with aura, seven without). Performance improved two days prior to a migraine attack and remained improved for two days afterwards. This outcome is as expected from an extrapolation of earlier electrophysiological research. This research points to the possibility of developing sensitive visual tests that patients can use at home to predict an impending migraine attack and so take steps to try to abort it or, if it is inevitable, to plan their lives around it.
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Affiliation(s)
- A J Shepherd
- Department of Psychological Sciences, Birkbeck, University of London, London WC1E 7HX, UK
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32
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Planchuelo-Gómez Á, García-Azorín D, Guerrero ÁL, Aja-Fernández S, Rodríguez M, de Luis-García R. White matter changes in chronic and episodic migraine: a diffusion tensor imaging study. J Headache Pain 2020; 21:1. [PMID: 31898478 PMCID: PMC6941267 DOI: 10.1186/s10194-019-1071-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 12/24/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND White matter alterations have been observed in patients with migraine. However, no microstructural white matter alterations have been found particularly in episodic or chronic migraine patients, and there is limited research focused on the comparison between these two groups of migraine patients. METHODS Fifty-one healthy controls, 55 episodic migraine patients and 57 chronic migraine patients were recruited and underwent brain T1-weighted and diffusion-weighted MRI acquisition. Using Tract-Based Spatial Statistics (TBSS), fractional anisotropy, mean diffusivity, radial diffusivity and axial diffusivity were compared between the different groups. On the one hand, all migraine patients were compared against healthy controls. On the other hand, patients from each migraine group were compared between them and also against healthy controls. Correlation analysis between clinical features (duration of migraine in years, time from onset of chronic migraine in months, where applicable, and headache and migraine frequency, where applicable) and Diffusion Tensor Imaging measures was performed. RESULTS Fifty healthy controls, 54 episodic migraine and 56 chronic migraine patients were finally included in the analysis. Significant decreased axial diffusivity (p < .05 false discovery rate and by number of contrasts corrected) was found in chronic migraine compared to episodic migraine in 38 white matter regions from the Johns Hopkins University ICBM-DTI-81 White-Matter Atlas. Significant positive correlation was found between time from onset of chronic migraine and mean fractional anisotropy in the bilateral external capsule, and negative correlation between time from onset of chronic migraine and mean radial diffusivity in the bilateral external capsule. CONCLUSIONS These findings suggest global white matter structural differences between episodic migraine and chronic migraine. Patients with chronic migraine could present axonal integrity impairment in the first months of chronic migraine with respect to episodic migraine patients. White matter changes after the onset of chronic migraine might reflect a set of maladaptive plastic changes.
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Affiliation(s)
| | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal 3, 47005, Valladolid, Spain
| | - Ángel L Guerrero
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal 3, 47005, Valladolid, Spain.
- Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.
- Department of Medicine, Universidad de Valladolid, Valladolid, Spain.
| | | | - Margarita Rodríguez
- Department of Radiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Wei HL, Zhou X, Chen YC, Yu YS, Guo X, Zhou GP, Zhou QQ, Qu LJ, Yin X, Li J, Zhang H. Impaired intrinsic functional connectivity between the thalamus and visual cortex in migraine without aura. J Headache Pain 2019; 20:116. [PMID: 31856703 PMCID: PMC6924083 DOI: 10.1186/s10194-019-1065-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 12/03/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Resting-state functional magnetic resonance imaging (fMRI) has confirmed disrupted visual network connectivity in migraine without aura (MwoA). The thalamus plays a pivotal role in a number of pain conditions, including migraine. However, the significance of altered thalamo-visual functional connectivity (FC) in migraine remains unknown. The goal of this study was to explore thalamo-visual FC integrity in patients with MwoA and investigate its clinical significance. METHODS Resting-state fMRI data were acquired from 33 patients with MwoA and 22 well-matched healthy controls. After identifying the visual network by independent component analysis, we compared neural activation in the visual network and thalamo-visual FC and assessed whether these changes were linked to clinical characteristics. We used voxel-based morphometry to determine whether functional differences were dependent on structural differences. RESULTS The visual network exhibited significant differences in regions (bilateral cunei, right lingual gyrus and left calcarine sulcus) by inter-group comparison. The patients with MwoA showed significantly increased FC between the left thalami and bilateral cunei and between the right thalamus and the contralateral calcarine sulcus and right cuneus. Furthermore, the neural activation of the left calcarine sulcus was positively correlated with visual analogue scale scores (r = 0.319, p = 0.043), and enhanced FC between the left thalamus and right cuneus in migraine patients was negatively correlated with Generalized Anxiety Disorder scores (r = - 0.617, p = 0.005). CONCLUSION Our data suggest that migraine distress is exacerbated by aberrant feedback projections to the visual network, playing a crucial role in migraine physiological mechanisms. The current study provides further insights into the complex scenario of migraine mechanisms.
