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Primary visual cortex excitability in migraine: a systematic review with meta-analysis

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Abstract

The objective is to update and extend previous results of a systematic review of the literature with meta-analysis performed to determine the prevalence of phosphenes and the phosphene threshold (PT) values obtained during single-pulse transcranial magnetic stimulation (TMS) in adults with migraine. Both published and unpublished controlled studies measuring PT by single-pulse TMS in adults with migraine with or without aura (MA, MwA) were systematically reviewed. Prevalence of phosphenes and PT values were assessed calculating mean difference (MD) and odds ratio (OR) with 95 % confidence intervals (CI). Fifteen trials (369 migraine patients and 269 controls), were included. Patients with MA had a statistically significant lower PT compared with controls when a circular coil was used (MD: −22.27, 95 % CI −33.44 to −11.10); with a figure-of-eight coil the difference was not statistically significant. There was a significant higher phosphene prevalence in MA compared with controls (OR: 3.57, 95 % CI 1.16–10.94). No significant differences were found either in phosphene reporting between patients with MwA and controls, or in PT values obtained by figure-of-eight coil in subjects with MwA versus controls. In general, these results slightly support the hypothesis of a primary visual cortex hyper-excitability in MA, providing not enough evidence for MwA. A significant heterogeneity across studies probably reflects relevant clinical and methodological heterogeneity.

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Acknowledgments

We are in debt with Dr. Stefano Zago (Department of Neurological Sciences, University of Milan, Italy), who kindly provided us information on a still unpublished work (Cappellari), thus allowing us to include also this study in the meta-analysis. We also thank Dr. Sheena Aurora for providing us useful additional information on her works.

Conflict of interest

The authors declare that there is no conflict of interest.

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Authors and Affiliations

  1. Section of Clinical Neurology, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Piazzale L.A. Scuro, 37134, Verona, Italy

    Francesco Brigo & Paolo Manganotti

  2. Department of Neurology, Franz Tappeiner Hospital, Merano, Italy

    Francesco Brigo, Frediano Tezzon & Raffaele Nardone

  3. Department of Medicine, University of Verona, Verona, Italy

    Monica Storti

  4. Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria

    Raffaele Nardone

Authors
  1. Francesco Brigo
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  2. Monica Storti
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  3. Frediano Tezzon
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  4. Paolo Manganotti
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  5. Raffaele Nardone
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Corresponding author

Correspondence to Francesco Brigo.

Appendix: Search strategies used in the review

Appendix: Search strategies used in the review

MEDLINE:

((“Migraine Disorders”[Mesh]) OR migrain* OR migraine) AND (“Phosphenes”[Mesh]) OR phosphen* OR “phosphene treshold”) AND “Transcranial Magnetic Stimulation”[Mesh])): 94 results

EMBASE:

(migrain* AND phosphen* AND “Transcranial Magnetic Stimulation”): 34 results

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Brigo, F., Storti, M., Tezzon, F. et al. Primary visual cortex excitability in migraine: a systematic review with meta-analysis. Neurol Sci 34, 819–830 (2013). https://doi.org/10.1007/s10072-012-1274-8

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  • DOI: https://doi.org/10.1007/s10072-012-1274-8

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