偏头痛与睡眠质量关系的研究

目的:探讨偏头痛与睡眠质量的关系.方法:采用阿森斯睡眠量表(AIS)对112例偏头痛患者(偏头痛组)及112名健康体检者(正常对照组)的睡眠质量进行评分,比较两组间失眠的发生率.对偏头痛组中无睡眠障碍亚组、可疑失眠亚组和失眠亚组先兆发作率及疼痛程度进行比较,分析睡眠质量与偏头痛的关系.结果:偏头痛组失眠的发生率(58.9%)明显高于正常对照组(24.1%)(P<0.001).偏头痛各亚组间先兆发作率的差异无统计学意义;失眠亚组中、重度头痛的比例(53.0%,37.9%)明显高于无睡眠障碍亚组(23.8%,19.1%)和可疑失眠亚组(40.0%,16.0%)(均P<0.001).相关性分析显示,偏头痛组睡眠质量与头痛程度呈负相关(P<0.001).结论:偏头痛患者睡眠质量较差,且睡眠质量越差的患者头痛程度越重,改善睡眠质量有可能减轻头痛程度.     

偏头痛患者失能因素分析

目的探讨影响偏头痛患者失能相关因素,为优化偏头痛患者管理提供帮助。方法选择本院门诊178例偏头痛患者,完成偏头痛残疾程度评估量表(MIDAS)和头痛影响测验调查问卷(HIT-6),并记录患者年龄、性别、频率(每月头痛发作次数)、头痛程度评分、初发头痛持续时间、体质量指数(BMI)、广泛性焦虑量表(GAD-7)评分、患者健康问卷抑郁量表(PHQ-9)评分、阿森斯失眠量表(AIS)评分及是否药物滥用、是否先兆性头痛。按MIDAS和HIT-6量表将偏头痛患者分为失能和无失能2组,比较2组年龄、性别、频率(每月头痛发作次数)、头痛程度、初发头痛持续时间、BMI、GAD-7、PHQ-9、是否药物滥用、是否先兆性头痛、是否睡眠障碍。再以与是否失能有统计意义的因素为自变量,是否失能为因变量,进行多元线性回归分析。结果单因素分析显示,是否药物滥用、疼痛程度评分、BMI、频率、PHQ-9评分、GAD-7评分、AIS评分与失能有关(P0.05)。多因素分析显示,抑郁、焦虑评分、AIS评分未进入回归方程(P0.05),是否药物滥用、疼痛程度评分、BMI、频率与失能独立相关(P0.05)。结论偏头痛患者滥用止痛药,发作时头痛程度,发作频率,体质量指数,焦虑影响患者失能。     

亚甲基四氢叶酸还原酶基因C677T多态性与偏头痛的相关性研究

目的 探讨哈尔滨地区汉族人群中偏头痛患者亚甲基四氢叶酸还原酶(methylenetetrahydrofolate re-ductase,MTHFR)基因C677T位点多态性与偏头痛的相关性.方法 研究包括182例偏头痛患者(有先兆偏头痛43例,无先兆的偏头痛患者139例);健康对照103例.应用聚合酶链反应一限制性片段长度多态性(PCR-RFLP)方法检测MTHFRC677T.基因型.采用x2检验,t检验对实验结果进行统计分析.结果 (1)MTHFR基因型分布在病例组和对照组之间差异无统计学意义(P＞0.05);病例组与对照组间等位基因频率分布差异无统计学意义(P＞0.05).(2)偏头痛临床特征在野生型和突变型之间,在起病年龄、病程、头痛频率、头痛程度、有无先兆症状方面比较差异无统计学意义(P＞0.05),而在疼痛持续时间、伴随症状方面比较差异有统计意义(P＜0.05).结论 本研究显示:(1)MTHFR基因C677T位点多态性可能与哈尔滨地区汉族人群偏头痛的发病无相关性.(2)在哈尔滨地区汉族人群偏头痛患者中,MTHFR基因突变型(CT、TT型)与起病年龄、病程、头痛频率、头痛程度、有无先兆症状无相关性,而与头痛发作持续时间、伴随症状可能具有相关性.     

