1
|
Tanaka M, Tuka B, Vécsei L. Navigating the Neurobiology of Migraine: From Pathways to Potential Therapies. Cells 2024; 13:1098. [PMID: 38994951 PMCID: PMC11240811 DOI: 10.3390/cells13131098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 06/21/2024] [Indexed: 07/13/2024] Open
Abstract
Migraine is a debilitating neurological disorder characterized by recurring episodes of throbbing headaches that are frequently accompanied by sensory disturbances, nausea, and sensitivity to light and sound [...].
Collapse
Affiliation(s)
- Masaru Tanaka
- HUN-REN-SZTE Neuroscience Research Group, Danube Neuroscience Research Laboratory, Hungarian Research Network, University of Szeged (HUN-REN-SZTE), Tisza Lajos krt. 113, H-6725 Szeged, Hungary;
| | - Bernadett Tuka
- Department of Radiology, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary;
| | - László Vécsei
- HUN-REN-SZTE Neuroscience Research Group, Danube Neuroscience Research Laboratory, Hungarian Research Network, University of Szeged (HUN-REN-SZTE), Tisza Lajos krt. 113, H-6725 Szeged, Hungary;
- Department of Neurology, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary
| |
Collapse
|
2
|
Qiu E, Xing X, Wang Y, Tian L. Altered functional connectivity of the thalamus and salience network in patients with cluster headache: a pilot study. Neurol Sci 2024; 45:269-276. [PMID: 37578630 DOI: 10.1007/s10072-023-07011-4] [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: 05/29/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Previous studies have shown that the salience network (SN) and the thalamus are involved in cluster headache (CH) attacks. However, very little is known regarding the altered thalamus-SN functional connectivity in CH. The aim of this study was to explore alterations of functional connectivity between the thalamus and the SN in patients with CH to further gain insight into the pathophysiology of CH. MATERIALS AND METHODS The resting-state functional MRI (rs-fMRI) data of 21 patients with CH in the headache attack remission state during in-bout periods and 21 age- and sex-matched normal controls were obtained. The rs-fMRI data were analyzed by the independent component analysis (ICA) method, and the thalamus-SN functional connectivity in patients with right-sided and left-sided CH was compared with that in normal controls. RESULTS Decreased functional connectivity was found between the thalamus, both ipsilateral and contralateral to the headache side, and the SN during headache remission state in both right-sided CH patients and left-sided CH patients. CONCLUSIONS The findings suggest that the decreased functional connectivity between the thalamus and SN might be one of the pathologies underpinning the CH. This helps us to understand better the nature of the brain dysfunction in CH and the basic pathologies of CH, which implies that this deserves further investigation.
Collapse
Affiliation(s)
- Enchao Qiu
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, 19107, USA.
| | - Xinbo Xing
- Department of Radiology, the Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Yan Wang
- Department of Radiology, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Lixia Tian
- Department of Biomedical Engineering, Beijing Jiaotong University, Beijing, 100044, China
| |
Collapse
|
3
|
Cheema S, Ferreira F, Parras O, Lagrata S, Kamourieh S, Pakzad A, Zrinzo L, Matharu M, Akram H. Association of Clinical and Neuroanatomic Factors With Response to Ventral Tegmental Area DBS in Chronic Cluster Headache. Neurology 2023; 101:e2423-e2433. [PMID: 37848331 PMCID: PMC10752645 DOI: 10.1212/wnl.0000000000207750] [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: 02/08/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Deep brain stimulation (DBS) of the ventral tegmental area (VTA) is a surgical treatment option for selected patients with refractory chronic cluster headache (CCH). We aimed to identify clinical and structural neuroimaging factors associated with response to VTA DBS in CCH. METHODS This prospective observational cohort study examines consecutive patients with refractory CCH treated with VTA DBS by a multidisciplinary team in a single tertiary neuroscience center as part of usual care. Headache diaries and validated questionnaires were completed at baseline and regular follow-up intervals. All patients underwent T1-weighted structural MRI before surgery. We compared clinical features using multivariable logistic regression and neuroanatomic differences using voxel-based morphometry (VBM) between responders and nonresponders. RESULTS Over a 10-year period, 43 patients (mean age 53 years, SD 11.9), including 29 male patients, with a mean duration of CCH 12 years (SD 7.4), were treated and followed up for at least 1 year (mean follow-up duration 5.6 years). Overall, there was a statistically significant improvement in median attack frequency from 140 to 56 per month (Z = -4.95, p < 0.001), attack severity from 10/10 to 8/10 (Z = -4.83, p < 0.001), and duration from 110 to 60 minutes (Z = -3.48, p < 0.001). Twenty-nine (67.4%) patients experienced ≥50% improvement in attack frequency and were therefore classed as responders. There were no serious adverse events. The most common side effects were discomfort or pain around the battery site (7 patients) and transient diplopia and/or oscillopsia (6 patients). There were no differences in demographics, headache characteristics, or comorbidities between responders and nonresponders. VBM identified increased neural density in nonresponders in several brain regions, including the orbitofrontal cortex, anterior cingulate cortex, anterior insula, and amygdala, which were statistically significant (p < 0.001). DISCUSSION VTA DBS showed no serious adverse events, and, although there was no placebo control, was effective in approximately two-thirds of patients at long-term follow-up. This study did not reveal any reliable clinical predictors of response. However, nonresponders had increased neural density in brain regions linked to processing of pain and autonomic function, both of which are prominent in the pathophysiology of CCH.
