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Stephens E, Dhanasekara CS, Montalvan V, Zhang B, Bassett A, Hall R, Rodaniche A, Robohm-Leavitt C, Shen CL, Kahatuduwa CN. Utility of Repetitive Transcranial Magnetic Stimulation for Chronic Daily Headache Prophylaxis: A Systematic Review and Meta-Analysis. Curr Pain Headache Rep 2024; 28:149-167. [PMID: 38277066 DOI: 10.1007/s11916-024-01210-0] [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: 01/08/2024] [Indexed: 01/27/2024]
Abstract
PURPOSE OF REVIEW Management of chronic daily headaches (CDH) remains challenging due to the limited efficacy of standard prophylactic pharmacological measures. Several studies have reported that repetitive transcranial magnetic stimulation (rTMS) can effectively treat chronic headaches. The objective was to determine the utility of rTMS for immediate post-treatment and sustained CDH prophylaxis. RECENT FINDINGS All procedures were conducted per PRISMA guidelines. PubMed, Scopus, Web of Science, and ProQuest databases were searched for controlled clinical trials that have tested the efficacy of rTMS on populations with CDH. DerSimonian-Laird random-effects meta-analyses were performed using the 'meta' package in R to examine the post- vs. pre-rTMS changes in standardized headache intensity and frequency compared to sham-control conditions. Thirteen trials were included with a combined study population of N = 538 patients with CDH (rTMS, N = 284; Sham, N = 254). Patients exposed to rTMS had significantly reduced standardized CDH intensity and frequency in the immediate post-treatment period (Hedges' g = -1.16 [-1.89, -0.43], p = 0.002 and Δ = -5.07 [-10.05, -0.11], p = 0.045 respectively). However, these effects were sustained marginally in the follow-up period (Hedges' g = -0.43 [-0.76, -0.09], p = 0.012 and Δ = -3.33 [-5.52, -1.14], p = 0.003). Significant between-study heterogeneity was observed, at least partially driven by variations in rTMS protocols. Despite the observed clinically meaningful and statistically significant benefits in the immediate post-treatment period, the prophylactic effects of rTMS on CDH do not seem to sustain with discontinuation. Thus, the cost-effectiveness of the routine use of rTMS for CDH prophylaxis remains questionable. REGISTRATION Protocol preregistered in PROSPERO International Prospective Register of Systematic Reviews (CRD42021250100).
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Affiliation(s)
- Emily Stephens
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Chathurika S Dhanasekara
- Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Victor Montalvan
- Department of Neurology, School of Medicine, Texas Tech University Health Sciences Center, 3601 4th Street, Lubbock, TX, 79430, USA
- Department of Neurology, Division of Vascular Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Bei Zhang
- Division of Physical Medicine and Rehabilitation, Department of Neurology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Ashley Bassett
- Department of Laboratory Science and Primary Care, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Rebecca Hall
- Department of Laboratory Science and Primary Care, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Alyssa Rodaniche
- Department of Laboratory Science and Primary Care, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Christina Robohm-Leavitt
- Department of Laboratory Science and Primary Care, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Chwan-Li Shen
- Department of Pathology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Center of Excellence for Integrative Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Center of Excellence for Translational Neuroscience and Therapeutics, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Chanaka N Kahatuduwa
- Department of Neurology, School of Medicine, Texas Tech University Health Sciences Center, 3601 4th Street, Lubbock, TX, 79430, USA.
- Center of Excellence for Integrative Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
- Center of Excellence for Translational Neuroscience and Therapeutics, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
- Department of Psychiatry, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
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Yang YC, Wei XY, Zhang YY, Xu CY, Cheng JM, Gong ZG, Chen H, Huang YW, Yuan J, Xu HH, Wang H, Zhan SH, Tan WL. Modulation of temporal and occipital cortex by acupuncture in non-menstrual MWoA patients: a rest BOLD fMRI study. BMC Complement Med Ther 2024; 24:43. [PMID: 38245739 PMCID: PMC10799457 DOI: 10.1186/s12906-024-04349-w] [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: 05/22/2023] [Accepted: 01/12/2024] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVE To investigate the changes in amplitude of low-frequency fluctuation (ALFF) and degree centrality (DC) values before and after acupuncture in young women with non-menstrual migraine without aura (MWoA) through rest blood-oxygen-level-dependent functional magnetic resonance imaging (BOLD fMRI). METHODS Patients with non-menstrual MWoA (Group 1, n = 50) and healthy controls (Group 2, n = 50) were recruited. fMRI was performed in Group 1 at 2 time points: before acupuncture (time point 1, TP1); and after the end of all acupuncture sessions (time point 2, TP2), and performed in Group 2 as a one-time scan. Patients in Group 1 were assessed with the Migraine Disability Assessment Questionnaire (MIDAS) and the Short-Form McGill Pain Questionnaire (SF-MPQ) at TP1 and TP2 after fMRI was performed. The ALFF and DC values were compared within Group 1 at two time points and between Group 1 and Group2. The correlation between ALFF and DC values with the statistical differences and the clinical scales scores were analyzed. RESULTS Brain activities increased in the left fusiform gyrus and right angular gyrus, left middle occipital gyrus, and bilateral prefrontal cortex and decreased in left inferior parietal lobule in Group 1, which had different ALFF values compared with Group 2 at TP1. The bilateral fusiform gyrus, bilateral inferior temporal gyrus and right middle temporal gyrus increased and right angular gyrus, right superior marginal gyrus, right inferior parietal lobule, right middle occipital gyrus, right superior frontal gyrus, right middle frontal gyrus, right anterior central gyrus, and right supplementary motor area decreased in activity in Group 1 had different DC values compared with Group 2 at TP1. ALFF and DC values of right inferior temporal gyrus, right fusiform gyrus and right middle temporal gyrus were decreased in Group1 at TP1 compared with TP2. ALFF values in the left middle occipital area were positively correlated with the pain degree at TP1 in Group1 (correlation coefficient r, r = 0.827, r = 0.343; P < 0.01, P = 0.015). The DC values of the right inferior temporal area were positively correlated with the pain degree at TP1 in Group 1 (r = 0.371; P = 0.008). CONCLUSION Spontaneous brain activity and network changes in young women with non-menstrual MwoA were altered by acupuncture. The right temporal area may be an important target for acupuncture modulated brain function in young women with non-menstrual MwoA.
