Sebastianelli Gabriele, Casillo Francesco, Abagnale Chiara, Di Renzo Antonio, Ziccardi Lucia, Parisi Vincenzo, Di Lorenzo Cherubino, Serrao Mariano, Coppola Gianluca
Department of Medico-Surgical Sciences and Biotechnologies, Polo Pontino, Sapienza University of Rome, 04100 Latina, Italy.
IRCCS-Fondazione Bietti, 00184 Rome, Italy.
J Clin Med. 2024 Dec 9;13(23):7491. doi: 10.3390/jcm13237491.
: Chronic migraine with medication-overuse headache (CM-MOH) is neurophysiologically characterized by increased cortical excitability with sensitization at both the thalamocortical and the cortical levels. It is unclear whether the increased cortical excitability could be reverted by medication withdrawal (i.e., brain state) or whether it is a brain trait of individuals predisposed to medication overuse. In this study, we aim to investigate whether withdrawal from overused drugs can influence and restore these neurophysiological abnormalities. : Somatosensory evoked potentials (SSEPs) were elicited by electrical stimulation of the median nerve (M), the ulnar nerve (U), and the simultaneous stimulation of both nerves (MU) in 14 patients with CM-MOH before (T) and after (T) a three-week withdrawal protocol and, for comparison, in 14 healthy volunteers (HVs) of a comparable age distribution. We measured the level of thalamocortical (pre-HFO) and cortical activation (post-HFO) by analyzing the high-frequency oscillations (HFOs) embedded in parietal N20 median SSEPs. Furthermore, we calculated the habituation and the degree of cortical lateral inhibition (dLI) of N20-P25 low-frequency SSEPs. : After the three-week withdrawal protocol (T), we observed a normalization of the baseline habituation deficit (T: +0.10 ± 0.54; T: -0.53 ± 0.8; = 0.040) and a reduction in the amplitude for both pre-HFO ( < 0.009) and post-HFO ( = 0.042), with values comparable to those of the HVs. However, no effects were observed on the dLI ( = 0.141). : Our findings showed that withdrawal from overused drugs could affect the increased excitability of the non-painful somatosensory system in patients with CM-MOH, reducing the level of sensitization at both the thalamocortical and the cortical levels.
慢性偏头痛伴药物过度使用性头痛（CM-MOH）在神经生理学上的特征是皮质兴奋性增加，在丘脑皮质和皮质水平均存在敏化现象。目前尚不清楚皮质兴奋性增加是可通过停药（即脑状态）恢复，还是它是个体易发生药物过度使用的一种脑特征。在本研究中，我们旨在调查停用过度使用的药物是否能影响并恢复这些神经生理异常。：对14例CM-MOH患者在为期三周的停药方案前后（分别为T0和T1），通过电刺激正中神经（M）、尺神经（U）以及同时刺激两条神经（MU）来引出体感诱发电位（SSEP），并以年龄分布相当的14名健康志愿者（HV）作为对照。我们通过分析顶叶N20正中SSEP中嵌入的高频振荡（HFO）来测量丘脑皮质（HFO前）和皮质激活（HFO后）水平。此外，我们计算了N20-P25低频SSEP的习惯化和皮质侧向抑制程度（dLI）。：在为期三周的停药方案（T1）后，我们观察到基线习惯化缺陷恢复正常（T0：+0.10±0.54；T1：-0.53±0.8；P = 0.040），HFO前（P < 0.009）和HFO后（P = 0.042）的振幅均降低，其值与HV相当。然而，未观察到对dLI有影响（P = 0.141）。：我们的研究结果表明，停用过度使用的药物可影响CM-MOH患者非痛性体感系统的兴奋性增加，降低丘脑皮质和皮质水平的敏化程度。