Collapse
Affiliation(s)
- Sanjay Cheema
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK.
| | - Francisca Ferreira
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK
| | - Olga Parras
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK
| | - Susie Lagrata
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK
| | - Salwa Kamourieh
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK
| | - Ashkan Pakzad
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK
| | - Ludvic Zrinzo
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK
| | - Manjit Matharu
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK
| | - Harith Akram
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK
| |
Collapse
|
4
|
Chen Y, Xing X, Dai W, Tian L, Dong Z, Yu S. Brain regions involved in fractional amplitude of low-frequency fluctuation in cluster headache patients: a resting-state functional MRI study. BMC Neurol 2022; 22:336. [PMID: 36071405 PMCID: PMC9450424 DOI: 10.1186/s12883-022-02863-3] [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: 05/04/2022] [Accepted: 08/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We used resting-state functional magnetic resonance imaging (RS-fMRI) to assess the possible pathogenic role of fALFF in CH. A limited number of studies have reported on fractional amplitude of low-frequency fluctuation (fALFF) in cluster headache (CH). METHODS RS-fMRI scans of 23 patients with CH were obtained (11with left-sided headache and 12 with right-sided headache), along with scans of 23 age- and sex-matched normal controls. The RS-fMRI data were analyzed to explore abnormal brain activity in the left CH and right CH patients during the non-painful state in one cluster period. fALFF was compared between patients and controls, and correlation analysis between the regional mean fALFF values and clinical characteristics was performed. RESULTS A decrease in fALFF was detected in the left cerebellum, left lentiform nucleus, left frontal lobe, left anterior cingulate, and right postcentral gyrus in the left CH group compared to the controls, while a decrease of fALFF was detected in the right cerebellum, right cingulate gyrus, right superior parietal lobule, right inferior parietal lobule, right postcentral gyrus, and left precuneus in the right CH group. No patient had a region with increased fALFF. A moderate correlation was observed between some regional mean fALFF values and the clinical characteristics. CONCLUSIONS We deduced that dysfunction in multiple brain areas is involved in the non-painful state of CH during a cluster period.
Collapse
Affiliation(s)
- Yun Chen
- Department of Neurology, Chinese PLA General Hospital; International headache center, Chinese PLA General Hospital, Beijing, China.,Chinese PLA Medical School, Beijing, 100853, China.,Department of Neurology, Peking University Shougang Hospital, Beijing, 100144, China
| | - Xinbo Xing
- Department of Radiology, Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China
| | - Wei Dai
- Department of Neurology, Chinese PLA General Hospital; International headache center, Chinese PLA General Hospital, Beijing, China.,Chinese PLA Medical School, Beijing, 100853, China
| | - Lixia Tian
- School of Computer and Information Technology, Beijing Jiaotong University, Beijing, 100044, China
| | - Zhao Dong
- Department of Neurology, Chinese PLA General Hospital; International headache center, Chinese PLA General Hospital, Beijing, China.
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital; International headache center, Chinese PLA General Hospital, Beijing, China.
| |
Collapse
|
5
|
Lee DA, Lee J, Lee HJ, Park KM. Alterations of limbic structure volumes and limbic covariance network in patients with cluster headache. J Clin Neurosci 2022; 103:72-77. [PMID: 35843183 DOI: 10.1016/j.jocn.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/27/2022] [Accepted: 07/09/2022] [Indexed: 10/17/2022]
Abstract
The aim of this study was to compare the limbic structures and covariance network in patients with cluster headache to those of healthy controls. We enrolled 23 patients with newly diagnosed cluster headache and 31 healthy controls. They underwent three-dimensional T1-weighted imaging utilizing a 3.0 Tesla MRI scanner. Volumetric analysis of the subcortical limbic structures, including the hippocampus, amygdala, thalamus, mammillary body, hypothalamus, basal forebrain, septal nuclei, fornix, and nucleus accumbens, was performed. We examined the limbic covariance network using a graph theory. The volumes of the limbic structures between patients with cluster headache and healthy controls were significantly different. The volume of the left hippocampus in patients with cluster headache was significantly lower than that in healthy controls (0.256 vs 0.291 %, p = 0.002). Patients with cluster headache showed significant alterations of the limbic covariance network. The average strength, global efficiency, local efficiency, mean clustering coefficient, and transitivity were lower (5.238 vs 10.322, p = 0.030; 0.355 vs 0.608, p = 0.020; 0.547 vs 1.553, p = 0.020; 0.424 vs 0.895, p = 0.016; respectively), whereas the characteristic path length was higher (3.314 vs 1.752, p = 0.040) in patients with cluster headache than in healthy controls. We detected alterations of limbic structure volumes in patients with cluster headache compared to healthy controls, especially in the hippocampus. We also found significant alterations in the limbic covariance network in patients with cluster headache who showed decreased segregation and integration. These abnormalities could be related to the pathophysiology of cluster headache.
