偏头痛患者与三叉神经脑干传入放大相关的岛叶习惯化减少。

Reduced insula habituation associated with amplification of trigeminal brainstem input in migraine.

机构信息

1 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

2 Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School, Boston, MA, USA.

出版信息

Cephalalgia. 2017 Oct;37(11):1026-1038. doi: 10.1177/0333102416665223. Epub 2016 Aug 13.

Abstract

Background Impaired sensory processing in migraine can reflect diminished habituation, increased activation, or even increased gain or amplification of activity from the primary synapse in the brainstem to higher cortical/subcortical brain regions. Methods We scanned 16 episodic migraine (interictal) and 16 healthy controls (cross-sectional study), and evaluated brain response to innocuous air-puff stimulation over the right forehead in the ophthalmic nerve (V) trigeminal territory. We further evaluated habituation, and cortical/subcortical amplification relative to spinal trigeminal nucleus (Sp5) activation. Results Migraine subjects showed greater amplification from Sp5 to the posterior insula and hypothalamus. In addition, while controls showed habituation to repetitive sensory stimulation in all activated cortical regions (e.g. the bilateral posterior insula and secondary somatosensory cortices), for migraine subjects, habituation was not found in the posterior insula. Moreover, in migraine, the habituation slope was correlated with the amplification ratio in the posterior insula and secondary somatosensory cortex, i.e. greater amplification was associated with reduced habituation in these regions. Conclusions These findings suggest that in episodic migraine, amplified information processing from spinal trigeminal relay nuclei is linked to an impaired habituation response. This phenomenon was localized in the posterior insula, highlighting the important role of this structure in mechanisms supporting altered sensory processing in episodic migraine.

摘要

背景 偏头痛患者的感觉处理受损可能反映了脑干初级突触向更高的皮质/皮质下脑区的适应能力下降、活动增加,甚至活动增益或放大增加。

方法 我们扫描了 16 例发作性偏头痛(间歇期)和 16 例健康对照者(横断面研究),并评估了右侧额部眶上神经(V 颅神经)三叉神经区域无害空气喷射刺激的大脑反应。我们进一步评估了相对于脊髓三叉神经核(Sp5)激活的适应能力和皮质/皮质下放大。

结果 偏头痛患者的 Sp5 到后岛叶和下丘脑的放大作用更大。此外,尽管对照组在所有激活的皮质区域(如双侧后岛叶和次级体感皮质)都表现出对重复感觉刺激的适应,但偏头痛患者在后岛叶没有发现适应。此外,在偏头痛中,适应斜率与后岛叶和次级体感皮质的放大比相关,即这些区域的放大越大,适应能力越低。

结论 这些发现表明,在发作性偏头痛中,来自脊髓三叉神经中继核的放大信息处理与适应能力下降的反应有关。这种现象定位于后岛叶,突出了该结构在支持发作性偏头痛中改变的感觉处理机制中的重要作用。

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