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Affiliation(s)
- Yu-Chan Yang
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Xiang-Yu Wei
- Institute of Acupuncture and Anesthesia, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Ying-Ying Zhang
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Chun-Yang Xu
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Jian-Ming Cheng
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Zhi-Gang Gong
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Hui Chen
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Yan-Wen Huang
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Jie Yuan
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Hui-Hui Xu
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Hui Wang
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Song-Hua Zhan
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
| | - Wen-Li Tan
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
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3
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Lloyd A, Jain S, Duke D, Chatterjee S, Ibrahim B. Persistent Trigeminal Artery Causing an Abducens Nerve Palsy: A Case Report. Neuroophthalmology 2023; 47:29-34. [PMID: 36798864 PMCID: PMC9928449 DOI: 10.1080/01658107.2022.2086989] [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] [Indexed: 10/17/2022] Open
Abstract
We present a case of a 50-year-old female who was diagnosed with an isolated right abducens nerve palsy and was found to have a persistent trigeminal artery (PTA). The trigeminal artery is the most common persistent embryological carotid-vertebrobasilar anastomosis. A PTA can be picked up as an incidental finding on magnetic resonance imaging (MRI) or angiography. It has been reported that a PTA can be found in 0.1 to 0.6% of all cerebral angiograms. PTA has been linked to several rare abnormalities such as vascular aneurysms and cranial nerve compression. Our patient presented with diplopia and was found to have a paresis of the right lateral rectus muscle consistent with a right abducens nerve palsy. MRI found a right-sided PTA indenting the ventral surface of the pons. This case investigates and highlights that neurovascular compression from a PTA can cause an isolated abducens nerve palsy. Further research is required to investigate if surgical intervention for non-aneurysmal PTA would be beneficial for patients.
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Affiliation(s)
- Aimee Lloyd
- Department of Ophthalmology, Lancashire Teaching Hospitals NHS Trust, Preston, UK,School of Medicine, University of Dundee, Dundee, UK,CONTACT Aimee Lloyd Department of Ophthalmology, Lancashire Teaching Hospitals NHS Trust, Casterton Avenue, Briercliffe Road Burnley BB10 2PQ
| | - Sunila Jain
- Department of Ophthalmology, Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - Diana Duke
- Department of Ophthalmology, Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - Somenath Chatterjee
- Department of Radiology, Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - Bahauddin Ibrahim
- Department of Ophthalmology, Lancashire Teaching Hospitals NHS Trust, Preston, UK
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Begasse de Dhaem O, Wattiez AS, de Boer I, Pavitt S, Powers SW, Pradhan A, Gelfand AA, Nahman-Averbuch H. Bridging the gap between preclinical scientists, clinical researchers, and clinicians: From animal research to clinical practice. Headache 2023; 63:25-39. [PMID: 36633108 DOI: 10.1111/head.14441] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 07/02/2022] [Accepted: 08/26/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Collaborations amongst researchers and clinicians with complementary areas of expertise enhance knowledge for everyone and can lead to new discoveries. To facilitate these interactions, shared language and a general understanding of how colleagues in different subfields of headache and headache research approach their work are needed. METHODS This narrative review focuses on research methods applied in animal studies, human studies including clinical trials, and provides an overview of clinical practice. RESULTS For animal studies, we describe concepts needed to evaluate the quality and relevance of preclinical studies. For human research, fundamental concepts of neuroimaging, quantitative sensory testing, genetic and epidemiological research methods, and clinical research methodology that are commonly used in headache research are summarized. In addition, we provide an understanding of what guides headache clinicians, and summarize the practical approach to migraine management in adults and children. CONCLUSIONS It is hoped that this review facilitates further dialogue between clinicians and researchers that will help guide future research efforts and implementation of research findings into clinical practice.
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Affiliation(s)
| | - Anne-Sophie Wattiez
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, Iowa, USA.,Center for the Prevention and Treatment of Visual Loss, Veterans Administration Health Center, Iowa City, Iowa, USA
| | - Irene de Boer
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Sara Pavitt
- Child & Adolescent Headache Program, University of California, San Francisco, California, USA
| | - Scott W Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.,Center for Understanding Pediatric Pain, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Amynah Pradhan
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Amy A Gelfand
- Child & Adolescent Headache Program, University of California, San Francisco, California, USA
| | - Hadas Nahman-Averbuch
- Department of Anesthesiology, Washington University Pain Center, Washington University School of Medicine, St. Louis, Missouri, USA
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5
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Gomez-Pilar J, Martínez-Cagigal V, García-Azorín D, Gómez C, Guerrero Á, Hornero R. Headache-related circuits and high frequencies evaluated by EEG, MRI, PET as potential biomarkers to differentiate chronic and episodic migraine: Evidence from a systematic review. J Headache Pain 2022; 23:95. [PMID: 35927625 PMCID: PMC9354370 DOI: 10.1186/s10194-022-01465-1] [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: 06/29/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background The diagnosis of migraine is mainly clinical and self-reported, which makes additional examinations unnecessary in most cases. Migraine can be subtyped into chronic (CM) and episodic (EM). Despite the very high prevalence of migraine, there are no evidence-based guidelines for differentiating between these subtypes other than the number of days of migraine headache per month. Thus, we consider it timely to perform a systematic review to search for physiological evidence from functional activity (as opposed to anatomical structure) for the differentiation between CM and EM, as well as potential functional biomarkers. For this purpose, Web of Science (WoS), Scopus, and PubMed databases were screened. Findings Among the 24 studies included in this review, most of them (22) reported statistically significant differences between the groups of CM and EM. This finding is consistent regardless of brain activity acquisition modality, ictal stage, and recording condition for a wide variety of analyses. That speaks for a supramodal and domain-general differences between CM and EM that goes beyond a differentiation based on the days of migraine per month. Together, the reviewed studies demonstrates that electro- and magneto-physiological brain activity (M/EEG), as well as neurovascular and metabolic recordings from functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), show characteristic patterns that allow to differentiate between CM and EM groups. Conclusions Although a clear brain activity-based biomarker has not yet been identified to distinguish these subtypes of migraine, research is approaching headache specialists to a migraine diagnosis based not only on symptoms and signs reported by patients. Future studies based on M/EEG should pay special attention to the brain activity in medium and fast frequency bands, mainly the beta band. On the other hand, fMRI and PET studies should focus on neural circuits and regions related to pain and emotional processing.