Collapse
Affiliation(s)
- Dong Ah Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Joonwon Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Ho-Joon Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
| |
Collapse
|
6
|
Alterations of thalamic nuclei volumes in patients with cluster headache. Neuroradiology 2022; 64:1839-1846. [DOI: 10.1007/s00234-022-02951-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/05/2022] [Indexed: 01/03/2023]
|
7
|
Silvestro M, Tessitore A, Orologio I, Battista G, Siciliano M, Tedeschi G, Russo A. Cluster headache pathophysiology: What we have learned from advanced neuroimaging. Headache 2022; 62:436-452. [PMID: 35315064 PMCID: PMC9314615 DOI: 10.1111/head.14279] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 12/12/2022]
Abstract
Background Although remarkable progress has been achieved in understanding cluster headache (CH) pathophysiology, there are still several gaps about the mechanisms through which independent subcortical and cortical brain structures interact with each other. These gaps could be partially elucidated by structural and functional advanced neuroimaging investigations. Objective Although we are aware that substantial achievements have come from preclinical, neurophysiological, and biochemical experiments, the present narrative review aims to summarize the most significant findings from structural, microstructural, and functional neuroimaging investigations, as well as the consequent progresses in understanding CH pathophysiological mechanisms, to achieve a comprehensive and unifying model. Results Advanced neuroimaging techniques have contributed to overcoming the peripheral hypothesis that CH is of cavernous sinus pathology, in transitioning from the pure vascular hypothesis to a more comprehensive trigeminovascular model, and, above all, in clarifying the role of the hypothalamus and its connections in the genesis of CH. Conclusion Altogether, neuroimaging findings strongly suggest that, beyond the theoretical model of the “pain matrix,” the model of the “neurolimbic pain network” that is accepted in migraine research could also be extended to CH. Indeed, although the hypothalamus’ role is undeniable, the genesis of CH attacks is complex and seems to not be just the result of a single “generator.” Cortical‐hypothalamic‐brainstem functional interconnections that can switch between out‐of‐bout and in‐bout periods, igniting the trigeminovascular system (probably by means of top‐down mechanisms) and the consensual trigeminal autonomic reflexes, may represent the “neuronal background” of CH.
Collapse
Affiliation(s)
- Marcello Silvestro
- Headache Centre, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro Tessitore
- Headache Centre, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ilaria Orologio
- Headache Centre, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giorgia Battista
- Headache Centre, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mattia Siciliano
- Headache Centre, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gioacchino Tedeschi
- Headache Centre, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Russo
- Headache Centre, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| |
Collapse
|
8
|
Medina S, Bakar NA, O'Daly O, Miller S, Makovac E, Renton T, Williams SCR, Matharu M, Howard MA. Regional cerebral blood flow as predictor of response to occipital nerve block in cluster headache. J Headache Pain 2021; 22:91. [PMID: 34384347 PMCID: PMC8359299 DOI: 10.1186/s10194-021-01304-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/30/2021] [Indexed: 01/03/2023] Open
Abstract
Background Cluster headache is an excruciating disorder with no cure. Greater occipital nerve blockades can transiently suppress attacks in approximately 50% of patients, however, its mechanism of action remains uncertain, and there are no reliable predictors of treatment response. To address this, we investigated the effect of occipital nerve blockade on regional cerebral blood flow (rCBF), an index of brain activity, and differences between treatment responders and non-responders. Finally, we compared baseline perfusion maps from patients to a matched group of healthy controls. Methods 21 male, treatment-naive patients were recruited while in a cluster headache bout. During a pain-free phase between headaches, patients underwent pseudo-continuous arterial spin labelled MRI assessments to provide quantitative indices of rCBF. MRIs were performed prior to and 7-to-21 days following treatment. Patients also recorded the frequency of their headache attacks in a daily paper diary. Neuropsychological assessment including anxiety, depression and quality of life measures was performed in a first, scanning free session for each patient. Results Following treatment, patients demonstrated relative rCBF reductions in posterior temporal gyrus, cerebellum and caudate, and rCBF increases in occipital cortex. Responders demonstrated relative rCBF increases, compared to non-responders, in medial prefrontal cortex and lateral occipital cortex at baseline, but relative reductions in cingulate and middle temporal cortices. rCBF was increased in patients compared to healthy controls in cerebellum and hippocampus, but reduced in orbitofrontal cortex, insula and middle temporal gyrus. Conclusions We provide new mechanistic insights regarding the aetiology of cluster headache, the mechanisms of action of occipital nerve blockades and potential predictors of treatment response. Future investigation should determine whether observed effects are reproducible and extend to other headache disorders.