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Affiliation(s)
- Heng-Le Wei
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, No.169, Hushan Road, Nanjing, Jiangsu Province, 211100 China
| | - Xin Zhou
- Department of Neurology, The Affiliated Jiangning Hospital of Nanjing Medical University, No.169, Hushan Road, Nanjing, Jiangsu Province, 211100 China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, 210006 China
| | - Yu-Sheng Yu
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, No.169, Hushan Road, Nanjing, Jiangsu Province, 211100 China
| | - Xi Guo
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, No.169, Hushan Road, Nanjing, Jiangsu Province, 211100 China
| | - Gang-Ping Zhou
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, No.169, Hushan Road, Nanjing, Jiangsu Province, 211100 China
| | - Qing-Qing Zhou
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, No.169, Hushan Road, Nanjing, Jiangsu Province, 211100 China
| | - Li-Jie Qu
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, No.169, Hushan Road, Nanjing, Jiangsu Province, 211100 China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, 210006 China
| | - Junrong Li
- Department of Neurology, The Affiliated Jiangning Hospital of Nanjing Medical University, No.169, Hushan Road, Nanjing, Jiangsu Province, 211100 China
| | - Hong Zhang
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, No.169, Hushan Road, Nanjing, Jiangsu Province, 211100 China
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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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Haigh SM, Chamanzar A, Grover P, Behrmann M. Cortical Hyper‐Excitability in Migraine in Response to Chromatic Patterns. Headache 2019; 59:1773-1787. [DOI: 10.1111/head.13620] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Sarah M. Haigh
- Department of Psychology, Institute for Neuroscience University of Nevada Reno NV USA
- Department of Psychology, Center for the Neural Basis of Cognition Carnegie Mellon University Pittsburgh PA USA
| | - Alireza Chamanzar
- Department of Electrical and Computer Engineering Carnegie Mellon University Pittsburgh PA USA
| | - Pulkit Grover
- Department of Electrical and Computer Engineering Carnegie Mellon University Pittsburgh PA USA
| | - Marlene Behrmann
- Department of Psychology, Center for the Neural Basis of Cognition Carnegie Mellon University Pittsburgh PA USA
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Ellingson BM, Hesterman C, Johnston M, Dudeck NR, Charles AC, Villablanca JP. Advanced Imaging in the Evaluation of Migraine Headaches. Neuroimaging Clin N Am 2019; 29:301-324. [PMID: 30926119 PMCID: PMC8765285 DOI: 10.1016/j.nic.2019.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The use of advanced imaging in routine diagnostic practice appears to provide only limited value in patients with migraine who have not experienced recent changes in headache characteristics or symptoms. However, advanced imaging may have potential for studying the biological manifestations and pathophysiology of migraine headaches. Migraine with aura appears to have characteristic spatiotemporal changes in structural anatomy, function, hemodynamics, metabolism, and biochemistry, whereas migraine without aura produces more subtle and complex changes. Large, controlled, multicenter imaging-based observational trials are needed to confirm the anecdotal evidence in the literature and test the scientific hypotheses thought to underscore migraine pathophysiology.
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Affiliation(s)
- Benjamin M Ellingson
- UCLA Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Boulevard, Suite 615, Los Angeles, CA 90024, USA; Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Boulevard, Suite 615, Los Angeles, CA 90024, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90095, USA; UCLA Brain Research Institute (BRI), David Geffen School of Medicine, University of California Los Angeles, 695 Charles E Young Dr S, Los Angeles, CA 90095, USA; UCLA Brain Tumor Imaging Laboratory (BTIL), Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, 924 Westwood Boulevard, Suite 615, Los Angeles, CA 90024, USA; UCLA Brain Tumor Imaging Laboratory (BTIL), Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles, 924 Westwood Boulevard, Suite 615, Los Angeles, CA 90024, USA.
