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Sollmann N, Hoffmann G, Schramm S, Reichert M, Hernandez Petzsche M, Strobel J, Nigris L, Kloth C, Rosskopf J, Börner C, Bonfert M, Berndt M, Grön G, Müller HP, Kassubek J, Kreiser K, Koerte IK, Liebl H, Beer A, Zimmer C, Beer M, Kaczmarz S. Arterial Spin Labeling (ASL) in Neuroradiological Diagnostics - Methodological Overview and Use Cases. ROFO-FORTSCHR RONTG 2024; 196:36-51. [PMID: 37467779 DOI: 10.1055/a-2119-5574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND Arterial spin labeling (ASL) is a magnetic resonance imaging (MRI)-based technique using labeled blood-water of the brain-feeding arteries as an endogenous tracer to derive information about brain perfusion. It enables the assessment of cerebral blood flow (CBF). METHOD This review aims to provide a methodological and technical overview of ASL techniques, and to give examples of clinical use cases for various diseases affecting the central nervous system (CNS). There is a special focus on recent developments including super-selective ASL (ssASL) and time-resolved ASL-based magnetic resonance angiography (MRA) and on diseases commonly not leading to characteristic alterations on conventional structural MRI (e. g., concussion or migraine). RESULTS ASL-derived CBF may represent a clinically relevant parameter in various pathologies such as cerebrovascular diseases, neoplasms, or neurodegenerative diseases. Furthermore, ASL has also been used to investigate CBF in mild traumatic brain injury or migraine, potentially leading to the establishment of imaging-based biomarkers. Recent advances made possible the acquisition of ssASL by selective labeling of single brain-feeding arteries, enabling spatial perfusion territory mapping dependent on blood flow of a specific preselected artery. Furthermore, ASL-based MRA has been introduced, providing time-resolved delineation of single intracranial vessels. CONCLUSION Perfusion imaging by ASL has shown promise in various diseases of the CNS. Given that ASL does not require intravenous administration of a gadolinium-based contrast agent, it may be of particular interest for investigations in pediatric cohorts, patients with impaired kidney function, patients with relevant allergies, or patients that undergo serial MRI for clinical indications such as disease monitoring. KEY POINTS · ASL is an MRI technique that uses labeled blood-water as an endogenous tracer for brain perfusion imaging.. · It allows the assessment of CBF without the need for administration of a gadolinium-based contrast agent.. · CBF quantification by ASL has been used in several pathologies including brain tumors or neurodegenerative diseases.. · Vessel-selective ASL methods can provide brain perfusion territory mapping in cerebrovascular diseases.. · ASL may be of particular interest in patient cohorts with caveats concerning gadolinium administration..
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Affiliation(s)
- Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- cBrain, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Gabriel Hoffmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Severin Schramm
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Miriam Reichert
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Moritz Hernandez Petzsche
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Joachim Strobel
- Department of Nuclear Medicine, University Hospital Ulm, Ulm, Germany
| | - Lorenzo Nigris
- cBrain, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Christopher Kloth
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Johannes Rosskopf
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- Section of Neuroradiology, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Corinna Börner
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- LMU Hospital, Department of Pediatrics - Dr. von Hauner Children's Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity - iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Michaela Bonfert
- LMU Hospital, Department of Pediatrics - Dr. von Hauner Children's Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity - iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Maria Berndt
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Georg Grön
- Department of Psychiatry and Psychotherapy III, University Hospital Ulm, Ulm, Germany
| | | | - Jan Kassubek
- Department of Neurology, University Hospital Ulm, Ulm, Germany
- German Center for Neurodegenerative Diseases (DZNE), Ulm University, Ulm, Germany
| | - Kornelia Kreiser
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- Department of Radiology and Neuroradiology, Universitäts- und Rehabilitationskliniken Ulm, Ulm, Germany
| | - Inga K Koerte
- cBrain, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, United States
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, United States
| | - Hans Liebl
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Radiology, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
| | - Ambros Beer
- Department of Nuclear Medicine, University Hospital Ulm, Ulm, Germany
- MoMan - Center for Translational Imaging, University Hospital Ulm, Ulm, Germany
- i2SouI - Innovative Imaging in Surgical Oncology, University Hospital Ulm, Ulm, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- MoMan - Center for Translational Imaging, University Hospital Ulm, Ulm, Germany
- i2SouI - Innovative Imaging in Surgical Oncology, University Hospital Ulm, Ulm, Germany
| | - Stephan Kaczmarz
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Market DACH, Philips GmbH, Hamburg, Germany
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Clifford SM, Ghosh A, Zandifar A, Tierradentro-García LO, Kim JDU, Andronikou S. Arterial spin-labeled (ASL) perfusion in children with Sturge-Weber syndrome: a retrospective cross-sectional study. Neuroradiology 2023; 65:1825-1834. [PMID: 37794141 DOI: 10.1007/s00234-023-03224-8] [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: 03/13/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE Sturge-Weber syndrome (SWS) is a developmental disorder with venous hypertension and associated tissue responses including pial angiomatosis, cortical calcifications, and cerebral atrophy. Arterial spin-labeled (ASL) perfusion is an advanced MR sequence which can assess perfusion, without the need for contrast. We systematically evaluated the potential benefits of using ASL in Sturge-Weber syndrome, to determine the extent of intracranial perfusion abnormality and stage of disease, relevant for prognostication and surgical planning. METHODS Two pediatric neuroradiologists retrospectively evaluated ASL perfusion imaging of 31 children with confirmed SWS and recorded the presence of hyper-perfusion, hypo-perfusion, or normal perfusion. The presence and distribution of ASL abnormality were compared against the presence and side of atrophy/calcification and pial angiomatosis on standard MR sequences. RESULTS Thirty-one children (52% female, median age 16.7 months) with SWS had ASL imaging. Seven (23%) had hyper-perfusion, 15 (48%) had hypo-perfusion, and 9 (29%) had no perfusion abnormalities. ASL perfusion abnormality matched the location of SWS findings on conventional imaging in 86% (19/22). ASL demonstrated statistically significant increased perfusion in the early stage of the disease and decreased perfusion when there was atrophy. The parietal lobe was involved in 86% of cases. CONCLUSION ASL perfusion imaging is an advanced technique which may contribute to earlier diagnosis and more accurate prognostication of Sturge-Weber syndrome, helping guide management and potential surgical planning.