Collapse
Affiliation(s)
- Sonia Medina
- Department of Neuroimaging, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Box 89, De Crespigny Park, London, SE5 8AF, UK. .,Wolfson Centre for Age-Related Diseases, King's College London, London, UK.
| | | | - Owen O'Daly
- Department of Neuroimaging, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Box 89, De Crespigny Park, London, SE5 8AF, UK
| | - Sarah Miller
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Elena Makovac
- Department of Neuroimaging, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Box 89, De Crespigny Park, London, SE5 8AF, UK.,Wolfson Centre for Age-Related Diseases, King's College London, London, UK
| | - Tara Renton
- Department of Oral Surgery, King's College London, London, UK
| | - Steve C R Williams
- Department of Neuroimaging, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Box 89, De Crespigny Park, London, SE5 8AF, UK
| | - Manjit Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Matthew A Howard
- Department of Neuroimaging, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Box 89, De Crespigny Park, London, SE5 8AF, UK
| |
Collapse
|
9
|
Chronic Cluster Headache Update and East-West Comparisons: Focusing on Clinical Features, Pathophysiology, and Management. Curr Pain Headache Rep 2020; 24:68. [PMID: 32990832 DOI: 10.1007/s11916-020-00902-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW This review provides an update on chronic cluster headache (CH) focusing on clinical features, pathophysiology, and management as well as comparisons between Eastern and Western populations. RECENT FINDINGS Chronic CH in Eastern populations was relatively rare, compared to that in Western populations. Lacrimation and/or conjunctival injection is the most frequently reported cranial autonomic symptom, and visual aura is predominant in chronic CH patients. Neuroimaging evidence in both ethnic groups suggests that CH pathophysiology involves the hypothalamus and pain-modulatory areas, with dynamic alternations between CH episodes. Recent evidence indicates that midbrain dopaminergic systems may participate in CH chronicity. Noteworthy advances have emerged in neuromodulatory therapies for chronic CH, but treatment with calcitonin gene-related peptide (CGRP) monoclonal antibodies has been unsuccessful. Recent evidence shows divergence of chronic CH between Eastern and Western populations. Neuromodulatory therapies but not CGRP inhibition is effective in this intractable patient group.
Collapse
|
10
|
Ferraro S, Nigri A, Demichelis G, Pinardi C, Chiapparini L, Giani L, Proietti Cecchini A, Leone M. Understanding Cluster Headache Using Magnetic Resonance Imaging. Front Neurol 2020; 11:535. [PMID: 32695062 PMCID: PMC7338680 DOI: 10.3389/fneur.2020.00535] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 05/14/2020] [Indexed: 12/26/2022] Open
Abstract
Cluster headache is an excruciating pain syndrome characterized by unilateral head pain attacks, lasting between 15 and 180 min, accompanied by marked ipsilateral cranial autonomic symptoms, such as lacrimation and conjunctival injection. Despite important insights provided by neuroimaging studies and deep brain stimulation findings, the pathophysiology of cluster headache and its pathways of chronicization are still elusive. In this mini-review, we will provide an overview of the functional and structural neuroimaging studies in episodic and chronic cluster headache conditions conducted to clarify the underlying pathophysiology.
Collapse
Affiliation(s)
- Stefania Ferraro
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Anna Nigri
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Greta Demichelis
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Chiara Pinardi
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Luisa Chiapparini
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Luca Giani
- Neurology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Massimo Leone
- Neurology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| |
Collapse
|
11
|
Pagnozzi AM, Fripp J, Rose SE. Quantifying deep grey matter atrophy using automated segmentation approaches: A systematic review of structural MRI studies. Neuroimage 2019; 201:116018. [PMID: 31319182 DOI: 10.1016/j.neuroimage.2019.116018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 07/01/2019] [Accepted: 07/12/2019] [Indexed: 12/13/2022] Open
Abstract
The deep grey matter (DGM) nuclei of the brain play a crucial role in learning, behaviour, cognition, movement and memory. Although automated segmentation strategies can provide insight into the impact of multiple neurological conditions affecting these structures, such as Multiple Sclerosis (MS), Huntington's disease (HD), Alzheimer's disease (AD), Parkinson's disease (PD) and Cerebral Palsy (CP), there are a number of technical challenges limiting an accurate automated segmentation of the DGM. Namely, the insufficient contrast of T1 sequences to completely identify the boundaries of these structures, as well as the presence of iso-intense white matter lesions or extensive tissue loss caused by brain injury. Therefore in this systematic review, 269 eligible studies were analysed and compared to determine the optimal approaches for addressing these technical challenges. The automated approaches used among the reviewed studies fall into three broad categories, atlas-based approaches focusing on the accurate alignment of atlas priors, algorithmic approaches which utilise intensity information to a greater extent, and learning-based approaches that require an annotated training set. Studies that utilise freely available software packages such as FIRST, FreeSurfer and LesionTOADS were also eligible, and their performance compared. Overall, deep learning approaches achieved the best overall performance, however these strategies are currently hampered by the lack of large-scale annotated data. Improving model generalisability to new datasets could be achieved in future studies with data augmentation and transfer learning. Multi-atlas approaches provided the second-best performance overall, and may be utilised to construct a "silver standard" annotated training set for deep learning. To address the technical challenges, providing robustness to injury can be improved by using multiple channels, highly elastic diffeomorphic transformations such as LDDMM, and by following atlas-based approaches with an intensity driven refinement of the segmentation, which has been done with the Expectation Maximisation (EM) and level sets methods. Accounting for potential lesions should be achieved with a separate lesion segmentation approach, as in LesionTOADS. Finally, to address the issue of limited contrast, R2*, T2* and QSM sequences could be used to better highlight the DGM due to its higher iron content. Future studies could look to additionally acquire these sequences by retaining the phase information from standard structural scans, or alternatively acquiring these sequences for only a training set, allowing models to learn the "improved" segmentation from T1-sequences alone.