| | - Chelsea Hesterman
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095-1769, USA
| | - Mollie Johnston
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095-1769, USA
| | - Nicholas R Dudeck
- UCLA Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Boulevard, Suite 615, Los Angeles, CA 90024, USA; Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Boulevard, Suite 615, Los Angeles, CA 90024, USA
| | - Andrew C Charles
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095-1769, USA
| | - Juan Pablo Villablanca
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Boulevard, Suite 615, Los Angeles, CA 90024, USA
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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: 45] [Impact Index Per Article: 9.0] [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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Chong CD, Peplinski J, Berisha V, Ross K, Schwedt TJ. Differences in fibertract profiles between patients with migraine and those with persistent post-traumatic headache. Cephalalgia 2019; 39:1121-1133. [DOI: 10.1177/0333102418815650] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objectives Often, persistent post-traumatic headache and migraine are phenotypically similar. However, the similarities and differences in the neuropathological underpinnings of persistent post-traumatic headache and migraine require further understanding. We used diffusion tensor imaging (DTI) and a novel method for detecting subtle changes in fibertract integrity by measuring node-by-node parameters along each tract to compare fibertract profiles between those with migraine and those with persistent post-traumatic headache, and compared both cohorts to a group of controls. Methods Eighteen fibertracts were reconstructed for 131 subjects, including 49 patients with persistent post-traumatic headache attributed to mild traumatic brain injury, 41 with migraine, and 41 controls. Node-by-node diffusion parameters of mean diffusivity and radial diffusivity were calculated along each tract. Mean diffusivity and radial diffusivity measurements were averaged along quartiles of each tract for statistical interpretation and group comparison. Using a post-hoc analysis, correlations between tract quartile measurements and headache frequency were calculated. Results There were significant differences between migraine and persistent post-traumatic headache cohorts for quartile measurements of mean diffusivity or radial diffusivity in the bilateral anterior thalamic radiations, cingulum (angular bundles and cingulate gyri), inferior longitudinal fasciculi, and uncinate fasciculi, the left corticospinal tract, and the right superior longitudinal fasciculi-parietal portion. For migraine patients, there was a significant positive correlation between headache frequency and forceps major mean diffusivity, whereas for persistent post-traumatic headache there was a positive correlation between headache frequency and cingulum angular bundle mean diffusivity and radial diffusivity. Conclusions Quartile measurements of radial diffusivity and mean diffusivity indicate unique differences in fibertract profiles between those with migraine vs. persistent post-traumatic headache. Although for both migraine and persistent post-traumatic headache there was a positive relationship between fibertract alterations and headache frequency, there were disease-specific differences between headache frequency and fibertract injury patterns. These findings might suggest potential differences in the neuropathological mechanisms underlying migraine and persistent post-traumatic headache.
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Affiliation(s)
| | - Jacob Peplinski
- School of Electrical, Computer and Energy Engineering and Department of Speech and Hearing Science, Arizona State University, Phoenix, AZ, USA
| | - Visar Berisha
- School of Electrical, Computer and Energy Engineering and Department of Speech and Hearing Science, Arizona State University, Phoenix, AZ, USA
| | - Katherine Ross
- Phoenix VA Health Care System, Audiology and Speech Pathology Service, Phoenix, AZ, USA
| | - Todd J Schwedt
- Mayo Clinic Department of Neurology, Mayo Clinic, Phoenix, AZ, USA
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Viganò A, Toscano M, Puledda F, Di Piero V. Treating Chronic Migraine With Neuromodulation: The Role of Neurophysiological Abnormalities and Maladaptive Plasticity. Front Pharmacol 2019; 10:32. [PMID: 30804782 PMCID: PMC6370938 DOI: 10.3389/fphar.2019.00032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 01/14/2019] [Indexed: 12/20/2022] Open
Abstract
Chronic migraine (CM) is the most disabling form of migraine, because pharmacological treatments have low efficacy and cumbersome side effects. New evidence has shown that migraine is primarily a disorder of brain plasticity and migraine chronification depends on a maladaptive process favoring the development of a brain state of hyperexcitability. Due to the ability to induce plastic changes in the brain, researchers started to look at Non-Invasive Brain Stimulation (NIBS) as a possible therapeutic option in migraine field. On one side, NIBS techniques induce changes of neural plasticity that outlast the period of the stimulation (a fundamental prerequisite of a prophylactic migraine treatment, concurrently they allow targeting neurophysiological abnormalities that contribute to the transition from episodic to CM. The action may thus influence not only the cortex but also brainstem and diencephalic structures. Plus, NIBS is not burdened by serious medication side effects and drug–drug interactions. Although the majority of the studies reported somewhat beneficial effects in migraine patients, no standard intervention has been defined. This may be due to methodological differences regarding the used techniques (e.g., transcranial magnetic stimulation, transcranial direct current stimulation), the brain regions chosen as targets, and the stimulation types (e.g., the use of inhibitory and excitatory stimulations on the basis of opposite rationales), and an intrinsic variability of stimulation effect. Hence, it is difficult to draw a conclusion on the real effect of neuromodulation in migraine. In this article, we first will review the definition and mechanisms of brain plasticity, some neurophysiological hallmarks of migraine, and migraine chronification-related (dys)plasticity. Secondly, we will review available results from therapeutic and physiological studies using neuromodulation in CM. Lastly we will discuss the results obtained in these preventive trials in the light of a possible effect on brain plasticity.
