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González-Ávila C, García-Azorín D, Mínguez-Olaondo A, Rubio-Flores L, Lamas R, Nieves-Castellanos C, López-Bravo A, Muñoz-Vendrell A, Campoy S, Sebastian-Valles F, Quintas S. Visual snow syndrome in patients with migraine: widening the clinical spectrum of the syndrome with permanent and episodic manifestations. Neurol Sci 2024; 45:4437-4444. [PMID: 38536549 DOI: 10.1007/s10072-024-07483-y] [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: 01/22/2024] [Accepted: 03/19/2024] [Indexed: 08/09/2024]
Abstract
PURPOSE Migraine is the comorbidity most frequently associated with visual snow syndrome (VSS), but the prevalence of VSS in patients with migraine (PWM) has not been studied. Our objective was to evaluate the frequency of VSS in PWM and to analyze if symptoms of VSS happened in a permanent or episodic manner (eVSS) in this population. METHODS We conducted a multicenter observational cross-sectional study. PWM was recruited from headache units, and a survey about the presence of visual snow symptoms was administered. The frequency and characteristics of patients that met current VSS criteria were analyzed. Demographic and clinical features of patients with VSS, eVSS, and PWM with no visual snow were compared. RESULTS A total of 217 PWM were included. Seventeen patients (7.8%) met the VSS criteria. VSS patients had visual aura more frequently (58.8% vs. 31%; p = 0.019) and a higher MIDAS score (96.6 vs. 47.7; p = 0.014). Fifty-eight PWM (26.7%) showed visual snow and associated features in an episodic way and were classified as eVSS. Patients with VSS showed a tendency towards a higher frequency of visual symptoms than patients with eVSS (p > 0.05). No statistically significant differences in sociodemographic characteristics and comorbid conditions were found between VSS and eVSS. CONCLUSION The prevalence of VSS in PWM may be higher than that described for the general population. Some PWM may present similar visual symptoms to patients with VSS but in an episodic manner. Our study reinforces the observation that the clinical spectrum of visual snow is likely to be broader than previously described.
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Affiliation(s)
- Carmen González-Ávila
- Headache Unit, Neurology Department, Hospital Universitario de La Princesa, Madrid, Spain.
| | - David García-Azorín
- Headache Unit, Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Ane Mínguez-Olaondo
- Neurology Department, Hospital Universitario Donostia, San Sebastián, Spain
- Athenea Neuroclinics (Donostia), San Sebastián, Spain
- Neuroscience Area, Biodonostia Research Institute (Donostia), San Sebastián, Spain
- Departamento de Medicina, Facultad de Ciencias de La Salud, Universidad de Deusto (Bilbao), San Sebastián, Spain
| | - Laura Rubio-Flores
- Neurology Department, Hospital Universitario General de Villalba, Madrid, Spain
- Neuroscience Institute, La Milagrosa University Hospital and Vithas Madrid, Aravaca University Hospital, Vithas Hospital Group, Madrid, Spain
| | - Raquel Lamas
- Headache Unit, Neurology Department, Hospital Virgen del Rocío, Seville, Spain
| | | | - Alba López-Bravo
- Headache Unit, Department of Neurology, Hospital Reina Sofía, Tudela, Navarra, Spain
- Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - Albert Muñoz-Vendrell
- Headache Unit, Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sergio Campoy
- Headache Unit, Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Fernando Sebastian-Valles
- Endocrinology and Nutrition Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - Sonia Quintas
- Headache Unit, Neurology Department, Hospital Universitario de La Princesa, Madrid, Spain
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Aeschlimann SA, Klein A, Schankin CJ. Visual snow syndrome: recent advances in understanding the pathophysiology and potential treatment approaches. Curr Opin Neurol 2024; 37:283-288. [PMID: 38465699 PMCID: PMC11064904 DOI: 10.1097/wco.0000000000001258] [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: 03/12/2024]
Abstract
PURPOSE OF REVIEW Visual snow syndrome (VSS) is a disorder characterized by persistent visual disturbances, including the visual snow phenomenon, palinopsia, heightened perception of entoptic phenomena, impaired night vision, and photophobia. The purpose of this review is to provide an update on recent findings over the past 18 months in VSS research and to summarize the current state of treatment approaches. RECENT FINDINGS Electrophysiological studies have revealed cortical hyperresponsivity in visual brain areas, imaging studies demonstrated microstructural and functional connectivity alterations in multiple cortical and thalamic regions and investigated glutamatergic and serotoninergic neurotransmission. These findings suggest that VSS might be a network disorder.Only few treatment studies are currently available demonstrating limited response to medication and even worsening or triggering of visual symptoms by certain antidepressants. Promising nonpharmacological treatments include mindfulness-based cognitive therapy, the use of chromatic filters, and research on visual noise adaption and neuro-optometric visual rehabilitation therapy (NORT). However, the level of evidence is still low and further research is needed including larger trials and involving objective measures of individual dysfunction. SUMMARY Although there has been recent progress, we still have not fully understood the nature of VSS. Further research is needed on a clinical and pathophysiological level to successfully treat the condition.