Collapse
Affiliation(s)
- Alex M Pagnozzi
- CSIRO Health and Biosecurity, The Australian e-Health Research Centre, Brisbane, Australia.
| | - Jurgen Fripp
- CSIRO Health and Biosecurity, The Australian e-Health Research Centre, Brisbane, Australia
| | - Stephen E Rose
- CSIRO Health and Biosecurity, The Australian e-Health Research Centre, Brisbane, Australia
| |
Collapse
|
12
|
Buture A, Boland JW, Dikomitis L, Ahmed F. Update on the pathophysiology of cluster headache: imaging and neuropeptide studies. J Pain Res 2019; 12:269-281. [PMID: 30655693 PMCID: PMC6324919 DOI: 10.2147/jpr.s175312] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Cluster headache (CH) is the most severe primary headache condition. Its pathophysiology is multifaceted and incompletely understood. This review brings together the latest neuroimaging and neuropeptide evidence on the pathophysiology of CH. METHODS A review of the literature was conducted by searching PubMed and Web of Science. The search was conducted using the following keywords: imaging studies, voxel-based morphometry, diffusion-tensor imaging, diffusion magnetic resonance imaging, tractography, connectivity, cerebral networks, neuromodulation, central modulation, deep brain stimulation, orexin-A, orexin-B, tract-based spatial statistics, single-photon emission computer tomography studies, positron-emission tomography, functional magnetic resonance imaging, magnetic resonance spectroscopy, trigeminovascular system, neuropeptides, calcitonin gene-related peptide, neurokinin A, substance P, nitric oxide synthase, pituitary adenylate cyclase-activating peptide, vasoactive intestinal peptide, neuropeptide Y, acetylcholine, noradrenaline, and ATP. "Cluster headache" was combined with each keyword for more relevant results. All irrelevant and duplicated records were excluded. Search dates were from October 1976 to May 2018. RESULTS Neuroimaging studies support the role of the hypothalamus in CH, as well as other brain areas involved in the pain matrix. Activation of the trigeminovascular system and the release of neuropeptides play an important role in CH pathophysiology. Among neuropeptides, calcitonin gene-related peptide, vasoactive intestinal peptide, and pituitary adenylate cyclase-activating peptide have been reported to be reliable biomarkers for CH attacks, though not specific for CH. Several other neuropeptides are involved in trigeminovascular activation, but the current evidence does not qualify them as reliable biomarkers in CH. CONCLUSION CH has a complex pathophysiology and the pain mechanism is not completely understood. Recent neuroimaging studies have provided insight into the functional and structural network bases of CH pathophysiology. Although there has been important progress in neuropeptide studies, a specific biomarker for CH is yet to be found.
Collapse
Affiliation(s)
- Alina Buture
- Department of Neurology, Hull Royal Infirmary, Hull, UK,
- Hull York Medical School, University of Hull, Hull, UK,
| | | | - Lisa Dikomitis
- School of Medicine and Institute of Primary Care and Health Sciences, Keele University, Newcastle, UK
| | - Fayyaz Ahmed
- Department of Neurology, Hull Royal Infirmary, Hull, UK,
- Hull York Medical School, University of Hull, Hull, UK,
| |
Collapse
|
13
|
Vollesen AL, Benemei S, Cortese F, Labastida-Ramírez A, Marchese F, Pellesi L, Romoli M, Ashina M, Lampl C. Migraine and cluster headache - the common link. J Headache Pain 2018; 19:89. [PMID: 30242519 PMCID: PMC6755613 DOI: 10.1186/s10194-018-0909-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 08/20/2018] [Indexed: 01/07/2023] Open
Abstract
Although clinically distinguishable, migraine and cluster headache share prominent features such as unilateral pain, common pharmacological triggers such glyceryl trinitrate, histamine, calcitonin gene-related peptide (CGRP) and response to triptans and neuromodulation. Recent data also suggest efficacy of anti CGRP monoclonal antibodies in both migraine and cluster headache. While exact mechanisms behind both disorders remain to be fully understood, the trigeminovascular system represents one possible common pathophysiological pathway and network of both disorders. Here, we review past and current literature shedding light on similarities and differences in phenotype, heritability, pathophysiology, imaging findings and treatment options of migraine and cluster headache. A continued focus on their shared pathophysiological pathways may be important in paving future treatment avenues that could benefit both migraine and cluster headache patients.