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Affiliation(s)
- Simon M Clifford
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Adarsh Ghosh
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Jorge D U Kim
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Savvas Andronikou
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
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Szabo E, Ashina S, Melo-Carrillo A, Bolo NR, Borsook D, Burstein R. Peripherally acting anti-CGRP monoclonal antibodies alter cortical gray matter thickness in migraine patients: A prospective cohort study. Neuroimage Clin 2023; 40:103531. [PMID: 37866119 PMCID: PMC10623369 DOI: 10.1016/j.nicl.2023.103531] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 10/24/2023]
Abstract
Migraine is underpinned by central nervous system neuroplastic alterations thought to be caused by the repetitive peripheral afferent barrage the brain receives during the headache phase (cortical hyperexcitability). Calcitonin gene-related peptide monoclonal antibodies (anti-CGRP-mAbs) are highly effective migraine preventative treatments. Their ability to alter brain morphometry in treatment-responders vs. non-responders is not well understood. Our aim was to determine the effects of the anti-CGRP-mAb galcanezumab on cortical thickness after 3-month treatment of patients with high-frequency episodic or chronic migraine. High-resolution magnetic resonance imaging was performed pre- and post-treatment in 36 migraine patients. In this group, 19 patients were classified responders (≥50 % reduction in monthly migraine days) and 17 were considered non-responders (<50 % reduction in monthly migraine days). Following cross-sectional processing to analyze the baseline differences in cortical thickness, two-stage longitudinal processing and symmetrized percent change were conducted to investigate treatment-related brain changes. At baseline, no significant differences were found between the responders and non-responders. After 3-month treatment, decreased cortical thickness (compared to baseline) was observed in the responders in regions of the somatosensory cortex, anterior cingulate cortex, medial frontal cortex, superior frontal gyrus, and supramarginal gyrus. Non-responders demonstrated decreased cortical thickness in the left dorsomedial cortex and superior frontal gyrus. We interpret the cortical thinning seen in the responder group as suggesting that reduction in head pain could lead to changes in neural swelling and dendritic complexity and that such changes reflect the recovery process from maladaptive neural activity. This conclusion is further supported by our recent study showing that 3 months after treatment initiation, the incidence of premonitory symptoms and prodromes that are followed by headache decreases but not the incidence of the premonitory symptoms or prodromes themselves (that is, cortical thinning relates to reductions in the nociceptive signals in the responders). We speculate that a much longer recovery period is required to allow the brain to return to a more 'normal' functioning state whereby prodromes and premonitory symptoms no longer occur.
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Affiliation(s)
- Edina Szabo
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Anaesthesiology, Harvard Medical School, Boston, MA 02215, USA
| | - Sait Ashina
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Anaesthesiology, Harvard Medical School, Boston, MA 02215, USA; Comprehensive Headache Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Agustin Melo-Carrillo
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Anaesthesiology, Harvard Medical School, Boston, MA 02215, USA
| | - Nicolas R Bolo
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - David Borsook
- Department of Anaesthesiology, Harvard Medical School, Boston, MA 02215, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02215, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Anaesthesiology, Harvard Medical School, Boston, MA 02215, USA; Comprehensive Headache Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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Noseda R, Villanueva L. Central generators of migraine and autonomic cephalalgias as targets for personalized pain management: Translational links. Eur J Pain 2023; 27:1126-1138. [PMID: 37421221 PMCID: PMC10979820 DOI: 10.1002/ejp.2158] [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: 03/16/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Migraine oscillates between different states in association with internal homeostatic functions and biological rhythms that become more easily dysregulated in genetically susceptible individuals. Clinical and pre-clinical data on migraine pathophysiology support a primary role of the central nervous system (CNS) through 'dysexcitability' of certain brain networks, and a critical contribution of the peripheral sensory and autonomic signalling from the intracranial meningeal innervation. This review focuses on the most relevant back and forward translational studies devoted to the assessment of CNS dysfunctions involved in primary headaches and discusses the role they play in rendering the brain susceptible to headache states. METHODS AND RESULTS We collected a body of scientific literature from human and animal investigations that provide a compelling perspective on the anatomical and functional underpinnings of the CNS in migraine and trigeminal autonomic cephalalgias. We focus on medullary, hypothalamic and corticofugal modulation mechanisms that represent strategic neural substrates for elucidating the links between trigeminovascular maladaptive states, migraine triggering and the temporal phenotype of the disease. CONCLUSION It is argued that a better understanding of homeostatic dysfunctional states appears fundamental and may benefit the development of personalized therapeutic approaches for improving clinical outcomes in primary headache disorders. SIGNIFICANCE This review focuses on the most relevant back and forward translational studies showing the crucial role of top-down brain modulation in triggering and maintaining primary headache states and how these central dysfunctions may interact with personalized pain management strategies.
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Affiliation(s)
- Rodrigo Noseda
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Luis Villanueva
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris-Cité, Team Imaging Biomarkers of Brain Disorders (IMA-Brain), INSERM U1266, Paris, France
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Pohl H, Sandor PS, Moisa M, Ruff CC, Schoenen J, Luechinger R, O'Gorman R, Riederer F, Gantenbein AR, Michels L. Occipital transcranial direct current stimulation in episodic migraine patients: effect on cerebral perfusion. Sci Rep 2023; 13:13944. [PMID: 37626074 PMCID: PMC10457373 DOI: 10.1038/s41598-023-39659-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
Cerebral blood flow differs between migraine patients and healthy controls during attack and the interictal period. This study compares the brain perfusion of episodic migraine patients and healthy controls and investigates the influence of anodal transcranial direct current stimulation (tDCS) over the occipital cortex. We included healthy adult controls and episodic migraineurs. After a 28-day baseline period and the baseline visit, migraine patients received daily active or sham anodal tDCS over the occipital lobe for 28 days. All participants underwent a MRI scan at baseline; migraineurs were also scanned shortly after the stimulation period and about five months later. At baseline, brain perfusion of migraine patients and controls differed in several areas; among the stimulated areas, perfusion was increased in the cuneus of healthy controls. At the first visit, the active tDCS group had an increased blood flow in regions processing visual stimuli and a decreased perfusion in other areas. Perfusion did not differ at the second follow-up visit. The lower perfusion level in migraineurs in the cuneus indicates a lower preactivation level. Anodal tDCS over the occipital cortex increases perfusion of several areas shortly after the stimulation period, but not 5 months later. An increase in the cortical preactivation level could mediate the transient reduction of the migraine frequency.Trial registration: NCT03237754 (registered at clincicaltrials.gov; full date of first trial registration: 03/08/2017).
