Functional connectivity changes in complex migraine aura: beyond the visual network. (3rd September 2021)

• Record Type: Journal Article
• Authors: Silvestro, Marcello; Tessitore, Alessandro; Di Nardo, Federica; Scotto di Clemente, Fabrizio; Trojsi, Francesca; Cirillo, Mario; Esposito, Fabrizio; Tedeschi, Gioacchino; Russo, Antonio
• Is Part Of: European journal of neurology. Volume 29:Number 1(2022)
• Page Start: 295
• Page End: 304
• Publication Date: 2021-09-03
• Subjects: complex aura -- insula -- lingual gyrus -- migraine with aura -- sensorimotor network -- visual network; Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/ene.15061
• Languages: English
• ISSNs: 1351-5101

Abstract

Abstract: Background and purpose: Although the majority of migraine with aura (MwA) patients experience simple visual aura, a discrete percentage also report somatosensory, dysphasic or motor symptoms (the so‐called complex auras). The wide aura clinical spectrum led to an investigation of whether the heterogeneity of the aura phenomenon could be produced by different neural correlates, suggesting an increased visual cortical excitability in complex MwA. The aim was to explore whether complex MwA patients are characterized by more pronounced connectivity changes of the visual network and whether functional abnormalities may extend beyond the visual network encompassing also the sensorimotor network in complex MwA patients compared to simple visual MwA patients. Methods: By using a resting‐state functional magnetic resonance imaging approach, the resting‐state functional connectivity (RS‐Fc) of both visual and sensorimotor networks in 20 complex MwA patients was compared with 20 simple visual MwA patients and 20 migraine without aura patients. Results: Complex MwA patients showed a significantly higher RS‐Fc of the left lingual gyrus, within the visual network, and of the right anterior insula, within the sensorimotor network, compared to both simple visual MwA and migraine without aura patients ( p < 0.001). The abnormal right anterior insula RS‐Fc was able to discriminate complex MwA patients from simple aura MwA patients as demonstrated by logistic regression analysis (area under the curve 0.83). Conclusion: Our findings suggest that higher extrastriate RS‐Fc might promote cortical spreading depression onset representing the neural correlate of simple visual aura that can propagate to sensorimotor regions if an increased insula RS‐Fc coexists, leading to complex aura phenotypes. Abstract : (i) Hyper‐connected cortical areas encompassing visual and somatosensory networks in migraine with aura patients compared to migraine without aura patients may represent the breeding ground for cortical spreading depression wave ignition and propagation. (ii) Higher resting‐state functional connectivity of the visual network might promote cortical spreading depression initiation representing the neural correlate of simple visual aura that, if an increased insula resting‐state functional connectivity coexists, will be able to propagate to sensorimotor regions leading to complex migraine aura. (iii) The abnormal resting‐state functional connectivity of visual and sensorimotor networks could represent diagnostic biomarkers able to discriminate complex aura phenotypes.