Collapse
Affiliation(s)
- Anne Luise Vollesen
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Silvia Benemei
- Health Sciences Department, University of Florence and Headache Centre, Careggi University Hospital, Florence, Italy
| | - Francesca Cortese
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza, University of Rome, Polo Pontino, Latina, Italy
| | - Alejandro Labastida-Ramírez
- Dep Internal Medicine, Division of Vascular Pharmacology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Lanfranco Pellesi
- Medical Toxicology, Headache and Drug Abuse Center, University of Modena and Reggio Emilia, Modena, Italy
| | - Michele Romoli
- Neurology Clinic, University of Perugia - S.M. Misericordiae Hospital, Perugia, Italy
| | - Messoud Ashina
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian Lampl
- Department of Neurogeriatric Medicine, Headache Medical Center Linz, Ordensklinikum Linz Barmherzige Schwestern, Seilerstaette 4, 4010 Linz, Austria
| | - on behalf of the School of Advanced Studies of the European Headache Federation (EHF-SAS)
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Health Sciences Department, University of Florence and Headache Centre, Careggi University Hospital, Florence, Italy
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza, University of Rome, Polo Pontino, Latina, Italy
- Dep Internal Medicine, Division of Vascular Pharmacology, Erasmus Medical Center, Rotterdam, The Netherlands
- Child Neuropsichiatry Unit, University of Palermo, Palermo, Italy
- Medical Toxicology, Headache and Drug Abuse Center, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Clinic, University of Perugia - S.M. Misericordiae Hospital, Perugia, Italy
- Department of Neurogeriatric Medicine, Headache Medical Center Linz, Ordensklinikum Linz Barmherzige Schwestern, Seilerstaette 4, 4010 Linz, Austria
| |
Collapse
|
14
|
Veréb D, Szabó N, Tuka B, Tajti J, Király A, Faragó P, Kocsis K, Tóth E, Kincses B, Bagoly T, Helyes Z, Vécsei L, Kincses ZT. Correlation of neurochemical and imaging markers in migraine: PACAP38 and DTI measures. Neurology 2018; 91:e1166-e1174. [PMID: 30135251 DOI: 10.1212/wnl.0000000000006201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/26/2018] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To examine whether interictal plasma pituitary adenylate cyclase-activating peptide 38-like immunoreactivity (PACAP38-LI) shows correlation with the microstructural integrity of the white matter in migraine. METHODS Interictal plasma PACAP38-LI was measured by radioimmunoassay in 26 patients with migraine (24 women) who underwent diffusion tensor imaging afterward using a 1.5-tesla magnetic resonance scanner. Data were analyzed using tract-based spatial statistics included in FMRIB's Software Library. RESULTS Interictal plasma PACAP38-LI showed significant correlation with mean diffusivity (p < 0.0179) mostly in the bilateral occipital white matter spreading into parietal and temporal white matter. Axial and radial diffusivity showed positive correlation with interictal PACAP38-LI (p < 0.0432 and p < 0.0418, respectively) in the left optic radiation and left posterior corpus callosum. Fractional anisotropy did not correlate significantly with PACAP38-LI. With disease duration as a nuisance regressor in the model, PACAP38-LI correlated with axial and mean diffusivity in the left thalamus (p < 0.01). CONCLUSION We report a link between PACAP38, a pathobiologically important neurochemical biomarker, and imaging markers of the disease that may bolster further research into the role of PACAP38 in migraine.
Collapse
Affiliation(s)
- Dániel Veréb
- From the Departments of Neurology (D.V., N.S., J.T., A.K., P.F., K.K., E.T., B.K., L.V., Z.T.K.) and Radiology (Z.T.K.), Albert Szent-Györgyi Clinical Center, University of Szeged, Hungary; Central European Institute of Technology (N.S., A.K.), Brno, Czech Republic; MTA-SZTE Neuroscience Research Group (B.T., L.V.), Szeged; and Department of Pharmacology and Pharmacotherapy, Faculty of Medicine (T.B., Z.H.), and János Szentágothai Research Centre & Centre for Neuroscience (Z.H.), University of Pécs, Hungary
| | - Nikoletta Szabó
- From the Departments of Neurology (D.V., N.S., J.T., A.K., P.F., K.K., E.T., B.K., L.V., Z.T.K.) and Radiology (Z.T.K.), Albert Szent-Györgyi Clinical Center, University of Szeged, Hungary; Central European Institute of Technology (N.S., A.K.), Brno, Czech Republic; MTA-SZTE Neuroscience Research Group (B.T., L.V.), Szeged; and Department of Pharmacology and Pharmacotherapy, Faculty of Medicine (T.B., Z.H.), and János Szentágothai Research Centre & Centre for Neuroscience (Z.H.), University of Pécs, Hungary
