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ORIGINAL ARTICLE
Year : 2018  |  Volume : 131  |  Issue : 18  |  Page : 2158-2163

Volume Gain of Brainstem on Medication-Overuse Headache Using Voxel-Based Morphometry


1 Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing 100853; Department of Radiology, Hainan Branch of Chinese People's Liberation Army General Hospital, Sanya, Hainan 572013; Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
2 Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
3 Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing 100853; Department of Radiology, Hainan Branch of Chinese People's Liberation Army General Hospital, Sanya, Hainan 572013, China
4 Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China

Correspondence Address:
Dr. Sheng-Yuan Yu
Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0366-6999.240807

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Background: Histopathology identified the anatomical and molecular abnormalities of brainstem nuclei in migraine patients. However, the exact whole brainstem structural changes in vivo have not yet been identified in medication-overuse headache (MOH) transformed from migraine. The aim of this study was to investigate the regional volume changes over the whole brainstem in the MOH patients using voxel-based morphometry (VBM) in vivo. Methods: High-resolution three-dimensional structural images were obtained using a 3.0-Tesla magnetic resonance system from 36 MOH patients and 32 normal controls (NCs) who were consecutively recruited from the International Headache Center, Chinese People's Liberation Army General Hospital, from March 2013 to June 2016. VBM was used to assess the brainstem structural alteration in the MOH patients, and voxel-wise correlation was performed to evaluate the relationship with the clinical characteristics. Results: The brainstem region with increased volume located in the left ventrolateral periaqueductal gray (MNI coordinate: -1, -33, -8), ventral tegmental area (MNI coordinate: 0, -22, -12), bilateral substantia nigra (MNI coordinate: -8, -16, -12, 9, -16, -12), and trigeminal root entry zone (MNI coordinate: -19, -29, -31; 19, -32, -29) in MOH patients compared with NCs. The headache visual analog scale score was positively related with the left rostral ventromedial medulla (RVM) (MNI coordinate: -1, -37, -56; cluster size: 20; r = 0.602) in the MOH patients. Conclusions: The regional volume gain of brainstem could underlie the neuromechanism of impaired ascending and descending pathway in the MOH patients, and the left RVM volume alteration could imply the impaired tolerance of nociceptive pain input and could be used to assess the headache disability in the MOH patients.

 

 Abstract in Chinese

药物过度使用性头痛患者脑干体积增加:基于体素的形态测量学研究

摘要
背景:组织病理学已明确偏头痛患者脑干核团可发生解剖学及分子学异常改变,然而,由偏头痛转换所致的药物过度使用性头痛的整个脑干结构活体精确结构变化仍无报道。本研究的目的是采用基于体素的形态测量学的方法活体探索药物过度使用性头痛患者脑干结构的局部变化。
方法:于2013年3月至2016年6月在解放军总医院国际头痛中心序贯招募药物过度使用性头痛患者36名、正常志愿者32名,均在3.0T磁共振设备上采集高分辨率脑结构成像。采用基于体素的形态测量学评估药物过度使用性头痛患者脑干结构变化,采用体素式相关性分析评估脑干结构与临床变量的相关性。
结果:与正常志愿者比较,药物过度使用性头痛患者脑干结构增加脑区主要位于左侧腹外侧中脑导水管区(MNI坐标: -1, -33, -8),腹侧顶盖区(MNI坐标:0, -22, -12),双侧黑质(MNI坐标:-8, -16, -12,9, -16, -12),双侧三叉神经根进入区(MNI坐标:-19, -29, -31; 19, -32, -29)。药物过度使用性头痛患者疼痛视觉模拟量表评分与左侧延脑头端腹内侧区体积呈正相关(MNI坐标:-1, -37, -56,簇大小为20,相关系数为0.602)。

结论:脑干结构的局部体积增加可以解释药物过度使用性头痛患者上行及下行痛觉通路损伤的神经机制。左侧延脑头端腹内侧区体积的变化可以解释伤害性疼痛传入耐受性损伤,且可以用来评估药物过度使用性头痛患者头痛损伤程度。



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