Exploring Cortical Muscle Representations in Patients With Migraine using TMS – A Preliminary Study
Poster No:
2113
Submission Type:
Abstract Submission
Authors:
Olivia Gerrard1, Severin Schramm1, Corinna Börner-Schröder1,2,3, Miriam Reichert1, Matthias Toth1, Gabriel Eberle1, Silas Preis1, Tobias Jost1, Claus Zimmer1, Bernhard Meyer4, Florian Heinen2,3, Michaela Bonfert2,3, Nico Sollmann1,5
Institutions:
1Dep. of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany, 2LMU Center for Children with Medical Complexity, iSPZ Hauner, Ludwig Maximilian University, Munich, Germany, 3LMU Hospital, Dr. von Hauner Children`s Hospital, Dep. of Pediatric Neurology and Development Medicine, Munich, Germany, 4Dep. of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany, 5Dep. of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
First Author:
Olivia Gerrard
Dep. of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich
Munich, Germany
Dep. of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich
Munich, Germany
Co-Author(s):
Severin Schramm, Dr. med. sci
Dep. of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich
Munich, Germany
Dep. of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich
Munich, Germany
Corinna Börner-Schröder
Dep. of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich|LMU Center for Children with Medical Complexity, iSPZ Hauner, Ludwig Maximilian University|LMU Hospital, Dr. von Hauner Children`s Hospital, Dep. of Pediatric Neurology and Development Medicine
Munich, Germany|Munich, Germany|Munich, Germany
Dep. of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich|LMU Center for Children with Medical Complexity, iSPZ Hauner, Ludwig Maximilian University|LMU Hospital, Dr. von Hauner Children`s Hospital, Dep. of Pediatric Neurology and Development Medicine
Munich, Germany|Munich, Germany|Munich, Germany
Miriam Reichert
Dep. of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich
Munich, Germany
Dep. of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich
Munich, Germany
Matthias Toth
Dep. of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich
Munich, Germany
Dep. of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich
Munich, Germany
Gabriel Eberle
Dep. of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich
Munich, Germany
Dep. of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich
Munich, Germany
Silas Preis
Dep. of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich
Munich, Germany
Dep. of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich
Munich, Germany
Tobias Jost
Dep. of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich
Munich, Germany
Dep. of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich
Munich, Germany
Claus Zimmer, Prof. Dr.
Dep. of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich
Munich, Germany
Dep. of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich
Munich, Germany
Bernhard Meyer, Prof. Dr.
Dep. of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich
Munich, Germany
Dep. of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich
Munich, Germany
Florian Heinen, Prof. Dr.
LMU Center for Children with Medical Complexity, iSPZ Hauner, Ludwig Maximilian University|LMU Hospital, Dr. von Hauner Children`s Hospital, Dep. of Pediatric Neurology and Development Medicine
Munich, Germany|Munich, Germany
LMU Center for Children with Medical Complexity, iSPZ Hauner, Ludwig Maximilian University|LMU Hospital, Dr. von Hauner Children`s Hospital, Dep. of Pediatric Neurology and Development Medicine
Munich, Germany|Munich, Germany
Michaela Bonfert, Dr. med
LMU Center for Children with Medical Complexity, iSPZ Hauner, Ludwig Maximilian University|LMU Hospital, Dr. von Hauner Children`s Hospital, Dep. of Pediatric Neurology and Development Medicine
Munich, Germany|Munich, Germany
LMU Center for Children with Medical Complexity, iSPZ Hauner, Ludwig Maximilian University|LMU Hospital, Dr. von Hauner Children`s Hospital, Dep. of Pediatric Neurology and Development Medicine
Munich, Germany|Munich, Germany
Nico Sollmann, PD Dr. Dr. med
Dep. of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich|Dep. of Diagnostic and Interventional Radiology, University Hospital Ulm
Munich, Germany|Ulm, Germany
Dep. of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich|Dep. of Diagnostic and Interventional Radiology, University Hospital Ulm
Munich, Germany|Ulm, Germany
Introduction:
Migraine (MIG) remains one of the leading causes of worldwide disability, resulting in 45.1 million years lived with disability at a global prevalence of twelve percent [1, 2]. Convergent multimodal evidence points towards cortical hyperexcitability as one aspect of MIG pathophysiology [3, 4]. Additionally, recent evidence suggests a link between cervical neuromuscular afferences and MIG pathophysiology, potentially mediated at the level of the trigemino-cervical complex (TCC) [4-7]. In this context, the current preliminary study employed a transcranial magnetic stimulation (TMS) paradigm to investigate cortical motor representations of the trapezius muscles in MIG patients and healthy controls (HC), given its innervation profile (C1-C3) and role within the TCC.
