Transcranial magnetic stimulation confirms hyperexcitability of occipital cortex in migraine
Transcranial magnetic stimulation confirms hyperexcitability of occipital cortex in migraine
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DOI：
10.1212/wnl.50.4.1111
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发表时间：
1998-04-01
期刊：
影响因子：
9.9
通讯作者：
Ramadan, NM
中科院分区：
文献类型：
--
作者：
Aurora, SK;Ahmad, BK;Ramadan, NM
目的：我们假设枕叶皮层神经元的过度兴奋可能使偏头痛患者易患扩散性抑郁，这是有先兆偏头痛（MwA）的假定基础。到目前为止，没有直接的生理相关性证实了这一点的患者。因此，我们使用经颅磁刺激（TMS）评估了MwA患者和正常对照（C）之间枕叶皮层兴奋阈值的差异。方法：采用Cadwell MES 10刺激器进行TMS。将直径为9.5 cm的圆形线圈应用于枕骨头皮（隆突上方7 cm）。刺激器强度以10%的增量增加，直到受试者报告视觉现象或达到100%强度。然后微调刺激强度以确定光幻视刚刚可视化的阈值。结果：11例MwA患者，平均年龄37 ± 7岁，与11例C患者，平均年龄37.7 ± 7岁进行了比较。MwA患者和C患者之间具有光幻视生成的受试者比例的差异是显著的（MwA患者100%对C 27.3%，p = 0.001）。MwA患者的平均阈值水平为44.2 +/- 8.6，而C患者为68.7 +/- 3.1（p = 0.0001）。MwA患者的所有阈值水平均低于C的最低阈值;具有最低阈值的MwA患者在刺激后有先兆。结论：MwA患者枕叶皮层兴奋性阈值低于C。这是一个直接的神经生理学相关的临床观察，表明过度兴奋的枕叶皮质在偏头痛。
Objectives: We hypothesized that the hyperexcitability of occipital cortex neurons may predispose migraine subjects to develop spreading depression, the putative basis of migraine with aura (MwA). To date there is no direct physiologic correlate confirming this in patients. Accordingly, we evaluated the differences in the threshold of occipital cortex excitation between MwA patients and normal controls (C) using transcranial magnetic stimulation (TMS). Methods: TMS was performed using the Cadwell MES 10 stimulator. A circular coil 9.5 cm in diameter was applied to the occipital scalp (7 cm above the inion). Stimulator intensity was increased in 10% increments until subjects reported visual phenomena or 100% intensity was reached. Stimulation intensity was then fine-tuned to determine the threshold at which phosphenes were just visualized. Results: Eleven MwA patients, mean age 37 +/- 7 years, were compared with 11 C, mean age 37.7 +/- 7 years. The difference in the proportion of subjects with phosphene generation between MwA patients and C was significant (MwA patients 100% versus C 27.3%, p = 0.001). The mean threshold level for MwA patients was 44.2 +/- 8.6 versus 68.7 +/- 3.1 for C (p = 0.0001). All threshold levels for MwA patients were lower than the lowest threshold for C; the MwA patient with the lowest threshold had an aura after stimulation. Conclusions: The threshold for excitability of occipital cortex is lower in MwA patients compared with C. This is a direct neurophysiologic correlate for clinical observations that have indicated hyperexcitability of the occipital cortex in migraineurs.