Viganò Alessandro, Sasso D'Elia Tullia, Sava Simona Liliana, Colosimo Alfredo, Di Piero Vittorio, Magis Delphine, Schoenen Jean
Headache Research Unit, Department of Neurology, University of Liège, Citadelle Hospital, 4000 Liège, Belgium.
IRCCS San Raffaele Alla Pisana, 00163 Rome, Italy.
Biomedicines. 2024 Jan 26;12(2):288. doi: 10.3390/biomedicines12020288.
In chronic migraine with medication overuse (CM-MOH), sensitization of visual cortices is reflected by (i) increased amplitude of stimulus-evoked responses and (ii) habituation deficit during repetitive stimulation. Both abnormalities might be mitigated by inhibitory transcranial neurostimulation. Here, we tested an inhibitory quadripulse repetitive transcranial magnetic stimulation (rTMS-QPI) protocol to decrease durably visual cortex excitability in healthy subjects (HS) and explored its therapeutic potential in CM-MOH patients. Pattern-reversal visual evoked potentials (VEP) were used as biomarkers of effect and recorded before (T1), immediately after (T2), and 3 h after stimulation (T3). In HS, rTMS-QPI durably decreased the VEP 1st block amplitude ( < 0.05) and its habituation ( < 0.05). These changes were more pronounced for the P1N2 component that was modified already at T2 up to T3, while for N1P1 they were significant only at T3. An excitatory stimulation protocol (rTMS-QPE) tended to have an opposite effect, restricted to P1N2. In 12 CM-MOH patients, during a four-week treatment (2 sessions/week), rTMS-QPI significantly reduced monthly headache days ( < 0.01). In patients reversing from CM-MOH to episodic migraine ( = 6), VEP habituation significantly improved after treatment ( = 0.005). rTMS-QPI durably decreases visual cortex responsivity in healthy subjects. In a proof-of-concept study of CM-MOH patients, rTMS-QPI also has beneficial clinical and electrophysiological effects, but sham-controlled trials are needed.
在药物过度使用性慢性偏头痛(CM-MOH)中,视觉皮层的敏化表现为:(i)刺激诱发反应的幅度增加;(ii)重复刺激期间的习惯化缺陷。这两种异常情况都可能通过抑制性经颅神经刺激得到缓解。在此,我们测试了一种抑制性四脉冲重复经颅磁刺激(rTMS-QPI)方案,以持久降低健康受试者(HS)的视觉皮层兴奋性,并探索其在CM-MOH患者中的治疗潜力。模式翻转视觉诱发电位(VEP)被用作效应的生物标志物,并在刺激前(T1)、刺激后立即(T2)和刺激后3小时(T3)进行记录。在HS中,rTMS-QPI持久降低了VEP第一个刺激块的幅度(P<0.05)及其习惯化(P<0.05)。这些变化在P1N2成分上更为明显,该成分在T2至T3时就已发生改变,而对于N1P1成分,仅在T3时才有显著变化。一种兴奋性刺激方案(rTMS-QPE)往往产生相反的效果,仅限于P1N2成分。在12例CM-MOH患者中,在为期四周的治疗期间(每周2次),rTMS-QPI显著减少了每月头痛天数(P<0.01)。在从CM-MOH转变为发作性偏头痛的患者(n = 6)中,治疗后VEP习惯化显著改善(P = 0.005)。rTMS-QPI可持久降低健康受试者的视觉皮层反应性。在一项CM-MOH患者的概念验证研究中,rTMS-QPI也具有有益的临床和电生理效应,但仍需要进行假对照试验。
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