Sustained visual cortex hyperexcitability in migraine with persistent visual aura
Sustained visual cortex hyperexcitability in migraine with persistent visual aura
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DOI：
10.1093/brain/awr157
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发表时间：
2011-08-01
期刊：
影响因子：
14.5
通讯作者：
Wang, Shuu-Jiun
中科院分区：
文献类型：
--
作者：
Chen, Wei-Ta;Lin, Yung-Yang;Wang, Shuu-Jiun
无梗死的持续性先兆是一种罕见的偏头痛疾病，其定义为先兆症状持续100周而无脑梗死的影像学证据。为了揭示其病理生理机制，本研究利用脑磁图对持续性先兆偏头痛的视觉皮层兴奋性进行了表征，并与发作性和慢性偏头痛进行了比较。我们招募了6例持续性视觉先兆患者，39例发作性偏头痛患者[12例处于发作期；发作期27例（有先兆者，n = 9；无先兆者，n = 18），慢性偏头痛18例，健康对照24例。获得5个连续的50个神经磁突出100 ms反应区块，通过与区块1相比，区块2-5的个体平均突出100 ms振幅的变化百分比来评估视觉皮层兴奋性的动态变化，其中显著增加表明增强。我们发现，在持续先兆的患者中，兴奋性变化与先兆持续时间呈负相关（相关系数-0.812,P = 0.050, block 2），在初始期有显著的增强（P = 0.009和0.006,block 2）。间歇记录（n = 3）也显示增强。在其他偏头痛谱系障碍方面，持续性先兆不同于发作性偏头痛，存在头期增强。持续性先兆进一步不同于慢性偏头痛，在慢性偏头痛中没有间期增强。持续先兆组（43.3 +/- 11.7）刺激结束时的反应幅度变化百分比高于慢性偏头痛组（-7.6 +/- 5.5,P = 0.006）和发作性偏头痛发作记录组（-4.9 +/- 9.6,P = 0.020）。正常对照者无明显反应变化。这项脑磁图研究表明，持续性视觉先兆患者的视觉皮层保持稳态高兴奋性，没有明显的动态调节。兴奋性特征支持持续视觉先兆作为偏头痛谱系障碍的一种病理性实体，并表明与持续兴奋效应的病理生理联系可能与回响皮质扩张性抑制有关。
Persistent aura without infarction, a rare migraine disorder, is defined by aura symptoms that persist for > 1 week without radiological evidence of cerebral infarction. To unveil its pathophysiological mechanisms, this study used magnetoencephalography to characterize the visual cortex excitability in persistent aura by comparison with episodic and chronic migraine. We recruited six patients with persistent visual aura, 39 patients with episodic migraine [12 in ictal phase; 27 in interictal phase (with aura, n = 9; without aura, n = 18)], 18 patients with chronic migraine and 24 healthy controls. Five sequential blocks of 50 neuromagnetic prominent 100 ms responses were obtained, and the dynamic change in visual cortex excitability was evaluated by the percentage changes of individual mean prominent 100 ms amplitudes at blocks 2-5 compared with block 1, with a significant increase indicating potentiation. We found that in patients with persistent aura, there was significant potentiation during ictal periods (P = 0.009 and 0.006 at blocks 2 and 5, respectively), and the excitability change was inversely correlated with the duration of aura persistence (correlation coefficient -0.812, P = 0.050, block 2). The interictal recordings (n = 3) also showed potentiation. In terms of the other migraine spectrum disorders, persistent aura differed from episodic migraine in the presence of ictal potentiation. Persistent aura further differed from chronic migraine in the absence of interictal potentiation in chronic migraine. There was a higher percentage change of response amplitude at the end of stimulation (block 5) in persistent aura (43.3 +/- 11.7) than in chronic migraine (-7.6 +/- 5.5, P = 0.006) and ictal recordings of episodic migraine (-4.9 +/- 9.6, P = 0.020). Normal control subjects had no significant response changes. This magnetoencephalographic study showed that the visual cortex in patients with persistent visual aura maintains a steady-state hyperexcitability without significant dynamic modulation. The excitability characteristic supports persistent visual aura as a nosological entity in migraine spectrum disorders and suggests a pathophysiological link to sustained excitatory effects possibly related to reverberating cortical spreading depression.