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Affiliation(s)
- Javier Gomez-Pilar
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales Y Nanomedicina (CIBER-BBN), Valladolid, Spain
| | - Víctor Martínez-Cagigal
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales Y Nanomedicina (CIBER-BBN), Valladolid, Spain
| | - David García-Azorín
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Ramón y Cajal 3, 47003, Valladolid, Spain.
| | - Carlos Gómez
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales Y Nanomedicina (CIBER-BBN), Valladolid, Spain
| | - Ángel Guerrero
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Ramón y Cajal 3, 47003, Valladolid, Spain.,Department of Medicine, University of Valladolid, Valladolid, Spain
| | - Roberto Hornero
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales Y Nanomedicina (CIBER-BBN), Valladolid, Spain
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6
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Bassez I, Van de Steen F, Hackl S, Jahn P, Mayr A, Marinazzo D, Schulz E. Investigation on how dynamic effective connectivity patterns encode the fluctuating pain intensity in chronic migraine. NEUROBIOLOGY OF PAIN 2022; 12:100100. [PMID: 36051490 PMCID: PMC9424568 DOI: 10.1016/j.ynpai.2022.100100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/20/2022] [Accepted: 07/28/2022] [Indexed: 11/10/2022]
Abstract
Chronic migraine is characterised by persistent headaches for >15 days per month; the intensity of the pain is fluctuating over time. Here, we explored the dynamic interplay of connectivity patterns between regions known to be related to pain processing and their relation to the ongoing dynamic pain experience. We recorded EEG from 80 sessions (20 chronic migraine patients in 4 separate sessions of 25 min). The patients were asked to continuously rate the intensity of their endogenous headache. On different time-windows, a dynamic causal model (DCM) of cross spectral responses was inverted to estimate connectivity strengths. For each patient and session, the evolving dynamics of effective connectivity were related to pain intensities and to pain intensity changes by using a Bayesian linear model. Hierarchical Bayesian modelling was further used to examine which connectivity-pain relations are consistent across sessions and across patients. The results reflect the multi-facetted clinical picture of the disease. Across all sessions, each patient with chronic migraine exhibited a distinct pattern of pain intensity-related cortical connectivity. The diversity of the individual findings are accompanied by inconsistent relations between the connectivity parameters and pain intensity or pain intensity changes at group level. This suggests a rejection of the idea of a common neuronal core problem for chronic migraine.
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7
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Wang W, Zhang X, Bai X, Zhang Y, Yuan Z, Tang H, Li Z, Hu Z, Zhang Y, Yu X, Sui B, Wang Y. Gamma-aminobutyric acid and glutamate/glutamine levels in the dentate nucleus and periaqueductal gray with episodic and chronic migraine: a proton magnetic resonance spectroscopy study. J Headache Pain 2022; 23:83. [PMID: 35840907 PMCID: PMC9287958 DOI: 10.1186/s10194-022-01452-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/04/2022] [Indexed: 11/19/2022] Open
Abstract
Background The pathogenesis of migraine chronification remains unclear. Functional and structural magnetic resonance imaging studies have shown impaired functional and structural alterations in the brains of patients with chronic migraine. The cerebellum and periaqueductal gray (PAG) play pivotal roles in the neural circuits of pain conduction and analgesia in migraine. However, few neurotransmitter metabolism studies of these migraine-associated regions have been performed. To explore the pathogenesis of migraine chronification, we measured gamma-aminobutyric acid (GABA) and glutamate/glutamine (Glx) levels in the dentate nucleus (DN) and PAG of patients with episodic and chronic migraine and healthy subjects. Methods Using the MEGA-PRESS sequence and a 3-Tesla magnetic resonance scanner (Signa Premier; GE Healthcare, Chicago, IL, USA), we obtained DN and PAG metabolite concentrations from patients with episodic migraine (n = 25), those with chronic migraine (n = 24), and age-matched and sex-matched healthy subjects (n = 16). Patients with chronic migraine were further divided into those with (n = 12) and without (n = 12) medication overuse headache. All scans were performed at the Beijing Tiantan Hospital, Capital Medical University. Results We found that patients with chronic migraine had significantly lower levels of GABA/water (p = 0.011) and GABA/creatine (Cr) (p = 0.026) in the DN and higher levels of Glx/water (p = 0.049) in the PAG than healthy controls. In all patients with migraine, higher GABA levels in the PAG were significantly associated with poorer sleep quality (GABA/water: r = 0.515, p = 0.017, n = 21; GABA/Cr: r = 0.522, p = 0.015, n = 21). Additionally, a lower Glx/Cr ratio in the DN may be associated with more severe migraine disability (r = -0.425, p = 0.055, n = 20), and lower GABA/water (r = -0.424, p = 0.062, n = 20) and Glx/Water (r = -0.452, p = 0.045, n = 20) may be associated with poorer sleep quality. Conclusions Neurochemical levels in the DN and PAG may provide evidence of the pathological mechanisms of migraine chronification. Correlations between migraine characteristics and neurochemical levels revealed the pathological mechanisms of the relevant characteristics. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01452-6.
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Affiliation(s)
- Wei Wang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Xueyan Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No.1, Jianshe East Road, Zhengzhou, Henan Province, 450000, China
| | - Xiaoyan Bai
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.,Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Yingkui Zhang
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Ziyu Yuan
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Hefei Tang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Zhiye Li
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.,Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Zhangxuan Hu
- GE Healthcare, No.1 Tongji Nan Road, Beijing Economic Technological Development Area, Beijing, 100070, China
| | - Yaqing Zhang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Xueying Yu
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Binbin Sui
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.
| | - Yonggang Wang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.
