Headache Research Unit, University Department of Neurology CHR, CHU de Liège, Boulevard du 12eme de Ligne 1, 4000, Liege, Belgium.
G. B. Bietti Foundation IRCCS, Research Unit of Neurophysiology of Vision and Neuro-Ophthalmology, Rome, Italy.
J Headache Pain. 2018 Jul 5;19(1):49. doi: 10.1186/s10194-018-0877-8.
Migraine attacks might be triggered by a disruption of cerebral homeostasis. During the interictal period migraine patients are characterized by abnormal sensory information processing, but this functional abnormality may not be sufficient to disrupt the physiological equilibrium of the cortex unless it is accompanied by additional pathological mechanisms, like a reduction in energetic reserves. The aim of this study was to compare resting cerebral glucose uptake (using positron emission tomography (fluorodeoxyglucose-PET)), and visual cortex activation (using visual evoked potentials (VEP)), between episodic migraine without aura patients in the interictal period and healthy volunteers.
Twenty episodic migraine without aura patients and twenty healthy volunteers were studied. FDG-PET and VEP recordings were performed on separate days. The overall glucose uptake in the visual cortex-to-VEP response ratio was calculated and compared between the groups. Additionally, PET scan comparisons adding area under the VEP curve as a covariate were performed. For case-wise analysis, eigenvalues from a specific region exhibiting significantly different FDG-PET signal in the visual cortex were extracted. Standardized glucose uptake values from this region and VEP values from each subject were then coupled and compared between the groups.
The mean area under the curve of VEP was greater in migraine patients compared to healthy controls. In the same line, patients had an increased neuronal activation-to-resting glucose uptake ratio in the visual cortex. Statistical parametric mapping analysis revealed that cortical FDG-PET signal in relation to VEP area under the curve was significantly reduced in migraineurs in a cluster extending throughout the left visual cortex, from Brodmann's areas 19 and 18 to area 7. Within this region, case-wise analyses showed that a visual neuronal activation exceeding glucose uptake was present in 90% of migraine patients, but in only 15% of healthy volunteers.
This study identifies an area of increased neuronal activation-to-resting glucose uptake ratio in the visual cortex of migraine patients between attacks. Such observation supports the concept that an activity-induced rupture of cerebral metabolic homeostasis may be a cornerstone of migraine pathophysiology. This article has been selected as the winner of the 2018 Enrico Greppi Award. The Enrico Greppi Award is made to an unpublished paper dealing with clinical, epidemiological, genetic, pathophysiological or therapeutic aspects of headache. Italian Society for the Study of Headaches (SISC) sponsors this award, and the award is supported through an educational grant from Teva Neuroscience. This article did not undergo the standard peer review process for The Journal of Headache and Pain. The members of the 2018 Enrico Greppi Award Selection Committee were: Francesco Pierelli, Paolo Martelletti, Lyn Griffiths, Simona Sacco, Andreas Straube and Cenk Ayata.
偏头痛发作可能是由于大脑内环境稳态的破坏所致。在发作间期，偏头痛患者表现出异常的感觉信息处理，但这种功能异常可能不足以破坏皮质的生理平衡，除非它伴有其他病理机制，如能量储备减少。本研究旨在比较发作间期无先兆偏头痛患者和健康志愿者之间的静息大脑葡萄糖摄取（使用正电子发射断层扫描（氟脱氧葡萄糖-PET））和视觉皮层激活（使用视觉诱发电位（VEP））。
研究了 20 例发作间期无先兆偏头痛患者和 20 例健康志愿者。在不同的日子进行了 FDG-PET 和 VEP 记录。计算并比较了两组之间视觉皮层总葡萄糖摄取与 VEP 反应的比值。此外，还进行了 PET 扫描比较，将 VEP 曲线下面积作为协变量。对于病例分析，从视觉皮层中显示出明显不同的 FDG-PET 信号的特定区域提取特征值。然后将该区域的标准化葡萄糖摄取值和每个受试者的 VEP 值耦合，并在组间进行比较。
与健康对照组相比，偏头痛患者的 VEP 曲线下面积更大。同样，患者的视觉皮层神经元激活与静息葡萄糖摄取比值增加。统计参数映射分析显示，偏头痛患者左侧视觉皮层从 Brodmann 区 19 和 18 到区 7 的区域内，与 VEP 曲线下面积相关的皮质 FDG-PET 信号明显减少。在该区域内，病例分析显示，90%的偏头痛患者存在视觉神经元激活超过葡萄糖摄取的情况，而健康志愿者中只有 15%存在这种情况。
本研究在偏头痛发作间期患者的视觉皮层中发现了一个神经元激活与静息葡萄糖摄取比值增加的区域。这种观察结果支持这样一种观点，即活动诱导的大脑代谢内稳态破裂可能是偏头痛病理生理学的基石。本文被选为 2018 年恩里科·格雷皮奖的获奖论文。恩里科·格雷皮奖授予处理头痛的临床、流行病学、遗传学、病理生理学或治疗方面的未发表论文。意大利头痛研究学会（SISC）赞助该奖项，该奖项得到了梯瓦神经科学公司的教育资助。本文未经过《头痛和疼痛杂志》的标准同行评审流程。2018 年恩里科·格雷皮奖评选委员会成员包括：Francesco Pierelli、Paolo Martelletti、Lyn Griffiths、Simona Sacco、Andreas Straube 和 Cenk Ayata。