偏头痛发作期伴发的非头痛症状临床分析

目的 探讨偏头痛患者头痛发作期伴随的非头痛症状的类型、发生率及与其他因素之间的关系. 方法 选择吉林大学第二医院神经内科头痛门诊自2010年1月至2011年1月诊治的先兆偏头痛(MA)和无先兆偏头痛(MOA)患者71例,分析并比较不同偏头痛患者头痛发作期伴随的非头痛症状数和性别、偏头痛亚型对非头痛症状发生率的影响. 结果 年龄、性别、受教育水平、偏头痛亚型、头痛程度、平均每月的发作次数不同的偏头痛患者之间非头痛症状数的差异无统计学意义(P＞0.05);偏头痛患者最常见的非头痛症状是恶心(87.3％),其次是畏声(81.7％)和情绪改变(69.0％).MOA患者畏声、睡眠障碍、畏嗅的发生率高于MA患者,差异有统计学意义(P＜0.05). 结论 偏头痛患者(伴或不伴先兆)头痛发作期存在多种多样的非头痛症状,其中以恶心、畏声及情绪改变的发生率最高,MOA患者畏声、睡眠障碍、畏嗅的发生率高于MA患者.     

脑白质损害与偏头痛发作频率分析

目的探讨脑白质损害与偏头痛发作频率关系。方法选取重庆市铜梁区中医院接诊的86例偏头痛患者作为研究对象,对患者进行头颅MRI检查以明确脑白质损害程度,根据是否发生脑白质损害分为两组:损害组、未损害组,对比两组的偏头痛发作频率、持续时间。结果脑白质损害病灶位于额叶20个(30.30%)、顶叶13个(23.21%)、基底核区11个(19.64%)、颞枕叶8个(14.29%)、脑干及小脑3个(5.36%)、顶叶1个(1.79%)。两组在冠心病史、高血压病史、糖尿病史、吸烟史、饮酒史、家族病史方面比较,差异均无统计学意义(P>0.05)。损害组的病程明显比未损害组更长(P<0.05)。两组患者在偏头痛类型、发作频率、持续时间方面比较,差异均有统计学意义(P <0.05)。损害组的先兆型偏头痛、发作频率> 3次/月、持续时间> 24h占比均显著高于未损害组(P <0.05)。多因素回归分析显示,除头痛持续时间外,病程、先兆症状、头痛发作频率均是脑白质损害的独立危险因素(均P <0.05)。结论偏头痛患者的脑白质损害好发于额顶叶,偏头痛病程、先兆症状及发作频率都是偏头痛患者发生脑白质损害的独立危险因素。     

晚发型偏头痛与青年偏头痛临床特点的比较

目的 比较晚发型偏头痛和青年偏头痛患者的临床特点.方法 对40例晚发型偏头痛患者(晚发型组)和40例青年偏头痛患者(青年组)的临床资料进行收集和比较.结果 晚发型组19例(47.5％)发病有明显诱因,青年组3例(7.5％)有明显诱因,差异有统计学意义(P＜0.05).晚发型组中先兆型偏头痛6例(15.0％),无先兆型33例(82.5％),偏瘫型1例(2.5％);青年组先兆型偏头痛15例(37.5％),无先兆型25例(62.5％).晚发型组中先兆型比率显著低于青年组(P＜0.05).晚发型组单侧头痛及额部头痛的比率及头痛程度显著低于青年组,双侧头痛及全头痛的比率显著高于青年组(均P＜0.05).晚发型组伴面色苍白、厌食及口干的比率显著高于青年组(均P＜0.05).晚发型组头痛性质、持续时间、发作频率及缓解因素与青年组比较,差异无统计学意义.结论 与青年偏头痛相比,晚发型偏头痛患者发作有诱因的比率高,出现先兆症状少,头痛程度轻,多为双侧及全头痛;易合并自主神经症状.     