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Affiliation(s)
- Heiko Pohl
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Peter S Sandor
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Department of Neurology and Neurorehabilitation, ZURZACH Care, Bad Zurzach, Switzerland
| | - Marius Moisa
- Zurich Center for Neuroeconomics (ZNE), Department of Economics, University of Zurich, Zurich, Switzerland
| | - Christian C Ruff
- Zurich Center for Neuroeconomics (ZNE), Department of Economics, University of Zurich, Zurich, Switzerland
| | - Jean Schoenen
- Headache Research Unit, Department of Neurology-Citadelle Hospital, University of Liège, Liège, Belgium
| | - Roger Luechinger
- Institute for Biomedical Engineering, ETH Zurich and University of Zurich, Zurich, Switzerland
| | - Ruth O'Gorman
- Center for MR-Research, University Children's Hospital, Zurich, Switzerland
- Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Franz Riederer
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Department of Neurology, Clinic Hietzing, Vienna, Austria
- Karl Landsteiner Institute for Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Andreas R Gantenbein
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Department of Neurology and Neurorehabilitation, ZURZACH Care, Bad Zurzach, Switzerland
| | - Lars Michels
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, 8091, Zurich, Switzerland.
- Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland.
- Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland.
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Russo A, Silvestro M, Tessitore A, Orologio I, De Rosa AP, De Micco R, Tedeschi G, Esposito F, Cirillo M. Arterial spin labeling MRI applied to migraine: current insights and future perspectives. J Headache Pain 2023; 24:71. [PMID: 37322466 DOI: 10.1186/s10194-023-01597-y] [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: 04/20/2023] [Accepted: 05/19/2023] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION Advanced neuroimaging techniques have extensively contributed to elucidate the complex mechanisms underpinning the pathophysiology of migraine, a neurovascular disorder characterized by episodes of headache associated with a constellation of non-pain symptoms. The present manuscript, summarizing the most recent progresses of the arterial spin labelling (ASL) MRI techniques and the most significant findings from ASL studies conducted in migraine, is aimed to clarify how ASL investigations are contributing to the evolving insight on migraine pathophysiology and their putative role in migraine clinical setting. ASL techniques, allowing to quantitatively demonstrate changes in cerebral blood flow (CBF) both during the attacks and in the course of interictal period, could represent the melting point between advanced neuroimaging investigations, conducted with pure scientific purposes, and conventional neuroimaging approaches, employed in the diagnostic decision-making processes. MAIN BODY Converging ASL evidences have demonstrated that abnormal CBF, exceeding the boundaries of a single vascular territory, with biphasic trend dominated by an initial hypoperfusion (during the aura phenomenon but also in the first part of the headache phase) followed by hyperperfusion, characterizes migraine with aura attack and can represent a valuable clinical tool in the differential diagnosis from acute ischemic strokes and epileptic seizures. Studies conducted during migraine without aura attacks are converging to highlight the involvement of dorsolateral pons and hypothalamus in migraine pathophysiology, albeit not able to disentangle their role as "migraine generators" from mere attack epiphenomenon. Furthermore, ASL findings tend to support the presence of perfusion abnormalities in brain regions known to be involved in aura ignition and propagation as well as in areas involved in multisensory processing, in both patients with migraine with aura and migraine without aura. CONCLUSION Although ASL studies have dramatically clarified quality and timing of perfusion abnormalities during migraine with aura attacks, the same cannot be said for perfusion changes during migraine attacks without aura and interictal periods. Future studies with more rigorous methodological approaches in terms of study protocol, ASL technique and sample selection and size are mandatory to exploit the possibility of better understanding migraine pathophysiology and identifying neuroimaging biomarkers of each migraine phase in different migraine phenotypes.
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Affiliation(s)
- Antonio Russo
- Headache Centre, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
- Advanced MRI Neuroimaging Centre, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - 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
| | - Alessandro Pasquale De Rosa
- Advanced MRI Neuroimaging Centre, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Rosa De Micco
- 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
- Advanced MRI Neuroimaging Centre, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Fabrizio Esposito
- Advanced MRI Neuroimaging Centre, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Cirillo
- Advanced MRI Neuroimaging Centre, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
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Bourgeais-Rambur L, Beynac L, Mariani JC, Tanter M, Deffieux T, Lenkei Z, Villanueva L. Altered Cortical Trigeminal Fields Excitability by Spreading Depolarization Revealed with in Vivo Functional Ultrasound Imaging Combined with Electrophysiology. J Neurosci 2022; 42:6295-6308. [PMID: 35817577 PMCID: PMC9374159 DOI: 10.1523/jneurosci.1825-21.2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 06/14/2022] [Accepted: 06/23/2022] [Indexed: 11/21/2022] Open
Abstract
Spreading depolarization, usually termed cortical spreading depression has been proposed as the pathophysiological substrate of migraine aura and as an endogenous trigger of headache pain. The links between neurovascular coupling and cortical craniofacial nociceptive activities modulated by SD were assessed by combining in vivo local field potential (LFP) recordings in the primary somatosensory cortex (S1) with functional ultrasound imaging of S1 and caudal insular (INS) cortices of anesthetized male rats. A single SD wave triggered in the primary visual cortex elicited an ipsilateral, quadriphasic hemodynamic and electrophysiological response in S1 with an early phase consisting of concomitant increases of relative cerebral blood volume (rCBV) and LFPs. A transient hypoperfusion was then correlated with the beginning of the neuronal silence, followed by a strong increase of rCBV, whereas synaptic activities remained inhibited.LFPs and rCBV recovery period was followed by a progressive increase in S1 and INS baseline activities and facilitation of cortical responses evoked by periorbital cutaneous receptive field stimulation. Sensitization of cortical ophthalmic fields by SD was bilateral, occurred with precise spatiotemporal profiles, and was significantly reduced by pretreatment with an NMDA antagonist. Combined high-resolution assessing of neurovascular coupling and electrophysiological activities has revealed a useful preclinical tool for deciphering central sensitization mechanisms involved in migraine attacks.SIGNIFICANCE STATEMENT A crucial unsolved issue is whether visual aura and migraine headache are parallel or sequential processes. Here, we show that a single spreading depolarization wave triggered from the primary visual cortex is powerful enough to elicit progressive, sustained increases of hemodynamic and sensory responses to percutaneous periorbital noxious stimuli recorded in S1 and insular ophthalmic fields. Sensitization of cortical ophthalmic fields by SD was bilateral, occurred with precise spatiotemporal profiles, and was significantly reduced by pretreatment with an NMDA antagonist. Combined high-resolution assessing of neurovascular coupling and electrophysiological activities has revealed a useful preclinical tool for deciphering central sensitization mechanisms involved in migraine attacks.
