Aurora S K, Welch K M A, Al-Sayed F
Headache Research Center, Henry Ford Health Sciences Center, Detroit, MI, USA.
Cephalalgia. 2003 May;23(4):258-63. doi: 10.1046/j.1468-2982.2003.00471.x.
We have reported a preliminary study confirming hyperexicitability of occipital cortex in migraine with aura (MwA) using transcranial magnetic stimulation (TMS). We have now completed a blinded study to investigate the occipital cortex in MwA and without aura (MwoA) compared with normal controls (NC) using TMS. TMS was performed using the Caldwell MES-10 stimulator. A circular coil 9.5 cm 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 seen. Fisher's exact t-test and logrank test were used for statistical comparisons. Ten subjects with MwA and MwoA were compared to 10 NC. The difference in the proportion of subjects with phosphene generation was statistically significant (MwA 100%, MwoA 60% and NC 30%) [P = 0.003]. The difference in threshold levels for phosphenes was also significant for MwA 42.8%, and controls 57.3% [P = 0.0001]. There is a difference in threshold for excitability of occipital cortex in MwA and MwoA compared to NC. This is a direct neurophysiological correlate for clinical observations, which have inferred hyperexicitability of the occipital cortex in migraineurs.
我们曾报道过一项初步研究，该研究使用经颅磁刺激（TMS）证实了伴先兆偏头痛（MwA）患者枕叶皮质的兴奋性过高。我们现在完成了一项双盲研究，使用TMS对MwA和无先兆偏头痛（MwoA）患者的枕叶皮质进行研究，并与正常对照（NC）进行比较。使用考德威尔MES - 10刺激器进行TMS。将一个直径9.5厘米的圆形线圈置于枕部头皮（枕外隆凸上方7厘米处）。刺激器强度以10%的增量增加，直到受试者报告出现视觉现象或达到100%强度。然后对刺激强度进行微调以确定出现光幻视的阈值。使用Fisher精确t检验和对数秩检验进行统计学比较。将10例MwA和MwoA患者与10例NC进行比较。出现光幻视的受试者比例差异具有统计学意义（MwA为100%，MwoA为60%，NC为30%）[P = 0.003]。MwA患者光幻视的阈值水平差异也很显著，为42.8%，而对照组为57.3%[P = 0.0001]。与NC相比，MwA和MwoA患者枕叶皮质的兴奋阈值存在差异。这是临床观察结果的直接神经生理学关联，临床观察推断偏头痛患者枕叶皮质兴奋性过高。