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Gossrau G, Frost M, Klimova A, Koch T, Sabatowski R, Mignot C, Haehner A. Interictal osmophobia is associated with longer migraine disease duration. J Headache Pain 2022; 23:81. [PMID: 35840888 PMCID: PMC9284850 DOI: 10.1186/s10194-022-01451-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/01/2022] [Indexed: 11/20/2022] Open
Abstract
Background Sensitization to sensory stimuli is an essential feature of migraine attacks. The relationship between the clinical course of migraine and increased sensitivity to olfactory stimuli has been little studied so far. Methods We analyzed the frequency and quality of osmophobia depending on the phase of migraine in patients with episodic and chronic migraine treated in an tertiary headache center with regard to gender, age, medical history and migraine disability assessment score (MIDAS). Standardized diagnostic questions were used for the assessment of osmophobia. Results In our cross-sectional investigation (n = 113), 38.1% of the patients showed an increased preictal hypersensitivity to odors, whereas 61.9% described ictal and 31.9% interictal hypersensitivity to odors, odor-triggered migraine was described in 30.1%. Median migraine disease duration has been statistically significantly longer in patients who suffered from interictal hypersensitivity to odors (28.5 years vs. 20 years; p = 0.012). There was a significant correlation between interictal hypersensitivity and higher age (54.50 vs. 45; p = 0.015). Patients with higher migraine disability in MIDAS experienced more frequently preictal and interictal olfactory sensitization and odor triggered migraine attacks. Conclusions In patients with longer migraine disease duration and higher migraine-related impairment, osmophobia was more frequently observed. These results might support the hypothesis of increasing sensitization with increasing burden of migraine.
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Affiliation(s)
- Gudrun Gossrau
- University Pain Center Dresden, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Marie Frost
- University Pain Center Dresden, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Anna Klimova
- NCT Partner Site Dresden, Institute for Medical Informatics and Biometrics, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Thea Koch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Rainer Sabatowski
- University Pain Center Dresden, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.,Department of Anesthesiology and Intensive Care Medicine, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Coralie Mignot
- Department of Otorhinolaryngology, Smell & Taste Clinic, TU Dresden, Dresden, Germany
| | - Antje Haehner
- Department of Otorhinolaryngology, Smell & Taste Clinic, TU Dresden, Dresden, Germany
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9
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Lan L, Liu Y, Xu JJ, Ma D, Yin X, Wu Y, Chen YC, Cai Y. Aberrant Modulations of Neurocognitive Network Dynamics in Migraine Comorbid With Tinnitus. Front Aging Neurosci 2022; 14:913191. [PMID: 35813956 PMCID: PMC9257523 DOI: 10.3389/fnagi.2022.913191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeThe possible relationship between migraine and tinnitus still remains elusive although migraine is often accompanied by chronic tinnitus. Several neuroimaging studies have reinforced the cognitive network abnormality in migraine and probably as well as tinnitus. The present work aims to investigate the dynamic neurocognitive network alterations of migraine comorbid with tinnitus.Materials and MethodsParticipants included migraine patients (n = 32), tinnitus patients (n = 20), migraine with tinnitus (n = 27), and healthy controls (n = 47), matched for age and gender. Resting-state functional magnetic resonance imaging (rs-fMRI) with independent component analysis (ICA), sliding window cross-correlation, and clustering state analysis was used to detect the dynamic functional network connectivity (dFNC) of each group. Correlation analyses illustrated the association between clinical symptoms and abnormal dFNC in migraine as well as tinnitus.ResultsCompared with healthy controls, migraine patients exhibited decreased cerebellar network and visual network (CN-VN) connectivity in State 2; migraine with tinnitus patients showed not only decreased CN-VN connectivity in State 2 but also decreased cerebellar network and executive control network (CN-ECN) connectivity in State 2 and increased cerebellar network and somatomotor network (SMN-VN) connectivity in State 1. The abnormal cerebellum dFNC with the executive control network (CN-ECN) was negatively correlated with headache frequency of migraine (rho = −0.776, p = 0.005).ConclusionBrain network characteristics of migraine with tinnitus patients may indicate different mechanisms for migraine and tinnitus. Our results demonstrated a transient pathologic state with atypical cerebellar-cortical connectivity in migraine with tinnitus patients, which might be used to identify the neuro-pathophysiological mechanisms in migraine accompanied by tinnitus.
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Affiliation(s)
- Liping Lan
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yin Liu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jin-Jing Xu
- Department of Otolaryngology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Di Ma
- College of Information Science and Technology, Nanjing Forestry University, Nanjing, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yuanqing Wu
- Department of Otolaryngology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- *Correspondence: Yu-Chen Chen,
| | - Yuexin Cai
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Yuexin Cai,
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10
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Abstract
PURPOSE OF REVIEW The underlying mechanisms of migraine are complex and heterogenous. Advances in neuroimaging techniques during the past few decades have contributed to our understanding of migraine pathophysiology. Brain function in migraine patients has been widely explored using functional MRI (fMRI). This review will highlight the major fMRI findings that characterize the different phases of migraine. RECENT FINDINGS The migraine attack starts with hypothalamic hyperexcitability and early reorganization of the common ascending pain and central trigeminovascular pathways. Moreover, the visual cortex becomes hyperexcitable during the aura phase. During the headache phase, further disruptions of the pontine, thalamic, sensorimotor and visual networks occur, although the hypothalamic activity and connectivity normalizes. The visual cortex remains hyperexcitable during the postdromal phase. Asymptomatic migraine patients can also experience functional alternations of pain and visual processing brain areas. At present, the heterogeneity of the asymptomatic phase and fMRI findings make it difficult to find common denominator. SUMMARY fMRI studies have captured functional brain changes associated with migraine phases, leading to an improvement of our understanding of migraine pathophysiology. Further MRI studies are needed to disclose whether the migraine attack is triggered by intrinsic brain dysfunction or external factors.
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11
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Intrinsic network activity reflects the ongoing experience of chronic pain. Sci Rep 2021; 11:21870. [PMID: 34750460 PMCID: PMC8576042 DOI: 10.1038/s41598-021-01340-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/26/2021] [Indexed: 11/08/2022] Open
Abstract
Analyses of intrinsic network activity have been instrumental in revealing cortical processes that are altered in chronic pain patients. In a novel approach, we aimed to elucidate how intrinsic functional networks evolve in regard to the fluctuating intensity of the experience of chronic pain. In a longitudinal study with 156 fMRI sessions, 20 chronic back pain patients and 20 chronic migraine patients were asked to continuously rate the intensity of their endogenous pain. We investigated the relationship between the fluctuation of intrinsic network activity with the time course of subjective pain ratings. For chronic back pain, we found increased cortical network activity for the salience network and a local pontine network, as well as decreased network activity in the anterior and posterior default mode network for higher pain intensities. Higher pain intensities in chronic migraine were accompanied with lower activity in a prefrontal cortical network. By taking the perspective of the individual, we focused on the variability of the subjective perception of pain, which include phases of relatively low pain and phases of relatively high pain. The present design of the assessment of ongoing endogenous pain can be a powerful and promising tool to assess the signature of a patient's endogenous pain encoding.
