Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
Neurology Unit, Regional Referral Headache Center, University of Rome "Tor Vergata", Rome, Italy.
Headache. 2024 Jul-Aug;64(7):825-837. doi: 10.1111/head.14750. Epub 2024 Jun 4.
In this pilot prospective cohort study, we aimed to evaluate, using high-density electroencephalography (HD-EEG), the longitudinal changes in functional connectivity (FC) in patients with chronic migraine (CM) treated with onabotulinumtoxinA (OBTA).
OBTA is a treatment for CM. Several studies have shown the modulatory action of OBTA on the central nervous system; however, research on migraine is limited.
This study was conducted at the Neurology Unit of "Policlinico Tor Vergata," Rome, Italy, and included 12 adult patients with CM treated with OBTA and 15 healthy controls (HC). Patients underwent clinical scales at enrollment (T0) and 3 months (T1) from the start of treatment. HD-EEG was recorded using a 64-channel system in patients with CM at T0 and T1. A source reconstruction method was used to identify brain activity. FC in δ-θ-α-β-low-γ bands was analyzed using the weighted phase-lag index. FC changes between HCs and CM at T0 and T1 were assessed using cross-validation methods to estimate the results' reliability.
Compared to HCs at T0, patients with CM showed hyperconnected networks in δ (p = 0.046, area under the receiver operating characteristic curve [AUC: 0.76-0.98], Cohen's κ [0.65-0.93]) and β (p = 0.031, AUC [0.68-0.95], Cohen's κ [0.51-0.84]), mainly involving orbitofrontal, occipital, temporal pole and orbitofrontal, superior temporal, occipital, cingulate areas, and hypoconnected networks in α band (p = 0.029, AUC [0.80-0.99], Cohen's κ [0.42-0.77]), predominantly involving cingulate, temporal pole, and precuneus. Patients with CM at T1, compared to T0, showed hypoconnected networks in δ band (p = 0.032, AUC [0.73-0.99], Cohen's κ [0.53-0.90]) and hyperconnected networks in α band (p = 0.048, AUC [0.58-0.93], Cohen's κ [0.37-0.78]), involving the sensorimotor, orbitofrontal, cingulate, and temporal cortex.
These preliminary results showed that patients with CM presented disrupted EEG-FC compared to controls restored by a single session of OBTA treatment, suggesting a primary central modulatory action of OBTA.
在这项前瞻性队列研究的初步研究中，我们旨在通过高密度脑电图（HD-EEG）评估慢性偏头痛（CM）患者在接受肉毒毒素 A（OBTA）治疗后的功能连接（FC）的纵向变化。
OBTA 是 CM 的一种治疗方法。几项研究表明 OBTA 对中枢神经系统具有调节作用；然而，针对偏头痛的研究有限。
本研究在意大利罗马的“Tor Vergata 综合医院”神经病学系进行，纳入了 12 名接受 OBTA 治疗的成年 CM 患者和 15 名健康对照组（HC）。患者在治疗开始时（T0）和 3 个月（T1）进行临床量表评估。CM 患者在 T0 和 T1 时使用 64 通道系统进行 HD-EEG 记录。使用加权相位滞后指数分析 δ-θ-α-β-低-γ 波段的 FC。使用交叉验证方法评估 HC 和 CM 在 T0 和 T1 之间的 FC 变化，以估计结果的可靠性。
与 T0 时的 HC 相比，CM 患者在 δ 频段表现出过度连接的网络（p=0.046，受试者工作特征曲线下面积 [AUC：0.76-0.98]，Cohen's κ [0.65-0.93]）和 β 频段（p=0.031，AUC [0.68-0.95]，Cohen's κ [0.51-0.84]），主要涉及眶额、枕叶、颞极和眶额、颞上、枕叶、扣带回区域，而 α 频段表现出连接不足的网络（p=0.029，AUC [0.80-0.99]，Cohen's κ [0.42-0.77]），主要涉及扣带回、颞极和楔前叶。与 T0 相比，CM 患者在 T1 时在 δ 频段表现出连接不足的网络（p=0.032，AUC [0.73-0.99]，Cohen's κ [0.53-0.90]）和 α 频段表现出过度连接的网络（p=0.048，AUC [0.58-0.93]，Cohen's κ [0.37-0.78]），涉及感觉运动、眶额、扣带回和颞叶皮层。
这些初步结果表明，与对照组相比，CM 患者的脑电图 FC 存在紊乱，经单次 OBTA 治疗后得到恢复，提示 OBTA 具有主要的中枢调节作用。