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Affiliation(s)
- Laurence Bourgeais-Rambur
- Université de Paris, Institut National de la Santé et de la Recherche Médicale U1266, Institute of Psychiatry and Neuroscience of Paris, 75014 Paris, France
- Electrophysiology-Functional Ultrasound imaging Technical Core, Institute of Psychiatry and Neuroscience of Paris, 75014 Paris, France
- Team Pathogenesis of Small Vessel Diseases of the Brain
| | - Laurianne Beynac
- Université de Paris, Institut National de la Santé et de la Recherche Médicale U1266, Institute of Psychiatry and Neuroscience of Paris, 75014 Paris, France
- Electrophysiology-Functional Ultrasound imaging Technical Core, Institute of Psychiatry and Neuroscience of Paris, 75014 Paris, France
| | - Jean-Charles Mariani
- Université de Paris, Institut National de la Santé et de la Recherche Médicale U1266, Institute of Psychiatry and Neuroscience of Paris, 75014 Paris, France
- Team Dynamics of Neuronal Structure in Health and Disease
| | - Mickael Tanter
- Institut National de la Santé et de la Recherche Médicale U1273, Physics for Medicine Technological and Research Accelerator in Biomedical Ultrasound, Centre National de la Recherche Scientifique UMR 8361, École Supérieure de Physique et de Chimie Industrielles de la Ville de Paris, Université Paris Science et Lettres, 70512 Paris, France
| | - Thomas Deffieux
- Institut National de la Santé et de la Recherche Médicale U1273, Physics for Medicine Technological and Research Accelerator in Biomedical Ultrasound, Centre National de la Recherche Scientifique UMR 8361, École Supérieure de Physique et de Chimie Industrielles de la Ville de Paris, Université Paris Science et Lettres, 70512 Paris, France
| | - Zsolt Lenkei
- Université de Paris, Institut National de la Santé et de la Recherche Médicale U1266, Institute of Psychiatry and Neuroscience of Paris, 75014 Paris, France
- Team Dynamics of Neuronal Structure in Health and Disease
| | - Luis Villanueva
- Université de Paris, Institut National de la Santé et de la Recherche Médicale U1266, Institute of Psychiatry and Neuroscience of Paris, 75014 Paris, France
- Team Imaging Biomarkers of Brain Disorders (IMA-Brain)
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Nahman-Averbuch H, Schneider VJ, Lee GR, Peugh JL, Hershey AD, Powers SW, de Zambotti M, Coghill RC, King CD. New insight into the neural mechanisms of migraine in adolescents: Relationships with sleep. Headache 2022; 62:668-680. [PMID: 35467018 DOI: 10.1111/head.14299] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 03/05/2022] [Accepted: 03/06/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This case-control study examines if measures of subjective and objective (actigraphic) sleep difficulties mediate alterations in amygdalar connectivity in adolescents with migraine compared to healthy adolescents. BACKGROUND Adolescents with migraine have different functional connectivity of the amygdala compared to individuals without migraine. Sleep is often disturbed in adolescents with migraine, and could contribute to the alterations in functional connectivity. METHODS Twenty adolescents with migraine and 20 healthy controls were recruited from Cincinnati Children's Hospital. Participants completed surveys about their headaches and overall sleep quality, sleep hygiene, and perceived sleep difficulties (Insomnia Severity Scale [ISI]); completed wrist-worn actigraphy; and underwent a magnetic resonance imaging scan. RESULTS Adolescents with migraine differed from healthy controls only in perceived difficulty in sleep initiation and maintenance (ISI: 8.5 ± 4.7 and 4.5 ± 3.7 [mean ± standard deviation], -4.00 [95% confidence: -6.7 to -1.3], p = 0.005) and had greater functional connectivity between the amygdala and the posterior cingulate cortex, precuneus, dorsolateral prefrontal, sensorimotor, and the occipital cortexes. The differences in functional connectivity of the amygdala were not mediated by the subjective/objective sleep measures (ISI/wake minutes after sleep onset). CONCLUSIONS Adolescents with migraine have greater connectivity between the amygdala and areas involved in sensory, affective, and cognitive aspects of pain. These alterations may not be due to higher levels of sleep difficulties in adolescents with migraine, suggesting that both amygdala and sleep alterations may play an independent role in migraine pathophysiology. This advances the understanding of the mechanisms underlying pediatric migraine and can potentially advance migraine management.
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Affiliation(s)
- Hadas Nahman-Averbuch
- Division of Clinical and Translational Research and Washington University Pain Center, Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Pediatric Pain Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Victor J Schneider
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA.,Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Gregory R Lee
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - James L Peugh
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andrew D Hershey
- Pediatric Pain Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Scott W Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Pediatric Pain Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Robert C Coghill
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Pediatric Pain Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Christopher D King
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Pediatric Pain Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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9
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Kaplan CM, Schrepf A, Mawla I, Ichesco E, Boehnke KF, Beltz A, Foxen-Craft E, Puglia MP, Tsodikov A, Williams DA, Hassett AL, Clauw DJ, Harte SE, Harris RE. Neurobiological antecedents of multisite pain in children. Pain 2022; 163:e596-e603. [PMID: 34382607 PMCID: PMC8720318 DOI: 10.1097/j.pain.0000000000002431] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/23/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Altered brain structure and function is evident in adults with multisite chronic pain. Although many such adults trace their pain back to childhood, it has been difficult to disentangle whether central nervous system alterations precede or are consequences of chronic pain. If the former is true, aberrant brain activity may identify children vulnerable to developing chronic pain later in life. We examined structural and functional brain magnetic resonance imaging metrics in a subset of children from the first 2 assessments of the Adolescent Brain and Cognitive Development Study. Children (aged 9-10) who were pain free at baseline and then developed multisite pain 1 year later (n = 115) were matched to control children who were pain free at both timepoints (n = 230). We analyzed brain structure (cortical thickness and gray matter volume) and function (spontaneous neural activity and functional connectivity). Results were deemed significant at the cluster level P < 0.05 false discovery rate corrected for multiple comparisons. At baseline, children who subsequently developed multisite pain had increased neural activity in superior parietal /primary somatosensory and motor cortices and decreased activity in the medial prefrontal cortex. They also exhibited stronger functional connectivity between the salience network, somatosensory, and default mode network regions. No significant differences in the brain structure were observed. Increased neural activity and functional connectivity between brain regions, consistent to that seen in adults with chronic pain, exist in children before developing multisite pain. These findings may represent a neural vulnerability to developing future chronic pain.
