Kalita Jayantee, Bansal Robin, Mahajan Roopali, Jha Vishal
Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India.
Mol Neurobiol. 2025 Jul 14. doi: 10.1007/s12035-025-05190-z.
Phonophobia is a cardinal symptom in migraine, and migraineur may have impaired habituation of brainstem auditory evoked potential (BAEP). High-rate repetitive transcranial magnetic stimulation (rTMS) has been found effective in migraine, but its effect on brainstem excitability has not been evaluated. We report the effect of high-rate rTMS on ictal phonophobia, hearing threshold (HT), and BAEP as the biomarkers of impaired habituation in the patients with migraine. Forty-three migraineurs and 31 healthy controls were included. Their headache frequency and severity were noted, and ictal phonophobia was recorded on a 0-4 scale at baseline and one month after rTMS. Hearing threshold and three consecutive BAEP at 40 dBSL, 50 dBSL, and 60 dBSL were recorded at baseline and repeated after the 3rd session of rTMS. Peak latencies and amplitudes of BAEP waveforms were measured. Three sessions of 10 trains of 10 Hz rTMS were delivered over the left motor cortex corresponding to the hot spot of the abductor digiti minimi. Consecutive 3 tracings of BAEP at 40 dBSL, 50 dBSL, and 60 dBSL revealed increasing amplitudes of wave III and IV in migraineurs, which persisted even after rTMS. At 60 dBSL, wave III amplitude was higher in migraineurs compared to the control, and remained so after rTMS. The severity of phonophobia and HT, however, improved after rTMS. Migraineurs had improvement in phonophobia and HT following rTMS, which did not commensurate with the biomarkers of impaired habituation in BAEP. However, longer trains and multiple sessions of rTMS may be explored in further study.
恐音症是偏头痛的主要症状，偏头痛患者可能存在脑干听觉诱发电位（BAEP）习惯化受损。高频重复经颅磁刺激（rTMS）已被发现对偏头痛有效，但其对脑干兴奋性的影响尚未得到评估。我们报告了高频rTMS对偏头痛患者发作期恐音症、听力阈值（HT）以及作为习惯化受损生物标志物的BAEP的影响。研究纳入了43名偏头痛患者和31名健康对照者。记录了他们的头痛频率和严重程度，并在基线和rTMS治疗后1个月以0 - 4级记录发作期恐音症情况。在基线时记录听力阈值以及在40 dBSL、50 dBSL和60 dBSL水平下连续三次的BAEP，并在rTMS第3次治疗后重复测量。测量BAEP波形的峰潜伏期和波幅。在对应于小指展肌热点的左侧运动皮层上给予10 Hz的10串高频rTMS，共3组。在40 dBSL、50 dBSL和60 dBSL水平下连续3次记录BAEP，结果显示偏头痛患者中波III和波IV的波幅增加，即使在rTMS后仍持续。在60 dBSL时，偏头痛患者的波III波幅高于对照组，且rTMS后依然如此。然而，恐音症的严重程度和HT在rTMS后有所改善。偏头痛患者在rTMS后恐音症和HT有所改善，但这与BAEP习惯化受损的生物标志物并不相符。然而，在进一步研究中可以探索更长串刺激和多次rTMS治疗。
