title: Biochemical changes in the brain of hemiplegic migraine patients measured with 7 tesla 1H-MRS.
abstract: OBJECTIVE
  The aim of this study was to assess biochemical changes in the brain of patients with hemiplegic migraine in between attacks.
  
  
  METHODS
  Eighteen patients with hemiplegic migraine (M:F, 7:11; age 38 ± 14 years) of whom eight had a known familial hemiplegic migraine (FHM) mutation (five in the CACNA1A gene (FHM1), three in the ATP1A2 gene (FHM2)) and 19 age- and sex-matched healthy controls (M:F, 7:12; mean age 38 ± 12 years) were studied. We used single-voxel 7 tesla (1)H-MRS (STEAM, TR/TM/TE = 2000/19/21 ms) to investigate four brain regions in between attacks: cerebellum, hypothalamus, occipital lobe, and pons.
  
  
  RESULTS
  Patients with hemiplegic migraine showed a significantly lower total N-acetylaspartate/total creatine ratio (tNAA/tCre) in the cerebellum (median 0.73, range 0.59-1.03) than healthy controls (median 0.79, range (0.67-0.95); p = 0.02). In FHM1 patients with a CACNA1A mutation, the tNAA/tCre was lowest.
  
  
  CONCLUSIONS
  We found a decreased cerebellar tNAA/tCre ratio that might serve as an early biomarker for neuronal dysfunction and/or loss. This is the first high-spectral resolution 7 tesla (1)H-MRS study of interictal biochemical brain changes in hemiplegic migraine patients.
authors.affiliation: Department of Neurology, Leiden University Medical Centre, the Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Zielman
authors.affiliation: Department of Radiology, Leiden University Medical Centre, the Netherlands.
authors.forename: W M
authors.initials: WM
authors.lastname: Teeuwisse
authors.affiliation: Department of Neurology, Leiden University Medical Centre, the Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Bakels
authors.affiliation: Department of Radiology, Leiden University Medical Centre, the Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Van der Grond
authors.affiliation: Department of Radiology, Leiden University Medical Centre, the Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Webb
authors.affiliation: Department of Radiology, Leiden University Medical Centre, the Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: van Buchem
authors.affiliation: Department of Neurology, Leiden University Medical Centre, the Netherlands.
authors.forename: M D
authors.initials: MD
authors.lastname: Ferrari
authors.affiliation: Department of Radiology, Leiden University Medical Centre, the Netherlands.
authors.forename: M C
authors.initials: MC
authors.lastname: Kruit
authors.affiliation: Department of Neurology, Leiden University Medical Centre, the Netherlands G.M.Terwindt@lumc.nl.
authors.forename: G M
authors.initials: GM
authors.lastname: Terwindt
mesh_terms: D000328:Adult; D001921:Brain / Q000378:metabolism* / Q000503:physiopathology; D001923:Brain Chemistry; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000378:metabolism* / Q000503:physiopathology; D020325:Migraine with Aura / Q000378:metabolism; D066244:Proton Magnetic Resonance Spectroscopy / Q000379:methods*; D055815:Young Adult
keywords: FHM; Migraine; genetics; imaging; magnetic resonance spectroscopy