| | - Bernadett Tuka
- From the Departments of Neurology (D.V., N.S., J.T., A.K., P.F., K.K., E.T., B.K., L.V., Z.T.K.) and Radiology (Z.T.K.), Albert Szent-Györgyi Clinical Center, University of Szeged, Hungary; Central European Institute of Technology (N.S., A.K.), Brno, Czech Republic; MTA-SZTE Neuroscience Research Group (B.T., L.V.), Szeged; and Department of Pharmacology and Pharmacotherapy, Faculty of Medicine (T.B., Z.H.), and János Szentágothai Research Centre & Centre for Neuroscience (Z.H.), University of Pécs, Hungary
| | - János Tajti
- From the Departments of Neurology (D.V., N.S., J.T., A.K., P.F., K.K., E.T., B.K., L.V., Z.T.K.) and Radiology (Z.T.K.), Albert Szent-Györgyi Clinical Center, University of Szeged, Hungary; Central European Institute of Technology (N.S., A.K.), Brno, Czech Republic; MTA-SZTE Neuroscience Research Group (B.T., L.V.), Szeged; and Department of Pharmacology and Pharmacotherapy, Faculty of Medicine (T.B., Z.H.), and János Szentágothai Research Centre & Centre for Neuroscience (Z.H.), University of Pécs, Hungary
| | - András Király
- From the Departments of Neurology (D.V., N.S., J.T., A.K., P.F., K.K., E.T., B.K., L.V., Z.T.K.) and Radiology (Z.T.K.), Albert Szent-Györgyi Clinical Center, University of Szeged, Hungary; Central European Institute of Technology (N.S., A.K.), Brno, Czech Republic; MTA-SZTE Neuroscience Research Group (B.T., L.V.), Szeged; and Department of Pharmacology and Pharmacotherapy, Faculty of Medicine (T.B., Z.H.), and János Szentágothai Research Centre & Centre for Neuroscience (Z.H.), University of Pécs, Hungary
| | - Péter Faragó
- From the Departments of Neurology (D.V., N.S., J.T., A.K., P.F., K.K., E.T., B.K., L.V., Z.T.K.) and Radiology (Z.T.K.), Albert Szent-Györgyi Clinical Center, University of Szeged, Hungary; Central European Institute of Technology (N.S., A.K.), Brno, Czech Republic; MTA-SZTE Neuroscience Research Group (B.T., L.V.), Szeged; and Department of Pharmacology and Pharmacotherapy, Faculty of Medicine (T.B., Z.H.), and János Szentágothai Research Centre & Centre for Neuroscience (Z.H.), University of Pécs, Hungary
| | - Krisztián Kocsis
- From the Departments of Neurology (D.V., N.S., J.T., A.K., P.F., K.K., E.T., B.K., L.V., Z.T.K.) and Radiology (Z.T.K.), Albert Szent-Györgyi Clinical Center, University of Szeged, Hungary; Central European Institute of Technology (N.S., A.K.), Brno, Czech Republic; MTA-SZTE Neuroscience Research Group (B.T., L.V.), Szeged; and Department of Pharmacology and Pharmacotherapy, Faculty of Medicine (T.B., Z.H.), and János Szentágothai Research Centre & Centre for Neuroscience (Z.H.), University of Pécs, Hungary
| | - Eszter Tóth
- From the Departments of Neurology (D.V., N.S., J.T., A.K., P.F., K.K., E.T., B.K., L.V., Z.T.K.) and Radiology (Z.T.K.), Albert Szent-Györgyi Clinical Center, University of Szeged, Hungary; Central European Institute of Technology (N.S., A.K.), Brno, Czech Republic; MTA-SZTE Neuroscience Research Group (B.T., L.V.), Szeged; and Department of Pharmacology and Pharmacotherapy, Faculty of Medicine (T.B., Z.H.), and János Szentágothai Research Centre & Centre for Neuroscience (Z.H.), University of Pécs, Hungary
| | - Bálint Kincses
- From the Departments of Neurology (D.V., N.S., J.T., A.K., P.F., K.K., E.T., B.K., L.V., Z.T.K.) and Radiology (Z.T.K.), Albert Szent-Györgyi Clinical Center, University of Szeged, Hungary; Central European Institute of Technology (N.S., A.K.), Brno, Czech Republic; MTA-SZTE Neuroscience Research Group (B.T., L.V.), Szeged; and Department of Pharmacology and Pharmacotherapy, Faculty of Medicine (T.B., Z.H.), and János Szentágothai Research Centre & Centre for Neuroscience (Z.H.), University of Pécs, Hungary
| | - Teréz Bagoly
- From the Departments of Neurology (D.V., N.S., J.T., A.K., P.F., K.K., E.T., B.K., L.V., Z.T.K.) and Radiology (Z.T.K.), Albert Szent-Györgyi Clinical Center, University of Szeged, Hungary; Central European Institute of Technology (N.S., A.K.), Brno, Czech Republic; MTA-SZTE Neuroscience Research Group (B.T., L.V.), Szeged; and Department of Pharmacology and Pharmacotherapy, Faculty of Medicine (T.B., Z.H.), and János Szentágothai Research Centre & Centre for Neuroscience (Z.H.), University of Pécs, Hungary
| | - Zsuzsanna Helyes
- From the Departments of Neurology (D.V., N.S., J.T., A.K., P.F., K.K., E.T., B.K., L.V., Z.T.K.) and Radiology (Z.T.K.), Albert Szent-Györgyi Clinical Center, University of Szeged, Hungary; Central European Institute of Technology (N.S., A.K.), Brno, Czech Republic; MTA-SZTE Neuroscience Research Group (B.T., L.V.), Szeged; and Department of Pharmacology and Pharmacotherapy, Faculty of Medicine (T.B., Z.H.), and János Szentágothai Research Centre & Centre for Neuroscience (Z.H.), University of Pécs, Hungary
