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ABSTRACT: The aim of this study was to evaluate the function of Adelta fibers at the hand level in patients with clinical symptoms of Carpal Tunnel Syndrome (CTS) using CO(2) laser evoked potentials (LEPs), in light of the intensity and distribution of sensory symptoms and pain.
Thirty-four CTS outpatients (62 hands) were compared to 23 sex- and age-matched control subjects (46 hands). The periungueal skin of the first, second, third and fifth fingers, and the dorsum of the hands were stimulated in random order. The latency and amplitude of the N2, P2 and N1 components were evaluated with respect to the Nerve Conduction Study (NCS) data, clinical scales, pain intensity and glove-like symptoms distribution.
The amplitude of the N2-P2 complex was significantly reduced in CTS hands compared to normal hands after stimulation of the second and third fingers, even in patients with mild nerve conduction impairment. No significant fifth finger LEP abnormalities were found in patients with glove-like distribution symptoms. The N2-P2 amplitude at the second and third fingers was positively correlated with the severity of sensory symptoms.
The involvement of median nerve Adelta fibers in CTS seems to be an early phenomenon, which concurs with the impairment of large motor and sensory afferents and is linked to the severity of the disease.
The finding of reduced sensory symptoms in patients with severe thin afferents damage, may suggest a slight expression of central sensitisation phenomena in the advanced stage of CTS syndrome.
Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology 02/2009; 120(2):353-9. · 3.12 Impact Factor
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ABSTRACT: The present study aimed to evaluate heat pain thresholds and evoked potentials following CO(2) laser thermal stimulation (laser-evoked potentials, LEPs), during remote application of capsaicin, in migraine patients vs. non-migraine healthy controls. Twelve outpatients suffering from migraine without aura were compared with 10 healthy controls. The LEPs were recorded by 6 scalp electrodes, stimulating the dorsum of the right hand and the right supraorbital zone in basal condition, during the application of 3% capsaicin on the dorsum of the left hand and after capsaicin removal. In normal subjects, the laser pain and the N2-P2 vertex complex obtained by the hand and face stimulation were significantly reduced during remote capsaicin application, with respect to pre-and post-capsaicin conditions, while in migraine LEPs and laser pain were not significantly modified during remote painful stimulation. In migraine a defective brainstem inhibiting control may coexist with cognitive factors of focalised attention to facial pain, less sensitive to distraction by a second pain.
The Journal of Headache and Pain 07/2007; 8(3):167-74. · 2.43 Impact Factor
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ABSTRACT: The aim of this study was to perform a topographic and dipolar analysis of nociceptive-evoked responses obtained by laser stimulus under basal conditions in a cohort of chronic migraine (CM) patients, compared with migraine without aura (MWA) patients and noncraniofacial pain controls.
An increased activation of cortical areas devoted to the emotional and attentive components of pain was previously found during the course of the migraine attack; it was more pronounced in patients reporting higher frequency of migraine.
Twenty-six outpatients were enrolled in the study; 16 fulfilled the criteria of CM, and 10 were affected by MWA. Fifteen noncraniofacial pain subjects were also selected. The pain stimulus was a CO2 laser pulses. The right-supraorbital zone was stimulated. Source localization analysis was performed on the most prominent laser-evoked potentials (LEPs) peak (P2) for each data set. The anatomical locations of the P2 sources were projected onto a standard normalized 3D MRI model.
The CM group differed significantly from both MWA patients and controls for the x coordinate and from controls for the z coordinates. The P2 dipole localized in the rostral cingulate cortex in CM patients, lying in a more posterior location within the anterior cingulate cortex (ACC) in both controls and MWA patients. The x coordinate of the P2 dipole, expressing the postero-anterior location, was significantly correlated with frequency of headache.
CM seems to be characterized by a distinctive pattern of cortical elaboration of pain, with a prevalent activation of the rostral portion of the ACC: our results suggest that this may be a predisposing factor to migraine chronicity.
Headache The Journal of Head and Face Pain 11/2005; 45(9):1208-18. · 2.52 Impact Factor
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ABSTRACT: A reduced habituation of averaged laser-evoked potential (LEP) amplitudes was previously found in migraine patients. The aim of the present study was to assess the habituation of single LEP responses and pain sensation during the interictal phase in migraine patients. Fourteen migraine patients were compared with ten control subjects. The pain stimulus was laser pulses, generated by CO2 laser, delivered to right supraorbital zone. Patients were evaluated during attack-free conditions. The LEP habituation was studied by measuring the changes of LEP amplitudes across and within three consecutive repetitions of 21 non-averaged trials. In migraine patients the N2-P2 wave amplitudes did not show a tendency toward habituation across and, above all, within the three repetitions. Anomalous behaviour of nociceptive cortex during the interictal phase of migraine may predispose patients to headache occurrence and persistence.
