Evidence of an increased neuronal activation-to-resting glucose uptake ratio in the visual cortex of migraine patients: a study comparing 18FDG-PET and visual evoked potentials

• Published in: Journal of headache and pain 2018-07, Vol.19 (1), p.1-9, Article 49
• Main Authors: Lisicki, Marco, D’Ostilio, Kevin, Coppola, Gianluca, Scholtes, Felix, Maertens de Noordhout, Alain, Parisi, Vincenzo, Schoenen, Jean, Magis, Delphine
• Format: Article
• Language: English
• Subjects: Astrocytes; Cerebral energy metabolism; Cortex (somatosensory); Epidemiology; Gene mapping; Glucose; Headache; Homeostasis; Human health sciences; Information processing; Internal Medicine; Medicine; Medicine & Public Health; Migraine; Nervous system; Neurologie; Neurology; Neurophysiology; Pain; Pain Medicine; Positron emission tomography; Research Article; Sciences de la santé humaine; Sensory integration; Visual cortex; Visual evoked potentials
• ISSN: 1129-2369; 1129-2377; 1129-2377
• DOI: 10.1186/s10194-018-0877-8

Background Migraine attacks might be triggered by a disruption of cerebral homeostasis. During the interictal period migraine patients are characterized by abnormal sensory information processing, but this functional abnormality may not be sufficient to disrupt the physiological equilibrium of the cortex unless it is accompanied by additional pathological mechanisms, like a reduction in energetic reserves. The aim of this study was to compare resting cerebral glucose uptake (using positron emission tomography ( 18 fluorodeoxyglucose-PET)), and visual cortex activation (using visual evoked potentials (VEP)), between episodic migraine without aura patients in the interictal period and healthy volunteers. Methods Twenty episodic migraine without aura patients and twenty healthy volunteers were studied. 18 FDG-PET and VEP recordings were performed on separate days. The overall glucose uptake in the visual cortex-to-VEP response ratio was calculated and compared between the groups. Additionally, PET scan comparisons adding area under the VEP curve as a covariate were performed. For case-wise analysis, eigenvalues from a specific region exhibiting significantly different FDG-PET signal in the visual cortex were extracted. Standardized glucose uptake values from this region and VEP values from each subject were then coupled and compared between the groups. Results The mean area under the curve of VEP was greater in migraine patients compared to healthy controls. In the same line, patients had an increased neuronal activation-to-resting glucose uptake ratio in the visual cortex. Statistical parametric mapping analysis revealed that cortical FDG-PET signal in relation to VEP area under the curve was significantly reduced in migraineurs in a cluster extending throughout the left visual cortex, from Brodmann’s areas 19 and 18 to area 7. Within this region, case-wise analyses showed that a visual neuronal activation exceeding glucose uptake was present in 90% of migraine patients, but in only 15% of healthy volunteers. Conclusion This study identifies an area of increased neuronal activation-to-resting glucose uptake ratio in the visual cortex of migraine patients between attacks. Such observation supports the concept that an activity-induced rupture of cerebral metabolic homeostasis may be a cornerstone of migraine pathophysiology. This article has been selected as the winner of the 2018 Enrico Greppi Award. The Enrico Greppi Award is made to an unpublished paper dea