Cao Wenfei, Jiao Lei, Zhou Huizhong, Zhong Jiaqi, Wang Nizhuan, Yang Jiajun
Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Chinese and Bilingual Studies, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.
Front Hum Neurosci. 2024 Aug 30;18:1432525. doi: 10.3389/fnhum.2024.1432525. eCollection 2024.
Migraine, a neurological condition perpetually under investigation, remains shrouded in mystery regarding its underlying causes. While a potential link to Right-to-Left Shunt (RLS) has been postulated, the exact nature of this association remains elusive, necessitating further exploration.
The amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), regional homogeneity (ReHo) and functional connectivity (FC) were employed to investigate functional segregation and functional integration across distinct brain regions. Graph theory-based network analysis was utilized to assess functional networks in migraine patients with RLS. Pearson correlation analysis further explored the relationship between RLS severity and various functional metrics.
Compared with migraine patients without RLS, patients with RLS exhibited a significant increase in the ALFF within left middle occipital and superior occipital gyrus; In migraine patients with RLS, significantly reduced brain functional connectivity was found, including the connectivity between default mode network and visual network, ventral attention network, as well as the intra-functional connectivity of somatomotor network and its connection with the limbic network, and also the connectivity between the left rolandic operculum and the right middle cingulate gyrus. Notably, a significantly enhanced functional connectivity between the frontoparietal network and the ventral attention network was found in migraine with RLS; Patients with RLS displayed higher values of the normalized clustering coefficient and greater betweenness centrality in specific regions, including the left precuneus, right insula, and right inferior temporal gyrus. Additionally, these patients displayed a diminished nodal degree in the occipital lobe and reduced nodal efficiency within the fusiform gyrus; Further, the study found positive correlations between ALFF in the temporal lobes, thalamus, left middle occipital, and superior occipital gyrus and RLS severity. Conversely, negative correlations emerged between ALFF in the right inferior frontal gyrus, middle frontal gyrus, and insula and RLS grading. Finally, the study identified a positive correlation between angular gyrus betweenness centrality and RLS severity.
RLS-associated brain functional alterations in migraine consisted of local brain regions, connectivity, and networks involved in pain conduction and regulation did exist in migraine with RLS.
偏头痛是一种一直处于研究中的神经系统疾病，其潜在病因仍然扑朔迷离。虽然推测其与右向左分流（RLS）可能存在联系，但这种关联的确切性质仍不清楚，需要进一步探索。
采用低频振幅（ALFF）、分数低频振幅（fALFF）、局部一致性（ReHo）和功能连接（FC）来研究不同脑区的功能分离和功能整合。基于图论的网络分析用于评估伴有RLS的偏头痛患者的功能网络。Pearson相关分析进一步探讨RLS严重程度与各种功能指标之间的关系。
与无RLS的偏头痛患者相比，伴有RLS的患者左枕中回和枕上回的ALFF显著增加；在伴有RLS的偏头痛患者中，发现脑功能连接显著降低，包括默认模式网络与视觉网络、腹侧注意网络之间的连接，以及躯体运动网络的功能内连接及其与边缘网络的连接，还有左中央 operculum与右中扣带回之间的连接。值得注意的是，在伴有RLS的偏头痛中，额顶网络与腹侧注意网络之间的功能连接显著增强；伴有RLS的患者在特定区域显示出更高的标准化聚类系数值和更大的中介中心性，包括左楔前叶、右岛叶和右下颞叶。此外，这些患者枕叶的节点度降低，梭状回内的节点效率降低；此外，研究发现颞叶、丘脑、左枕中回和枕上回的ALFF与RLS严重程度呈正相关。相反，右下额回、额中回和岛叶的ALFF与RLS分级呈负相关。最后，研究确定角回中介中心性与RLS严重程度呈正相关。
伴有RLS的偏头痛患者脑功能改变包括局部脑区、连接以及参与疼痛传导和调节的网络，在伴有RLS的偏头痛中确实存在。
