Table_3_Neuroimaging markers of Alice in Wonderland syndrome in patients with migraine with aura.docx

BackgroundThe Alice in Wonderland syndrome (AIWS) is a transient neurological disturbance characterized by sensory distortions most frequently associated with migraine in adults. Some lines of evidence suggest that AIWS and migraine might share common pathophysiological mechanisms, therefore we set out to investigate the common and distinct neurophysiological alterations associated with these conditions in migraineurs.MethodsWe conducted a case–control study acquiring resting-state fMRI data from 12 migraine patients with AIWS, 12 patients with migraine with typical aura (MA) and 24 age-matched healthy controls (HC). We then compared the interictal thalamic seed-to-voxel and ROI-to-ROI cortico-cortical resting-state functional connectivity between the 3 groups.ResultsWe found a common pattern of altered thalamic connectivity in MA and AIWS, compared to HC, with more profound and diffuse alterations observed in AIWS. The ROI-to-ROI functional connectivity analysis highlighted an increased connectivity between a lateral occipital region corresponding to area V3 and the posterior part of the superior temporal sulcus (STS) in AIWS, compared to both MA and HC.ConclusionThe posterior STS is a multisensory integration area, while area V3 is considered the starting point of the cortical spreading depression (CSD), the neural correlate of migraine aura. This interictal hyperconnectivity might increase the probability of the CSD to directly diffuse to the posterior STS or deactivating it, causing the AIWS symptoms during the ictal phase. Taken together, these results suggest that AIWS in migraineurs might be a form of complex migraine aura, characterized by the involvement of associative and multisensory integration areas.

背景：爱丽丝梦游仙境综合症（AIWS）是一种短暂的神经系统紊乱，其特征为感觉扭曲，通常与成人偏头痛相关。一些证据表明，AIWS与偏头痛可能存在共同的病理生理机制，因此我们旨在研究这些疾病在偏头痛患者中共同和独特的神经生理学改变。方法：我们进行了一项病例对照研究，收集了12名患有AIWS的偏头痛患者、12名患有典型先兆偏头痛（MA）的患者以及24名年龄匹配的健康对照者（HC）的静息态fMRI数据。然后，我们比较了三组间发作间期的丘脑种子到体素和ROI到ROI皮层-皮层静息态功能连接。结果：我们发现与HC相比，MA和AIWS中存在一种共同的丘脑连接改变模式，AIWS中观察到更深刻和广泛的改变。ROI到ROI功能连接分析突出了AIWS中，与V3区相对应的颞上沟外侧区域与颞上沟后部之间连接的增加，与MA和HC相比。结论：颞上沟后部是一个多感官整合区域，而V3区被认为是皮质扩散性抑制（CSD）的起点，这是偏头痛先兆的神经对应物。这种发作间期的超连接性可能增加了CSD直接扩散到颞上沟后部或使其失活的概率，导致发作期出现AIWS症状。综上所述，这些结果表明，偏头痛患者的AIWS可能是一种复杂型偏头痛先兆，其特征在于涉及联合和多感官整合区域。