Abnormal cortical responses to somatosensory stimulation in medication-overuse headache

Background

Medication-overuse headache (MOH) is a frequent, disabling disorder. Despite a controversial pathophysiology convincing evidence attributes a pivotal role to central sensitization. Most patients with MOH initially have episodic migraine without aura (MOA) characterized interictally by an absent amplitude decrease in cortical evoked potentials to repetitive stimuli (habituation deficit), despite a normal initial amplitude (lack of sensitization). Whether central sensitization alters this electrophysiological profile is unknown. We therefore sought differences in somatosensory evoked potential (SEP) sensitization and habituation in patients with MOH and episodic MOA.

Methods

We recorded median-nerve SEPs (3 blocks of 100 sweeps) in 29 patients with MOH, 64 with MOA and 42 controls. Episodic migraineurs were studied during and between attacks. We measured N20-P25 amplitudes from 3 blocks of 100 sweeps, and assessed sensitization from block 1 amplitude, and habituation from amplitude changes between the 3 sequential blocks.

Results

In episodic migraineurs, interictal SEP amplitudes were normal in block 1, but thereafter failed to habituate. Ictal SEP amplitudes increased in block 1, then habituated normally. Patients with MOH had larger-amplitude block 1 SEPs than controls, and also lacked SEP habituation. SEP amplitudes were smaller in triptan overusers than in patients overusing nonsteroidal anti-inflammatory drugs (NSAIDs) or both medications combined, lowest in patients with the longest migraine history, and highest in those with the longest-lasting headache chronification.

Conclusions

In patients with MOH, especially those overusing NSAIDs, the somatosensory cortex becomes increasingly sensitized. Sensory sensitization might add to the behavioral sensitization that favors compulsive drug intake, and may reflect drug-induced changes in central serotoninergic transmission.

     

Visual cortical unit responses to photic stimulation of different zones of the receptive fields in cats

In acute experiments on unanesthetized curarized cats the intensity functions, response thresholds, inhibition thresholds, and differential sensitivity of 96 neurons in the primary visual projection cortex were investigated by extracellular recording of unit activity during central and peripheral stimulation of their receptive fields. In darkness the neurons had wide threshold and above-threshold reliefs (3–30°). The threshold reliefs of the receptive fields of some cells were found to be V-shaped, whereas others were marked by alternation of zones of increased and reduced excitability. Sensitivity of both excitatory and inhibitory inputs of the receptive field as a rule was greatest in the center. Inhibitory inputs of different cortical neurons were much more standard and less sensitive to light, and they were mainly activated within the intermediate (mesoptic) range of brightnesses. During light adaptation the threshold contour of the receptive field narrows sharply, mainly because of the fall in sensitivity of its peripheral inputs. Compared with the lateral geniculate body and retina, the relative number of low-threshold elements, sensitivity in the system of inhibitory elements, and differential brightness sensitivity are greater in the cortex. The mechanisms of formation of receptive fields of cortical neurons and their modification during changes in the level of adaptation, and also the role of excitatory and inhibitory inputs of the cell in these effects are discussed.Institute of Higher Nervous Activity and Neurophysiology, Academy of Sciences of the USSR, Moscow. Translated from Neirofiziologiya, Vol. 11, No. 3, pp. 227–235, May–June, 1979.     

Excitability cycles of direct cortical responses during elaboration of conditioned defense reflexes in dogs]

Direct cortical responses (DCRs) to paired stimuli were studied in chronic experiments in dogs during elaboration of classical and instrumental defensive conditioned reflexes. The DCRs were recorded with 20 to 250 ms intervals between stimuli. Paired and single electrical stimulations of the middle suprasylvian gyrus given with a frequency of one per second were used as conditioned stimuli and were reinforced in a similar way. During electrical cutaneous stimulation of the dog's paw and to an even greater extent during isolated action of the conditioned stimulus the initial negativity of the testing DCR became shorter and the degree of its depression diminished. In the case of a following period of facilitation, its degree became greater. It was higher at a distance of 4 to 5 mm from the point of stimulation than at a distance of 2 to 3 mm. During isolated action of the conditioned stimulus, the degree of facilitation was higher than at the period of the possible action of the unconditioned stimulus. The greatest shorterning of the DCR excitability cycle was observed immediately before and during the conditioned lifting of the dog's paw. Excitability cycles of DCR, and possibly of other evoked potentials as well, are a more sensitive indicator of the function state of the cerebral cortex than responses to single stimuli. For this reason it appears promising to use them in studying conditioned reflexes.     

Direct current self stimulation in rats]

In experiments on 16 male albino rats a phenomenon of self-stimulation of the hypothalamic structures has been produced by a DC anode and cathode, with 20 to 100 microamperes intensity. DC self-stimulation consists in regular succession of approaching the pedal, staying on the pedal and leaving it, i. e. a succession of states of motivational drive, reinforcement and avoidance. In a number of cases the conditioned reflex of self-stimulation is not extinguished for two to three days after switching off the current.     

Response of cortical evoked potentials to electric stimulation of the acoustic nerve in animals with damaged cochlea

Evoked potentials of the auditory cortex during the electrical stimulation of the cochlea were studied in acute experiments on cats. A series of electric pulses of short duration and different frequency delivered to the streptomycin-damaged cochlea were used as a stimulus. It has been shown that an amplitude and latency of electrical cortex responses depended on the number of pulses in series and on the interpulse intervals. Amplitudes of evoked responses increased with the growth of the number of stimuli. Latent periods changed in a narrower stimulation frequency band. Dependence of the induced potentials' amplitude growth on the increase in the number of electric pulses changed as a result of the two-fold enhancement of the stimulation amplitude.     

Cyclic AMP response in cells exposed to electric fields of different frequencies and intensities

The action on intracellular cyclic AMP (cAMP) of therapeutically used 4000-Hz electric fields was investigated and compared with 50-Hz data. Cultured mouse fibroblasts were exposed for 5 minutes to 4000-Hz sine wave internal electric fields between 3 mV/m and 30 V/m applied within culture medium. A statistically significant decrease in cellular cAMP concentration relative to unexposed cells was observed for fields higher than 10 mV/m. The drop in cAMP was most pronounced at lower field strengths (71 % of controls at 30 mV/m) and tended to disappear at higher field strengths. An increase of cAMP content was observed with 50-Hz electric fields, as was also the case when 4000-Hz fields were modulated with certain low frequencies.