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Affiliation(s)
- Chelsea M Kaplan
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Andrew Schrepf
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Ishtiaq Mawla
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States
| | - Eric Ichesco
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Kevin F Boehnke
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Adriene Beltz
- Department of Psychology, University of Michigan, Ann Arbor, MI, United States
| | - Emily Foxen-Craft
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Michael P Puglia
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Alexandre Tsodikov
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - David A Williams
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, United States
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Afton L Hassett
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, United States
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Richard E Harris
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, United States
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10
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Dai W, Liu RH, Qiu E, Liu Y, Chen Z, Chen X, Ao R, Zhuo M, Yu S. Cortical mechanisms in migraine. Mol Pain 2021; 17:17448069211050246. [PMID: 34806494 PMCID: PMC8606910 DOI: 10.1177/17448069211050246] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Migraine is the second most prevalent disorder in the world; yet, its underlying mechanisms are still poorly understood. Cumulative studies have revealed pivotal roles of cerebral cortex in the initiation, propagation, and termination of migraine attacks as well as the interictal phase. Investigation of basic mechanisms of the cortex in migraine not only brings insight into the underlying pathophysiology but also provides the basis for designing novel treatments. We aim to summarize the current research literatures and give a brief overview of the cortex and its role in migraine, including the basic structure and function; structural, functional, and biochemical neuroimaging; migraine-related genes; and theories related to cortex in migraine pathophysiology. We propose that long-term plasticity of synaptic transmission in the cortex encodes migraine.
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Affiliation(s)
- Wei Dai
- Department of Neurology, Chinese PLA General Hospital, Beijing, China.,Chinese PLA Medical School, Beijing, China
| | - Ren-Hao Liu
- Center for Neuron and Disease, Frontier Institutes of Science and Technology, 12480Xi'an Jiaotong University, Xi'an, China
| | - Enchao Qiu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Yinglu Liu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Zhiye Chen
- Department of Neurology, Chinese PLA General Hospital, Beijing, China.,Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Xiaoyan Chen
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Ran Ao
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Min Zhuo
- Center for Neuron and Disease, Frontier Institutes of Science and Technology, 12480Xi'an Jiaotong University, Xi'an, China.,International Institute for Brain Research, Qingdao International Academician Park, Qingdao, China.,Department of Physiology, 1 King's College Circle, University of Toronto, Toronto, ON, Canada
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
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11
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Li X, Khan A, Li Y, Chen D, Yang J, Zhan H, Du G, Xu J, Lou W, Tong RKY. Hyperconnection and hyperperfusion of overlapping brain regions in patients with menstrual-related migraine: a multimodal neuroimaging study. Neuroradiology 2021; 63:741-749. [PMID: 33392732 DOI: 10.1007/s00234-020-02623-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/09/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE Menstrual-related migraine (MRM) results in moderate to severe intensity headaches accompanied by physical and emotional disability over time in women. Neuroimaging methodologies have advanced our understanding of migraine; however, the neural mechanisms of MRM are not clearly understood. METHODS In this study, fourteen MRM patients in the interictal phase and fifteen age- and education-matched healthy control females were recruited. Resting-state functional magnetic resonance imaging (fMRI) and pulsed arterial spin labeling (PASL) MRI were collected for both the subject groups outside of their menstrual periods. Eigenvector centrality mapping (ECM) was performed on resting-state fMRI, and the relative cerebral blood flow (relCBF) was assessed using PASL-MRI. RESULTS MRM patients showed a significantly increased eigenvector centrality in the right medial frontal gyrus compared to healthy controls. Seed-based ECM analysis revealed that increased centrality was associated with the right medial frontal gyrus's hyperconnectivity with the left insula and the right supplementary motor area. The perfusion MRI revealed significantly increased relCBF in the hyperconnected regions. Furthermore, the hyperconnection positively correlated with the attack frequency, while the hyperperfusion showed a positive correlation with the disease duration. CONCLUSION The results suggest that menstrual-related migraine is associated with cerebral hyperconnection and hyperperfusion in critical pain-processing brain regions. Furthermore, this elevated cerebral activity is correlated with different aspects of functional impairment in MRM patients suggesting that perfusion analysis, along with whole-brain connectivity analysis, can provide a comprehensive understanding of neural mechanisms of MRM.
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Affiliation(s)
- Xinyu Li
- Imaging Center, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Ahsan Khan
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yingying Li
- Imaging Center, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Diansen Chen
- Imaging Center, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Jing Yang
- Imaging Center, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Haohui Zhan
- Division of MRI, The Second Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Ganqin Du
- Department of Neurology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Jin Xu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Wutao Lou
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Raymond Kai-Yu Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
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12
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Abstract
This literature review provides an overview of the research using magnetic resonance imaging (MRI) in pediatric migraine and compares findings with the adult migraine literature. A literature search using PubMed was conducted using all relevant sources up to February 2019. Using MRI methods to categorize and explain pediatric migraine in comparison with adult migraine is important, in order to recognize and appreciate the differences between the two entities, both clinically and physiologically. We aim to demonstrate the differences and similarities between pediatric and adult migraine using data from white matter and gray matter structural studies, cerebral perfusion, metabolites, and functional MRI (fMRI) studies, including task-based and resting-state blood oxygen level-dependent studies. By doing this we identify areas that need further research, as well as possible areas where intervention could alter outcomes.
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13
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Dysregulation of multisensory processing stands out from an early stage of migraine: a study in pediatric patients. J Neurol 2019; 267:760-769. [DOI: 10.1007/s00415-019-09639-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 12/18/2022]
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14
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Michels L, Villanueva J, O'Gorman R, Muthuraman M, Koirala N, Büchler R, Gantenbein AR, Sandor PS, Luechinger R, Kollias S, Riederer F. Interictal Hyperperfusion in the Higher Visual Cortex in Patients With Episodic Migraine. Headache 2019; 59:1808-1820. [PMID: 31680242 DOI: 10.1111/head.13646] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Migraine pathophysiology is complex and probably involves cortical and subcortical alterations. Structural and functional brain imaging studies indicate alterations in the higher order visual cortex in patients with migraine. Arterial spin labeling magnetic resonance imaging (ASL-MRI) is a non-invasive imaging method for assessing changes in cerebral blood flow (CBF) in vivo. OBJECTIVE To examine if interictal CBF differs between patients with episodic migraine (EM) with or without aura and healthy controls (HC). METHODS We assessed interictal CBF using 2D pseudo-continuous ASL-MRI on a 3 Tesla Philips scanner (University Hospital Zurich, Switzerland) in EM (N = 17, mean age 32.7 ± 9.9, 13 females) and HC (N = 19, mean age 31.0 ± 9.3, 11 females). RESULTS Compared to HC, EM showed exclusively hyperperfusion in the right MT+ and Cohen's d effect size was 0.99 (HC mean CBF ± SD: 33.1 ± 5.9 mL/100 g/minutes; EM mean CBF: 40.9 ± 9.4 mL/100 g/minutes). EM with aura (N = 13, MwA) revealed hyperperfusion compared to HC in the right MT+ and superior temporal gyrus. For MT, Cohen's d effect size was 1.34 (HC mean CBF ± SD: 33.1 ± 5.9 mL/100 g/minutes; MwA mean CBF: 43.3 ± 8.6 mL/100 g/minutes). For the superior temporal gyrus, Cohen's d effect size was 1.28 (HC mean CBF ± SD: 40.1 ± 4.9 mL/100 g/minutes; MwA mean CBF: 47.4 ± 6.4 mL/100 g/minutes). In EM, anxiety was positively associated with CBF in the parietal operculum and angular gyrus. CONCLUSIONS Our results suggest that extrastriate brain regions probably involved in cortical spreading depression are associated with CBF changes in the interictal state. We conclude that ASL-MRI is a sensitive method to identify local neuro-functional abnormalities in CBF in patients with EM in the interictal state.
