Danish Headache Center and Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Headache. 2012 Jul-Aug;52(7):1146-54. doi: 10.1111/j.1526-4610.2012.02098.x. Epub 2012 Feb 21.
The pathophysiological alterations in patients with familial hemiplegic migraine (FHM) are not yet fully known. The headache characteristics in patients with FHM mutations have been examined in a series of glyceryl trinitrate (GTN) provocation studies in FHM patients, but the cortical vascular response to GTN in FHM patients has never been investigated before.
To investigate changes in spontaneous low-frequency oscillations (LFO) of cortical vessels in response to the nitric oxide donor GTN by near-infrared spectroscopy in FHM patients.
Twenty-three FHM patients without known mutations and 9 healthy controls received a continuous intravenous infusion of GTN 0.5 µg/kg/minute over 20 minutes. Using near-infrared spectroscopy, we recorded oxygenated hemoglobin (oxyHb) LFO amplitude bilateral at the frontal cortex at baseline and 15 minutes and 40 minutes after start of the GTN infusion.
GTN changed oxyHb LFO amplitude in FHM patients (P = .002), but not in healthy controls (P = .121). Only in FHM patients with coexisting common migraine types did GTN infusion induced changes in LFO amplitudes (P < .001), where post-hoc analysis revealed an increase in LFO amplitude 15 minutes (P = .003) and 40 (P = .013) minutes after start of infusion compared with baseline. Interestingly, GTN infusion induced no changes in LFO amplitude in patients with a pure FHM phenotype (P = .695).
FHM patients with a mixed phenotype (coexisting common type of migraine) showed an increase in oxyHb LFO amplitude during GTN infusion, whereas FHM patients with pure phenotype showed no changes. These data suggest possible differences in frontal cortical nitric oxide vascular sensitivity between FHM patients with a mixed phenotype and patients with pure FHM.
家族性偏瘫性偏头痛（FHM）患者的病理生理改变尚不完全清楚。在一系列 FHM 患者的甘油三硝酸酯（GTN）激发研究中，已经检查了 FHM 突变患者的头痛特征，但 FHM 患者对 GTN 的皮质血管反应从未被研究过。
通过近红外光谱技术（NIRS）研究 FHM 患者一氧化氮供体 GTN 引起的皮质血管自发性低频振荡（LFO）的变化。
23 例无已知突变的 FHM 患者和 9 例健康对照者接受 0.5μg/kg/min 持续静脉输注 GTN 20 分钟。使用近红外光谱仪，我们记录基线时和 GTN 输注开始后 15 分钟和 40 分钟时双侧额皮质的氧合血红蛋白（oxyHb）LFO 振幅。
GTN 改变了 FHM 患者的 oxyHb LFO 振幅（P=0.002），但在健康对照组中没有改变（P=0.121）。只有在同时伴有常见偏头痛类型的 FHM 患者中，GTN 输注诱导了 LFO 振幅的变化（P<0.001），其中事后分析显示输注后 15 分钟（P=0.003）和 40 分钟（P=0.013）的 LFO 振幅增加。有趣的是，纯 FHM 表型患者的 GTN 输注未引起 LFO 振幅的变化（P=0.695）。
具有混合表型（共存常见偏头痛类型）的 FHM 患者在 GTN 输注期间显示 oxyHb LFO 振幅增加，而纯表型的 FHM 患者没有变化。这些数据表明，具有混合表型的 FHM 患者与纯 FHM 患者之间，额皮质中一氧化氮血管敏感性可能存在差异。