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Affiliation(s)
- Alessandro Viganò
- Headache Research Centre and Neurocritical Care Unit, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy.,Molecular and Cellular Networks Lab, Department of Anatomy, Histology, Forensic Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy
| | - Massimiliano Toscano
- Headache Research Centre and Neurocritical Care Unit, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy.,Department of Neurology, Fatebenefratelli Hospital, Rome, Italy
| | - Francesca Puledda
- Headache Group, Department of Basic and Clinical Neuroscience, King's College Hospital, King's College London, London, United Kingdom
| | - Vittorio Di Piero
- Headache Research Centre and Neurocritical Care Unit, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy.,University Consortium for Adaptive Disorders and Head Pain - UCADH, Pavia, Italy
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Magon S, May A, Stankewitz A, Goadsby PJ, Schankin C, Ashina M, Amin FM, Seifert CL, Mallar Chakravarty M, Müller J, Sprenger T. Cortical abnormalities in episodic migraine: A multi-center 3T MRI study. Cephalalgia 2018; 39:665-673. [PMID: 30525946 DOI: 10.1177/0333102418795163] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Several previous studies have investigated cortical abnormalities, specifically cortical thickness, in patients with migraine, with variable results. The relatively small sample sizes of most previous studies may partially explain these inconsistencies. OBJECTIVE To investigate differences of cortical thickness between control subjects and migraineurs in a large cohort. METHODS Three Tesla MRI data of 131 patients (38 with and 93 without aura) and 115 control subjects were analysed. A vertex-wise linear model was applied controlling for age, gender and MRI scanner to investigate differences between groups and determine the impact of clinical factors on cortical thickness measures. RESULTS Migraineurs showed areas of thinned cortex compared with controls bilaterally in the central sulcus, in the left middle-frontal gyrus, in left visual cortices and the right occipito-temporal gyrus. Frequency of migraine attacks and the duration of the disorder had a significant impact on cortical thickness in the sensorimotor cortex and middle-frontal gyrus. Patients without aura showed thinner cortex than controls bilaterally in the central sulcus and in the middle frontal gyrus, in the left primary visual cortices, in the left supramarginal gyrus and in the right cuneus. Patients with aura showed clusters of thinner cortex bilaterally in the subparietal sulcus (between the precuneus and posterior cingulate cortex), in the left intraparietal sulcus and in the right anterior cingulate. CONCLUSION These results indicate cortical abnormalities in specific brain regions in migraineurs. Some of the observed abnormalities may reflect a genetic susceptibility towards developing migraine attacks, while others are probably a consequence of repeated head pain attacks.
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Affiliation(s)
- Stefano Magon
- 1 Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland.,2 Medical Image Analysis Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Arne May
- 3 Institute for Systems Neuroscience, University of Hamburg, Hamburg, Germany
| | - Anne Stankewitz
- 3 Institute for Systems Neuroscience, University of Hamburg, Hamburg, Germany.,4 Department of Neurology, Technische Universität Muenchen, Munich, Germany
| | - Peter J Goadsby
- 5 Headache Group-Department of Neurology, University of California, San Francisco, CA, USA.,6 NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, London, UK
| | - Christoph Schankin
- 7 Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Messoud Ashina
- 8 Danish Headache Center and Department of Neurology, University of Copenhagen, Copenhagen, Denmark
| | - Faisal M Amin
- 8 Danish Headache Center and Department of Neurology, University of Copenhagen, Copenhagen, Denmark
| | | | - M Mallar Chakravarty
- 9 Cerebral Imaging Centre, Douglas Mental Health University Institute Montreal, Montreal, Quebec, Canada.,10 Department of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Jannis Müller
- 1 Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Till Sprenger
- 1 Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland.,11 Department of Neurology, DKD HELIOS Klinik Wiesbaden, Wiesbaden, Germany
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Shibata Y, Ishiyama S, Matsushita A. White matter diffusion abnormalities in migraine and medication overuse headache: A 1.5-T tract-based spatial statistics study. Clin Neurol Neurosurg 2018; 174:167-173. [DOI: 10.1016/j.clineuro.2018.09.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 08/06/2018] [Accepted: 09/15/2018] [Indexed: 01/03/2023]
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Hu B, Wang X, He JB, Dai YJ, Zhang J, Yu Y, Sun Q, Lin-FengYan, Hu YC, Nan HY, Yang Y, Kaye AD, Cui GB, Wang W. Structural and functional brain changes in perimenopausal women who are susceptible to migraine: a study protocol of multi-modal MRI trial. BMC Med Imaging 2018; 18:26. [PMID: 30189858 PMCID: PMC6127929 DOI: 10.1186/s12880-018-0272-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/29/2018] [Indexed: 01/01/2023] Open
Abstract