黛力新治疗伴抑郁或焦虑的偏头痛临床分析

目的探索治疗偏头痛伴有抑郁和(或)焦虑患者的有效办法以及研究加用抗抑郁/焦虑药物是否比头痛发作时单用镇痛药物疗效更佳。方法将60例伴有抑郁和(或)焦虑的偏头痛患者随机分为2组各30例。治疗组用黛力新、非言(非甾体抗炎药,主要成分是双氯芬酸钠)和硫必利治疗,对照组给予非言、硫必利治疗,疗程均为6周;于治疗前及治疗后2、4、6周末记录前1周头痛发作次数、持续时间和头痛程度,同时用汉密尔顿抑郁量表评分(HAMD)和汉密尔顿焦虑量表评分(HAMA)。结果治疗组患者头痛发作次数显著减少,头痛程度显著减轻,头痛发作持续时间缩短(P0.05或P0.01);同时能显著减少HAMD及HAMA评分(P0.05或P0.01)。结论伴有抑郁和(或)焦虑的偏头痛患者,除对症治疗外,可以合并应用黛力新。     

偏头痛合并卵圆孔未闭的临床特点

目的探讨偏头痛合并卵圆孔未闭(PFO)的临床特点。方法对95例临床确诊的偏头痛患者进行经胸心脏超声检查,根据是否合并PFO进行分组。所有患者给予口服盐酸氟桂利嗪治疗3个月。采集患者的临床资料,记录患者治疗前后头痛发作频率、持续时间和严重程度,对结果进行组间比较并分析。结果经胸心脏超声检查发现合并PFO患者29例,作为PFO组;其余66例患者无PFO,作为非PFO组。偏头痛患者合并PFO的发生率为30.5%。与非PFO组比较,PFO组患者有先兆偏头痛的比例和治疗前头痛发作频率明显增高(均P0.05)。与治疗前比较,PFO组与非PFO组治疗后头痛发作频率明显降低,持续时间明显缩短,严重程度明显减轻(均P0.05)。两组患者治疗后头痛发作频率、持续时间和严重程度的差异无统计学意义。两组患者均无严重不良反应出现。结论偏头痛合并PFO的临床特点为有先兆偏头痛的比例较高,头痛发作频率较高。     

肥胖及瘦素水平对偏头痛患者的影响

目的探讨肥胖及血清瘦素水平对偏头痛患者的影响。方法收集52例偏头痛患者的临床资料,并与52名健康人(正常对照组)进行比较。根据肥胖状况将偏头痛患者分为全身型肥胖(TBO)亚组,非TBO亚组及腹型肥胖(ABd-O)亚组、非ABd-O亚组。采用放射免疫法测定患者的血清瘦素水平,并进行比较。结果与非TBO亚组比较,TBO亚组患者偏头痛的发作频率增多,持续时间延长,疼痛程度重(均P0.05)。与非ABd-O亚组比较,ABd-O亚组患者偏头痛的发作频率增多,持续时间延长,疼痛程度重(均P0.05)。偏头痛组血清瘦素水平与正常对照组的差异无统计学意义。TBO亚组与非TBO亚组的血清瘦素水平差异无统计学意义。ABd-O亚组血清瘦素水平显著高于非ABd-O亚组(P0.05)。多因素Logistic回归分析显示,瘦素及ABd-O对偏头痛发作频率、疼痛程度及持续时间的影响无统计学意义;TBO与偏头痛的发作频率及疼痛程度有显著关系(均P0.05),而与持续时间无关。结论 TBO对偏头痛的发作频率及疼痛程度有影响,血清瘦素水平对偏头痛无明显影响。     

