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Perrotta A, Gambardella S, Ambrosini A, Anastasio MG, Albano V, Fornai F, Pierelli F. A Novel ATP1A2 Gene Variant Associated With Pure Sporadic Hemiplegic Migraine Improved After Patent Foramen Ovale Closure: A Case Report. Front Neurol 2018; 9:332. [PMID: 29867740 PMCID: PMC5966544 DOI: 10.3389/fneur.2018.00332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 04/25/2018] [Indexed: 01/03/2023] Open
Abstract
We describe the case of one patient with pure sporadic hemiplegic migraine (SHM) with a novel ATP1A2 gene variant and a large patent foramen ovale (PFO) with atrial septal aneurysm. In hemiplegic migraine (HM), the relationship between incomplete penetrance, environmental triggers, and phenotypic expression is underdetermined. A genetic evaluation of the proband was requested for the HM associated genes and extended to the members of his family. Genetic analysis revealed a never described before ATP1A2 gene mutation, inherited by his father, who never experienced motor aura but only typical visual aura. The proband—but not his father—was also affected by a large PFO with atrial septal aneurysm. SHM patient showed a marked reduction in motor aura episodes per year in the 12 months following the PFO percutaneous closure, followed by a complete remission from attacks at least in the following 24 months. We speculated that as well as incomplete penetrance of the novel mutation and natural history of the disease, an additional pathological condition such as the PFO could contribute to the phenotypical expression in this case of HM.
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Affiliation(s)
| | | | | | | | | | - Francesco Fornai
- IRCCS Neuromed, Pozzilli, Italy.,Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Francesco Pierelli
- IRCCS Neuromed, Pozzilli, Italy.,Unit of Neurorehabilitation, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Istituto Chirurgico Ortopedico Traumatologico (ICOT), Latina, Italy
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Perrotta A, Coppola G, Anastasio MG, De Icco R, Ambrosini A, Serrao M, Parisi V, Evangelista M, Sandrini G, Pierelli F. Trait- and Frequency-Dependent Dysfunctional Habituation to Trigeminal Nociceptive Stimulation in Trigeminal Autonomic Cephalalgias. J Pain 2018; 19:1040-1048. [PMID: 29655843 DOI: 10.1016/j.jpain.2018.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/31/2018] [Accepted: 03/02/2018] [Indexed: 01/03/2023]
Abstract
We investigated whether the stimulation frequency (SF), the pain phases, and different diagnoses of trigeminal autonomic cephalalgias (TACs) may influence the habituation to pain. We studied the habituation of the nociceptive blink reflex R2 responses at different SFs (.05, .1, .2, .3, .5, and 1 Hz), in 28 episodic cluster headache (ECH) patients, 16 during and 12 outside the bout; they were compared with 16 episodic paroxysmal hemicrania (EPH) during the bout and 21 healthy subjects. We delivered 26 electrical stimuli and subdivided stimuli 2 to 26 in 5 blocks of 5 responses for each SF. Habituation values for each SF were expressed as the percentages of the mean area value of second through fifth blocks with respect to the first one. A significant lower mean percentage decrease of the R2 area across all blocks was found at .2 to 1 Hz SF during ECH, outside of the ECH, and EPH compared with healthy subjects. We showed a common frequency-dependent deficit of habituation of trigeminal nociceptive responses at higher SFs in ECH and EPH patients, independently from the disease phase. This abnormal temporal pattern of pain processing may suggest a trait-dependent dysfunction of some underlying pain-related subcortical structures, rather than a state-dependent functional abnormality due to the recurrence of the headache attacks during the active period. PERSPECTIVE TACs showed a frequency-related defective habituation of nociceptive trigeminal responses at the higher SFs, irrespectively of the diagnosis and/or the disease phase. We showed that the clinical similarities in the different subtypes of TACs are in parallel with a trait-dependent dysfunction in pain processing.