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Affiliation(s)
- Sarah A Aeschlimann
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Klein A, Aeschlimann SA, Zubler F, Scutelnic A, Riederer F, Ertl M, Schankin CJ. Alterations of the alpha rhythm in visual snow syndrome: a case-control study. J Headache Pain 2024; 25:53. [PMID: 38584260 PMCID: PMC11000394 DOI: 10.1186/s10194-024-01754-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/19/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Visual snow syndrome is a disorder characterized by the combination of typical perceptual disturbances. The clinical picture suggests an impairment of visual filtering mechanisms and might involve primary and secondary visual brain areas, as well as higher-order attentional networks. On the level of cortical oscillations, the alpha rhythm is a prominent EEG pattern that is involved in the prioritisation of visual information. It can be regarded as a correlate of inhibitory modulation within the visual network. METHODS Twenty-one patients with visual snow syndrome were compared to 21 controls matched for age, sex, and migraine. We analysed the resting-state alpha rhythm by identifying the individual alpha peak frequency using a Fast Fourier Transform and then calculating the power spectral density around the individual alpha peak (+/- 1 Hz). We anticipated a reduced power spectral density in the alpha band over the primary visual cortex in participants with visual snow syndrome. RESULTS There were no significant differences in the power spectral density in the alpha band over the occipital electrodes (O1 and O2), leading to the rejection of our primary hypothesis. However, the power spectral density in the alpha band was significantly reduced over temporal and parietal electrodes. There was also a trend towards increased individual alpha peak frequency in the subgroup of participants without comorbid migraine. CONCLUSIONS Our main finding was a decreased power spectral density in the alpha band over parietal and temporal brain regions corresponding to areas of the secondary visual cortex. These findings complement previous functional and structural imaging data at a electrophysiological level. They underscore the involvement of higher-order visual brain areas, and potentially reflect a disturbance in inhibitory top-down modulation. The alpha rhythm alterations might represent a novel target for specific neuromodulation. TRIAL REGISTRATION we preregistered the study before preprocessing and data analysis on the platform osf.org (DOI: https://doi.org/10.17605/OSF.IO/XPQHF , date of registration: November 19th 2022).
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Affiliation(s)
- Antonia Klein
- Department of Neurology Inselspital, Bern University Hospital, University of Bern, Rosenbühlgasse 25, Bern, CH-3010, Switzerland
| | - Sarah A Aeschlimann
- Department of Neurology Inselspital, Bern University Hospital, University of Bern, Rosenbühlgasse 25, Bern, CH-3010, Switzerland
| | - Frederic Zubler
- Department of Neurology Inselspital, Bern University Hospital, University of Bern, Rosenbühlgasse 25, Bern, CH-3010, Switzerland
| | - Adrian Scutelnic
- Department of Neurology Inselspital, Bern University Hospital, University of Bern, Rosenbühlgasse 25, Bern, CH-3010, Switzerland
| | - Franz Riederer
- Department of Neurology Inselspital, Bern University Hospital, University of Bern, Rosenbühlgasse 25, Bern, CH-3010, Switzerland
| | - Matthias Ertl
- Department of Psychology, University of Bern, Bern, CH 3010, Switzerland
- Neurocenter, Luzerner Kantonsspital, Lucerne, 6000, Switzerland
| | - Christoph J Schankin
- Department of Neurology Inselspital, Bern University Hospital, University of Bern, Rosenbühlgasse 25, Bern, CH-3010, Switzerland.
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Stern JI, Robertson CE. Visual Snow: Updates and Narrative Review. Curr Pain Headache Rep 2024; 28:55-63. [PMID: 38079073 DOI: 10.1007/s11916-023-01186-3] [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] [Accepted: 10/25/2023] [Indexed: 02/22/2024]
Abstract
PURPOSE OF REVIEW Visual snow (VS) involves visualization of innumerable dots throughout the visual field, sometimes resembling "TV static." Patients who experience this symptom may also have additional visual symptoms (e.g., photophobia, palinopsia, floaters, and nyctalopia) with a pattern now defined as visual snow syndrome (VSS). This manuscript describes both VS and VSS in detail and provides an updated review on the clinical features, pathophysiology, and optimal management strategies for these symptoms. RECENT FINDINGS VS/VSS may be primary or secondary to a variety of etiologies, including ophthalmologic or brain disorders, systemic disease, and medication/hallucinogen exposure. Evaluation involves ruling out secondary causes and mimics of VS. Increasing evidence suggests that VSS is a widespread process extending beyond the visual system. Pathophysiology may involve cortical hyperexcitability or dysfunctional connectivity of thalamocortical or attention/salience networks. VSS is typically a benign, non-progressive syndrome and can be managed with non-medicine strategies. Though no medication provides complete relief, some may provide partial improvement in severity of VS.
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Affiliation(s)
- Jennifer I Stern
- Neurology Department, Mayo Clinic College of Medicine and Science, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Carrie E Robertson
- Neurology Department, Mayo Clinic College of Medicine and Science, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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