Modulation of brainstem activity and connectivity by respiratory-gated auricular vagal afferent nerve stimulation in migraine patients.
Modulation of brainstem activity and connectivity by respiratory-gated auricular vagal afferent nerve stimulation in migraine patients.
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DOI：
10.1097/j.pain.0000000000000930
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发表时间：
2017-08
期刊：
影响因子：
7.4
通讯作者：
Napadow V
中科院分区：
文献类型：
--
作者：
Garcia RG;Lin RL;Lee J;Kim J;Barbieri R;Sclocco R;Wasan AD;Edwards RR;Rosen BR;Hadjikhani N;Napadow V
偏头痛的病理生理包括脑干兴奋性的改变，最近旨在控制偏头痛发作的神经调节方法已经针对关键的脑干中继和调节核。在这项研究中，我们评估了呼吸门控耳迷走传入神经刺激（RAVANS）的影响，这是一种基于现有经皮迷走神经刺激方法的新型神经调节干预，对偏头痛患者脑干活动和连性的调节。我们在发作性偏头痛（间歇期）和年龄和性别匹配的健康对照中应用提高平面内空间分辨率（2.62×2.62 mm）的3t功能磁共振成像来评估大脑对RAVANS（吸入或呼出）和假刺激的反应。我们进一步研究了RAVANS对脑干触觉三叉神经感觉传入反应的调节，并在功能磁共振成像中直接对前额进行吹气刺激。与假手术和吸入门控RAVANS （iRAVANS）相比，呼气门控RAVANS （eRAVANS）激活了与孤立束核（NTS）一致的同侧桥髓区。与假手术和iRAVANS相比，在偏头痛患者中，在eRAVANS期间，NTS连接到前岛和前中扣带皮层增加。连通性的增加与下一次偏头痛发作的相对时间呈负相关，表明这种连通性的变化与临床相关。eRAVANS的刺激后效应也被立即注意到，因为我们发现在三叉神经感觉传入的反应中，假定的脑桥5 -羟色胺能核（即中隔核）和去肾上腺素能核（即蓝斑核）的激活增加。参与5 -羟色胺和去甲肾上腺素能调节和疼痛调节的脑干和皮质区域的活动和连通性的调节可能构成支持eRAVANS用于发作性偏头痛的有益临床结果的潜在机制。
Migraine pathophysiology includes altered brainstem excitability, and recent neuromodulatory approaches aimed at controlling migraine episodes have targeted key brainstem relay and modulatory nuclei. In this study, we evaluated the impact of respiratory-gated auricular vagal afferent nerve stimulation (RAVANS), a novel neuromodulatory intervention based on an existing transcutaneous Vagus Nerve Stimulation approach, in the modulation of brainstem activity and connectivity in migraine patients. We applied 3T-functional magnetic resonance imaging with improved in-plane spatial resolution (2.62×2.62 mm) in episodic migraine (interictal) and age- and sex-matched healthy controls to evaluate brain response to RAVANS (gated to either inhalation or exhalation) and sham stimulation. We further investigated RAVANS modulation of tactile trigeminal sensory afference response in the brainstem using air-puff stimulation directed to the forehead during functional magnetic resonance imaging. Compared to sham and inhalatory-gated RAVANS (iRAVANS), exhalatory-gated RAVANS (eRAVANS) activated an ipsilateral pontomedullary region consistent with nucleus tractus solitarii (NTS). During eRAVANS, NTS connectivity was increased to anterior insula and anterior mid-cingulate cortex, compared to both sham and iRAVANS, in migraine patients. Increased connectivity was inversely correlated with relative time to the next migraine attack, suggesting clinical relevance to this change in connectivity. Post-stimulation effects were also noted immediately following eRAVANS, as we found increased activation in putative pontine serotonergic (i.e. nucleus raphe centralis) and noradrenergic (i.e. locus coeruleus) nuclei in response to trigeminal sensory afference. Regulation of activity and connectivity of brainstem and cortical regions involved in serotonergic and noradrenergic regulation and pain modulation may constitute an underlying mechanism supporting beneficial clinical outcomes for eRAVANS applied for episodic migraine.
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影响因子：
7.7
作者：
Frangos, Eleni;Ellrich, Jens;Komisaruk, Barry R.
通讯作者：
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影响因子：
7.4
作者：
Ellrich, J;Messlinger, K;Hu, JW
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DOI：
10.1177/0333102413490344
发表时间：
2013-11
期刊：
Cephalalgia : an international journal of headache
影响因子：
--
作者：
Hadjikhani N;Ward N;Boshyan J;Napadow V;Maeda Y;Truini A;Caramia F;Tinelli E;Mainero C
通讯作者：
Mainero C
DOI：
10.1515/bmt.2008.022
发表时间：
2008-01-01
期刊：
BIOMEDIZINISCHE TECHNIK
影响因子：
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作者：
Dietrich, Stefan;Smith, James;Ringler, Ralf
通讯作者：
Ringler, Ralf
无先兆女性偏头痛患者疼痛相关脑区功能连接密度降低
影响因子：
2.9
作者：
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通讯作者：
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