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Viganò A, Sasso D’Elia T, Sava SL, Colosimo A, Di Piero V, Magis D, Schoenen J. Exploring the Therapeutic Potential of Quadripulse rTMS over the Visual Cortex: A Proof-of-Concept Study in Healthy Volunteers and Chronic Migraine Patients with Medication Overuse Headache. Biomedicines 2024; 12:288. [PMID: 38397890 PMCID: PMC10886990 DOI: 10.3390/biomedicines12020288] [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: 12/12/2023] [Revised: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 02/25/2024] Open
Abstract
In chronic migraine with medication overuse (CM-MOH), sensitization of visual cortices is reflected by (i) increased amplitude of stimulus-evoked responses and (ii) habituation deficit during repetitive stimulation. Both abnormalities might be mitigated by inhibitory transcranial neurostimulation. Here, we tested an inhibitory quadripulse repetitive transcranial magnetic stimulation (rTMS-QPI) protocol to decrease durably visual cortex excitability in healthy subjects (HS) and explored its therapeutic potential in CM-MOH patients. Pattern-reversal visual evoked potentials (VEP) were used as biomarkers of effect and recorded before (T1), immediately after (T2), and 3 h after stimulation (T3). In HS, rTMS-QPI durably decreased the VEP 1st block amplitude (p < 0.05) and its habituation (p < 0.05). These changes were more pronounced for the P1N2 component that was modified already at T2 up to T3, while for N1P1 they were significant only at T3. An excitatory stimulation protocol (rTMS-QPE) tended to have an opposite effect, restricted to P1N2. In 12 CM-MOH patients, during a four-week treatment (2 sessions/week), rTMS-QPI significantly reduced monthly headache days (p < 0.01). In patients reversing from CM-MOH to episodic migraine (n = 6), VEP habituation significantly improved after treatment (p = 0.005). rTMS-QPI durably decreases visual cortex responsivity in healthy subjects. In a proof-of-concept study of CM-MOH patients, rTMS-QPI also has beneficial clinical and electrophysiological effects, but sham-controlled trials are needed.
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Affiliation(s)
- Alessandro Viganò
- Headache Research Unit, Department of Neurology, University of Liège, Citadelle Hospital, 4000 Liège, Belgium
| | - Tullia Sasso D’Elia
- Headache Research Unit, Department of Neurology, University of Liège, Citadelle Hospital, 4000 Liège, Belgium
- IRCCS San Raffaele Alla Pisana, 00163 Rome, Italy
| | - Simona Liliana Sava
- Headache Research Unit, Department of Neurology, University of Liège, Citadelle Hospital, 4000 Liège, Belgium
- Headache Clinic of Valdor—ISOSL, 4020 Liège, Belgium
| | - Alfredo Colosimo
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics Sapienza, Sapienza—University of Rome, 00185 Rome, Italy
| | - Vittorio Di Piero
- Subintensive Neurology & Headache Centre, Department of Human Neurosciences, Sapienza—University of Rome, 00185 Rome, Italy
| | - Delphine Magis
- Headache Research Unit, Department of Neurology, University of Liège, Citadelle Hospital, 4000 Liège, Belgium
- Neurology Department and Pain Clinic (CMTD), CHR East Belgium, 4800 Verviers, Belgium
| | - Jean Schoenen
- Headache Research Unit, Department of Neurology, University of Liège, Citadelle Hospital, 4000 Liège, Belgium
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Vinueza-Buitrón P, Montes-Peña VJ, Rodríguez-Mena D, Boada-Cuellar JL, Santos-Lasaosa S. [Habituation deficit study in patients with episodic migraine thru nociceptive blink reflex]. Rev Neurol 2023; 77:159-165. [PMID: 37750546 PMCID: PMC10831709 DOI: 10.33588/rn.7707.2023036] [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: 09/04/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION Lack of habituation is the most reproducible interictal neurophysiological phenomenon in episodic migraine. The aim of this study is to evaluate the habituation phenomenon by examining the nociceptive blink reflex in patients with episodic migraine. SUBJECTS AND METHODS We conducted a cross-sectional observational case-control study. Patients with episodic migraine were selected consecutively and studied during the interictal phase. The nociceptive blink reflex was examined and a study was conducted comparing symmetry, analysis of the Euclidean distances and assessment of latency prolongation between stimulation blocks. RESULTS Thirty-one patients and 16 healthy controls were included, their mean ages being 32.25 and 32.35 years, respectively. The controls displayed left-right symmetry. The Euclidean and Manhattan distances showed that the means of the block latencies of the groups are different and increase according to the number of blocks being compared. The means of the block latencies do not differ significantly in the migraine patient group, in contrast to what is seen in the healthy group. CONCLUSION Habituation deficit was observed in the interictal phase in patients with episodic migraine compared to controls, as measured by the absence of latency prolongation in the nociceptive blink reflex.
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Affiliation(s)
- Paúl Vinueza-Buitrón
- Servicio de Neurología. Hospital Clínico Lozano Blesa. Zaragoza, EspañaHospital Clínico Lozano BlesaHospital Clínico Lozano BlesaZaragozaEspaña
| | - Vizmary J. Montes-Peña
- Servicio de Neurofisiología clínica. Hospital Clínico Lozano Blesa. Zaragoza, EspañaHospital Clínico Lozano BlesaHospital Clínico Lozano BlesaZaragozaEspaña
| | - Diego Rodríguez-Mena
- Servicio de Neurofisiología clínica. Hospital Clínico Lozano Blesa. Zaragoza, EspañaHospital Clínico Lozano BlesaHospital Clínico Lozano BlesaZaragozaEspaña
| | - José L. Boada-Cuellar
- Servicio de Neurofisiología clínica. Hospital Clínico Lozano Blesa. Zaragoza, EspañaHospital Clínico Lozano BlesaHospital Clínico Lozano BlesaZaragozaEspaña
| | - Sonia Santos-Lasaosa
- Servicio de Neurología. Hospital Clínico Lozano Blesa. Zaragoza, EspañaHospital Clínico Lozano BlesaHospital Clínico Lozano BlesaZaragozaEspaña
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