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12
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Mungoven TJ, Henderson LA, Meylakh N. Chronic Migraine Pathophysiology and Treatment: A Review of Current Perspectives. FRONTIERS IN PAIN RESEARCH 2021; 2:705276. [PMID: 35295486 PMCID: PMC8915760 DOI: 10.3389/fpain.2021.705276] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/31/2021] [Indexed: 11/13/2022] Open
Abstract
Chronic migraine is a disabling neurological disorder that imposes a considerable burden on individual and socioeconomic outcomes. Chronic migraine is defined as headaches occurring on at least 15 days per month with at least eight of these fulfilling the criteria for migraine. Chronic migraine typically evolves from episodic migraine as a result of increasing attack frequency and/or several other risk factors that have been implicated with migraine chronification. Despite this evolution, chronic migraine likely develops into its own distinct clinical entity, with unique features and pathophysiology separating it from episodic migraine. Furthermore, chronic migraine is characterized with higher disability and incidence of comorbidities in comparison to episodic migraine. While existing migraine studies primarily focus on episodic migraine, less is known about chronic migraine pathophysiology. Mounting evidence on aberrant alterations suggest that pronounced functional and structural brain changes, central sensitization and neuroinflammation may underlie chronic migraine mechanisms. Current treatment options for chronic migraine include risk factor modification, acute and prophylactic therapies, evidence-based treatments such as onabotulinumtoxinA, topiramate and newly approved calcitonin gene-related peptide or receptor targeted monoclonal antibodies. Unfortunately, treatments are still predominantly ineffective in aborting migraine attacks and decreasing intensity and frequency, and poor adherence and compliance with preventative medications remains a significant challenge. Novel emerging chronic migraine treatments such as neuromodulation offer promising therapeutic approaches that warrant further investigation. The aim of this narrative review is to provide an update of current knowledge and perspectives regarding chronic migraine background, pathophysiology, current and emerging treatment options with the intention of facilitating future research into this debilitating and largely indeterminant disorder.
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Affiliation(s)
| | | | - Noemi Meylakh
- Department of Anatomy and Histology, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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13
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Torres-Ferrus M, Pareto D, Gallardo VJ, Cuberas-Borrós G, Alpuente A, Caronna E, Vila-Balló A, Lorenzo-Bosquet C, Castell-Conesa J, Rovira A, Pozo-Rosich P. Cortical metabolic and structural differences in patients with chronic migraine. An exploratory 18FDG-PET and MRI study. J Headache Pain 2021; 22:75. [PMID: 34273945 PMCID: PMC8285838 DOI: 10.1186/s10194-021-01289-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/06/2021] [Indexed: 12/29/2022] Open
Abstract
Background To describe interictal brain structural and metabolic differences between patients with episodic migraine (EM), chronic migraine (CM) and healthy controls (HC). Methods This is an exploratory study including right-handed age-matched women with EM, CM and HC. On the same day, a sequential interictal scan was performed with 18FDG-PET and MRI. 3D T1-weighted images were segmented with FreeSurfer, normalized to a reference atlas and the mean values of metabolism, cortical thickness (CTh) and local gyrification index (IGI) were determined. Groups were compared using age-adjusted linear models, corrected for multiple comparisons. 18FDG-PET measurements between groups were also analysed adjusting by patient’s age, CTh and lGI. The variables independently associated with diagnosis were obtained using a logistic regression analysis. Results Fifteen patients (8 EM, 7 CM) and 11 HC were included. Morphometric data showed an increased CTh in 6 frontal areas (L/R-Caudal Middle Frontal, L/R-Rostral Middle Frontal, L-Medial Orbitofrontal and L-Superior Frontal) in CM patients compared to HC without differences for IGI. The structural adjusted analysis in CM showed a statistically significantly hypometabolism in 9 frontal areas (L-Lateral Orbitofrontal, L/R-Medial Orbitofrontal, L-Frontal Superior, R-Frontal pole, R-Parts Triangularis, L/R-Paracentral and R-Precentral) and 7 temporal areas (L/R-Insula, L/R-Inferior temporal, L/R-Temporal pole and R-Banks superior temporal sulcus) compared to HC. EM patients presented intermediate metabolic values between EM and HC (non-significant). Conclusions CM patients showed frontotemporal hypometabolism and increased frontal cortical thickness when compared to HC that may explain some cognitive and behavioural pain-processing and sensory integration alterations in CM patients. Combined information from sequential or simultaneous PET and MRI could optimize the study of complex functional neurological disorders such as migraine. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-021-01289-5.
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Affiliation(s)
- Marta Torres-Ferrus
- Headache and Craniofacial Pain Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Deborah Pareto
- Section of Neuroradiology, Department of Radiology, Vall d'Hebron University Hospital and Research Institute (VHIR), Barcelona, Spain
| | - Victor J Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gemma Cuberas-Borrós
- Research and Innovation Unit , Althaia Xarxa Assistencial Universitària de Manresa , Manresa, Spain.,Nuclear Medicine Department , Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alicia Alpuente
- Headache and Craniofacial Pain Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edoardo Caronna
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Adrià Vila-Balló
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Joan Castell-Conesa
- Nuclear Medicine Department , Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Vall d'Hebron University Hospital and Research Institute (VHIR), Barcelona, Spain
| | - Patricia Pozo-Rosich
- Headache and Craniofacial Pain Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain. .,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
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14
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Abstract
Migraine is a complex genetic brain disorder with an intricate pathogenesis and polymorphous clinical presentations, particularly in children. In this Perspective, we describe the different phenotypes of migraine in children, including conditions that have been referred to in the International Classification of Headache Disorders as "syndromes that may be related to migraine''. Evidence is presented for the integration of abdominal migraine, cyclical vomiting syndrome, benign paroxysmal vertigo, benign paroxysmal torticollis and infantile colic into the unified diagnosis of 'childhood migraine syndrome' on the basis of clinical and epidemiological characteristics, and shared inheritance. In our opinion, such integration will guide clinicians from specialities other than neurology to consider migraine in the assessment of children with these disorders, as well as stimulate research into the genetics, pathophysiology and clinical features of all disorders within the syndrome. A diagnosis of childhood migraine syndrome would also enable patients to benefit from inclusion in clinical trials of old and new migraine treatments, thus potentially increasing the number of treatment options available.
