Abstract
IntroductionConsiderable connections between migraine with aura and cortical spreading depression (CSD), a depolarization wave originating in the visual cortex and traveling toward the frontal lobe, lead to the hypothesis that CSD is underlying migraine aura. The highly individual and complex characteristics of the brain cortex suggest that the geometry might impact the propagation of cortical spreading depression.MethodsIn a single‐case study, we simulated the CSD propagation for five migraine with aura patients, matching their symptoms during a migraine attack to the CSD wavefront propagation. This CSD wavefront was simulated on a patient‐specific triangulated cortical mesh obtained from individual MRI imaging and personalized diffusivity tensors derived locally from diffusion tensor imaging data.ResultsThe CSD wave propagation was simulated on both hemispheres, despite in all but one patient the symptoms were attributable to one hemisphere. The CSD wave diffused with a large wavefront toward somatosensory and prefrontal regions, devoted to pain processing.DiscussionThis case‐control study suggests that the cortical geometry may contribute to the modality of CSD evolution and partly to clinical expression of aura symptoms. The simulated CSD is a large and diffuse phenomenon, possibly capable to activate trigeminal nociceptors and to involve cortical areas devoted to pain processing.
Highlights
Considerable connections between migraine with aura and cortical spreading depression (CSD), a depolarization wave originating in the visual cortex and traveling toward the frontal lobe, lead to the hypothesis that CSD is underlying migraine aura
The majority of migraine patients experience only visual scotoma, so several factors could potentially limit the progression of CSD wavefront, or reduce the possibility for cortical areas other than the visual one to become eloquent during the depolarization phenomenon
CSD propagation was studied by using a computational neuronal model distributed throughout a realistic cortical mesh, integrated with patient‐specific diffusivity tensors derived locally from diffusion tensor imaging (Kroos, Diez, Cortes, Stramaglia, & Gerardo‐Giorda, 2016; Kroos et al, 2017)
Summary
The 2016 Global Burden of Disease study (GBD, 2019) reports that among neurological disorders, migraine is the second highest cause of years lost due to disability worldwide. Functional and anatomical characteristics of cortical regions, especially in the oc‐ cipital area, could explain the facilitation of CSD progression and the associated symptoms perception in migraine with aura (Gaist, et al, 2018; de Tommaso et al, 2017;). In this multifaceted scenario, the complex and highly individual characteristics of the brain cor‐ tex suggest that the geometry might have a significant impact in supporting or contrasting the propagation of cortical spreading depression. These theory and single cases applications suggested that corti‐ cal geometry could explain some features of CSD propagation: In the present study, we aimed to apply this computational neuronal model to single cases of migraine with aura
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