黛力新联合西比灵治疗偏头痛伴抑郁和焦虑90例疗效观察

目的观察黛力新联合西比灵治疗偏头痛伴焦虑、抑郁情绪患者的疗效与不良反应。方法将90例伴抑郁和焦虑的偏头痛患者随机均分为2组,治疗组给予黛力新与西比灵口服,对照组单用西比灵,均以6周为1个疗程。根据治疗前后头痛发作次数、持续时间及头痛严重程度的变化进行疗效评定,并用汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）进行评分,自制副反应量表记录不良反应。结果两种治疗方法均可显著减少偏头痛发作次数,缩短头痛发作时间,减轻头痛程度（P〈0.05）;治疗组还可明显减轻患者的抑郁、焦虑症状,治疗后2、4、6周HAMD和HAMA评分的改善优于对照组（P〈0.01）;治疗组头痛持续时间缩短也优于对照组（P〈0.05）。结论黛力新联合西比灵治疗伴情绪障碍的偏头痛疗效较好,不良反应不需作特殊处理。     

Direction discrimination of moving gratings and plaids and coherence in dot displays without primary visual cortex (V1)

We present new experimental observations of G.Y., a well-tested patient with unilateral loss of primary visual cortex. We stimulated G.Y.'s blind hemifield using first- and second-order motion stimuli at velocities around psychophysical threshold. Using a dual response paradigm (awareness level of visual motion, motion direction discrimination) psychophysical performance improved with increasing velocity and dot coherence. We were also able to influence directly G.Y.'s performance for the better and at will, by placing the emphasis solely on direction discrimination. In the absence of V1, graduated detection and discrimination of stimuli known to activate both V1 and extrastriate motion areas MT/V5 and MST is still possible. These results are in line with residual visual processing but did not show evidence of unconscious processing of motion stimuli characteristic of ‘blindsight’.     

Physiological evidence of interaction of first- and second-order motion processes in the human visual system: a magnetoencephalographic study

Humans have several mechanisms for the visual perception of motion, including one that is luminance-based (first-order) and another that is luminance-independent (second-order). Recent psychophysical studies have suggested that significant interaction occurs between these two neural processes. We investigated whether such interactions are represented as neural activity measured by magnetoencephalography (MEG). The second-order motion of a drifting sinusoidal grating, which is defined by the speed of the dot motion, did not generate a response. Apparent motion (AM) of the square area, defined by the speed of randomly moving dots, evoked a magnetic response whose latency and amplitude changed with the distance that the area moved (a second-order characteristic), though the response properties were significantly different from those for the first-order AM. AM, defined by both first- and second-order attributes, evoked an MEG response and the latencies and the amplitudes were distributed between those for the first- and second-order motions. The cortical source of the response was estimated to be around MT+. The results show a distinct difference in the neural processing of the second-order motion that cannot be explained by the difference in visibility, and they indicate that the interaction of the neural processes underlying first- and second-order motion detection occurs before the MEG response. Our study provides the first physiological evidence of a neural interaction between the two types of early motion detection.     

Setup and data analysis for functional magnetic resonance imaging of awake cat visual cortex

Functional magnetic resonance imaging（fMRI）is one of the most commonly used methods in cognitive neuroscience on humans.In recent decades,fMRI has also been used in the awake monkey experiments to localize functional brain areas and to compare the functional differences between human and monkey brains.Several procedures and paradigms have been developed to maintain proper head fixation and to perform motion control training.In this study,we extended the application of fMRI to awake cats without training,receiving a flickering checkerboard visual stimulus projected to a screen in front of them in a block-design paradigm.We found that body movement-induced non-rigid motion introduced artifacts into the functional scans,especially those around the eye and neck.To correct for these artifacts,we developed two methods：one for general experimental design,and the other for studies of whether a checkerboard task could be used as a localizer to optimize the motioncorrection parameters.The results demonstrated that,with proper animal fixation and motion correction procedures,it is possible to perform fMRI experiments with untrained awake cats.     