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15
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Barad MJ, Sturgeon JA, Hong J, Aggarwal AK, Mackey SC. Characterization of chronic overlapping pain conditions in patients with chronic migraine: A CHOIR study. Headache 2021; 61:872-881. [PMID: 34184263 DOI: 10.1111/head.14129] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/30/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Chronic overlapping pain conditions (COPCs) represent a co-aggregation of widespread pain disorders. We characterized differences in physical and psychosocial functioning in patients with chronic migraine (CM) and those with CM and COPCs. BACKGROUND Patients with CM and COPCs have been identified as a distinct subgroup of patients with CM, and these patients may be vulnerable to greater symptom severity and burden. METHODS Data were extracted from Collaborative Health Outcomes Information Registry (an open-source learning health-care system), completed at the patients' first visit at a large tertiary care pain management center and electronic medical records. In 1601 patients with CM, the number of non-cephalic areas of pain endorsed on a body map was used to examine the differences in pain, physical and psychosocial function, adverse life experience, and health-care utilization. RESULTS Patients endorsing more body map regions reported significantly worse symptoms and function across all domains. Scored on a t-score metric (mean = 50, SD = 10), endorsement of one additional body map region corresponded with a 0.69-point increase in pain interference (95% CI = 0.55, 0.82; p < 0.001; Cohen's f = 0.328), 1.15-point increase in fatigue (95% CI = 0.97, 1.32; p < 0.001; Cohen's f = 0.432), and 1.21-point decrease in physical function (95% CI = -1.39, -1.03; p < 0.001; Cohen's f = 0.560). Patients with more widespread pain reported approximately 5% more physician visits (95% CI = 0.03, 0.07; p < 0.001), and patients reporting adverse life events prior to age 17 endorsed 22% more body map regions (95% CI = 0.11, 0.32; p < 0.001). CONCLUSIONS Patients with CM and other overlapping pain conditions as noted on the body map report significantly worse pain-related physical function, psychosocial functioning, increased health-care utilization, and greater association with adverse life experiences, compared with those with localized CM. This study provides further evidence that patients with CM and co-occurring pain conditions are a distinct subgroup of CM and can be easily identified through patient-reported outcome measures.
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Affiliation(s)
- Meredith J Barad
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - John A Sturgeon
- Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Juliette Hong
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Anuj K Aggarwal
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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16
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Zou Y, Tang W, Qiao X, Li J. Aberrant modulations of static functional connectivity and dynamic functional network connectivity in chronic migraine. Quant Imaging Med Surg 2021; 11:2253-2264. [PMID: 34079699 DOI: 10.21037/qims-20-588] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Chronic migraine (CM) is a common and disabling neurological disorder that affects 1-2% of the global population. The aim of the present study was to identify the functional characteristics of the CM brain using static functional connectivity (s-FC), static functional network connectivity (s-FNC), and dynamic functional network connectivity (d-FNC) analyses. Methods In the present study, 17 CM patients and 20 sex- and age-matched healthy controls (HCs) underwent resting-state functional magnetic resonance imaging. We utilized independent component (IC) analysis to identify 13 ICs. These 13 ICs were then classified into the following 6 resting-state networks (RSNs): the default mode network (DMN), executive control network (ECN), dorsal attention network, auditory network (AN), visual network (VN), and cerebellum network. Subsequently, s-FC, s-FNC, and d-FNC analyses of 13 ICs were employed for between-group comparisons. Three temporal metrics (fraction of time spent, mean dwell time, and number of transitions), which were derived from the state-transition vector, were calculated for group comparisons. In addition, correlation analyses were performed between these dynamic metrics and clinical characteristics [mean visual analog scale (VAS) scores, days with headache per month, days with migraine pain feature per month, and disease duration]. Results In the comparison of s-FC of 13 ICs within RSNs between the CM and HC groups, increased connectivity was observed in the left angular gyrus (Angular_L) of the ECN (IC 2) and the right superior parietal gyrus (Parietal_Sup_R) of the AN (IC 5), and reduced connectivity was found in the left superior frontal gyrus (Frontal_Sup_2_L) of the AN (IC 5) and DMN (IC 19), the right calcarine sulcus (Calcarine_R) of the VN (IC 7), and the left precuneus (Precuneus_L) of the DMN (IC 17) in CM patients. In the comparison of the d-FNC of 13 IC pairs within RSNs between the two groups, the CM group exhibited significantly decreased connections between the DMN (IC 11) and AN (IC 5), and increased connections between the ECN (IC 2, IC 4) and DMN (IC 19), ECN (IC 4) and AN (IC 5), and ECN (IC 4) and VN (IC 13) in state 1. However, no significant differences in s-FNC were observed between the two groups during the s-FNC analysis. Between-group comparisons of three dynamic metrics between the CM and HC groups showed a longer fraction of time spent and mean dwell time in state 2 for CM patients. Furthermore, from the correlation analyses between these metrics and clinical characteristics, we observed a significant positive correlation between the number of transitions and mean VAS scores. Conclusions Our findings suggest that functional features of the CM brain may fluctuate over time instead of remaining static, and provide further evidence that migraine chronification may be related to abnormal pattern connectivity between sensory and cognitive brain networks.
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Affiliation(s)
- Yan Zou
- Department of Integrated Traditional and Western Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Weijun Tang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiangyang Qiao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ji Li
- Department of Integrated Traditional and Western Medicine, Huashan Hospital, Fudan University, Shanghai, China
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17
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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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18
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Baksh BS, Garcia JC, Galor A. Exploring the Link Between Dry Eye and Migraine: From Eye to Brain. Eye Brain 2021; 13:41-57. [PMID: 33692643 PMCID: PMC7939506 DOI: 10.2147/eb.s234073] [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: 12/02/2020] [Accepted: 02/17/2021] [Indexed: 11/23/2022] Open
Abstract
Dry eye and migraine are common diseases with large societal and economic burdens that have recently been associated in the literature. This review outlines the link between dry eye and migraine, which may have implications for reducing their respective burdens. We highlight possible shared pathophysiology, including peripheral and central sensitization, as the potential link between dry eye and migraine. Finally, therapies targeting similar pathophysiological mechanisms between dry eye and migraine are discussed.