The Journal of Headache and Pain 10/2005; 6(4):195-8. · 2.43 Impact Factor
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ABSTRACT: This study aimed to compute phase synchronization of the alpha band from a multichannel electroencephalogram (EEG) recorded under repetitive flash stimulation from migraine patients without aura. This allowed examination of ongoing EEG activity during visual stimulation in the pain-free phase of migraine.
Flash stimuli at frequencies of 3, 6, 9, 12, 15, 18, 21, 24, and 27 Hz were delivered to 15 migraine patients without aura and 15 controls, with the EEG recorded from 18 scalp electrodes, referred to the linked earlobes. The EEG signals were filtered in the alpha (7.5-13 Hz) band. For all stimulus frequencies that we evaluated, the phase synchronization index was based on the Hilbert transformation.
Phase synchronization separated the patients and controls for the 9, 24 and 27 Hz stimulus frequencies; hyper phase synchronization was observed in patients, whereas healthy subjects were characterized by a reduced phase synchronization. These differences were found in all regions of the scalp.
During migraine, the brain synchronizes to the idling rhythm of the visual areas under certain photic stimulations; in normal subjects however, brain regions involved in the processing of sensory information demonstrate desynchronized activity. Hypersynchronization of the alpha rhythm may suggest a state of cortical hypoexcitability during the interictal phase of migraine.
The employment of non-linear EEG analysis may identify subtle functional changes in the migraine brain.
International Journal of Psychophysiology 10/2005; 57(3):203-10. · 2.14 Impact Factor
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ABSTRACT: In migraineurs nitroglycerin (NTG) induces severe delayed headache, resembling spontaneous migraine attacks. The aim of the present study was to evaluate NTG laser evoked potentials (LEP) features amplitude and pain sensation to laser stimuli during NTG-induced headache. Nine patients were selected. Headache was induced by oral administration of 0.6 mg of NTG; signals were recorded through disk electrodes placed at the vertex and referred to linked earlobes. CO(2)-LEPs delivered by stimulation of the dorsum of both hands and the right and left supraorbital zones were evaluated after the onset of moderate or severe headache resembling spontaneous migraine and at least 72 h after the end of the headache phase. Patients exhibited a significant heat pain threshold reduction and an LEPs amplitude increment during headache when both the supraorbital zones were stimulated. NTG appeared to support a reliable experimental model of migraine, based on the neuronal effects on the integrative-nociceptive structures. The LEPs facilitation during NTG-induced headache may be subtended by a hyperactivity of nociceptive cortex as well as by a failure of pain-inhibitory control.
Neuroscience Letters 07/2004; 363(3):272-5. · 2.11 Impact Factor
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ABSTRACT: Previous studies have revealed that migraine patients display an increased photic driving to flash stimuli in the medium frequency range. The aim of this study was to perform a topographic analysis of steady-state visual evoked potentials (SVEPs) in the low frequency range (3-9 Hz), evaluating the temporal behaviour of the F1 amplitude by investigating habituation and variability phenomena. The main component of SVEPs, the F1, demonstrated an increased amplitude in several channels at 3 Hz. Behaviour of F1 amplitude was rather variable over time, and the wavelet-transform standard deviation was increased in migraine patients at a low stimulus rate. The discriminative value of the F1 mean amplitude and variability index, tested by both an artificial neural network classifier and a support vector machine, were high according to both methods. The increased photic driving in migraine should be subtended by a more generic abnormality of visual reactivity instead of a selective impairment of a visual subsystem. Temporal behaviour of SVEPs is not influenced by a clear tendency to habituation, but the F1 amplitude seemed to change in a complex way, which is better described by variability phenomena. An increased variability in response to flicker stimuli in migraine patients could be interpreted as an overactive regulation mechanism, prone to instability and consequently to headache attacks, whether spontaneous or triggered.
International Journal of Psychophysiology 09/2003; 49(2):165-74. · 2.14 Impact Factor
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ABSTRACT: Current opinion concerning the pathophysiology of tension-type headache (TTH) and its related pericranial muscle tenderness proposes a primary role of central sensitization at the level of dorsalhorn/trigeminal nucleus as well as the supraspinal level. Investigation of these phenomena can be conducted using laser-evoked potentials (LEPs), which are objective and quantitative neurophysiological tools for the assessment of pain perception. In the present study we examined features of LEPs, as well as cutaneous heat-pain thresholds to laser stimulation, in relation to the tenderness of pericranial muscles in chronic TTH resulting from pericranial muscle disorder, during a pain-free phase. Twelve patients with TTH and 11 healthy controls were examined using the Total Tenderness Scoring (TTS) system. The stimulus was a laser pulse generated by a CO(2) laser. The dorsum of the hand and the cutaneous zones corresponding to pericranial muscles were stimulated. Subjective perception of stimulus intensity was assessed by a visual analogue scale. Two responses, the earlier named N2a and the last named P2, were considered; the absolute latency was measured at the highest peak of each response. The N2a-P2 components' peak-to-peak amplitude was detected. The heat pain threshold was similar in TTH patients and controls at the level of both the hand and pericranial skin. The TTS scores at almost all pericranial sites were higher in TTH patients than in normal controls. The amplitude of the N2a-P2 complex elicited by stimulation of the pericranial zone was greater in TTH patients than in controls; the amplitude increase was significantly associated with the TTS score. Our findings suggest that pericranial tenderness may be a primary phenomenon that precedes headache, and is mediated by a greater pain-specific hypervigilance at the cortical level.
