Migraine |
Cortical spreading depression (CSD) or spreading depolarization (SD) is a wave of electrophysiological hyperactivity followed by a wave of inhibition. [1] Spreading depolarization describes a phenomenon characterized by the appearance of depolarization waves of the neurons and neuroglia [2] that propagates across the cortex at a velocity of 1.5–9.5 mm/min. [3] [4] [5] [6]
CSD can be induced by hypoxic conditions and facilitates neuronal death in energy-compromised tissue. [7] CSD has also been implicated in migraine aura, where CSD is assumed to ascend in well-nourished tissue and is typically benign in most cases, although it may increase the probability in migraine patients to develop a stroke. [8]
Spreading depolarization within brainstem tissues regulating functions crucial for life has been implicated in sudden unexpected death in epilepsy, by way of ion channel mutations such as those seen in Dravet syndrome, a particularly severe form of childhood epilepsy that appears to carry an unusually high risk of SUDEP (sudden unexpected death in epilepsy).
Although the terms cortical spreading depression and spreading depolarization are often used as synonyms, a study found spreading depolarizations can produce variable effects on cortical activity in humans and rats, ranging from depressed to booming activity depending on SD depth. [9]
Neuroscientists use the term cortical spreading depression to represent at least one of the following cortical processes:[ citation needed ]
The scintillating scotoma of migraine in humans may be related to the neurophysiologic phenomenon termed the spreading depression of Leão. [11]
Increased extracellular potassium ion concentration and excitatory glutamate contribute to the initiation and propagation of cortical spreading depression, which is the underlying cause of migraine aura. [12]
Chronic daily administration of migraine prophylactic drugs (topiramate, valproate, propranolol, amitriptyline, and methysergide) dose-dependently suppressed frequency of CSD induced by continuous cortical application of 1 M KCl solution. [13] However lamotrigine (a drug with specific anti-aura action, but no efficacy in migraine in general) has a marked suppressive effect which correlates with its rather selective action on the migraine aura. Valproate and riboflavin were shown to have no effect on the triggering of cortical spreading depression though they are effective in migraine without aura. [14] Taken together, these results are compatible with a causal role of cortical spreading depression in migraine with aura, but not in migraine without aura.[ citation needed ]
The folded structure of the cerebral cortex is capable of irregular and complex CSD propagation patterns. The irregularities of the folded cortex and the vasculature promote the presence of re-entrance waves, such as spirals and reverberating waves. [5] The expansion of the wave then is less predictable and it is affected by the concentration of different molecules and gradients on the cortex.[ citation needed ]
Its triggers and propagation mechanisms, as well as clinical manifestations of CSD, are a therapeutic target to reduce brain damage after a stroke or brain lesion. [15] [16] [17]
Migraine is a genetically influenced complex neurological disorder characterized by episodes of moderate-to-severe headache, most often unilateral and generally associated with nausea and light and sound sensitivity. Other characterizing symptoms may include nausea, vomiting, cognitive dysfunction, allodynia, and dizziness. Exacerbation of headache symptoms during physical activity is another distinguishing feature. Up to one-third of migraine sufferers experience aura, a premonitory period of sensory disturbance widely accepted to be caused by cortical spreading depression at the onset of a migraine attack. Although primarily considered to be a headache disorder, migraine is highly heterogenous in its clinical presentation and is better thought of as a spectrum disease rather than a distinct clinical entity. Disease burden can range from episodic discrete attacks, consisting of as little as several lifetime attacks, to chronic disease.
The cerebral cortex, also known as the cerebral mantle, is the outer layer of neural tissue of the cerebrum of the brain in humans and other mammals. It is the largest site of neural integration in the central nervous system. and plays a key role in attention, perception, awareness, thought, memory, language, and consciousness. The cerebral cortex is the part of the brain responsible for cognition.
Transcranial magnetic stimulation (TMS) is a noninvasive form of brain stimulation in which a changing magnetic field is used to induce an electric current at a specific area of the brain through electromagnetic induction. An electric pulse generator, or stimulator, is connected to a magnetic coil connected to the scalp. The stimulator generates a changing electric current within the coil which creates a varying magnetic field, inducing a current within a region in the brain itself.
Alice in Wonderland syndrome (AIWS), also known as Todd's syndrome or dysmetropsia, is a neurological disorder that distorts perception. People with this syndrome may experience distortions in their visual perception of objects, such as appearing smaller (micropsia) or larger (macropsia), or appearing to be closer (pelopsia) or farther (teleopsia) than they are. Distortion may also occur for senses other than vision.
The neocortex, also called the neopallium, isocortex, or the six-layered cortex, is a set of layers of the mammalian cerebral cortex involved in higher-order brain functions such as sensory perception, cognition, generation of motor commands, spatial reasoning and language. The neocortex is further subdivided into the true isocortex and the proisocortex.
Visual snow syndrome (VSS) is an uncommon neurological condition in which the primary symptom is that affected individuals see persistent flickering white, black, transparent, or coloured dots across the whole visual field.
