High-frequency transcranial magnetic stimulation on motor cortex of patients affected by migraine with aura: a way to restore normal cortical excitability?
F Brighina
Dipartimento Universitario di Neuroscienze Cliniche, University of Palermo, and
Search for more papers by this authorA Palermo
Dipartimento Universitario di Neuroscienze Cliniche, University of Palermo, and
Search for more papers by this authorO Daniele
Dipartimento Universitario di Neuroscienze Cliniche, University of Palermo, and
Search for more papers by this authorA Aloisio
Dipartimento di Neuroscienze, Civic Hospital, Palermo, Italy
Search for more papers by this authorCorresponding Author
B Fierro
Dipartimento Universitario di Neuroscienze Cliniche, University of Palermo, and
Brigida Fierro MD, Department of Neurological Sciences, University of Palermo, via G. La Loggia, 1; 90129 Palermo, Italy. Tel. + 3909 16555105; fax + 3909 16555102, e-mail [email protected]Search for more papers by this authorF Brighina
Dipartimento Universitario di Neuroscienze Cliniche, University of Palermo, and
Search for more papers by this authorA Palermo
Dipartimento Universitario di Neuroscienze Cliniche, University of Palermo, and
Search for more papers by this authorO Daniele
Dipartimento Universitario di Neuroscienze Cliniche, University of Palermo, and
Search for more papers by this authorA Aloisio
Dipartimento di Neuroscienze, Civic Hospital, Palermo, Italy
Search for more papers by this authorCorresponding Author
B Fierro
Dipartimento Universitario di Neuroscienze Cliniche, University of Palermo, and
Brigida Fierro MD, Department of Neurological Sciences, University of Palermo, via G. La Loggia, 1; 90129 Palermo, Italy. Tel. + 3909 16555105; fax + 3909 16555102, e-mail [email protected]Search for more papers by this authorAbstract
We showed reduced motor intracortical inhibition (ICI) and paradoxical increase of intracortical facilitation (ICF) to 1 Hz repetitive transcranial magnetic stimulation (rTMS) in patients affected by migraine with aura (MA). In conditions of enhanced excitability due to a reduced inhibition, high-frequency rTMS was found to potentiate intracortical inhibition. Here we explored the conditioning effects of high-frequency priming stimulation of motor cortex with the aim of normalizing excitability reverting paradoxical facilitation by 1 Hz rTMS in MA. Nine patients with MA and nine healthy controls underwent a paired-pulse TMS paradigm to evaluate motor intracortical excitability (ICI and ICF) before and after the following rTMS conditions: 1 Hz alone or preceded by a real or sham conditioning high-frequency (10 Hz) rTMS. Sham was used to control for rTMS specificity. In baseline, ICI was significantly lower in migraineurs with respect to controls. One hertz stimulation reduced motor evoked potential amplitude and ICF in healthy controls, while it caused a significant paradoxical ICF increase in migraineurs. High-frequency rTMS conditioning normalized excitability in migraine, increasing short ICI and so reversing the paradoxical effects of 1 Hz rTMS. These findings raise the possibility that the interictal reduced intracortical inhibition in migraine could be normalized by high-frequency rTMS. This would open perspectives for new treatment strategies in migraine prevention.
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