title: Cortical hot spots and labyrinths: why cortical neuromodulation for episodic migraine with aura should be personalized.
abstract: Stimulation protocols for medical devices should be rationally designed. For episodic migraine with aura we outline model-based design strategies toward preventive and acute therapies using stereotactic cortical neuromodulation. To this end, we regard a localized spreading depression (SD) wave segment as a central element in migraine pathophysiology. To describe nucleation and propagation features of the SD wave segment, we define the new concepts of cortical hot spots and labyrinths, respectively. In particular, we firstly focus exclusively on curvature-induced dynamical properties by studying a generic reaction-diffusion model of SD on the folded cortical surface. This surface is described with increasing level of details, including finally personalized simulations using patient's magnetic resonance imaging (MRI) scanner readings. At this stage, the only relevant factor that can modulate nucleation and propagation paths is the Gaussian curvature, which has the advantage of being rather readily accessible by MRI. We conclude with discussing further anatomical factors, such as areal, laminar, and cellular heterogeneity, that in addition to and in relation to Gaussian curvature determine the generalized concept of cortical hot spots and labyrinths as target structures for neuromodulation. Our numerical simulations suggest that these target structures are like fingerprints, they are individual features of each migraine sufferer. The goal in the future will be to provide individualized neural tissue simulations. These simulations should predict the clinical data and therefore can also serve as a test bed for exploring stereotactic cortical neuromodulation.
authors: Department of Physics, Humboldt-Universität zu Berlin Berlin, Germany ; Department of Biological Physik, Max Planck Institute for the Physics of Complex Systems Dresden, Germany.
authors: Markus A
authors: MA
authors: Dahlem
authors: Department of Physics, Humboldt-Universität zu Berlin Berlin, Germany.
authors: Bernd
authors: B
authors: Schmidt
authors: Cybernetics Research Group, School of Systems Engineering, University of Reading Reading, UK.
authors: Ingo
authors: I
authors: Bojak
authors: Department of Mathematics, The University of Auckland Auckland, New Zealand.
authors: Sebastian
authors: S
authors: Boie
authors: Department of Software Engineering and Theoretical Computer Science, Technische Universität Berlin Berlin, Germany.
authors: Frederike
authors: F
authors: Kneer
authors: Martinos Center for Biomedical Imaging, Harvard Medical School, Massachusetts General Hospital Charlestown, MA, USA.
authors: Nouchine
authors: N
authors: Hadjikhani
authors: Department of Physics, Humboldt-Universität zu Berlin Berlin, Germany ; Potsdam Institute for Climate Impact Research Potsdam, Germany ; Institute for Complex Systems and Mathematical Biology, University of Aberdeen Aberdeen, UK.
authors: Jürgen
authors: J
authors: Kurths
keywords: gyrification; migraine; neuromodulation; reaction-diffusion; spreading depression