Pain 08/2003; 104(1-2):111-9. · 5.78 Impact Factor
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ABSTRACT: The aim of the study was to evaluate the effects of transcutaneous electric nerve stimulation (TENS) on CO(2) laser evoked potentials (LEPs) in 16 normal subjects. The volar side of the forearm was stimulated by 10 Hz TENS in eight subjects and by 100 Hz TENS in the remainder; the skin of the forearm was stimulated by CO(2) laser and the LEPs were recorded in basal conditions and soon after and 15 min after TENS. Both low and high frequency TENS significantly reduced the subjective rating of heat stimuli and the LEPs amplitude, although high frequency TENS appeared more efficacious. TENS seemed to exert a mild inhibition of the perception and processing of pain induced by laser Adelta fibres activation; the implications of these effects in the clinical employment of TENS remain to be clarified.
Neuroscience Letters 06/2003; 342(1-2):17-20. · 2.11 Impact Factor
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ABSTRACT: Syndromes with chronic daily headache include chronic migraine (CM). The reason for the transformation of migraine into chronic daily headache is still unknown. In this study, we aimed to evaluate heat pain thresholds and event-related potentials following CO(2)-laser thermal stimulation (LEPS) in hand and facial regions in patients with CM, to show changes in nociceptive brain responses related to dysfunction of pain elaboration at the cortical level. The results were compared with findings from normal control subjects and from subjects who suffer from migraine without aura. The effects of stimulus intensity, subjective pain perception and attention were monitored and compared with features of the LEPS. Twenty-five CM patients, 15 subjects suffering from migraine without aura and 15 normal control subjects were enrolled in the study. LEPS amplitude variation was reduced in CM patients with respect to the perceived stimulus intensity, in comparison with migraine without aura patients and control subjects. In both headache groups, the distraction from the painful laser stimulus induced by an arithmetic task failed to suppress the LEPS amplitude, in comparison with control subjects. These results suggest an abnormal cortical processing of nociceptive input in CM patients, which could lead to the chronic state of pain. In both headache groups, an inability to reduce pain elaboration during an alternative cognitive task emerged as an abnormal behaviour probably predisposing to migraine.
Pain 02/2003; 101(1-2):25-32. · 5.78 Impact Factor
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ABSTRACT: We examined cutaneous pain thresholds using CO(2) laser stimuli during migraine attacks, and defined the evoked cortical potential characteristics. Ten patients without aura were studied during attacks and for at least 72 h subsequently. Pain stimuli were generated on the dorsum of both hands and the right and left supraorbital zones, using pulses from a CO(2) laser. Absolute latencies of scalp potentials were measured at the highest peak of each response component, and the peak-to-peak amplitudes of N2a-P2 components were recorded. Cutaneous pain thresholds were significantly reduced on both the symptomatic and non-symptomatic sides during the attack, in comparison with the headache-free phase. The N2a-P2 complexes also increased in amplitude during attacks in comparison with the pain-free side. Thus, cutaneous hyperalgesia occurs during migraine attack, and is subtended by central sensitization phenomena, probably involving the cortex.
Neuroscience Letters 12/2002; 333(1):29-32. · 2.11 Impact Factor
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ABSTRACT: The modulation of trigeminal reflex excitability in migraine patients was evaluated during the asymptomatic phase by studying the effects of attention, habituation and preconditioning stimulus on the R2 and R3 components of the blink reflex (BR). Fifty patients suffering from migraine without aura, 20 affected by migraine with aura and 35 sex- and age-matched controls were selected. In subgroups of migraine with-aura and without-aura patients, and normal controls, the blink reflex was elicited during different cognitive situations: (a) spontaneous mental activity; (b) stimulus anticipation; (c) recognition of target numbers. In the remaining subjects, R2 and R3 habituation was evaluated by repetitive stimulation at 1, 5, 10, 15, 20, 25 and 30 s intervals. The R2 and R3 recovery curves were also computed. A reduced R3 threshold with a normal pain threshold was found in migraine with-aura and without-aura patients; the R3 component was not significantly correlated with the pain thresholds in patients and controls. The R2 and R3 components were less influenced by the warning of the stimulus in migraine without-aura and migraine with-aura patients, in comparison with the control group. A slight increase of both R2 and R3 recovery after preconditioning stimulus was also observed in migraine patients, probably caused by a phenomenon of trigeminal hyperexcitability persisting after the last attack. The abnormal BR modulation by alerting expresses in migraine a dysfunction of adaptation capacity to environmental conditions, probably predisposing to migraine.
