Functional 1H-MRS findings in migraine patients with and without aura assessed interictally. Neuroimage

Neuroscience Department, University of Perugia, Policlinico Monteluce, Via E Dal Pozzo, 06126 Perugia, Italy.
NeuroImage (Impact Factor: 6.36). 03/2005; 24(4):1025-31. DOI: 10.1016/j.neuroimage.2004.11.005
Source: PubMed


The present study was aimed at investigating changes in brain metabolites due to visual cortex activation in migraineurs and normal subjects by (1)H-magnetic resonance spectroscopy (MRS). Twenty-two migraine patients with aura, 22 migraine patients without aura, and 10 control subjects were assessed. The volume of interest (about 8 cm(3)) was placed on the visual cortex area and the visual stimulus was applied using MR-compatible goggles with a flashing red light at a frequency of 8 Hz and an intensity of 14 lx. Data were acquired over 36'40". The experimental time course was: baseline phase, from 0 to 3'40" (1 spectrum); on phase (flashing light condition), from 3'40" to 29'20" (1540") (7 spectra), and off phase, from 29'20" to the end of the experiment at 36'40" (2 spectra). The main result of photic stimulation in patients with migraine with aura is the more consistent decrease (-14.61%) of the N-acetylaspartate (NAA) signal, which is significantly greater than that found in migraine patients without aura and control subjects. A parallel slight increase in the lactate peak was also detected. The above findings support little differences in brain metabolites between the two patient groups assessed in interictal periods, which suggests a less efficient mitochondrial functioning in migraine with aura patients.

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Available from: Giuseppe Stipa, Apr 26, 2014
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    • "The development of proton magnetic resonance spectroscopy (1H-MRS) has been used to assess noninvasively the metabolic status of human brain [43]. Several studies have employed 1H-MRS achieving numerous results for metabolites including N-acetylaspartate (NAA), as a marker of neuronal functioning [44], choline (Cho), as a marker for membrane turnover [45], total creatine (tCr) and lactate, for energy metabolism [46], and myo-inositol (a glial marker) [47]. With the exception of NAA, the results obtained for these molecules are heterogeneous and sometimes contradictory. "
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    ABSTRACT: The term omics consist of three main areas of molecular biology, such as genomics, proteomics and metabolomics. The omics synergism recognise migraine as an ideal study model, due to its multifactorial nature. In this review, the plainly research data featuring in this complex network are reported and analyzed, as single or multiple factor in pathophysiology of migraine. The future of migraine biomolecular research shall be focused on networking among these different and hierarchical disciplines. We have to look for its Ariadne's tread, in order to see the whole painting of migraine molecular biology.
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    • "Both studies used visual stimuli and paradigms similar to ours. Sarchielli et al. (10) found a decrease in NAA levels during visual stimulation for three groups of subjects: 22 patients with migraine with aura, 22 patients with migraine without aura, and 10 healthy subjects. The decrease was more marked for the first group (14.6% for the patients with migraine with aura). "
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    ABSTRACT: N-acetyl-aspartyl-glutamate (NAAG) and its hydrolysis product N-acetyl-L-aspartate (NAA) are among the most important brain metabolites. NAA is a marker of neuron integrity and viability, while NAAG modulates glutamate release and may have a role in neuroprotection and synaptic plasticity. Investigating on a quantitative basis the role of these metabolites in brain metabolism in vivo by magnetic resonance spectroscopy (MRS) is a major challenge since the main signals of NAA and NAAG largely overlap. This is a preliminary study in which we evaluated NAA and NAAG changes during a visual stimulation experiment using functional MRS. The paradigm used consisted of a rest period (5 min and 20 s), followed by a stimulation period (10 min and 40 s) and another rest period (10 min and 40 s). MRS from 17 healthy subjects were acquired at 3T with TR/TE = 2000/288 ms. Spectra were averaged over subjects and quantified with LCModel. The main outcomes were that NAA concentration decreased by about 20% with the stimulus, while the concentration of NAAG concomitantly increased by about 200%. Such variations fall into models for the energy metabolism underlying neuronal activation that point to NAAG as being responsible for the hyperemic vascular response that causes the BOLD signal. They also agree with the fact that NAAG and NAA are present in the brain at a ratio of about 1:10, and with the fact that the only known metabolic pathway for NAAG synthesis is from NAA and glutamate.
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    • "In Prescot et al., they mention patients who suffered from acute episodic migraine without verifying whether it concerned MwoA or MwA (45). In several studies the criteria for 'migraine attack frequency' were not very stringent (13,19,20,34,37) or were lacking altogether (5-7, 9-11, 15, 24, 48, 49). Several studies, though, did cover homogeneous patient groups who experienced a well-defined number of attacks, as was the case for MwoA (8, 12, 13, 30, 31, 34), MwA (19, 34) and FHM1 (37). "
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    ABSTRACT: To summarize and evaluate proton ((1)H) and phosphorus ((31)P) magnetic resonance spectroscopy (MRS) findings in migraine. A thorough review of (1)H and/or (31)P-MRS studies in any form of migraine published up to September 2011. Some findings were consistent in all studies, such as a lack of ictal/interictal brain pH change and a disturbed energy metabolism, the latter of which is reflected in a drop in phosphocreatine content, both in the resting brain and in muscle following exercise. In a recent interictal study ATP was found to be significantly decreased in the occipital lobe of migraine with aura patients, reinforcing the concept of a mitochondrial component to the migraine threshold, at least in a subgroup of patients. In several studies a correlation between the extent of the energy disturbance and the clinical phenotype severity was apparent. Less consistent but still congruent with a disturbed energy metabolism is an observed lactate increase in the occipital cortex of several migraine subtypes (MwA, migraine with prolonged aura). No increases in brain glutamate levels were found. The combined abnormalities found in MRS studies imply a mitochondrial component in migraine neurobiology. This could be due to a primary mitochondrial dysfunction or be secondary to, for example, alterations in brain excitability. The extent of variation in the data can be attributed to both the variable clinical inclusion criteria used and the variation in applied methodology. Therefore it is necessary to continue to optimize MRS methodology to gain further insights, especially concerning lactate and glutamate.
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