Background As a common clinical symptom that often bothers midlife females, migraine is closely associated with perimenopause. Previous studies suggest that one of the most prominent triggers is the sudden decline of estrogen during perimenopausal period. Hormone replacement therapy (HRT) is widely used to prevent this suffering in perimenopausal women, but effective diagnostic system is lacked for quantifying the severity of the diseaase. To avoid the abuse and overuse of HRT, we propose to conduct a diagnostic trial using multimodal MRI techniques to quantify the severity of these perimenopausal migraineurs who are susceptible to the decline of estrogen. Methods Perimenopausal women suffering from migraine will be recruited from the pain clinic of our hospital. Perimenopausal women not suffering from any kind of headache will be recruited from the local community. Clinical assessment and multi-modal MR imaging examination will be conducted. A follow up will be conducted once half year within 3 years. Pain behavior, neuropsychology scores, fMRI analysis combined with suitable statistical software will be used to reveal the potential association between these above traits and the susceptibility of migraine. Discussion Multi-modal imaging features of both healthy controls and perimenopausal women who are susceptible to estrogen decline will be acquired. Imaging features will include volumetric characteristics, white matter integrity, functional characteristics, topological properties, and perfusion properties. Clinical information, such as basic information, blood estrogen level, information of migraine, and a bunch of neurological scale will also be used for statistic assessment. This clinical trial would help to build an effective screen system for quantifying the severity of illness of those susceptible women during the perimenopausal period. Trial registration This study has already been registered at Clinical Trials. gov (ID: NCT02820974). Registration date: September 28th, 2014.
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Affiliation(s)
- Bo Hu
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Xu Wang
- Student Brigade, Fourth Military Medical University (Air Force Medical University), 169 West Changle Road, Xi'an, 710032, Shaanxi Province, China
| | - Jie-Bing He
- Student Brigade, Fourth Military Medical University (Air Force Medical University), 169 West Changle Road, Xi'an, 710032, Shaanxi Province, China
| | - Yu-Jie Dai
- Department of Clinical Nutrition, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Jin Zhang
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Ying Yu
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Qian Sun
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Lin-FengYan
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Yu-Chuan Hu
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Hai-Yan Nan
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Yang Yang
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Alan D Kaye
- Departments of Anesthesiology and Pharmacology, Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | - Guang-Bin Cui
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China.
| | - Wen Wang
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China.
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Russo A, Coppola G, Pierelli F, Parisi V, Silvestro M, Tessitore A, Tedeschi G. Pain Perception and Migraine. Front Neurol 2018; 9:576. [PMID: 30116215 PMCID: PMC6082953 DOI: 10.3389/fneur.2018.00576] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 06/26/2018] [Indexed: 12/20/2022] Open
Abstract
Background: It is well-known that both inter- and intra-individual differences exist in the perception of pain; this is especially true in migraine, an elusive pain disorder of the head. Although electrophysiology and neuroimaging techniques have greatly contributed to a better understanding of the mechanisms involved in migraine during recent decades, the exact characteristics of pain threshold and pain intensity perception remain to be determined, and continue to be a matter of debate. Objective: The aim of this review is to provide a comprehensive overview of clinical, electrophysiological, and functional neuroimaging studies investigating changes during various phases of the so-called “migraine cycle” and in different migraine phenotypes, using pain threshold and pain intensity perception assessments. Methods: A systematic search for qualitative studies was conducted using search terms “migraine,” “pain,” “headache,” “temporal summation,” “quantitative sensory testing,” and “threshold,” alone and in combination (subject headings and keywords). The literature search was updated using the additional keywords “pain intensity,” and “neuroimaging” to identify full-text papers written in English and published in peer-reviewed journals, using PubMed and Google Scholar databases. In addition, we manually searched the reference lists of all research articles and review articles. Conclusion: Consistent data indicate that pain threshold is lower during the ictal phase than during the interictal phase of migraine or healthy controls in response to pressure, cold and heat stimuli. There is evidence for preictal sub-allodynia, whereas interictal results are conflicting due to either reduced or no observed difference in pain threshold. On the other hand, despite methodological limitations, converging observations support the concept that migraine attacks may be characterized by an increased pain intensity perception, which normalizes between episodes. Nevertheless, future studies are required to longitudinally evaluate a large group of patients before and after pharmacological and non-pharmacological interventions to investigate phases of the migraine cycle, clinical parameters of disease severity and chronic medication usage.
