Exploring the Therapeutic Potential of Quadripulse rTMS over the Visual Cortex: A Proof-of-Concept Study in Healthy Volunteers and Chronic Migraine Patients with Medication Overuse Headache.
central sensitization; chronic migraine; medication overuse headache; neuromodulation; quadripulse rTMS; visual evoked potentials; Medicine (miscellaneous); Biochemistry, Genetics and Molecular Biology (all)
Abstract :
[en] In chronic migraine with medication overuse (CM-MOH), sensitization of visual cortices is reflected by (i) increased amplitude of stimulus-evoked responses and (ii) habituation deficit during repetitive stimulation. Both abnormalities might be mitigated by inhibitory transcranial neurostimulation. Here, we tested an inhibitory quadripulse repetitive transcranial magnetic stimulation (rTMS-QPI) protocol to decrease durably visual cortex excitability in healthy subjects (HS) and explored its therapeutic potential in CM-MOH patients. Pattern-reversal visual evoked potentials (VEP) were used as biomarkers of effect and recorded before (T1), immediately after (T2), and 3 h after stimulation (T3). In HS, rTMS-QPI durably decreased the VEP 1st block amplitude (p < 0.05) and its habituation (p < 0.05). These changes were more pronounced for the P1N2 component that was modified already at T2 up to T3, while for N1P1 they were significant only at T3. An excitatory stimulation protocol (rTMS-QPE) tended to have an opposite effect, restricted to P1N2. In 12 CM-MOH patients, during a four-week treatment (2 sessions/week), rTMS-QPI significantly reduced monthly headache days (p < 0.01). In patients reversing from CM-MOH to episodic migraine (n = 6), VEP habituation significantly improved after treatment (p = 0.005). rTMS-QPI durably decreases visual cortex responsivity in healthy subjects. In a proof-of-concept study of CM-MOH patients, rTMS-QPI also has beneficial clinical and electrophysiological effects, but sham-controlled trials are needed.
Disciplines :
Neurology
Author, co-author :
Viganò, Alessandro; Headache Research Unit, Department of Neurology, University of Liège, Citadelle Hospital, 4000 Liège, Belgium
Sasso D'Elia, Tullia ; Headache Research Unit, Department of Neurology, University of Liège, Citadelle Hospital, 4000 Liège, Belgium ; IRCCS San Raffaele Alla Pisana, 00163 Rome, Italy
Sava, Simona Liliana; Headache Research Unit, Department of Neurology, University of Liège, Citadelle Hospital, 4000 Liège, Belgium ; Headache Clinic of Valdor-ISOSL, 4020 Liège, Belgium
Colosimo, Alfredo; Department of Anatomy, Histology, Forensic Medicine and Orthopedics Sapienza, Sapienza-University of Rome, 00185 Rome, Italy
Di Piero, Vittorio; Subintensive Neurology & Headache Centre, Department of Human Neurosciences, Sapienza-University of Rome, 00185 Rome, Italy
Magis, Delphine ; Université de Liège - ULiège > Département des sciences cliniques ; Neurology Department and Pain Clinic (CMTD), CHR East Belgium, 4800 Verviers, Belgium
Schoenen, Jean ; Université de Liège - ULiège > Département des sciences biomédicales et précliniques
Language :
English
Title :
Exploring the Therapeutic Potential of Quadripulse rTMS over the Visual Cortex: A Proof-of-Concept Study in Healthy Volunteers and Chronic Migraine Patients with Medication Overuse Headache.
Publication date :
26 January 2024
Journal title :
Biomedicines
eISSN :
2227-9059
Publisher :
Multidisciplinary Digital Publishing Institute (MDPI), Switzerland
FP7 - 602633 - EUROHEADPAIN - Mechanisms and Treatment of Migraine and its Chronification
Funders :
F.R.S.-FNRS - Fund for Scientific Research Walloon region EU - European Union
Funding text :
Sources of financial support: This work was supported by the research convention 3.4.650.09 of the National Fund for Scientific Research-Belgium to J.S., by research convention 1117427 of the CWALity program of the Walloon Region, and by the European Union’s Seventh Framework programme under grant agreement no. 602633.
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