Ryotaro Takashima

Monitoring cortical hemodynamic changes after sumatriptan injection during migraine attack by near-infrared spectroscopy

The aim of the present study is to provide effective tools for monitoring hemodynamic changes in the cortical and scalp surface during migraine attack and treatment. Using near-infrared spectroscopy system (NIRS) and laser Doppler skin blood flow (SkBF) devices in combination, we monitored changes in extra- and intra-cranial vasculature states upon sumatriptan injection during spontaneous migraine attack. We examined 4 control subjects and 4 migraine patients. Multi-channel NIRS probes were placed over the temporoparietal area bilaterally and oxygenated hemoglobin (oxy-Hb) was analyzed. Laser Doppler SkBF was simultaneously recorded to measure scalp surface blood flow changes. All patients were treated with a sumatriptan injection (3 mg), and all control subjects received a saline injection as a control for oxy-Hb/SkBF signals caused by injection pain over the monitoring period. There was a marked reduction of oxy-Hb/SkBF in all patients after sumatriptan injection, consistent with pain relief. Moreover, the changes in oxy-Hb/SkBF were significantly correlated. By contrast, saline injection did not cause any significant changes. These data suggest that sumatriptan induces blood vessel contraction at both cortical and scalp surfaces. Simultaneous oxy-Hb/SkBF recording enables real-time continuous monitoring of the effects of sumatriptan treatment in clinical situations.

Dream-enacting behaviour is associated with impaired sleep and severe headache-related disability in migraine patients.

Background Sleep disorders, nightmares and visual hallucinations have been reported in migraine patients, which may suggest the involvement of rapid eye movement (REM) sleep regulation in migraine. However, the relationship between migraine and REM sleep behaviour disorder (RBD) remains unclear. Methods To investigate the clinical correlates of dream-enacting behaviours (DEB) in migraine patients, we assessed episodic migraine patients (n = 161, mean age 33.1 years) and headache-free control subjects (n = 140, mean age 33.1 years) under 50 years of age in a cross-sectional, case-control study. The Japanese version of the RBD screening questionnaire was used, and subjects scoring 5 or higher were defined as having DEB. Results A significantly increased frequency of DEB was observed in migraine patients compared to controls (24.2% vs. 14.3%). Migraine patients with DEB presented higher scores on the Migraine Disability Assessment and Pittsburgh Sleep Quality Index and an increased rate of smoking compared to those without DEB. Duration of migraine and headache frequency and intensity were not different between migraine patients with or without DEB. Conclusion DEB was associated with impaired sleep and severe headache-related disability in migraine patients and may reflect brainstem dysfunction and increased brain excitability in migraine patients.

Does Pramipexole Treatment Improve Headache in Patients with Concomitant Migraine and Restless Legs Syndrome

Background Recent studies have suggested a strong link between migraines and restless legs syndrome (RLS). It is possible that these disorders share a dopaminergic dysfunction in the hypothalamic A11 nucleus that contributes to this association. However, there have been no clinical studies to evaluate the effect of dopaminergic treatment on migraine symptoms in patients with concomitant migraines and RLS. Methods We present an illustrative patient with concomitant RLS and migraine who showed improvement in her headache frequency and RLS symptoms following immediate-release pramipexole (P-IR) treatment and provide review results from the medical records of patients who experienced both migraines and RLS in our previous cross-sectional study. Results Ten patients (nine patients from the previously completed single-center study) received P-IR treatment were included in the study. RLS symptoms improved markedly in all of the subjects. Five out of the 10 patients (50%) reported improvement in migraine headaches. Of these five patients, four (80%) had reported morning headaches before P-IR treatment. Discussion Our results indicate that the identification of RLS in migraine patients is clinically significant and that dopaminergic treatment may improve both migraines, particularly morning headache (80% improvement in this study), and RLS symptoms. However, further clinical studies are warranted to verify our results.