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Affiliation(s)
- Lars Michels
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland.,Center for MR-Research, University Children's Hospital Zurich, Zurich, Switzerland
| | - Jeanette Villanueva
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Ruth O'Gorman
- Center for MR-Research, University Children's Hospital Zurich, Zurich, Switzerland
| | - Muthuraman Muthuraman
- Biomedical Statistics and Multimodal Signal Processing Unit, Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), Johannes-Gutenberg-University Hospital, Mainz, Germany
| | - Nabin Koirala
- Biomedical Statistics and Multimodal Signal Processing Unit, Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), Johannes-Gutenberg-University Hospital, Mainz, Germany
| | - Roman Büchler
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas R Gantenbein
- University of Zurich, Zurich, Switzerland.,RehaClinic Bad Zurzach, Bad Zurzach, Switzerland
| | - Peter S Sandor
- University of Zurich, Zurich, Switzerland.,RehaClinic Bad Zurzach, Bad Zurzach, Switzerland
| | - Roger Luechinger
- Institute for Biomedical Engineering, ETH Zurich and University of Zurich, Zurich, Switzerland
| | - Spyros Kollias
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Franz Riederer
- University of Zurich, Zurich, Switzerland.,Neurological Center Rosenhuegel and Karl Landsteiner Institute for Epilepsy Research and Cognitive Neurology, Vienna, Austria
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15
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Chong CD, Wang L, Wang K, Traub S, Li J. Homotopic region connectivity during concussion recovery: A longitudinal fMRI study. PLoS One 2019; 14:e0221892. [PMID: 31577811 PMCID: PMC6774501 DOI: 10.1371/journal.pone.0221892] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 08/16/2019] [Indexed: 02/02/2023] Open
Abstract
Objectives To (i) investigate alterations in homotopic functional connectivity (hfc) in concussed patients relative to healthy controls (HC) and to (ii) interrogate whether hfc in concussed patients normalized during the recovery process. The relationship between symptom recovery and change in hfc was assessed using post-hoc analyses. Methods This study included 15 concussed patients (mean age = 39.1, SD = 10.1; sex: 13 females, 2 males) and 15 HC (mean age = 39.1, SD = 11.7; sex: 13 females, 2 males). Hfc patterns were interrogated using resting-state magnetic resonance imaging (rs-MRI) for 29 a priori selected pain-processing regions. Concussed patients underwent imaging at two time-points; at 1-month post-concussion (mean time following concussion: 28 days, SD = 9.5) and again at 5-months post-concussion (mean time following concussion: 121 days, SD = 13). At both time-points, symptoms associated with concussion were assessed using the Sports Concussion Assessment Tool (SCAT-3). Results Concussed patients had significantly weaker hfc in the following six regions 1-month post-concussion compared to HC: middle cingulate, posterior insula, middle occipital, spinal trigeminal nucleus, precentral and the pulvinar. There were no regions of significantly stronger hfc in concussed patients relative to HC. Longitudinally, patients showed significant symptom recovery 5-months post-concussion and had significant strengthening of hfc patterns in seven homotopic ROIs: middle cingulate, posterior insula, middle occipital, secondary somatosensory area, spinal trigeminal nucleus, precentral, and the pulvinar. Post-hoc analyses indicated a significant negative correlation between somatosensory functional connectivity strengthening and symptom severity. Conclusion At 1-month post-concussion, patients had significantly weaker hfc in a number of pain-processing regions relative to HC. However, over a period of 5-months, region-pair connectivity showed significant recovery and normalization. Those patients with more successful symptom recovery at 5-months post-concussion had more functional somatosensory strengthening, suggesting an association between functional strengthening and post-concussion symptom recovery.
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Affiliation(s)
| | - Lujia Wang
- School of Computing, Informatics and Decision Systems Engineering, Arizona State University, Tempe, AZ, United States of America
| | - Kun Wang
- School of Computing, Informatics and Decision Systems Engineering, Arizona State University, Tempe, AZ, United States of America
| | - Stephen Traub
- Mayo Clinic Arizona, Phoenix, AZ, United States of America
| | - Jing Li
- School of Computing, Informatics and Decision Systems Engineering, Arizona State University, Tempe, AZ, United States of America
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16
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Abstract
Arterial Spin Labeling (ASL) is a perfusion-based functional magnetic resonance imaging technique that uses water in arterial blood as a freely diffusible tracer to measure regional cerebral blood flow (rCBF) noninvasively. To date its application to the study of pain has been relatively limited. Yet, ASL possesses key features that make it uniquely positioned to study pain in certain paradigms. For instance, ASL is sensitive to very slowly fluctuating brain signals (in the order of minutes or longer). This characteristic makes ASL particularly suitable to the evaluation of brain mechanisms of tonic experimental, post-surgical and ongoing/or continuously varying pain in chronic or acute pain conditions (whereas BOLD fMRI is better suited to detect brain responses to short-lasting or phasic/evoked pain). Unlike positron emission tomography or other perfusion techniques, ASL allows the estimation of rCBF without requiring the administration of radioligands or contrast agents. Thus, ASL is well suited for within-subject longitudinal designs (e.g., to study evolution of pain states over time, or of treatment effects in clinical trials). ASL is also highly versatile, allowing for novel paradigms exploring a flexible array of pain states, plus it can be used to simultaneously estimate not only pain-related alterations in perfusion but also functional connectivity. In conclusion, ASL can be successfully applied in pain paradigms that would be either challenging or impossible to implement using other techniques. Particularly when used in concert with other neuroimaging techniques, ASL can be a powerful tool in the pain imager's toolbox.
