Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
Neuroradiology Unit, NESMOS Department, Sant'Andrea Hospital, La Sapienza University, Via di Grottarossa, 1035-1039, 00189, Rome, Italy.
J Headache Pain. 2021 Jul 22;22(1):79. doi: 10.1186/s10194-021-01290-y.
Migraine is the most common neurological disease, with high social-economical burden. Although there is growing evidence of brain structural and functional abnormalities in patients with migraine, few studies have been conducted on children and no studies investigating cortical gyrification have been conducted on pediatric patients affected by migraine without aura.
Seventy-two pediatric patients affected by migraine without aura and eighty-two controls aged between 6 and 18 were retrospectively recruited with the following inclusion criteria: MRI exam showing no morphological or signal abnormalities, no systemic comorbidities, no abnormal neurological examination. Cortical thickness (CT) and local gyrification index (LGI) were obtained through a dedicated algorithm, consisting of a combination of voxel-based and surface-based morphometric techniques. The statistical analysis was performed separately on CT and LGI between: patients and controls; subgroups of controls and subgroups of patients.
Patients showed a decreased LGI in the left superior parietal lobule and in the supramarginal gyrus, compared to controls. Female patients presented a decreased LGI in the right superior, middle and transverse temporal gyri, right postcentral gyrus and supramarginal gyrus compared to male patients. Compared to migraine patients younger than 12 years, the ≥ 12-year-old subjects showed a decreased CT in the superior and middle frontal gyri, pre- and post-central cortex, paracentral lobule, superior and transverse temporal gyri, supramarginal gyrus and posterior insula. Migraine patients experiencing nausea and/or vomiting during headache attacks presented an increased CT in the pars opercularis of the left inferior frontal gyrus.
Differences in CT and LGI in patients affected by migraine without aura may suggest the presence of congenital and acquired abnormalities in migraine and that migraine might represent a vast spectrum of different entities. In particular, ≥ 12-year-old pediatric patients showed a decreased CT in areas related to the executive function and nociceptive networks compared to younger patients, while female patients compared to males showed a decreased CT of the auditory cortex compared to males. Therefore, early and tailored therapies are paramount to obtain migraine control, prevent cerebral reduction of cortical thickness and preserve executive function and nociception networks to ensure a high quality of life.
偏头痛是最常见的神经疾病，具有较高的社会经济负担。尽管越来越多的证据表明偏头痛患者存在大脑结构和功能异常，但针对儿童的研究较少，且针对无先兆偏头痛的儿科患者的皮质脑回研究尚无报道。
本研究回顾性纳入了 72 例无先兆偏头痛的儿科患者和 82 例年龄在 6 至 18 岁的对照组。纳入标准如下：MRI 检查未见形态或信号异常，无系统性合并症，无异常神经检查。通过一种专用算法获得皮质厚度（CT）和局部脑回指数（LGI），该算法由基于体素和基于表面的形态计量技术的组合构成。在以下组别之间对 CT 和 LGI 进行了统计分析：患者和对照组；对照组和患者的亚组。
与对照组相比，患者的左侧顶上小叶和缘上回的 LGI 降低。与男性患者相比，女性患者的右侧额上、中、横回，右侧中央后回和缘上回的 LGI 降低。与 12 岁以下的偏头痛患者相比，≥12 岁的患者的额上、中回，额、中央前、后回，旁中央小叶，额上、中、横回，缘上回和后岛叶的 CT 降低。在偏头痛发作时伴有恶心和/或呕吐的患者中，左侧额下回的口盖部 CT 增加。
无先兆偏头痛患者的 CT 和 LGI 差异可能表明偏头痛存在先天和后天的异常，且偏头痛可能代表不同实体的广泛谱系。特别是与年轻患者相比，≥12 岁的儿科患者的执行功能和痛觉网络相关区域的 CT 降低，而与男性相比，女性患者的听觉皮层 CT 降低。因此，早期和针对性的治疗至关重要，以实现偏头痛的控制，防止大脑皮质厚度的减少，并保护执行功能和痛觉网络，以确保高质量的生活。