Evaluation of the word fluency in parkinson's disease patients treated with deep brain stimulation-a pilot study-

Parkinsons disease is a chronic, progressive and common disease of neurological disorders. Motor complication in parkinsons disease (PD) is resting tremor, slow movement, rigidity and postural instability. The motor symptoms of PD respond well to bilateral deep brain stimulation (DBS). Recent study, there are also reports of worsened verbal fluency, executive dysfunction, and processing speed with DBS. Whether subthalamic nuclei (STN) stimulation worsens there are under debate. The aim of this study was to explore the effects of STN stimulation verbal fluency as assessed with clinical neuropsychological tests. Eight patients treated with deep brain stimulation were enrolled, and some of the patients continued anti-PD medications. Assessments were done both with the STN stimulation turned OFF and ON. In both test conditions, the following were assessed: speech , word fluency A, and B. The score of the word fluency test of all patients have undergone DBS surgery significantly worsened as compared with before surgery. Five patients speech ware worsened, but three patients were improved when the STN stimulation was turned OFF. On the other hand, five patients were reduced the word fluencys total score when the STN stimulation was turned OFF. In this sample, STN stimulation significantly worsened the result of the word fluency test. When the STN stimulation was turned OFF, it was reduced. These finding suggests that STN-DBS might be worse speech conditions and verbal fluency.

The relationship between right-to-left shunt and brain white matter lesions in Japanese patients with migraine: a single center study

BackgroundThere may be a link between right-to-left shunt (RLs) and brain white matter lesions (WMLs) in patients with migraine. In this study, we assessed the relationship between WMLs and RLs in Japanese migraine patients.MethodsA total of 107 consecutive patients with migraine with (MA) and without aura (MWOA) were included in this study. Contrast transcranial Doppler ultrasound was used to detect RLs. WMLs were graded using brain magnetic resonance imaging based on well-established criteria.FindingsThe prevalence of RLs was significantly increased in the WMLs positive group (n = 24) compared with the WMLs negative group (n = 83) (75.0% vs. 47.0%, p = 0.015). In prevalence of WMLs between MA and MWOA patients, there were no statistical differences (p = 0.410). Logistic regression analysis adjusted by age and disease duration of migraine identified an RLs-positive status as the sole determinant for the presence of WMLs (OR = 6.15; 95% CI 1.82–20.8; p = 0.003)ConclusionOur study suggests a possible link between RLs and WMLs in Japanese patients with migraine.

Topographic Analysis of Electroencephalographic Changes during Photic Driving Responses in Patients with Migraine

Objective: Migraineurs demonstrate abnormal information processing such as photic hypersensitivity. The photic driving response to photic stimulation (PS) is a reaction to the visual stimulation of electroencephalography (EEG). Both the photic driving response and photic hypersensitivity appear during light stimulation. We considered that evaluation of a migraineurs photic driving response may help to elucidate the mechanism of the migraineurs sensitive condition. Our study aimed to investigate EEG photic driving responses with a source-localizing method. Methods: We recorded spontaneous resting EEG with eyes closed from 20 electrodes on the scalp during the interictal phase. After recording, each PS was separately selected. We also analyzed EEG by fast Fourier transform and observed the spectrum frequency peaks and topographies in response to PS. Results: The photic driving response could be observed at a flashing rate of >15 Hz. Patients with photic hypersensitivity tended to show more photic driving regardless of the migraine subtype. Moreover, in topographies, their activated areas were shifted anteriorly from fundamental driving to harmonic driving for each photic frequency. This anterior shift was more evident with a longer duration of illness, although no significant differences were seen between migraine subtypes. The global field power value had a positive correlation with the duration of illness. Conclusion: Photic hypersensitivity and photic driving responses were increased in migraineurs. Photic hypersensitivity might result in sensitization of the limbic system.

Clinical and genetic features of Charcot-Marie-Tooth disease 2F and hereditary motor neuropathy 2B in Japan: Tanabe et al

Mutations in small heat shock protein beta‐1 (HspB1) have been linked to Charcot‐Marie‐Tooth (CMT) disease type 2F and distal hereditary motor neuropathy type 2B. Only four cases with HSPB1 mutations have been reported to date in Japan. In this study between April 2007 and October 2014, we conducted gene panel sequencing in a case series of 1,030 patients with inherited peripheral neuropathies (IPNs) using DNA microarray, targeted resequencing, and whole‐exome sequencing. We identified HSPB1 variants in 1.3% (13 of 1,030) of the patients with IPNs, who exhibited a male predominance. Based on neurological and electrophysiological findings, seven patients were diagnosed with CMT disease type 2F, whereas the remaining six patients were diagnosed with distal hereditary motor neuropathy type 2B. P39L, R127W, S135C, R140G, K141Q, T151I, and P182A mutations identified in 12 patients were described previously, whereas a novel K123* variant with unknown significance was found in 1 patient. Diabetes and impaired glucose tolerance were detected in 6 of the 13 patients. Our findings suggest that HSPB1 mutations result in two phenotypes of inherited neuropathies and extend the phenotypic spectrum of HSPB1‐related disorders.