| | - László Vécsei
- From the Departments of Neurology (D.V., N.S., J.T., A.K., P.F., K.K., E.T., B.K., L.V., Z.T.K.) and Radiology (Z.T.K.), Albert Szent-Györgyi Clinical Center, University of Szeged, Hungary; Central European Institute of Technology (N.S., A.K.), Brno, Czech Republic; MTA-SZTE Neuroscience Research Group (B.T., L.V.), Szeged; and Department of Pharmacology and Pharmacotherapy, Faculty of Medicine (T.B., Z.H.), and János Szentágothai Research Centre & Centre for Neuroscience (Z.H.), University of Pécs, Hungary
| | - Zsigmond Tamás Kincses
- From the Departments of Neurology (D.V., N.S., J.T., A.K., P.F., K.K., E.T., B.K., L.V., Z.T.K.) and Radiology (Z.T.K.), Albert Szent-Györgyi Clinical Center, University of Szeged, Hungary; Central European Institute of Technology (N.S., A.K.), Brno, Czech Republic; MTA-SZTE Neuroscience Research Group (B.T., L.V.), Szeged; and Department of Pharmacology and Pharmacotherapy, Faculty of Medicine (T.B., Z.H.), and János Szentágothai Research Centre & Centre for Neuroscience (Z.H.), University of Pécs, Hungary.
| |
Collapse
|
15
|
Rektor I, Svátková A, Vojtíšek L, Zikmundová I, Vaníček J, Király A, Szabó N. White matter alterations in Parkinson's disease with normal cognition precede grey matter atrophy. PLoS One 2018; 13:e0187939. [PMID: 29304183 PMCID: PMC5755732 DOI: 10.1371/journal.pone.0187939] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 10/27/2017] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION While progressive MRI brain changes characterize advanced Parkinson's disease (PD), little has been discovered about structural alterations in the earliest phase of the disease, i.e. in patients with motor symptoms and with normal cognition. Our study aimed to detect grey matter (GM) and white matter (WM) changes in PD patients without cognitive impairment. METHODS Twenty PD patients and twenty-one healthy controls (HC) were tested for attention, executive function, working memory, and visuospatial and language domains. High-resolution T1-weighted and 60 directional diffusion-weighted 3T MRI images were acquired. The cortical, deep GM and WM volumes and density, as well as the diffusion properties of WM, were calculated. Analyses were repeated on data flipped to the side of the disease origin. RESULTS PD patients did not show any significant differences from HC in cognitive functioning or in brain volumes. Decreased GM intensity was found in the left superior parietal lobe in the right (p<0.02) and left (p<0.01) flipped data. The analysis of original, un-flipped data demonstrated elevated axial diffusivity (p<0.01) in the superior and anterior corona radiata, internal capsule, and external capsule in the left hemisphere of PD relative to HC, while higher mean and radial diffusivity were discovered in the right (p<0.02 and p<0.03, respectively) and left (p<0.02 and p<0.02, respectively) in the fronto-temporal WM utilizing flipped data. CONCLUSIONS PD patients without cognitive impairment and GM atrophy demonstrated widespread alterations of WM microstructure. Thus, WM impairment in PD might be a sensitive sign preceding the neuronal loss in associated GM regions.
Collapse
Affiliation(s)
- Ivan Rektor
- Movement Disorders Center; First Department of Neurology, School of Medicine, Masaryk University and St. Anne’s University Hospital, Brno, Czech Republic
- Central European Institute of Technology (CEITEC) Masaryk University, Neuroscience Centre, Brno, Czech Republic
| | - Alena Svátková
- Central European Institute of Technology (CEITEC) Masaryk University, Neuroscience Centre, Brno, Czech Republic
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Lubomir Vojtíšek
- Central European Institute of Technology (CEITEC) Masaryk University, Neuroscience Centre, Brno, Czech Republic
| | - Iva Zikmundová
- Movement Disorders Center; First Department of Neurology, School of Medicine, Masaryk University and St. Anne’s University Hospital, Brno, Czech Republic
| | - Jirí Vaníček
- Department of Imaging, School of Medicine, Masaryk University and St. Anne’s University Hospital, Brno, Czech Republic
| | - András Király
- Central European Institute of Technology (CEITEC) Masaryk University, Neuroscience Centre, Brno, Czech Republic
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Nikoletta Szabó
- Central European Institute of Technology (CEITEC) Masaryk University, Neuroscience Centre, Brno, Czech Republic
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| |
Collapse
|