Transcranial magnetic stimulation of visual cortex in migraine patients: a systematic review with meta-analysis
The Journal of Headache and Pain,

Brigo F et al. – Skull thickness and ovarian cycle should be assessed as possible confounding variables, and sham stimulation should be performed to reduce the rate of false positives. Phosphene prevalence alone cannot be considered a measure of cortical excitability, but should be integrated with phosphene threshold (PT) evaluation.

Methods
  • Authors systematically reviewed the literature to evaluate the prevalence of phosphenes and the phosphene threshold (PT) values obtained during single–pulse transcranial magnetic stimulation (TMS) in adults with migraine.
  • Controlled studies measuring PT by single–pulse TMS in adults with migraine with or without aura (MA, MwA) were systematically searched.
  • Prevalence of phosphenes and PT values were assessed calculating mean difference (MD) and odds ratio (OR) with 95 % confidence intervals (CI).
  • Ten trials (277 migraine patients and 193 controls) were included.
  • Patients with MA had statistically significant lower PT compared with controls when a circular coil was used (MD –28.33; 95 % CI –36.09 to –20.58); a similar result was found in MwA patients (MD –17.12; 95 % CI –23.81 to –10.43); using a figure–of–eight coil the difference was not statistically significant.
  • There was a significantly higher phosphene prevalence in MA patients compared with control subjects (OR 4.21; 95 % CI 1.18–15.01).
  • No significant differences were found either in phosphene reporting between patients with MwA and controls, or in PT values obtained with a figure–of–eight coil in MA and MwA patients versus controls.
  • Overall considered, these results support the hypothesis of a primary visual cortex hyper–excitability in MA, providing not enough evidence for MwA.
  • A significant statistical heterogeneity reflects clinical and methodological differences across studies, and higher temporal variabilities among PT measurements over time, related to unstable excitability levels.
  • Patients should therefore be evaluated in the true interictal period with an adequate headache–free interval.

Please login or register to follow this author.
► Click here to access PubMed, Publisher and related articles...
<< Previous Article | Next Article >>

Your Unread Messages in Internal Medicine

See All >> Messages include industry-sponsored communications and special communications from MDLinx

Most Popular Internal Medicine Articles

1 Effects of tea intake on blood pressure: A meta-analysis of 21 randomized controlled trials JACC - Journal of the American College of Cardiology, October 22, 2014    Clinical Article

2 Cost-effectiveness of CT screening in the national lung screening trial New England Journal of Medicine, November 7, 2014    Evidence Based Medicine    Clinical Article
Exclusive Author Commentary

3 Effects of hyperbaric oxygen on symptoms and quality of life among service members with persistent postconcussion symptoms: a randomized clinical trial JAMA Internal Medicine, November 21, 2014    Evidence Based Medicine    Clinical Article

4 Sweetened carbonated beverage consumption and cancer risk: Meta-analysis and review European Journal of Cancer Prevention, August 1, 2014    Evidence Based Medicine    Review Article

5 The burden of disease in older people and implications for health policy and practice The Lancet, November 12, 2014    Evidence Based Medicine    Clinical Article

6 How World War 1 changed global attitudes to war and infectious diseases The Lancet, November 10, 2014    Evidence Based Medicine    Clinical Article

7 The causal effect of vitamin D binding protein (DBP) levels on calcemic and cardiometabolic diseases: a Mendelian randomization study Full Text PLoS Medicine, November 4, 2014    Free full text    Evidence Based Medicine    Clinical Article

8 Efficacy of a tetravalent dengue vaccine in children in Latin America New England Journal of Medicine, November 6, 2014    Evidence Based Medicine    Clinical Article

9 Sodium zirconium cyclosilicate in hyperkalemia New England Journal of Medicine, November 26, 2014    Evidence Based Medicine    Clinical Article

10 Changes in patients' experiences in medicare accountable care organizations New England Journal of Medicine, November 3, 2014    Evidence Based Medicine    Clinical Article

11 Milk intake and risk of mortality and fractures in women and men: cohort studies BMJ, November 11, 2014    Evidence Based Medicine    Clinical Article

12 Acupuncture for chronic knee pain: a randomized clinical trial JAMA, October 1, 2014    Evidence Based Medicine    Clinical Article

13 Nonobstructive coronary artery disease and risk of myocardial infarction JAMA, November 6, 2014    Evidence Based Medicine    Clinical Article

14 Evaluation and treatment of older patients with hypercholesterolemia: A clinical review JAMA, October 20, 2014    Clinical Article

15 Effects of vaccination on invasive pneumococcal disease in South Africa New England Journal of Medicine, November 19, 2014    Evidence Based Medicine    Clinical Article

16 Three-year denosumab treatment in postmenopausal Japanese women and men with osteoporosis: Results from a 1-year open-label extension of the Denosumab Fracture Intervention Randomized Placebo Controlled Trial (DIRECT) Osteoporosis International, November 25, 2014    Evidence Based Medicine    Clinical Article

17 An interferon-free antiviral regimen for HCV after liver transplantation New England Journal of Medicine, November 13, 2014    Evidence Based Medicine    Clinical Article

18 Aspirin in type 2 diabetes, a randomised controlled study: effect of different doses on inflammation, oxidative stress, insulin resistance and endothelial function International Journal of Clinical Practice, December 27, 2013    Clinical Article

19 Non-psychotic mental disorders in the perinatal period The Lancet, November 20, 2014    Evidence Based Medicine    Clinical Article

20 Oral contraceptive use and mortality after 36 years of follow-up in the Nurses' Health Study: prospective cohort study BMJ, November 7, 2014    Evidence Based Medicine    Clinical Article

Indexed Journals in Internal Medicine: New England Journal of Medicine, The Lancet, Archives of Internal Medicinemore