小脑与高频偏头痛患者的 2 年预后相关。
The cerebellum is associated with 2-year prognosis in patients with high-frequency migraine.
机构信息
Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2 Shih-Pai Rd, Taipei, Taiwan.
School of Medicine, National Yang-Ming University, Taipei, Taiwan.
出版信息
J Headache Pain. 2020 Mar 18;21(1):29. doi: 10.1186/s10194-020-01096-4.
BACKGROUND
The increase of headache frequency is associated with higher headache related disability and lower quality of life in patients with migraine. However, the pathophysiology of migraine progression, persistence, or remission is elusive. The purpose of this study is to identify the brain signatures that are predictive of the long-term outcomes among patients with high-frequency migraine (HFM: 10-30 headache days/month).
METHODS
We prospectively enrolled patients with HFM and healthy controls and collected their baseline clinical profiles and brain-MRI data at first visit. We longitudinally followed the patients and determined their outcomes at 2-year follow-up. Good outcome was defined as ≥50% reduction of baseline headache days and poor outcome was defined as reduction < 50% or frequency increase. Voxel-based morphometry was used to study gray matter volume (GMV), and structural covariance was used to investigate structural connectivity.
RESULTS
Among 56 patients with HFM, 37 had good outcome and 19 poor outcome. Compared to the healthy controls (n = 37), patients with poor outcome had decreased GMV over the left posterior cingulate gyrus, and increased GMV over the bilateral cerebellum and the right precentral gyrus. Further, patients with poor outcome had greater GMV over the right and the left cerebella compared to patients with good outcome, and the GMVs of the cerebella were correlated to 2-year headache frequencies (right: r = 0.38, P = 0.005; left: r = 0.35, P = 0.009). Structural connectivity were increased between the cerebellum and the cuneus, the calcarine cortex, and the temporal lobe, respectively, in patients with poor outcome, and was decreased between the cerebellum and the prefrontal cortex in patients with poor outcome. The structural covariance integrities between the right cerebellum and the right cuneus were correlated to 2-year headache frequencies (r = 0.36, P = 0.008).
CONCLUSIONS
Structural volume and connectivity changes of the cerebellum may underlie headache persistence in patients with HFM.
背景
头痛频率的增加与偏头痛患者头痛相关残疾程度更高和生活质量更低相关。然而，偏头痛进展、持续或缓解的病理生理学仍不清楚。本研究的目的是确定可预测高频偏头痛（HFM：每月 10-30 次头痛）患者长期结局的大脑特征。
方法
我们前瞻性地招募了 HFM 患者和健康对照者，并在首次就诊时收集了他们的基线临床资料和脑 MRI 数据。我们对患者进行了纵向随访，并在 2 年随访时确定了他们的结局。良好结局定义为基线头痛天数减少≥50%，不良结局定义为减少<50%或频率增加。体素形态计量学用于研究灰质体积（GMV），结构协方差用于研究结构连接。
结果
在 56 例 HFM 患者中，37 例患者结局良好，19 例患者结局不良。与健康对照组（n=37）相比，结局不良的患者左侧后扣带回的 GMV 减少，双侧小脑和右侧中央前回的 GMV 增加。此外，与结局良好的患者相比，结局不良的患者右、左小脑 GMV 更大，小脑 GMVs 与 2 年头痛频率相关（右侧：r=0.38，P=0.005；左侧：r=0.35，P=0.009）。结局不良的患者小脑与楔叶、距状皮质和颞叶之间的结构连接增加，而小脑与前额叶皮质之间的结构连接减少。右侧小脑与右侧楔叶之间的结构协方差完整性与 2 年头痛频率相关（r=0.36，P=0.008）。
结论
小脑的结构体积和连接变化可能是 HFM 患者头痛持续存在的基础。
Zotero 插件