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Affiliation(s)
- Antonio Russo
- Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences, Headache Center, University of Campania "Luigi Vanvitelli, ", Naples, Italy.,MRI Research Center SUN-FISM, University of Campania "Luigi Vanvitelli,", Naples, Italy
| | - Gianluca Coppola
- Research Unit of Neurophysiology of Vision and Neuro-Ophthalmology, G. B. Bietti Foundation-IRCCS, Rome, Italy
| | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Vincenzo Parisi
- Research Unit of Neurophysiology of Vision and Neuro-Ophthalmology, G. B. Bietti Foundation-IRCCS, Rome, Italy
| | - Marcello Silvestro
- Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences, Headache Center, University of Campania "Luigi Vanvitelli, ", Naples, Italy
| | - Alessandro Tessitore
- Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences, Headache Center, University of Campania "Luigi Vanvitelli, ", Naples, Italy.,MRI Research Center SUN-FISM, University of Campania "Luigi Vanvitelli,", Naples, Italy
| | - Gioacchino Tedeschi
- Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences, Headache Center, University of Campania "Luigi Vanvitelli, ", Naples, Italy.,MRI Research Center SUN-FISM, University of Campania "Luigi Vanvitelli,", Naples, Italy.,Institute for Diagnosis and Care "Hermitage Capodimonte," Naples, Italy
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Russo A, Silvestro M, Tessitore A, Tedeschi G. Advances in migraine neuroimaging and clinical utility: from the MRI to the bedside. Expert Rev Neurother 2018; 18:533-544. [PMID: 29883214 DOI: 10.1080/14737175.2018.1486708] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION In current migraine clinical practice, no specific diagnostic investigations are available and therefore the diagnosis is an eminently clinical process where instrumental examinations may have a part to exclude possible causes of secondary headaches. While migraine clinical phenotype has been widely characterized, migraine pathophysiology has still a gap that might be partly bridged by structural and functional neuroimaging investigations. Areas covered: This article aims to review the recent advances in functional neuroimaging, the consequent progress in the knowledge of migraine pathophysiology and their putative application and impact in the clinical setting. A comprehensive review was conducted of PubMed citations by entering the key word 'MRI' combined with 'migraine' AND/OR 'headache.' Other key words included 'gray matter' OR 'white matter,' 'structural' OR 'functional.' The only restriction was English-language publication. The abstracts of all articles meeting these criteria were reviewed, and full texts were examined for relevant references. Expert commentary: Advanced magnetic resonance imaging (MRI) techniques are tremendously improving our knowledge about brain abnormalities in migraine patients. However, advanced MRI could nowadays overcome the limits linked to the clinicians' judgment through the identification of objectively measurable neuroimaging findings (quantitative biomarkers) concerning the diagnosis, the prognosis and 'tailored' therapeutic-care pathways.
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Affiliation(s)
- Antonio Russo
- a Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences , University of Campania "Luigi Vanvitelli" , Naples , Italy.,b MRI Research Center SUN-FISM , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Marcello Silvestro
- a Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Alessandro Tessitore
- a Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences , University of Campania "Luigi Vanvitelli" , Naples , Italy.,b MRI Research Center SUN-FISM , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Gioacchino Tedeschi
- a Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences , University of Campania "Luigi Vanvitelli" , Naples , Italy.,b MRI Research Center SUN-FISM , University of Campania "Luigi Vanvitelli" , Naples , Italy.,c Institute for Diagnosis and Care ''Hermitage Capodimonte'', Neurology Department , Naples , Italy
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Close LN, Eftekhari S, Wang M, Charles AC, Russo AF. Cortical spreading depression as a site of origin for migraine: Role of CGRP. Cephalalgia 2018; 39:428-434. [PMID: 29695168 DOI: 10.1177/0333102418774299] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PREMISE Migraine is a complex neurologic disorder that leads to significant disability, yet remains poorly understood. PROBLEM One potential triggering mechanism in migraine with aura is cortical spreading depression, which can activate the trigeminal nociceptive system both peripherally and centrally in animal models. A primary neuropeptide of the trigeminal system is calcitonin gene-related peptide, which is a potent vasodilatory peptide and is currently a major therapeutic target for migraine treatment. Despite the importance of both cortical spreading depression and calcitonin gene-related peptide in migraine, the relationship between these two players has been relatively unexplored. However, recent data suggest several potential vascular and neural connections between calcitonin gene-related peptide and cortical spreading depression. CONCLUSION This review will outline calcitonin gene-related peptide-cortical spreading depression connections and propose a model in which cortical spreading depression and calcitonin gene-related peptide act at the intersection of the vasculature and cortical neurons, and thus contribute to migraine pathophysiology.