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17
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Colon E, Ludwick A, Wilcox SL, Youssef AM, Danehy A, Fair DA, Lebel AA, Burstein R, Becerra L, Borsook D. Migraine in the Young Brain: Adolescents vs. Young Adults. Front Hum Neurosci 2019; 13:87. [PMID: 30967767 PMCID: PMC6438928 DOI: 10.3389/fnhum.2019.00087] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 02/20/2019] [Indexed: 12/14/2022] Open
Abstract
Migraine is a disease that peaks in late adolescence and early adulthood. The aim of this study was to evaluate age-related brain changes in resting state functional connectivity (rs-FC) in migraineurs vs. age-sex matched healthy controls at two developmental stages: adolescence vs. young adulthood. The effect of the disease was assessed within each developmental group and age- and sex-matched healthy controls and between developmental groups (migraine-related age effects). Globally the within group comparisons indicated more widespread abnormal rs-FC in the adolescents than in the young adults and more abnormal rs-FC associated with sensory networks in the young adults. Direct comparison of the two groups showed a number of significant changes: (1) more connectivity changes in the default mode network in the adolescents than in the young adults; (2) stronger rs-FC in the cerebellum network in the adolescents in comparison to young adults; and (3) stronger rs-FC in the executive and sensorimotor network in the young adults. The duration and frequency of the disease were differently associated with baseline intrinsic connectivity in the two groups. fMRI resting state networks demonstrate significant changes in brain function at critical time point of brain development and that potentially different treatment responsivity for the disease may result.
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Affiliation(s)
- Elisabeth Colon
- Department of Anesthesiology, Perioperative and Pain Medicine, Center for Pain and the Brain, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Allison Ludwick
- Department of Anesthesiology, Perioperative and Pain Medicine, Center for Pain and the Brain, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Sophie L Wilcox
- Department of Anesthesiology, Perioperative and Pain Medicine, Center for Pain and the Brain, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Andrew M Youssef
- Department of Anesthesiology, Perioperative and Pain Medicine, Center for Pain and the Brain, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Amy Danehy
- Department of Radiology, Boston Children's Hospital, Boston, MA, United States
| | - Damien A Fair
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, United States
| | - Alyssa A Lebel
- Department of Anesthesiology, Perioperative and Pain Medicine, Center for Pain and the Brain, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,Pediatric Headache Program, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Waltham, MA, United States.,Department of Neurology, Boston Children's Hospital, Waltham, MA, United States
| | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Lino Becerra
- Department of Anesthesiology, Perioperative and Pain Medicine, Center for Pain and the Brain, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - David Borsook
- Department of Anesthesiology, Perioperative and Pain Medicine, Center for Pain and the Brain, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,Pediatric Headache Program, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Waltham, MA, United States.,Department of Neurology, Boston Children's Hospital, Waltham, MA, United States
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18
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Kroon Van Diest AM, Powers SW. Cognitive Behavioral Therapy for Pediatric Headache and Migraine: Why to Prescribe and What New Research Is Critical for Advancing Integrated Biobehavioral Care. Headache 2018; 59:289-297. [PMID: 30444269 DOI: 10.1111/head.13438] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW To highlight current evidence supporting the prescription of cognitive behavioral therapy (CBT) as part of first-line preventive treatment for children and adolescents with headache and discuss a research strategy aimed at: (1) understanding how and why CBT works, and (2) developing effective and efficient approaches for integrating CBT into headache specialty, neurology, and primary care settings. RECENT FINDINGS Although preventive medications for pediatric headache and migraine are commonly prescribed, recent meta-analyses and an NIH-funded, multi-center clinical trial suggests that the effect of pill-taking therapies may be mostly due to a placebo effect. These findings have led to greater consideration of prescription of non-pharmacological therapies as first-line interventions (either alone or in combination with pill-based therapy). A literature that extends back to the 1980s and includes recent clinical trials and meta-analyses demonstrates that CBT decreases headache frequency and related disability in youth with headache and migraine and has a favorable benefit to risk profile with almost no negative side effects. SUMMARY CBT has been repeatedly demonstrated as effective in treating pediatric headache and migraine. As such, it should be considered as part of first-line preventive treatment for pediatric headache (either alone or in combination with a pill-based therapy). We need to better understand how this therapy works and what makes it distinct (if anything) from the placebo effect. What we need to achieve is empirical support for efficient access to this evidence-based treatment and clarity on how to match the intensity of non-pharmacological intervention to the needs of our patients at the time they present for care.
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Affiliation(s)
- Ashley M Kroon Van Diest
- Department of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Scott W Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Hu B, Wang X, He JB, Dai YJ, Zhang J, Yu Y, Sun Q, Lin-FengYan, Hu YC, Nan HY, Yang Y, Kaye AD, Cui GB, Wang W. Structural and functional brain changes in perimenopausal women who are susceptible to migraine: a study protocol of multi-modal MRI trial. BMC Med Imaging 2018; 18:26. [PMID: 30189858 PMCID: PMC6127929 DOI: 10.1186/s12880-018-0272-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/29/2018] [Indexed: 01/01/2023] Open
Abstract
Background As a common clinical symptom that often bothers midlife females, migraine is closely associated with perimenopause. Previous studies suggest that one of the most prominent triggers is the sudden decline of estrogen during perimenopausal period. Hormone replacement therapy (HRT) is widely used to prevent this suffering in perimenopausal women, but effective diagnostic system is lacked for quantifying the severity of the diseaase. To avoid the abuse and overuse of HRT, we propose to conduct a diagnostic trial using multimodal MRI techniques to quantify the severity of these perimenopausal migraineurs who are susceptible to the decline of estrogen. Methods Perimenopausal women suffering from migraine will be recruited from the pain clinic of our hospital. Perimenopausal women not suffering from any kind of headache will be recruited from the local community. Clinical assessment and multi-modal MR imaging examination will be conducted. A follow up will be conducted once half year within 3 years. Pain behavior, neuropsychology scores, fMRI analysis combined with suitable statistical software will be used to reveal the potential association between these above traits and the susceptibility of migraine. Discussion Multi-modal imaging features of both healthy controls and perimenopausal women who are susceptible to estrogen decline will be acquired. Imaging features will include volumetric characteristics, white matter integrity, functional characteristics, topological properties, and perfusion properties. Clinical information, such as basic information, blood estrogen level, information of migraine, and a bunch of neurological scale will also be used for statistic assessment. This clinical trial would help to build an effective screen system for quantifying the severity of illness of those susceptible women during the perimenopausal period. Trial registration This study has already been registered at Clinical Trials. gov (ID: NCT02820974). Registration date: September 28th, 2014.
