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      Altered structure of the vestibular cortex in patients with vestibular migraine

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          Abstract

          Introduction

          Previous voxel‐based morphometry (VBM) studies have revealed changes in brain structure in patients with vestibular migraine (VM); these findings have improved the present understanding of pathophysiology. Few other studies have assessed the association between structural changes and the severity of dizziness in VM. This study aimed to examine the structural changes and cortical morphometric features associated with migraine and vertigo attacks in patients with VM.

          Methods

          Twenty patients with VM and 20 healthy normal volunteers were scanned on a 3‐tesla MRI scanner. The gray matter volume (GMV) was estimated using the automated Computational Anatomy Toolbox (CAT12). The relationship between clinical parameters and morphometric abnormalities was also analyzed in VM.

          Results

          Compared with controls, VM patients have decreased GMV in the prefrontal cortex (PFC), posterior insula–operculum regions, inferior parietal gyrus, and supramarginal gyrus. Moreover, patient scores on the Dizziness Handicap Inventory (DHI) score showed a negative correlation with GMV in the posterior insula–operculum regions.

          Conclusion

          These findings demonstrated abnormality in the central vestibular cortex and correlations between dizziness severity and GMV in core regions of the vestibular cortex of VM patients, suggesting a pathophysiological role of these core vestibular regions in VM patients.

          Abstract

          This study employs computational anatomy toolbox (CAT12) to assess the patterns of regional gray matter volumetric (GMV) abnormalities in patients with vestibular migraine (VM). Our results demonstrated that structural multiple vestibular cortex deficits in VM patients, especially abnormalities in posterior insula–operculum region of vestibular cortical core region, suggesting that these areas were involved in the pathophysiological of VM.

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          Most cited references54

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          The International Classification of Headache Disorders, 3rd edition (beta version).

          (2013)
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            Vestibular migraine: diagnostic criteria.

            This paper presents diagnostic criteria for vestibular migraine, jointly formulated by the Committee for Classification of Vestibular Disorders of the Bárány Society and the Migraine Classification Subcommittee of the International Headache Society (IHS). The classification includes vestibular migraine and probable vestibular migraine. Vestibular migraine will appear in an appendix of the third edition of the International Classification of Headache Disorders (ICHD) as a first step for new entities, in accordance with the usual IHS procedures. Probable vestibular migraine may be included in a later version of the ICHD, when further evidence has been accumulated. The diagnosis of vestibular migraine is based on recurrent vestibular symptoms, a history of migraine, a temporal association between vestibular symptoms and migraine symptoms and exclusion of other causes of vestibular symptoms. Symptoms that qualify for a diagnosis of vestibular migraine include various types of vertigo as well as head motion-induced dizziness with nausea. Symptoms must be of moderate or severe intensity. Duration of acute episodes is limited to a window of between 5 minutes and 72 hours.
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              Towards a theory of chronic pain.

              In this review, we integrate recent human and animal studies from the viewpoint of chronic pain. First, we briefly review the impact of chronic pain on society and address current pitfalls of its definition and clinical management. Second, we examine pain mechanisms via nociceptive information transmission cephalad and its impact and interaction with the cortex. Third, we present recent discoveries on the active role of the cortex in chronic pain, with findings indicating that the human cortex continuously reorganizes as it lives in chronic pain. We also introduce data emphasizing that distinct chronic pain conditions impact on the cortex in unique patterns. Fourth, animal studies regarding nociceptive transmission, recent evidence for supraspinal reorganization during pain, the necessity of descending modulation for maintenance of neuropathic behavior, and the impact of cortical manipulations on neuropathic pain is also reviewed. We further expound on the notion that chronic pain can be reformulated within the context of learning and memory, and demonstrate the relevance of the idea in the design of novel pharmacotherapies. Lastly, we integrate the human and animal data into a unified working model outlining the mechanism by which acute pain transitions into a chronic state. It incorporates knowledge of underlying brain structures and their reorganization, and also includes specific variations as a function of pain persistence and injury type, thereby providing mechanistic descriptions of several unique chronic pain conditions within a single model.
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                Author and article information

                Contributors
                leixiaoyan1971@163.com
                zxl822@163.com
                Journal
                Brain Behav
                Brain Behav
                10.1002/(ISSN)2157-9032
                BRB3
                Brain and Behavior
                John Wiley and Sons Inc. (Hoboken )
                2162-3279
                10 March 2020
                April 2020
                : 10
                : 4 ( doiID: 10.1002/brb3.v10.4 )
                : e01572
                Affiliations
                [ 1 ] Department of MRI Diagnosis Shaanxi Provincial People's Hospital Xi'an China
                [ 2 ] Department of Neurology Shaanxi Provincial People's Hospital Xi'an China
                [ 3 ] Philips Healthcare Shanghai China
                Author notes
                [*] [* ] Correspondence

                Xiaoyan Lei and Xiaoling Zhang, Department of MRI Diagnosis, Shaanxi Provincial People's Hospital, No. 256 Youyi West Road, Xi'an, Shaanxi 710068, China.

                Email: leixiaoyan1971@ 123456163.com (X. L.); zxl822@ 123456163.com (X. Z.)

                Author information
                https://orcid.org/0000-0003-4946-1302
                https://orcid.org/0000-0001-9633-8521
                Article
                BRB31572
                10.1002/brb3.1572
                7177586
                32157823
                1f4ef22e-004a-44f5-a552-e8946d2bfa42
                © 2020 The Authors. Brain and Behavior published by Wiley Periodicals, Inc.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 August 2019
                : 27 January 2020
                : 30 January 2020
                Page count
                Figures: 2, Tables: 2, Pages: 8, Words: 6385
                Funding
                Funded by: Shaanxi Provincial Science and Technology Development Funds
                Award ID: 2017‐032
                Categories
                Original Research
                Original Research
                Custom metadata
                2.0
                April 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.1 mode:remove_FC converted:23.04.2020

                Neurosciences
                gray matter volume,migraine,vertigo,vestibular cortex,vestibular migraine,voxel‐based morphometry

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