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Affiliation(s)
- Liesl N Close
- 1 Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Sajedeh Eftekhari
- 2 UCLA Goldberg Migraine Program, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Minyan Wang
- 3 Centre for Neuroscience, Department of Biological Sciences, Xi'an Jiaotong-Liverpool University (XJTLU), SIP, Suzhou, China
| | - Andrew C Charles
- 2 UCLA Goldberg Migraine Program, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Andrew F Russo
- 4 Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA, USA.,5 Department of Neurology, University of Iowa, Iowa City, IA, USA.,6 Veterans Affairs Medical Center, Iowa City, IA, USA
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Hebestreit JM, May A. The enigma of site of action of migraine preventives: no effect of metoprolol on trigeminal pain processing in patients and healthy controls. J Headache Pain 2017; 18:116. [PMID: 29285569 PMCID: PMC5745371 DOI: 10.1186/s10194-017-0827-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 12/07/2017] [Indexed: 01/03/2023] Open
Abstract
Background Beta-blockers are a first choice migraine preventive medication. So far it is unknown how they exert their therapeutic effect in migraine. To this end we examined the neural effect of metoprolol on trigeminal pain processing in 19 migraine patients and 26 healthy controls. All participants underwent functional magnetic resonance imaging (fMRI) during trigeminal pain twice: Healthy subjects took part in a placebo-controlled, randomized and double-blind study, receiving a single dose of metoprolol and placebo. Patients were examined with a baseline scan before starting the preventive medication and 3 months later whilst treated with metoprolol. Results Mean pain intensity ratings were not significantly altered under metoprolol. Functional imaging revealed no significant differences in nociceptive processing in both groups. Contrary to earlier findings from animal studies, we did not find an effect of metoprolol on the thalamus in either group. However, using a more liberal and exploratory threshold, hypothalamic activity was slightly increased under metoprolol in patients and migraineurs. Conclusions No significant effect of metoprolol on trigeminal pain processing was observed, suggesting a peripheral effect of metoprolol. Exploratory analyses revealed slightly enhanced hypothalamic activity under metoprolol in both groups. Given the emerging role of the hypothalamus in migraine attack generation, these data need further examination.
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Affiliation(s)
- Julia M Hebestreit
- Department of Systems Neuroscience, Center for Experimental Medicine, University Medical Center Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Arne May
- Department of Systems Neuroscience, Center for Experimental Medicine, University Medical Center Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Puledda F, Messina R, Goadsby PJ. An update on migraine: current understanding and future directions. J Neurol 2017; 264:2031-2039. [PMID: 28321564 PMCID: PMC5587613 DOI: 10.1007/s00415-017-8434-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/20/2017] [Indexed: 01/16/2023]
Abstract
Migraine is a common brain disorder with high disability rates which involves a series of abnormal neuronal networks, interacting at different levels of the central and peripheral nervous system. An increase in the interest around migraine pathophysiology has allowed researchers to unravel certain neurophysiological mechanisms and neurotransmitter involvement culminating in the recent development of novel therapies, which might substantially change the clinical approach to migraine patients. The present review will highlight the current aspects of migraine pathophysiology, covering an understanding of the complex workings of the migraine state and the brain regions responsible for them. We will further discuss the therapeutic agents which have appeared in the most recent years for migraine care, from calcitonin gene-related peptide (CGRP) receptor antagonists, gepants; through serotonin 5-HT1F receptor agonists, ditans, and CGRP or CGRP receptor monoclonal antibodies to invasive and non-invasive neuromodulation techniques.
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Affiliation(s)
- Francesca Puledda
- Headache Group, Department of Basic and Clinical Neuroscience, King's College London, London, UK
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London, UK
| | - Roberta Messina
- Headache Group, Department of Basic and Clinical Neuroscience, King's College London, London, UK
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London, UK
| | - Peter J Goadsby
- Headache Group, Department of Basic and Clinical Neuroscience, King's College London, London, UK.
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London, UK.