Methods:
We prospectively recruited 12 MIG patients, who were matched with HC based on the criteria of body mass index (BMI), age, and sex. Neuronavigated TMS (nTMS) and electromyography (EMG) were used to create cortical motor representation maps via motor evoked potentials (MEPs) of the medial (TrM) and lateral (TrL) trapezius muscles on both hemispheres, with all MIG patients being investigated during inter-ictal intervals. The EMG recordings from the biceps brachii (BI) were simultaneously acquired as a control muscle. After motor hotspot determination and identification of optimal e-field orientation, the resting motor threshold (rMT) was determined for either TrM or TrL. Subsequently, cortical motor representations of the TrM and TrL were mapped using an intensity of 105% rMT. The stimulation intensities and MEP amplitudes were extracted for comparisons between MIG and HC groups.
Results:
Mean age for both groups was 26±3 years, with a sex distribution of 11 females and 1 male per group. The rMT did not significantly differ between both groups (p>0.05). After Bonferroni correction, TrM and BI demonstrated significantly higher MEP amplitudes spread over the primary motor cortex (M1), supplementary motor area (SMA), and premotor cortex (PrM) in MIG as compared to HC (TrM: 2.21±1.32 µV vs. 1.90±1.16 µV, p<0.0006; BI: 16.21±10.57 µV vs. 14.91±11.10 µV, p<0.0001).
Conclusions:
According to the results of this preliminary study, the observed results for MEPs across different muscle groups may be interpreted in the context of inter-ictal motor hyperexcitability in MIG patients [3, 4]. The group differences were found for the trapezius muscles, involved in the concept of the TCC, but also for the BI, thus potentially emphasizing general hyperresponsiveness over trigemino-cervical specificity. However, given the small sample size and lack of further parameters to assess excitability and neuromodulatory effects in more detail (e.g., active motor threshold, cortical silent period), the findings of this preliminary study need to be followed up by investigations in larger samples. Specifically, future analyses need to take into account the extent and distribution of cortical motor representations, as well as longitudinal measurements across the MIG cycle to further elucidate motor system hyperexcitability.
Brain Stimulation:
Non-invasive Magnetic/TMS 2
TMS
Motor Behavior:
Motor Planning and Execution
Neuroanatomy, Physiology, Metabolism and Neurotransmission:
Cortical Anatomy and Brain Mapping 1
Keywords:
Cortex
ELECTROPHYSIOLOGY
Headache
Motor
Transcranial Magnetic Stimulation (TMS)
Other - trigeminocervical complex, migraine, cortical hyperresponsiveness, motor mapping, motor evoked potential
1|2Indicates the priority used for review
Provide references using author date format
2. Collaborators, D.a.I., Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020. 396(10258): p. 1204-1222.
3. Calabro, R.S., et al., Applications of transcranial magnetic stimulation in migraine: evidence from a scoping review. J Integr Neurosci, 2022. 21(4): p. 110.
4. Schramm, S., et al., Functional magnetic resonance imaging in migraine: A systematic review. Cephalalgia, 2023. 43(2): p. 3331024221128278.
5. Sollmann, N., et al., Headache frequency and neck pain are associated with trapezius muscle T2 in tension-type headache among young adults. J Headache Pain, 2023. 24(1): p. 84.
6. Sollmann, N., et al., Magnetic stimulation of the upper trapezius muscles in patients with migraine - A pilot study. Eur J Paediatr Neurol, 2016. 20(6): p. 888-897.
7. Borner, C., et al., The bottom-up approach: Non-invasive peripheral neurostimulation methods to treat migraine: A scoping review from the child neurologist's perspective. Eur J Paediatr Neurol, 2021. 32: p. 16-28.