Tripathi Gyanesh M, Kalita Jayantee, Misra Usha K
Department of Neurology, Sanjay Gandhi Post Graduate Institutes of Medical Sciences, Lucknow 226014, Uttar Pradesh, India.
Department of Neurology, Sanjay Gandhi Post Graduate Institutes of Medical Sciences, Lucknow 226014, Uttar Pradesh, India.
Brain Res. 2018 Oct 1;1696:31-37. doi: 10.1016/j.brainres.2018.05.046. Epub 2018 May 31.
Glutamate plays an important role in migraine pathogenesis but there is paucity of studies on glutamate in migraine subtypes, effect of treatment on glutamate levels and the changes in glutamate receptors. In this study we report the glutamate levels and changes in glutamate receptors following amitriptyline (AMT) or repetitive Transcranial Magnetic Stimulation (rTMS) therapy. One hundred and fifty migraine patients having more than 4 migraine attacks per month were included. Thirty patients were treated with AMT and 120 with rTMS; 24 patients received 3 sessions, 36 received single session of rTMS and 60 patients received sham stimulation. The severity of headache was assessed by VAS score, Migraine Index (MI) and frequency of headache. Good outcome was defined by 50% improvement in headache frequency; severity and MI. Plasma glutamate level were measured by enzyme linked immunosorbant assay and relative expression of NR2B and mGluR3 receptors by real time polymerase chain reaction. The changes in these parameters before and after treatment were measured and correlated with the clinical parameters. Glutamate levels (P = 0.006) and NR2B receptor expressions (P < 0.001) were significantly higher in migraine patients compared to the controls. Chronic migraine patients had higher glutamate level (P = 0.05). Glutamate and NR2B receptor declined after treatment (P < 0.001). There was a decline in glutamate levels following rTMS (P = 0.03), sham stimulation (P = 0.05) and AMT treatment (P = 0.003). NR2B receptors also declined after rTMS (P = 0.005) and AMT treatment (P = 0.01). It can be concluded that migraine is associated with high plasma glutamate and NR2B receptor which decline following AMT or rTMS therapy.
谷氨酸在偏头痛发病机制中起重要作用，但关于偏头痛亚型中的谷氨酸、治疗对谷氨酸水平的影响以及谷氨酸受体变化的研究较少。在本研究中，我们报告了阿米替林（AMT）或重复经颅磁刺激（rTMS）治疗后谷氨酸水平及谷氨酸受体的变化。纳入了每月偏头痛发作超过4次的150例偏头痛患者。30例患者接受AMT治疗，120例接受rTMS治疗；24例患者接受3次rTMS治疗，36例接受单次rTMS治疗，60例患者接受假刺激。通过视觉模拟评分（VAS）、偏头痛指数（MI）和头痛频率评估头痛严重程度。良好结局定义为头痛频率、严重程度和MI改善50%。采用酶联免疫吸附测定法测量血浆谷氨酸水平，通过实时聚合酶链反应检测NR2B和mGluR3受体的相对表达。测量治疗前后这些参数的变化，并与临床参数进行相关性分析。与对照组相比，偏头痛患者的谷氨酸水平（P = 0.006）和NR2B受体表达（P < 0.001）显著更高。慢性偏头痛患者的谷氨酸水平更高（P = 0.05）。治疗后谷氨酸和NR2B受体水平下降（P < 0.001）。rTMS（P = 0.03）、假刺激（P = 0.05）和AMT治疗（P = 0.003）后谷氨酸水平均下降。rTMS（P = 0.005）和AMT治疗（P = 0.01）后NR2B受体也下降。可以得出结论，偏头痛与血浆谷氨酸和NR2B受体水平升高有关，AMT或rTMS治疗后其水平下降。