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Affiliation(s)
| | - Gianluca Coppola
- G.B. Bietti Foundation IRCCS, Research Unit of Neurophysiology of Vision and Neurophthalmology, Rome, Italy
| | - Maria Grazia Anastasio
- IRCCS Neuromed, Pozzilli, IS, Italy; Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Roberto De Icco
- C. Mondino National Neurological Institute, Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | | | - Mariano Serrao
- Unit of Neurorehabilitation, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, ICOT, Latina, Italy
| | - Vincenzo Parisi
- G.B. Bietti Foundation IRCCS, Research Unit of Neurophysiology of Vision and Neurophthalmology, Rome, Italy
| | - Maurizio Evangelista
- Istituto di Anestesiologia, Rianimazione e Terapia del Dolore, Università Cattolica del Sacro Cuore/CIC, Rome, Italy
| | - Giorgio Sandrini
- C. Mondino National Neurological Institute, Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Francesco Pierelli
- IRCCS Neuromed, Pozzilli, IS, Italy; Unit of Neurorehabilitation, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, ICOT, Latina, Italy
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Perrotta A, Anastasio MG, De Icco R, Coppola G, Ambrosini A, Serrao M, Sandrini G, Pierelli F. Frequency-Dependent Habituation Deficit of the Nociceptive Blink Reflex in Aura With Migraine Headache. Can Migraine Aura Modulate Trigeminal Excitability? Headache 2017; 57:887-898. [PMID: 28488755 DOI: 10.1111/head.13111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 02/14/2017] [Accepted: 02/27/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To study the influence of the migraine aura on the trigeminal nociception, we investigated the habituation of the nociceptive blink reflex (nBR) R2 responses in aura with migraine headache (AwMH) and comparatively in migraine without aura (MWoA) and healthy subjects (HS). BACKGROUND A clear deficit of habituation in trigeminal nociceptive responses has been documented in MWoA; however, similar data in MWA are lacking. METHODS Seventeen AwMH, 29 MWoA, and 30 HS were enrolled and a nonrandomized clinical neurophysiological study examining nBR habituation by clinical diagnosis was devised. We delivered a series of 26 electrical stimuli, at different stimulation frequencies (SF) (0.05, 0.1, 0.2, 0.3, 0.5, and 1 Hz), subsequently subdivided in five blocks of five responses for each SF. The mean area values of the second to the fifth block expressed as the percentage of the mean area value of the first block were taken as an index of habituation for each SF. RESULTS A significant lower mean percentage decrease of the R2 area across all blocks was found at 1, 0.5, 0.3, and 0.2 Hz SF in MWoA and at 0.3 and 0.2 Hz SF in AwMH, when compared to HS. In the most representative fifth block of responses, we found in MWoA vs HS at 1 Hz, 57.0 ± 27.8 vs 30.6 ± 12.0; at 0.5 Hz, 54.8 ± 26.1 vs 32.51 ± 17.7; at 0.3 Hz, 44.7 ± 21.6 vs 27.6 ± 13.2; at 0.2 Hz, 61.3 ± 29.5 vs 32.6 ± 18.0, and in AwMH vs HS at 0.3 Hz, 52.7 ± 24.7 vs 27.6 ± 13.2; at 0.2 Hz, 69.3 ± 38.6 vs 32.6 ± 18.0 as mean ± SD of the R2 area percentage of the first block, respectively. Interestingly, AwMH subjects did not show differences in mean percentage decrease of the R2 area at 1 and 0.5 Hz SF when compared to HS. No differences between groups were found at 0.1 and 0.05 Hz SF. CONCLUSIONS We demonstrated in AwMH a deficit of habituation of the nBR R2 responses after repeated stimulations, although less pronounced than that observed in MWoA of comparable clinical severity. We hypothesize that AwMH and MWoA share some pathogenetic aspects, and also that migraine aura physiopathology may play a modulating role on the excitability of the nociceptive trigeminal pathways.
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Affiliation(s)
| | - Maria Grazia Anastasio
- IRCCS Neuromed, Pozzilli, IS, Italy.,Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Roberto De Icco
- C. Mondino National Neurological Institute, Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Gianluca Coppola
- Foundation IRCCS, Research Unit of Neurophysiology of Vision and Neurophthalmology, Rome, Italy Unit of Neurorehabilitation, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, ICOT, Latina, Italy
| | | | - Mariano Serrao
- Foundation IRCCS, Research Unit of Neurophysiology of Vision and Neurophthalmology, Rome, Italy Unit of Neurorehabilitation, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, ICOT, Latina, Italy
| | - Giorgio Sandrini
- C. Mondino National Neurological Institute, Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Francesco Pierelli
- IRCCS Neuromed, Pozzilli, IS, Italy.,Foundation IRCCS, Research Unit of Neurophysiology of Vision and Neurophthalmology, Rome, Italy Unit of Neurorehabilitation, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, ICOT, Latina, Italy
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Perrotta A, Chiacchiaretta P, Anastasio MG, Pavone L, Grillea G, Bartolo M, Siravo E, Colonnese C, De Icco R, Serrao M, Sandrini G, Pierelli F, Ferretti A. Temporal summation of the nociceptive withdrawal reflex involves deactivation of posterior cingulate cortex. Eur J Pain 2016; 21:289-301. [PMID: 27452295 DOI: 10.1002/ejp.923] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Temporal summation of pain sensation is pivotal both in physiological and pathological nociception. In humans, it develops in parallel with temporal summation of the nociceptive withdrawal reflex (NWR) of the lower limb, an objective representation of the temporal processing of nociceptive signals into the spinal cord. METHODS To study the contribution of cortical and subcortical structures in temporal summation of pain reflex responses, we compared the fMRI signal changes related to the temporal summation threshold (TST) of the NWR with that related to the single NWR response. We studied 17 healthy subjects using a stimulation paradigm previously determined to evoke both the TST of the NWR (SUMM) and the NWR single response (SING). RESULTS We found a significant activation in left (contralateral) primary somatosensory cortex (SI), bilateral secondary somatosensory cortex (SII), bilateral insula, anterior cingulate cortex (ACC) and bilateral thalamus during both SUMM and SING conditions. The SUMM versus SING contrast revealed a significant deactivation in the posterior cingulate cortex (PCC) and bilateral middle occipital gyrus in SUMM when compared to SING condition. CONCLUSIONS Our data support the hypothesis that temporal summation of nociceptive reflex responses is driven through a switch between activation and deactivation of a specific set of brain areas linked to the default mode network. This behaviour could be explained in view of the relevance of the pain processing induced by temporal summation, recognized as a more significant potential damaging condition with respect to a single, isolated, painful stimulation of comparable pain intensity. SIGNIFICANCE The study demonstrated that TST of the NWR involves a selective deactivation of PCC.
