title: Visual and auditory cortical evoked potentials in interictal episodic migraine: An audit on 624 patients from three centres.
abstract: Background Many studies report a habituation deficit of visual evoked potentials (VEP) and/or increased intensity dependence of auditory evoked cortical potentials (IDAP) in episodic migraine patients between attacks. These findings have a pathophysiological interest, but their diagnostic utility is not known. Aims To perform an audit on a large database of interictal VEP and IDAP recordings in episodic migraine patients and evaluate their diagnostic accuracy. Methods We pooled data for VEP habituation and IDAP measured in 624 episodic migraineurs (EM) and 360 healthy volunteers (HV) from three centers. Thresholds were calculated by Receiver Operating Curve analysis and used to calculate sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-) and the accuracy of each test, using ICHD diagnostic criteria as the gold standard. Results In EM, VEP habituation was significantly lower than in HV, and IDAP slopes were significantly steeper. VEP (five blocks of 50 responses), VEP (six blocks of 100 responses) and IDAP had respectively 61.0%, 61.4% and 45.7% sensitivity, and 77.9%, 77.9% and 87.2% specificity. Their positive (LR+) and negative (LR-) likelihood ratios were respectively 2.760, 2.778, 3.570 and 0.500, 0.495, 0.623, with diagnostic accuracies of 65.3%, 69.0% and 54.3%. In combined VEP + IDAP recordings, an abnormality of at least one test had 83.4% sensitivity, 66.7% specificity, 2.504 LR+, 0.249 LR- and 81.1% accuracy. Conclusions In this large database, VEP habituation is significantly reduced and IDAP increased in episodic migraine patients between attacks. Taken alone, neither VEP nor IDAP has sufficient diagnostic accuracy. However, when both tests are performed in the same patient, an abnormality of at least one of them is highly predictive of interictal episodic migraine.
authors: 1 Headache Unit, IRCCS Neuromed, Pozzilli, IS, Italy.
authors: Anna
authors: A
authors: Ambrosini
authors: 2 Clinical and Molecular Epidemiology Unit, IRCCS San Raffaele Pisana, Rome, Italy.
authors: Aliaksei
authors: A
authors: Kisialiou
authors: 3 Department of Neurophysiology of Vision and Neurophthalmology, GB Bietti Foundation IRCCS, Rome, Italy.
authors: Gianluca
authors: G
authors: Coppola
authors: 4 Department of Developmental Psychology and Socialization, University of Padua, Italy.
authors: Livio
authors: L
authors: Finos
authors: 5 Headache Research Unit, University of Liège, Belgium.
authors: Delphine
authors: D
authors: Magis
authors: 1 Headache Unit, IRCCS Neuromed, Pozzilli, IS, Italy.|6 Sapienza University of Rome Polo Pontino, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy.
authors: Francesco
authors: F
authors: Pierelli
authors: 7 Headache Research Unit, University Dept of Neurology, Citadelle Hospital, Liège, Belgium.
authors: Jean
authors: J
authors: Schoenen
mesh_terms: D000328:Adult; D019540:Area Under Curve; D016208:Databases, Factual; D005072:Evoked Potentials, Auditory / Q000502:physiology*; D005074:Evoked Potentials, Visual / Q000502:physiology*; D005260:Female; D006185:Habituation, Psychophysiologic / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis* / Q000503:physiopathology*; D012372:ROC Curve; D012680:Sensitivity and Specificity
keywords: Migraine; auditory evoked cortical potentials; diagnosis; habituation; intensity dependence; visual evoked potentials