Pattern motion is present in V1 of awake but not anaesthetized monkeys

We compared responses of neurons, recorded in striate cortex (area V1) of awake, fixating monkeys, to a single drifting grating with those to a 'plaid' pattern comprised of two superimposed drifting gratings separated in orientation by 90 degrees. Five out of 54 (9%) of V1 direction selective neurons responded to the direction of motion of the whole pattern [pattern motion (PM) selectivity]. Tuning curves for plaid stimuli were similar in both optimum direction and width of tuning to those for single gratings. Twenty nine out of 54 (54%) responded simply to the motion of individual orientated gratings within the pattern [component motion (CM) selectivity]. The remaining 37% (20/54) neurons were unclassified. In control experiments, 39 direction selective neurons were recorded in area V1 of anaesthetized monkey and cats. Unlike area V1 in behaving monkeys, none of these neurons exhibited PM selectivity to the drifting plaids. Twenty eight out of 39 (72%) of them responded to the direction of the component gratings and were classified as CM selectivity. Our results indicate that although most V1 neurons are CM selective, as described in anaesthetized animals, a subpopulation is clearly PM selective in behaving monkeys, reflecting integration of locally derived motion signals. Neurons in V1 therefore carry signals that may contribute to pattern motion processing and perception. This perceptual interpretation in V1 might depend much more critically on information integration mechanisms that only function properly in awake, perceiving animals.     

Cells in monkey STS responsive to articulated body motions and consequent static posture: a case of implied motion?

We show that populations of visually responsive cells in the anterior part of the superior temporal sulcus (STSa) of the macaque monkey code for the sight of both specific articulated body actions and the consequent articulated static body postures. We define articulated actions as actions where one body part (e.g. a limb or head) moves with respect to the remainder of the body which remains static; conversely non-articulated actions are actions where the equivalent body parts do not move with respect to each other but move as one. Similarly, articulated static body postures contain a torsion or rotation between parts, while non-articulated postures do not. Cells were tested with the sight of articulated and non-articulated actions followed by the resultant articulated or non-articulated static body postures. In addition, the static body postures that formed the start and end of the actions were tested in isolation. The cells studied did not respond to the sight of non-articulated static posture, which formed the starting-point of the action, but responded vigorously to the articulated static posture that formed the end-point of the action. Other static postures resembling the articulated end-point posture, but which were in a more relaxed muscular state (i.e. non-articulated), did not evoke responses. The cells did not respond to body actions that were less often associated with the effective static articulated postures. Our results suggest that the cells' responses were related to the implied action rather than the static posture per se. We propose that the neural representations in STSa for actual biological motion may also extend to biological motion implied from static postures. These representations could play a role in producing the activity in the medial temporal/medial superior temporal (V5(MT)/MST) areas reported in fMRI studies when subjects view still photographs of people in action.     

Neuropsychological evidence for a competitive bias against contracting stimuli

Two experiments examined extinction to stimuli presented either with contracting or expanding motion. Experiment 1 used solid shapes which either increased or decreased in size rapidly, consistent with looming motion. Experiment 2 employed random dots so that stimulus size was not confounded with type of motion. In both experiments extinction was modulated by the type of motion presented, with extinction most evident when a contracting object was in the weaker visual field. In addition, in Experiment 2 there was evidence for grouping modulating extinction, when there were looming stimuli in both fields. The results suggest that looming motion is a powerful determinant of stimulus salience in selective attention.     

Motion standstill leads to activation of inferior parietal lobe

Previous studies on motion perception revealed motion-processing brain areas sensitive to changes in luminance and texture (low-level) and changes in salience (high-level). The present functional magnetic resonance imaging (fMRI) study focused on motion standstill. This phenomenon, occurring at fast presentation frequencies of visual moving objects that are perceived as static, has not been previously explored by neuroimaging techniques. Thirteen subjects were investigated while perceiving apparent motion at 4 Hz, at 30 Hz (motion standstill), isoluminant static and flickering stimuli, fixation cross, and blank screen, presented randomly and balanced for rapid event-related fMRI design. Blood oxygenation level-dependent (BOLD) signal in the occipito-temporal brain region MT/V5 increased during apparent motion perception. Here we could demonstrate that brain areas like the posterior part of the right inferior parietal lobule (IPL) demonstrated higher BOLD-signal during motion standstill. These findings suggest that the activation of higher-order motion areas is elicited by apparent motion at high presentation rates (motion standstill). We interpret this observation as a manifestation of an orienting reaction in IPL towards stimulus motion that might be detected but not resolved by other motion-processing areas (i.e., MT/V5).     