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Affiliation(s)
- A Perrotta
- IRCCS Neuromed, Pozzilli (Isernia), Italy
| | - P Chiacchiaretta
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti, Italy.,Institute for Advanced Biomedical Technologies (ITAB), University "G. d'Annunzio" of Chieti, Italy
| | | | - L Pavone
- IRCCS Neuromed, Pozzilli (Isernia), Italy
| | - G Grillea
- IRCCS Neuromed, Pozzilli (Isernia), Italy.,Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy
| | - M Bartolo
- IRCCS Neuromed, Pozzilli (Isernia), Italy
| | - E Siravo
- IRCCS Neuromed, Pozzilli (Isernia), Italy
| | - C Colonnese
- IRCCS Neuromed, Pozzilli (Isernia), Italy.,Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy
| | - R De Icco
- C. Mondino National Neurological Institute, Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - M Serrao
- Unit of Neurorehabilitation, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, ICOT, Latina, Italy
| | - G Sandrini
- C. Mondino National Neurological Institute, Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - F Pierelli
- IRCCS Neuromed, Pozzilli (Isernia), Italy.,Unit of Neurorehabilitation, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, ICOT, Latina, Italy
| | - A Ferretti
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti, Italy.,Institute for Advanced Biomedical Technologies (ITAB), University "G. d'Annunzio" of Chieti, Italy
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Perrotta A, Anastasio MG, Pavone L, Ferretti A, Chiacchiaretta P, Grillea G, Bartolo M, Siravo E, Coppola G, Ambrosini A, De Icco R, Sandrini G, Pierelli F. O042. Phase-dependent defective functional activity of the default mode network and facilitated temporal processing of nociceptive stimuli in cluster headache. J Headache Pain 2015; 16:A90. [PMID: 28132298 PMCID: PMC4715194 DOI: 10.1186/1129-2377-16-s1-a90] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - Maria Grazia Anastasio
- IRCCS INM Neuromed, Pozzilli, Italy.,Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome Polo Pontino, Rome, Italy
| | | | - Antonio Ferretti
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Institute for Advanced Biomedical Technologies (ITAB), Chieti, Italy
| | - Piero Chiacchiaretta
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Institute for Advanced Biomedical Technologies (ITAB), Chieti, Italy
| | | | | | | | - Gianluca Coppola
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome Polo Pontino, Rome, Italy
| | | | - Roberto De Icco
- IRCCS Neurological National Institute C. Mondino, Pavia, Italy
| | | | - Francesco Pierelli
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome Polo Pontino, Rome, Italy
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Perrotta A, Anastasio MG, Coppola G, Ambrosini A, De Icco R, Sandrini G, Pierelli F. O043. Frequency-dependent habituation deficit of the nociceptive blink reflex in cluster headache and paroxysmal hemicrania. J Headache Pain 2015; 16:A91. [PMID: 28132297 PMCID: PMC4759146 DOI: 10.1186/1129-2377-16-s1-a91] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - Maria Grazia Anastasio
- Headache Clinic, IRCCS INM Neuromed, Pozzilli, Italy.,Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome Polo Pontino, Rome, Italy
| | - Gianluca Coppola
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome Polo Pontino, Rome, Italy
| | | | - Roberto De Icco
- IRCCS Neurological National Institute C. Mondino, Pavia, Italy
| | | | - Francesco Pierelli
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome Polo Pontino, Rome, Italy
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Anastasio MG, Perrotta A, Coppola G, Ambrosini A, Sandrini G, De Icco R, Pierelli F. O044. Frequency-dependent habituation deficit of the nociceptive blink reflex in migraine with and without aura. J Headache Pain 2015; 16:A59. [PMID: 28132329 PMCID: PMC4759235 DOI: 10.1186/1129-2377-16-s1-a59] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Maria Grazia Anastasio
- Headache Clinic, IRCCS INM Neuromed, Pozzilli, Italy. .,Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome Polo Pontino, Rome, Italy.
| | | | - Gianluca Coppola
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome Polo Pontino, Rome, Italy
| | | | | | - Roberto De Icco
- IRCCS Neurological National Institute C. Mondino, Pavia, Italy
| | - Francesco Pierelli
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome Polo Pontino, Rome, Italy
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