Background and Aims:

There is evidence suggesting that both the hypothalamus and dorsal pons could be putative drivers of migraine attacks. Here, we explored whether longitudinal resting state (RS) functional connectivity (FC) changes of the pons and hypothalamus might influence migraine patients’ disease progression.

Methods:

RS functional magnetic resonance imaging (MRI) scans were acquired from 91 headache-free episodic migraine patients and 73 controls. Twenty-three patients and 23 controls underwent a clinical and MRI follow-up evaluation after 4 years. A seed-based correlation approach was used to study RS FC changes of the pons and hypothalamus, separately. The association between the hypothalamic and pontine RS FC networks was investigated using partial correlations analyses.

Results:

After 4 years, migraine patients developed an increased FC between the bilateral hypothalamus and bilateral orbitofrontal gyrus (OFG), as well as between the left pons and left cerebellum. They also experienced decreased RS FC between the right hypothalamus and the ipsilateral lingual gyrus. At baseline, the decreased hypothalamic-lingual gyrus RS FC correlated with higher migraine attack frequency. While, at follow-up, higher hypothalamic-OFG RS FC correlated with lower migraine attack frequency and higher pontine-cerebellar RS FC correlated with an increased number of migraine attacks over the years. A significant negative association between the pontine-cerebellar RS FC and the hypothalamic-lingual RS FC was found in migraine patients.

Conclusions:

Our findings support the presence of a common functional framework comprising the hypothalamic, pontine, cerebellar and visual networks that might influence migraine disease progression, as measured by changes in migraine frequency.

Background and Aims:

To assess magnetic resonance imaging (MRI) alterations occurring in patients with trigeminal neuralgia and to explore the predictive ability of MRI for initial radiosurgical outcome and long-term pain relief/recurrence after Gamma Knife radiosurgery (GKSRS).

Methods:

Thirty patients with idiopathic or classical TN, who underwent GKSRS and were followed for at least 24 months, were retrospectively included. Pre-treatment structural MRI and pre- and serial, post-operative clinical features were investigated. Fifteen age- and sex-matched healthy controls were also enrolled. Cortical thickness and gray matter (GM) volumes were assessed in TN patients relative to controls, as well as between patient subgroups according to treatment outcomes (initial responders/non-responders, patients with pain recurrence/long-lasting pain relief at the last follow-up). Clinical and MRI predictors of treatment outcomes were explored.

Results:

Cortical thinning of temporal, prefrontal, cingulate, somatosensory and occipital areas bilaterally was found in TN patients relative to controls. Patients who experienced TN recurrence after initial pain relief were characterized by thicker parahippocampal and temporal cortices bilaterally and greater volume of right amygdala and hippocampus compared to patients with long-lasting pain relief. In TN patients, disease duration and baseline cortical thinning of right parahippocampal, left fusiform and middle temporal cortices were associated with poor outcome after GKSRS at the last follow-up (R²=0.57, p<0.001).

Conclusions:

The study provides novel insights into structural brain alterations of TN patients, which might contribute to disease development and pain maintenance.

Background and Aims:

To apply mathematical modeling to unravel MRI connectomic signatures among the amyotrophic lateral sclerosis (ALS)-behavioral variant of frontotemporal dementia (bvFTD) spectrum.

Methods:

83 ALS, 35 bvFTD and 61 controls underwent clinical, cognitive evaluations and MRI scan. ALS were divided in 54 ALS with only motor deficits (ALS-cn), 21 ALS cognitively/behaviorally impaired (ALS-ci/bi) and 8 ALS with bvFTD (ALS-FTD).

Mathematical models based on connectomic approach and ROC curve analysis identified the characteristic patterns of damage of ALS-cn and bvFTD. Single-subject analysis was performed on ALS-ci/bi and ALS-FTD to assess shared features with ALS-cn and bvFTD.

Results:

The structural/functional patterns of damage characterizing ALS-cn and bvFTD were identified. ALS-like pattern resulted in a focused structural damage within motor areas. bvFTD-like pattern resulted in widespread structural damage and decreased functional connectivity, mainly in frontotemporoparietal areas. ALS-ci/bi showed structural damage mostly overlapping with the ALS-like pattern, whereas they diverged from ALS-cn in functional connectivity showing enhanced functional connectivity within sensorimotor and decreased functional connectivity in frontotemporal areas. The latter mirrored the bvFTD-like pattern. ALS-FTD patients resembled the bvFTD-like pattern of damage both structurally and functionally, with a frank structural ALS-like damage in motor areas.

Conclusions:

Alterations of the frontotemporoparietal network characterized bvFTD-like pattern, while a focal damage within sensorimotor-basal ganglia areas defined the ALS-like pattern. Commonalities and differences relative to the two ends of ALS-FTD spectrum were found in ALS-ci/bi and ALS-FTD.

Funding: The Italian Ministry of Health (GR-2011-02351217; GR-2013-02357415; RF-2011-02351193), AriSLA (ConnectALS), European Research Council (StG2016_714388_NeuroTRACK).