The photic driving response in electroencephalogram in migraine patients

It is well known that the migraine patients indicate abnormal information processing such as photic supersensitivity. And it is high incidence and an aggravation factor of migraine attack. In addition, it is included in the diagnostic criteria of ICHD-II. However, the underlining mechanism is still open for discussion. Our study aimed to investigate the photic driving responses of the electroencephalogram (EEG) with source localizing method. We recorded spontaneous eyes-closed resting EEG from 20 electrodes on the scalp during their inter-ictal phase. Stroboscope flashes consisting of 3-5-8-10-13-15-18-20 Hz were used. After recording, each photic stimulation was selected respectively. And we examined the relation between clinical backgrounds and the prophylaxis. In addition, we analyzed EEG by FFT and observed the frequency peaks and its topographies responded for photic stimulation. The photic driving response could be observed in higher flashing rate than 15 Hz in addition to lower flashing rate. And the case as having photic supersensitivity tended to show a lot of photic driving regardless of migraine subtypes. Moreover, in topographies, their activated areas were shifted anterior from fundamental driving to harmonic driving for each photic frequency. This anterior shift was more evident for longer duration of illness, although no significant differences between subgroups. And the global field power (GFP) value had a positive correlation between the duration of the illness. We conclude that high incidences of photic hypersensitivity and photic driving response in migraineurs were confirmed. The underlying mechanism of photic hypersensitivity might result in sensitization of limbic system.

51. Evaluation of cognitive function in migraine patients – A study using sLORETA

The aim of this study is to clarify the neurophysiological mechanism of cognitive impairments in migraine patients. We evaluated the relationships between event-related potentials (ERPs) and clinical parameters. Thirty-one migraine patients diagnosed by ICHD-II were submitted for this study. They were enrolled in headache-free periods. Clinical subtype (with/without aura), severity, duration, and preventative medicine use were evaluated as clinical parameters. We used 2 tones counting oddball paradigm to elicit P3 activities. EEG was recorded from 20 electrodes on the scalp according to international 10/20 system. We assessed the distribution of generator activity in the cortex by standardized low-resolution brain electromagnetic tomography (sLORETA). Regression analyzes of these clinical parameters and ERP source activities for the entire time frame was computed using sLORETA. sLORETA revealed a significant negative correlation in both attack frequency per a month and preventative medicine use in the cingulate gyrus and superior frontal gyrus 280 ms after the onset of target stimuli. Therefore, migraine patients might have impairment of cognitive function, such as executive dysfunction. The dysfunction is reflected by the attenuated activity of the frontal gyrus in sLORETA.

Evaluation of cognitive function in migraine patients-a study using event-related potential

It is known that cognitive impairments can be observed in some patients with migraine. To clarify the neurophysiological mechanism of cognitive impairments in migraine patients, we evaluated the relationships between event-related potentials (ERPs) and various behavioral data such as performance, subtype, severity, duration, and usage of preventive medicine. Thirty one patients suffering from migraine without and with aura were enrolled in headache-free periods. Severity of the headache was assessed by headache impact test-6(HIT-6). Two tones counting auditory oddball paradigm was used for the ERPs. EEG was recorded from 20 channels on the scalp and recomputed global field power (GFP) from the all channel. We assessed counting performance and the P3 GFP peak amplitude and latency. Forty four percent of patients (n=15) were classified into the good performance group. There were no differences in age, usage of prophylactic drug, the presence or absence of aura, score of HIT-6, and P3 parameters between the good and poor performance groups. The group of long duration showed decreased P3 GFP peak amplitude and HIT-6 score. The group with preventive treatment significantly had more attacks of the month than the non-medication group. In addition, this group showed prolonged P3 GFP peak latency and decreased P3 GFP peak amplitude. These findings suggest that ERPs abnormalities may reflect abnormal information-processing for the attention preceding target recognition in migraine patients regarding with preventive treatment.