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Affiliation(s)
- Bo Hu
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Xu Wang
- Student Brigade, Fourth Military Medical University (Air Force Medical University), 169 West Changle Road, Xi'an, 710032, Shaanxi Province, China
| | - Jie-Bing He
- Student Brigade, Fourth Military Medical University (Air Force Medical University), 169 West Changle Road, Xi'an, 710032, Shaanxi Province, China
| | - Yu-Jie Dai
- Department of Clinical Nutrition, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Jin Zhang
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Ying Yu
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Qian Sun
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Lin-FengYan
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Yu-Chuan Hu
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Hai-Yan Nan
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Yang Yang
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Alan D Kaye
- Departments of Anesthesiology and Pharmacology, Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | - Guang-Bin Cui
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China.
| | - Wen Wang
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China.
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20
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Chen Z, Chen X, Liu M, Liu M, Ma L, Yu S. Evaluation of gray matter perfusion in episodic migraine using voxel-wise comparison of 3D pseudo-continuous arterial spin labeling. J Headache Pain 2018; 19:36. [PMID: 29796865 PMCID: PMC5966347 DOI: 10.1186/s10194-018-0866-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/10/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although previous studies have demonstrated that structural and functional abnormalities in episodic migraine (EM), less is known about altered brain perfusion in the EM. The aim of this study is to investigate altered gray matter perfusion in EM using a 3D volumetric perfusion imaging. METHODS Fifteen EM patients and 15 normal controls (NC) underwent structural and 3D pseudo-continuous arterial spin labeling (3D pc-ASL). The structural images were segmented using DARTEL methods and the generated normalized T1 tissue probability maps were used to coregister the cerebral blood flow (CBF) images, which would further be performed with standardization using Fisher Z Transformation. Voxel-wise analysis was applied to CBF map with Z standardization, and the Z value of the abnormal brain region was extracted and performed with correlation with the clinical variables. RESULTS The increased CBF value located in the left Brodmann 38 (BA38) and no significantly decreased CBF value were detected in EM. HAMD scores presented significantly positive correlation with the CBF value of the left BA38. CONCLUSION The current study indicated that the pattern of cerebral hyperperfusion may elucidate the neurogenic mechanism in the EM genesis, and 3D pc-ASL technique would non-invasively provide valuable cerebral perfusion information for the further pathophysiological and neuropsychological study in EM.
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Affiliation(s)
- Zhiye Chen
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.,Department of Radiology, Hainan Branch of Chinese PLA General Hospital, Beijing, 100853, China.,Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xiaoyan Chen
- Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Mengyu Liu
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Mengqi Liu
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.,Department of Radiology, Hainan Branch of Chinese PLA General Hospital, Beijing, 100853, China
| | - Lin Ma
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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21
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Quantitative sensory testing in patients with migraine: a systematic review and meta-analysis. Pain 2018; 159:1202-1223. [DOI: 10.1097/j.pain.0000000000001231] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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22
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Solstrand Dahlberg L, Linnman CN, Lee D, Burstein R, Becerra L, Borsook D. Responsivity of Periaqueductal Gray Connectivity Is Related to Headache Frequency in Episodic Migraine. Front Neurol 2018; 9:61. [PMID: 29487563 PMCID: PMC5816750 DOI: 10.3389/fneur.2018.00061] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/24/2018] [Indexed: 01/17/2023] Open
Abstract
Migraineurs show hypersensitivity to sensory stimuli at various stages throughout the migraine cycle. A number of putative processes have been implicated including a dysfunction in the descending pain modulatory system in which the periaqueductal gray (PAG) is considered to play a crucial role. Recurring migraine attacks could progressively perturb this system, lowering the threshold for future attacks, and contribute to disease chronification. Here, we investigated PAG connectivity with other brain regions during a noxious thermal stimulus to determine changes in migraineurs, and associations with migraine frequency. 21 episodic migraine patients and 22 matched controls were included in the study. During functional MRI, a thermode was placed on the subjects' temple delivering noxious and non-noxious heat stimuli. A psychophysiological interaction (PPI) analysis was carried out to examine pain-induced connectivity of the PAG with other brain regions. The PPI analysis showed increased PAG connectivity with the S1 face representation area and the supplementary motor area, an area involved with pain expectancy, in patients with higher frequency of migraine attacks. PAG connectivity with regions involved with the descending pain modulatory system (i.e., prefrontal cortex) was decreased in the migraineurs versus healthy individuals. Our results suggest that high frequency migraineurs may have diminished resistance to cephalic pain and a less efficient inhibitory pain modulatory response to external stressor (i.e., noxious heat). The findings support the notion that in migraine there is less effective pain modulation (viz., decreased pain inhibition or increased pain facilitation), potentially contributing to increased occurrence of attacks/chronification of migraine.
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Affiliation(s)
- Linda Solstrand Dahlberg
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Clas N Linnman
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Danielle Lee
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States
| | - Rami Burstein
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Lino Becerra
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States.,Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - David Borsook
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States.,Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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23
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Kroon Van Diest AM, Ernst MM, Slater S, Powers SW. Similarities and Differences Between Migraine in Children and Adults: Presentation, Disability, and Response to Treatment. Curr Pain Headache Rep 2017; 21:48. [PMID: 29071512 DOI: 10.1007/s11916-017-0648-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW This review presents findings from investigations of migraine in children and adults. Similarities and differences in the presentation, related consequences, and treatments between children and adults are reviewed. RECENT FINDINGS Significant similarities exist in the presentation, disability, and treatments for migraine between children and adults. Despite such similarities, many adult migraine treatments adapted for use in children are not rigorously tested prior to becoming a part of routine care in youth. Existing research suggests that not all approaches are equally effective across age groups. Specifically, psychological treatments are shown to be somewhat less effective in adults than in children. Pharmacological interventions found to be statistically significant relative to placebo in adults may not be as effective in children and have the potential to present more risk than benefit when used in youth. The placebo effect in both children and adults is robust and is need of further study. Better understanding of treatment mechanisms for all interventions across the age spectrum is needed. Although migraine treatments determined to be effective for adults are frequently adapted for use in children with little evaluation prior to implementation, existing research suggests that this approach may not be the best practice. Adaptation of adult pharmacological treatment for use in youth may present a particular risk in comparison to benefits gained. Because of the known efficacy of psychological treatments, such as cognitive behavioral therapy, more universal use of these interventions should be considered, either as first-line treatment or in combination with pill-based therapies.
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Affiliation(s)
- Ashley M Kroon Van Diest
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 7039, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA
| | - Michelle M Ernst
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 7039, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Shalonda Slater
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 7039, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Scott W Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 7039, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA. .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA. .,Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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