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Affiliation(s)
- Brandon S Baksh
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Julia Costa Garcia
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Faculdade de Medicina (FMB) da Universidade do Estado de São Paulo (UNESP), Botucatu, Brazil
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA
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19
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González-Hernández A, Condés-Lara M, García-Boll E, Villalón CM. An outlook on the trigeminovascular mechanisms of action and side effects concerns of some potential neuropeptidergic antimigraine therapies. Expert Opin Drug Metab Toxicol 2021; 17:179-199. [DOI: 10.1080/17425255.2021.1856366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | - Miguel Condés-Lara
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, México
| | - Enrique García-Boll
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, México
| | - Carlos M. Villalón
- Departamento de Farmacobiología, Cinvestav-Coapa, Ciudad de México, México
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20
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Yin T, Sun G, Tian Z, Liu M, Gao Y, Dong M, Wu F, Li Z, Liang F, Zeng F, Lan L. The Spontaneous Activity Pattern of the Middle Occipital Gyrus Predicts the Clinical Efficacy of Acupuncture Treatment for Migraine Without Aura. Front Neurol 2020; 11:588207. [PMID: 33240209 PMCID: PMC7680874 DOI: 10.3389/fneur.2020.588207] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/30/2020] [Indexed: 12/11/2022] Open
Abstract
The purpose of the present study was to explore whether and to what extent the neuroimaging markers could predict the relief of the symptoms of patients with migraine without aura (MWoA) following a 4-week acupuncture treatment period. In study 1, the advanced multivariate pattern analysis was applied to perform a classification analysis between 40 patients with MWoA and 40 healthy subjects (HS) based on the z-transformed amplitude of low-frequency fluctuation (zALFF) maps. In study 2, the meaningful classifying features were selected as predicting features and the support vector regression models were constructed to predict the clinical efficacy of acupuncture in reducing the frequency of migraine attacks and headache intensity in 40 patients with MWoA. In study 3, a region of interest-based comparison between the pre- and post-treatment zALFF maps was conducted in 33 patients with MwoA to assess the changes in predicting features after acupuncture intervention. The zALFF value of the foci in the bilateral middle occipital gyrus, right fusiform gyrus, left insula, and left superior cerebellum could discriminate patients with MWoA from HS with higher than 70% accuracy. The zALFF value of the clusters in the right and left middle occipital gyrus could effectively predict the relief of headache intensity (R 2 = 0.38 ± 0.059, mean squared error = 2.626 ± 0.325) and frequency of migraine attacks (R 2 = 0.284 ± 0.072, mean squared error = 20.535 ± 2.701) after the 4-week acupuncture treatment period. Moreover, the zALFF values of these two clusters were both significantly reduced after treatment. The present study demonstrated the feasibility and validity of applying machine learning technologies and individual cerebral spontaneous activity patterns to predict acupuncture treatment outcomes in patients with MWoA. The data provided a quantitative benchmark for selecting acupuncture for MWoA.
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Affiliation(s)
- Tao Yin
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Guojuan Sun
- Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zilei Tian
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Mailan Liu
- College of Acupuncture and Moxibustion and Tui-na, Hunan University of Chinese Medicine, Changsha, China
| | - Yujie Gao
- Traditional Chinese Medicine School, Ningxia Medical University, Yinchuan, China
| | - Mingkai Dong
- Department of Acupuncture and Moxibustion, Xinjin Hospital of Traditional Chinese Medicine, Chengdu, China
| | - Feng Wu
- Department of Acupuncture and Moxibustion, Changsha Hospital of Traditional Chinese Medicine, Changsha, China
| | - Zhengjie Li
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fanrong Liang
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Key Laboratory of Sichuan Province for Acupuncture and Chronobiology, Chengdu, China
| | - Fang Zeng
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Key Laboratory of Sichuan Province for Acupuncture and Chronobiology, Chengdu, China
| | - Lei Lan
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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21
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Dai L, Yu Y, Zhao H, Zhang X, Su Y, Wang X, Hu S, Dai H, Hu C, Ke J. Altered local and distant functional connectivity density in chronic migraine: a resting-state functional MRI study. Neuroradiology 2020; 63:555-562. [PMID: 33057747 DOI: 10.1007/s00234-020-02582-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Previous studies have indicated disrupted functional connectivity in multiple brain regions and resting-state networks in episodic migraine, but it is unclear how brain network property is disrupted in chronic migraine. METHODS Using resting-state functional magnetic resonance imaging and voxel-wise functional connectivity density analysis, we examined the large-scale functional connectivity pattern over the whole brain in 17 patients with chronic migraine without medication overuse compared to 35 healthy controls. The associations between functional connectivity density and clinical variables were also explored. RESULTS Compared with controls, chronic migraine patients showed decreased local and distant functional connectivity density in the dorsolateral and medial prefrontal cortexes and precuneus and increased local and distant functional connectivity density in the hippocampal complex. The patients also presented increased local functional connectivity density in the orbital frontal gyrus and cerebellum and increased distant functional connectivity density in the temporal pole. Moreover, local functional connectivity density in several brain regions, such as the left superior temporal gyrus and dorsal anterior cingulate cortex, was found to be correlated with headache frequency or pain intensity. CONCLUSION Chronic migraine is associated with functional connectivity alterations in regions involved in multisensory integration, affective and cognitive processing, and pain modulation. Both local and distant functional connectivity density are complementary biomarkers for investigating the neural mechanism of this disorder. Some local functional connectivity density alterations may be useful for assessing the disease burden of chronic migraine.