A cortical column is a group of neurons forming a cylindrical structure through the cerebral cortex of the brain perpendicular to the cortical surface. The structure was first identified by Mountcastle in 1957. He later identified minicolumns as the basic units of the neocortex which were arranged into columns. Each contains the same types of neurons, connectivity, and firing properties. Columns are also called hypercolumn, macrocolumn, functional column or sometimes cortical module. Neurons within a minicolumn (microcolumn) encode similar features, whereas a hypercolumn "denotes a unit containing a full set of values for any given set of receptive field parameters". A cortical module is defined as either synonymous with a hypercolumn (Mountcastle) or as a tissue block of multiple overlapping hypercolumns.
In neuroanatomy, a gyrus is a ridge on the cerebral cortex. It is generally surrounded by one or more sulci. Gyri and sulci create the folded appearance of the brain in humans and other mammals.
An aura is a perceptual disturbance experienced by some with epilepsy or migraine. An epileptic aura is a seizure.
Familial hemiplegic migraine (FHM) is an autosomal dominant type of hemiplegic migraine that typically includes weakness of half the body which can last for hours, days, or weeks. It can be accompanied by other symptoms, such as ataxia, coma, and paralysis. Migraine attacks may be provoked by minor head trauma. Some cases of minor head trauma in patients with hemiplegic migraine can develop into delayed cerebral edema, a life-threatening medical emergency. Clinical overlap occurs in some FHM patients with episodic ataxia type 2 and spinocerebellar ataxia type 6, benign familial infantile epilepsy, and alternating hemiplegia of childhood.
Aristides Azevedo Pacheco Leão was a Brazilian neurophysiologist, researcher and university professor.
Scintillating scotoma is a common visual aura that was first described by 19th-century physician Hubert Airy (1838–1903). Originating from the brain, it may precede a migraine headache, but can also occur acephalgically, also known as visual migraine or migraine aura. It is often confused with retinal migraine, which originates in the eyeball or socket.
Martinotti cells are small multipolar neurons with short branching dendrites. They are scattered throughout various layers of the cerebral cortex, sending their axons up to the cortical layer I where they form axonal arborization. The arbors transgress multiple columns in layer VI and make contacts with the distal tuft dendrites of pyramidal cells. Martinotti cells express somatostatin and sometimes calbindin, but not parvalbumin or vasoactive intestinal peptide. Furthermore, Martinotti cells in layer V have been shown to express the nicotinic acetylcholine receptor α2 subunit (Chrna2).
Recurrent thalamo-cortical resonance or Thalamocortical oscillation is an observed phenomenon of oscillatory neural activity between the thalamus and various cortical regions of the brain. It is proposed by Rodolfo Llinas and others as a theory for the integration of sensory information into the whole of perception in the brain. Thalamocortical oscillation is proposed to be a mechanism of synchronization between different cortical regions of the brain, a process known as temporal binding. This is possible through the existence of thalamocortical networks, groupings of thalamic and cortical cells that exhibit oscillatory properties.
Spike-and-wave is a pattern of the electroencephalogram (EEG) typically observed during epileptic seizures. A spike-and-wave discharge is a regular, symmetrical, generalized EEG pattern seen particularly during absence epilepsy, also known as ‘petit mal’ epilepsy. The basic mechanisms underlying these patterns are complex and involve part of the cerebral cortex, the thalamocortical network, and intrinsic neuronal mechanisms.
Retinal migraine is a retinal disease often accompanied by migraine headache and typically affects only one eye. It is caused by ischaemia or vascular spasm in or behind the affected eye.
The trigeminovascular system (TVS) refers to neurons and their axonal projections within the trigeminal nerve that project to the cranial meninges and meningeal blood vessels residing on the brain's surface. The term, introduced in 1983 denotes also the neuropeptides contained within axons that are released into the meninges to target vessels and surrounding cells.
Illusory palinopsia is a subtype of palinopsia, a visual disturbance defined as the persistence or recurrence of a visual image after the stimulus has been removed. Palinopsia is a broad term describing a heterogeneous group of symptoms, which is divided into hallucinatory palinopsia and illusory palinopsia. Illusory palinopsia is likely due to sustained awareness of a stimulus and is similar to a visual illusion: the distorted perception of a real external stimulus.
A migrainous infarction is a rare type of ischaemic stroke which occurs in correspondence with migraine aura symptoms. Symptoms include headaches, visual disturbances, strange sensations and dysphasia, all of which gradually worsen causing neurological changes which ultimately increase the risk of an ischaemic stroke. Typically, women under the age of 45 who experience migraine with aura (MA) are at the greatest risk for developing migrainous infarction, especially when combined with smoking and use of oral contraceptives.
Martin Johannes Lauritzen is a Danish neuroscientist. He is a Professor of Translational Neurobiology at the Department of Neuroscience, University of Copenhagen, Denmark and also a Professor of Clinical Neurophysiology at the Department of Neurophysiology, Rigshospitalet.
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