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Cortese F, Pierelli F, Bove I, Di Lorenzo C, Evangelista M, Perrotta A, Serrao M, Parisi V, Coppola G. Anodal transcranial direct current stimulation over the left temporal pole restores normal visual evoked potential habituation in interictal migraineurs. J Headache Pain 2017; 18:70. [PMID: 28726157 PMCID: PMC5517389 DOI: 10.1186/s10194-017-0778-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 07/04/2017] [Indexed: 02/02/2023] Open
Abstract
Background Neuroimaging data has implicated the temporal pole (TP) in migraine pathophysiology; the density and functional activity of the TP were reported to fluctuate in accordance with the migraine cycle. Yet, the exact link between TP morpho-functional abnormalities and migraine is unknown. Here, we examined whether non-invasive anodal transcranial direct current stimulation (tDCS) ameliorates abnormal interictal multimodal sensory processing in patients with migraine. Methods We examined the habituation of visual evoked potentials and median nerve somatosensory evoked potentials (SSEP) before and immediately after 20-min anodal tDCS (2 mA) or sham stimulation delivered over the left TP in interictal migraineurs. Results Prior to tDCS, interictal migraineurs did not exhibit habituation in response to repetitive visual or somatosensory stimulation. After anodal tDCS but not sham stimulation, migraineurs exhibited normal habituation responses to visual stimulation; however, tDCS had no effect on SSEP habituation in migraineurs. Conclusion Our study shows for the first time that enhancing excitability of the TP with anodal tDCS normalizes abnormal interictal visual information processing in migraineurs. This finding has implications for the role of the TP in migraine, and specifically highlights the ventral stream of the visual pathway as a pathophysiological neural substrate for abnormal visual processing in migraine.
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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.
| | - 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
| | - Ilaria Bove
- 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, Rome, 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
| | - Gianluca Coppola
- G. B. Bietti Foundation IRCCS, Research Unit of Neurophysiology of Vision and Neuro-Ophthalmology, Rome, Italy
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Solomon AJ, Watts R, Dewey BE, Reich DS. MRI evaluation of thalamic volume differentiates MS from common mimics. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2017; 4:e387. [PMID: 28761906 PMCID: PMC5515603 DOI: 10.1212/nxi.0000000000000387] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/13/2017] [Indexed: 12/20/2022]
Abstract
Objective: To determine whether MRI evaluation of thalamic volume differentiates MS from other disorders that cause MRI white matter abnormalities. Methods: There were 40 study participants: 10 participants with MS without additional comorbidities for white matter abnormalities (MS − c); 10 participants with MS with additional comorbidities for white matter abnormalities (MS + c); 10 participants with migraine, MRI white matter abnormalities, and no additional comorbidities for white matter abnormalities (Mig − c); and 10 participants previously incorrectly diagnosed with MS (Misdx). T1-magnetization-prepared rapid gradient-echo and T2-weighted three-dimensional fluid attenuation inversion recovery sequences were acquired on a Phillips Achieva d-Stream 3T MRI, and scans were randomly ordered and de-identified for a blinded reviewer who performed MRI segmentation using LesionTOADS. Results: Mean normalized thalamic volume differed among the 4 cohorts (analysis of variance, p = 0.005) and was smaller in the 20 MS participants compared with the 20 non-MS participants (p < 0.001), smaller in MS − c compared with Mig − c (p = 0.03), and smaller in MS + c compared with Misdx (p = 0.006). The sensitivity and specificity were both 0.75 for diagnosis of MS with a thalamic volume <0.0077. Conclusions: MRI volumetric evaluation of the thalamus, but not other deep gray-matter structures, differentiated MS from other diseases that cause white matter abnormalities and are often mistaken for MS. Evaluation for thalamic atrophy may improve accuracy for diagnosis of MS as an adjunct to additional radiologic criteria. Thalamic volumetric assessment by MRI in larger cohorts of patients undergoing evaluation for MS is needed, along with the development of automated and easily applied volumetric assessment tools for future clinical application. Classification of evidence: This study provides Class III evidence that MRI evaluation of thalamic volume differentiates MS from other diseases that cause white matter abnormalities.
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Affiliation(s)
- Andrew J Solomon
- Department of Neurological Sciences (A.J.S.) and Department of Radiology (R.W.), University of Vermont College of Medicine, Burlington; Department of Electrical and Computer Engineering (B.E.D.), Johns Hopkins University; and Translational Neuroradiology Section (B.E.D., D.S.R.), Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Richard Watts
- Department of Neurological Sciences (A.J.S.) and Department of Radiology (R.W.), University of Vermont College of Medicine, Burlington; Department of Electrical and Computer Engineering (B.E.D.), Johns Hopkins University; and Translational Neuroradiology Section (B.E.D., D.S.R.), Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Blake E Dewey
- Department of Neurological Sciences (A.J.S.) and Department of Radiology (R.W.), University of Vermont College of Medicine, Burlington; Department of Electrical and Computer Engineering (B.E.D.), Johns Hopkins University; and Translational Neuroradiology Section (B.E.D., D.S.R.), Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Daniel S Reich
- Department of Neurological Sciences (A.J.S.) and Department of Radiology (R.W.), University of Vermont College of Medicine, Burlington; Department of Electrical and Computer Engineering (B.E.D.), Johns Hopkins University; and Translational Neuroradiology Section (B.E.D., D.S.R.), Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, Bethesda, MD
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