Directional anisotropy of motion responses in retinotopic cortex

Recently, evidence has emerged for a radial orientation bias in early visual cortex. These results predict that in early visual cortex a tangential bias should be present for motion direction. We tested this prediction in a human imaging study, using a translating random dot pattern that slowly rotated its motion direction 360° in cycles of 54 s. In addition, polar angle and eccentricity mapping were performed. This allowed the measurement of the BOLD response across the visual representations of the different retinotopic areas. We found that, in V1, V2, and V3, BOLD responses were consistently enhanced for centrifugal and centripetal motion, relative to tangential motion. The relative magnitude of the centrifugal and centripetal response biases changed with visual eccentricity. We found no motion direction biases in MT+. These results are in line with previously observed anisotropies in motion sensitivity across the visual field. However, the observation of radial motion biases in early visual cortex is surprising considering the evidence for a radial orientation bias. An additional experiment was performed to resolve this apparent conflict in results. The additional experiment revealed that the observed motion direction biases most likely originate from anisotropies in long range horizontal connections within visual cortex. Hum Brain Mapp, 2009. © 2009 Wiley‐Liss, Inc.     

Differential involvement of the cerebellum in biological and coherent motion perception

Perception of biological motion (BM) is a fundamental property of the human visual system. It is as yet unclear which role the cerebellum plays with respect to the perceptual analysis of BM represented as point-light displays. Imaging studies investigating BM perception revealed inconsistent results concerning cerebellar contribution. The present study aimed to explore the role of the cerebellum in the perception of BM by testing the performance of BM perception in patients suffering from circumscribed cerebellar lesions and comparing their performance with an age-matched control group. Perceptual performance was investigated in an experimental task testing the threshold to detect BM masked by scrambled motion and a control task testing the detection of motion direction of coherent motion masked by random noise. Results show clear evidence for a differential contribution of the cerebellum to the perceptual analysis of coherent motion compared with BM. Whereas the ability to detect BM masked by scrambled motion was unaffected in the patient group, their ability to discriminate the direction of coherent motion in random noise was substantially affected. We conclude that intact cerebellar function is not a prerequisite for a preserved ability to detect BM. Because the dorsal motion pathway as well as the ventral form pathway contribute to the visual perception of BM, the question of whether cerebellar dysfunction affecting the dorsal pathway is compensated for by the unaffected ventral pathway or whether perceptual analysis of BM is performed completely without cerebellar contribution remains to be determined.     

False fMRI activation after motion correction

Motion correction of echo‐planar imaging (EPI) data used in functional MRI (fMRI) is an essential preprocessing step performed prior to statistical analysis. At ultra‐high resolution fMRI, current requirements regarding translational and rotational motion may no longer be acceptable. This prompts the need for a systematic investigation of the effects of motion correction procedures with in vivo fMRI data. Here we systematically evaluated the effect of retrospective motion correction with freely available fMRI analysis software packages (FSL, AFNI, and SPM) on activation maps using fMRI data acquired with prospective motion detection, to identify and quantify confounding effects of retrospective motion correction, and to evaluate its dependence on spatial resolution and motion correction algorithms. Brain activation maps were obtained for two different resolutions, an ultrahigh, that is, 0.65³ mm³, and a more widely used 2.0³ mm³ isotropic resolutions at 7 T. The EPI data were acquired using simultaneous non‐image‐based optical moiré phase tracking (MPT) of physical motion. The results showed that image‐based motion detection, performed by SPM8 software package, may be erroneous in high‐field fMRI data with partial brain coverage and can introduce spurious motion leading to false‐positive and false‐negative activation. Further analyses demonstrated that limited acquisition field of view has the dominant influence on the effect. Hum Brain Mapp 38:4497–4510, 2017. © 2017 Wiley Periodicals, Inc.