International Journal of Psychophysiology 07/2002; 44(3):239-49. · 2.14 Impact Factor
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ABSTRACT: Objective. To evaluate the blink reflex (BR) in chronic cluster headache (CH) patients. Design. The elecrophysiological data
were collected in during the headache-free phase. Setting. Headache patients were recruited from outpatients seen for the
first time at the First Neurologic Clinic of Bari University. Patients and participants. Ten CH patients, 19 migraine without
aura patients with strictly unilateral headache (MwoA) and 18 normal controls were selected.
Measurements and results. The BR procedure was applied. In CH, a significant R2 duration increase was found on the symptomatic
side in comparison with MwoA and controls. In both patient groups an early appearance of the R3 component was bilaterally
clear. Conclusions. The BR findings confirm the central genesis of CH. The R3 abnormalities suggest a basic dysfunction of
the Central control on the trigeminal nociceptive circuits. The R2 involvement on the symptomatic side indicates a unilateral
facilitation of the trigeminal-facial connections persisting after the CH bout.
The Journal of Headache and Pain 11/2000; 1(2):97-104. · 2.43 Impact Factor
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ABSTRACT: Chronic pathologies, above all those in which is present pain, can induce a considerable impairment in quality of life. The concept of illness behaviour is closely related to that of quality of life. It can be defined as the way to estimate and to react to one's own health status. In this study on chronic headache patients, the sickness impact profile (SIP) was used as a measure of illness-related quality of life. The way of experiencing the disease was moreover quantified by means of the illness behaviour questionnaire (IBQ). Patients with chronic headache showed a remarkable impairment in most of their daily activities. At the same time, they lived their illnesses poorly. The longer was chronic headache duration, the more disability was marked. Fermale gender was associated with a more severe profile, both in SIP and in IBQ.
The Journal of Headache and Pain 01/2000; 1:S61-S65. · 2.43 Impact Factor
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ABSTRACT: The aim of this study was to compare the properties of the nociceptive system in eight migraine without aura patients in the pain-free phase with 10 healthy controls, by evaluating the topography and the source of the CO2 laser-evoked potentials (LEPs) obtained by the right supraorbital skin, during and after capsaicin topical application. In healthy subjects the acute cutaneous pain induced by capsaicin reduced the amplitude of the vertex LEPs and induced a posterior shifting of the P2 wave dipolar source within the anterior cingulate cortex. These functional changes seemed significantly reduced in migraine patients, for a disturbed pattern of pain modulation at the cortical level, which may subtend the onset and persistence of migraine.
Neuroscience Letters 384(1-2):150-5. · 2.11 Impact Factor
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ABSTRACT: The aim of this study was to perform further evaluation of laser-evoked potentials (LEPs) during migraine attacks using multichannel recording and topographic analysis. Specifically, this study aimed to confirm the pattern previously observed in acute migraine, while also defining the components of LEPs that are mainly modified during headache, as well as the correlation between features of LEPs and clinical variables. In addition, we aimed to conduct a dipolar source analysis of the main LEP waves in migraine patients to check the variability in the source location of LEPs during acute migraine.
An amplitude enhancement of LEPs was previously detected during migraine attack using a single scalp derivation on the vertex; hyperalgesia to heat stimuli was also detected for both the face and hand.
Eighteen patients suffering from migraine without aura were analyzed. The supraorbital zones and the dorsum of the hand were stimulated on both the symptomatic and nonsymptomatic sides in all patients. The LEPs were recorded via 25 scalp electrodes. Dipolar source analysis of the P2 components was performed using a spherical model in all patients and using a realistic Magnetic Resonance model in four patients.
During attacks, the later waves, and particularly the P2 component, were significantly enhanced; the amplitude of the P2 component obtained during the attack by stimulation of the supraorbital zone on the side of the headache was significantly correlated with the intensity of pain and the frequency of headache. In our patients, the P2 wave was generated in the anterior cingulate cortex, with a shift toward its rostrocaudal portion, and was mainly devoted to elaboration of the emotive compound of pain during migraine attack.
Cortical activation by laser stimuli during migraine attack was confirmed. This effect was more pronounced in patients with a higher frequency of migraine attacks. This may be due to a lack of inhibitory control over the transmission of pain to the cortex. The increased activation of cortical areas devoted to attention and emotion may be linked to headache.
Headache The Journal of Head and Face Pain 44(10):947-60. · 2.52 Impact Factor
