Differences in short-term primary motor cortex synaptic potentiation as assessed by repetitive transcranial magnetic stimulation in migraine patients with and without aura

Conte, Antonella; Barbanti, Piero; Frasca, Vittorio; Iacovelli, Elisa; Gabriele, Maria; Giacomelli, Elena; Aurilia, Cinzia; Pichiorri, Floriana; Gilio, Francesca; Inghilleri, Maurizio

doi:10.1016/j.pain.2009.09.031

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Volume 148, Issue 1 , Pages 43-48, January 2010

Differences in short-term primary motor cortex synaptic potentiation as assessed by repetitive transcranial magnetic stimulation in migraine patients with and without aura

Antonella Conte
- Department of Neurological Sciences and Neuromed Institute, “Sapienza”, University of Rome, Rome, Italy
Piero Barbanti
- Headache and Pain Unit, Department of Neurological, Motor and Sensorial Sciences, IRCSS San Raffaele Pisana, Rome, Italy
Vittorio Frasca
- Department of Neurological Sciences, “Sapienza”, University of Rome, Rome, Italy
Elisa Iacovelli
- Department of Neurological Sciences, “Sapienza”, University of Rome, Rome, Italy
Maria Gabriele
- Department of Neurological Sciences, “Sapienza”, University of Rome, Rome, Italy
Elena Giacomelli
- Department of Neurological Sciences, “Sapienza”, University of Rome, Rome, Italy
Cinzia Aurilia
- Headache and Pain Unit, Department of Neurological, Motor and Sensorial Sciences, IRCSS San Raffaele Pisana, Rome, Italy
Floriana Pichiorri
- Department of Neurological Sciences, “Sapienza”, University of Rome, Rome, Italy
Francesca Gilio
- Neurology and Neurophysiopathology Unit, S. Pertini Hospital, Rome, Italy
Maurizio Inghilleri
- Headache and Pain Unit, Department of Neurological, Motor and Sensorial Sciences, IRCSS San Raffaele Pisana, Rome, Italy
- Department of Neurological Sciences, “Sapienza”, University of Rome, Rome, Italy
- Corresponding author. Address: Department of Neurological Sciences, University of Rome “La Sapienza”, Viale dell’Università, 30, I-00185 Rome, Italy. Tel.: +39 06 49914485; fax: +39 06 49914576.

Received 30 March 2009; received in revised form 18 July 2009; accepted 29 September 2009. published online 26 October 2009.

Abstract

To find out more about glutamatergic and gabaergic transmission in migraine, in this study we investigated glutamate-dependent short-term synaptic potentiation and GABA-dependent inhibitory cortical interneuron excitability as assessed by 5Hz-rTMS delivered over primary motor cortex (M1) (motor evoked potential, MEP, amplitude facilitation and cortical silent period, CSP, duration lengthening) in migraine patients with (MA) and without aura (MwoA) and healthy controls. We studied 37 patients with migraine (19 MA and 18 MwoA) and 19 healthy control subjects. 5Hz-rTMS was delivered at 120% resting motor threshold to the hand motor area of the left hemisphere with the target muscle at rest and during contraction. Three of the MA patients were also tested at the end of visual aura during a spontaneous migraine attack. ANOVA showed that the MEP significantly increased in size and CSP significantly lengthened during 5Hz-rTMS in the three groups tested. The 5Hz-rTMS-induced MEP facilitation differed significantly being highest in MA patients. In the three patients tested both ictally and interictally the MEP increased during the interictal session but remained unchanged when the visual aura ended. Our study shows that the neurophysiological feature that differentiates MA patients from MwoA patients and healthy controls is an abnormal M1 susceptibility to 5Hz-rTMS both outside and during the attack suggesting that glutamate-dependent short-term M1 cortical potentiation patterns differ in migraine with and without aura.