Afra J, Mascia A, Gérard P, Maertens de Noordhout A, Schoenen J
Department of Neurology, CHR Citadelle, University of Liège, Belgium.
Ann Neurol. 1998 Aug;44(2):209-15. doi: 10.1002/ana.410440211.
We performed transcranial magnetic stimulations of the motor and visual cortices in healthy controls (n = 27) and in patients suffering from migraine without (n = 33) or with (n = 25) aura between attacks. By using a 13-cm circular coil placed over the vertex and recordings of the first dorsal interosseus muscle, we measured thresholds (at rest and during contraction), amplitudes of motor evoked potentials and cortical silent periods. Paired stimulations with short (1-20 msec) interstimulus intervals were performed to assess intracortical inhibition. The visual cortex was stimulated with the same coil placed over the occipital scalp (7 cm above the inion) and the prevalence and threshold of phosphene production was determined. In patients with migraine with aura, motor thresholds during isometric contraction were significantly higher, whereas the prevalence of stimulation-induced phosphene production was lower compared with healthy controls. These changes were not correlated with attack frequency or disease duration. No differences were found between subject groups in thresholds at rest, motor evoked potential amplitudes, cortical silent periods, or response curves after paired stimuli. These results are in favor of cortical hypoexcitability rather than hyperexcitability in patients with migraine with aura between attacks.
我们对健康对照组（n = 27）以及发作间期无先兆（n = 33）或有先兆（n = 25）的偏头痛患者进行了运动皮层和视觉皮层的经颅磁刺激。通过将一个13厘米的圆形线圈置于头顶，并记录第一背侧骨间肌的活动，我们测量了阈值（静息时和收缩时）、运动诱发电位的幅度以及皮层静息期。采用短（1 - 20毫秒）刺激间隔的配对刺激来评估皮层内抑制。用同样的线圈置于枕部头皮（枕外隆凸上方7厘米处）刺激视觉皮层，并确定光幻视产生的发生率和阈值。与健康对照组相比，有先兆偏头痛患者在等长收缩时的运动阈值显著更高，而刺激诱发光幻视产生的发生率更低。这些变化与发作频率或病程无关。在静息阈值、运动诱发电位幅度、皮层静息期或配对刺激后的反应曲线方面，各受试者组之间未发现差异。这些结果支持发作间期有先兆偏头痛患者存在皮层兴奋性降低而非兴奋性增高的观点。