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Affiliation(s)
- Lingling Dai
- Department of Radiology, The First Affiliated Hospital of Soochow University, Soochow, China.,Institute of Medical Imaging, Soochow University, Soochow, China
| | - Yang Yu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Soochow, China.,Institute of Medical Imaging, Soochow University, Soochow, China
| | - Hongru Zhao
- Department of Neurology, The First Affiliated Hospital of Soochow University, Soochow, China
| | - Xiaodong Zhang
- Department of Radiology, Tianjin First Central Hospital, Tianjin, China
| | - Yunyan Su
- Department of Radiology, The First Affiliated Hospital of Soochow University, Soochow, China.,Institute of Medical Imaging, Soochow University, Soochow, China
| | - Ximing Wang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Soochow, China.,Institute of Medical Imaging, Soochow University, Soochow, China
| | - Su Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Soochow, China.,Institute of Medical Imaging, Soochow University, Soochow, China
| | - Hui Dai
- Department of Radiology, The First Affiliated Hospital of Soochow University, Soochow, China.,Institute of Medical Imaging, Soochow University, Soochow, China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Soochow, China.,Institute of Medical Imaging, Soochow University, Soochow, China
| | - Jun Ke
- Department of Radiology, The First Affiliated Hospital of Soochow University, Soochow, China. .,Institute of Medical Imaging, Soochow University, Soochow, China.
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Chen G, Li Y, Dong Z, Wang R, Zhao D, Obeso I, Yu S. Response inhibition alterations in migraine: evidence from event-related potentials and evoked oscillations. J Headache Pain 2020; 21:119. [PMID: 33008328 PMCID: PMC7531083 DOI: 10.1186/s10194-020-01187-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/24/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Migraine is characterized by a hypersensitivity to environmental stimulation which climaxes during headache attacks but persists during attack-free period. Despite ongoing debates about the nature of the mechanisms giving rise to this abnormality, the presence of deficient inhibitory cortical processes has been proposed to be one possible mechanism underlying its pathogenesis. Empirical evidence supporting this claim is mainly based on previous accounts showing functional cortical disexcitability in the sensory domain. Considering that a general inhibitory control process can play an important role across early to later stage of information processing, this may indicate the important role other dimensions of inhibitory control can play in migraine disability. The present study examined the pathophysiological features of inhibitory control that takes place during suppression of prepotent responses in migraineurs. METHODS Twenty-two patients with migraine without aura (mean age = 30.86 ± 5.69 years; 19 females) during the interictal period and 25 healthy controls (mean age = 30.24 ± 3.52 years; 18 females) were recruited. We used a stop signal task in combination with event-related potentials (ERPs) to examine participants' neural activity supporting response inhibition. RESULTS Behaviorally, migraineurs exhibited prolonged stop signal reaction times relative to healthy controls. At the neural level, the amplitude of the stop-N2 over fronto-central, central and centro-parietal scalp regions, a component of the ERPs related to conflict monitoring during early, non-motoric stages of inhibition, was significantly increased in migraineurs. Meanwhile, the amplitude of the stop-P3 over central and centro-parietal scalp regions, a component of the ERPs reflecting late-stage inhibition of the motor system and cognitive evaluation of motor inhibition, was also significantly increased in migraineurs. Ultimately, our time-frequency analysis further revealed increased delta activity in migraineurs. CONCLUSIONS Consistent with the theory that alterations in cognitive cortical processes are a key signature of migraine, our findings revealed an abnormal state of suppressing prepotent responses in migraineurs, which can be attributed to cortical disexcitability of the pre-frontal executive network and centro-parietal sensorimotor network. These novel findings extend to show the existence of dysfunctional inhibition control that occurs during suppression of prepotent responses in migraneurs.
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Affiliation(s)
- Guoliang Chen
- Medical School of Chinese PLA, Beijing, China
- Department of Neurology, The first Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
- Department of Psychiatry, The 967th Hospital of Joint Logistic Support Force of PLA, Dalian, China
| | - Yansong Li
- Reward, Competition and Social Neuroscience Lab, Department of Psychology, School of Social and Behavioral Sciences, 210023, Nanjing, China
- Institute for Brain Sciences, Nanjing University, 210023, Nanjing, China
| | - Zhao Dong
- Medical School of Chinese PLA, Beijing, China
- Department of Neurology, The first Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Rongfei Wang
- Medical School of Chinese PLA, Beijing, China
- Department of Neurology, The first Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Dengfa Zhao
- Medical School of Chinese PLA, Beijing, China
- Department of Neurology, The first Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Ignacio Obeso
- HM Hospitales - Centro Integral en Neurociencias HM CINAC, Móstoles, Madrid, Spain
| | - Shengyuan Yu
- Medical School of Chinese PLA, Beijing, China.
- Department of Neurology, The first Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China.
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23
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Dehghan A, Saatchian E, Sobhani M, Montazerabadi A. Neurochemical metabolite alterations of the occipital lobe in migraine without aura by proton magnetic resonance spectroscopy. Neuroradiol J 2020; 33:410-415. [PMID: 32573358 PMCID: PMC7482038 DOI: 10.1177/1971400920932793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Migraine without aura is the most common type of migraine headache, accounting for about 80% of all migraines. The aim of the present investigation was to determine the neurochemical metabolite alterations in the occipital lobe of patients suffering from migraine without aura using proton magnetic resonance spectroscopy (1H-MRS). METHODS Fifteen patients suffering from migraine without aura with an occipital plaque and 16 healthy controls were included in this study. Changes in the neurochemical metabolites in the occipital lobe were assessed using 1H-MRS. The ratios of N-acetylaspartate (NAA) to creatine (Cr), choline (Cho) to Cr and myo-inositol (MI) to NAA were measured by voxel volume at 8 cm3. RESULTS The mean NAA/Cr ratio decreased significantly in patients compared to controls. Cho/Cr and MI/NAA ratios increased significantly in patients. In addition, the duration of the disease and the frequency of headache attacks were significantly associated with a decrease in the NAA/Cr ratio and an increase in the Cho/Cr ratio. CONCLUSIONS Migraine without aura shows a significant association with changes in neurochemical metabolites detectable by 1H-MRS in the occipital lobe of patients. In addition, changes in metabolic ratios showed a significant relationship with the duration of the disease and the frequency of headache attacks.
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Affiliation(s)
- Alireza Dehghan
- Medical Physics Research Centre, Mashhad University of Medical Sciences, Iran
| | - Erfan Saatchian
- Medical Physics Research Centre, Mashhad University of Medical Sciences, Iran
| | - Mohammadreza Sobhani
- Neurology Department, Faculty of Medicine, Gonabad University of Medical Sciences, Iran
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24
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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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