Progress in brain research
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Review
A new era for migraine: The role of calcitonin gene-related peptide in the trigeminovascular system.
There is a huge improvement in our understanding of migraine pathophysiology in the past decades. The activation of the trigeminovascular system has been proved to play a key role in migraine. Calcitonin gene-related peptide (CGRP) and CGRP receptors are widely distributed in the trigeminovascular system. ⋯ Based on these findings, several treatment options have been designed for migraine treatment, including CGRP receptor antagonists (gepants) and monoclonal antibodies targeting CGRP or CGRP receptors. The clinical trials show both gepants and monoclonal antibodies are effective for migraine treatment. In this section, we describe the roles of the trigeminovascular system in migraine, the discovery of CGRP, and the CGRP signaling pathway.
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The visual network is crucially implicated in the pathophysiology of migraine. Several lines of evidence indicate that migraine is characterized by an altered visual cortex excitability both during and between attacks. Visual symptoms, the most common clinical manifestation of migraine aura, are likely the result of cortical spreading depression originating from the extrastriate area V3A. ⋯ We will first provide an overview highlighting the direct implication of the visual network in migraine. Next, we will focus on the rationale behind using NIBS for migraine treatment, including its effects on the visual cortex, and the shortcomings of currently available evidence. Finally, we propose a broader perspective of how novel approaches, the concept of brain networks and the integration of multimodal imaging with computational modeling, can help refine current NIBS methods, with the ultimate goal of optimizing a more individualized treatment for migraine.
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Spasticity is one of the main complications after the spinal cord injury (SCI). Most commonly, severe cases of spasticity are treated surgically with intrathecal baclofen therapy (ITB). Spinal cord stimulation for chronic pains (SCS) serves as an alternative for ITB. Both methods have their benefits and limitations. This study is aimed at development of a personalized SCS and ITB treatment algorithm for patients with severe cases of spasticity after SCI. ⋯ Surgical treatment of patients with severe spasticity after SCI should start with experimental spinal cord stimulation, and, in case of a positive response, be followed by SCS system implantation. Patients with positive response to the experimental stimulation exhibit a significantly prolonged response to treatment, without substantial differences from ITB patients.
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This chapter provides a theoretical introduction to states of consciousness and reviews neuroscientific investigations of meditation. The different states of consciousness consist of four mental states, i.e., cancalata (random thinking), ekagrata (non-meditative focusing), dharna (focused meditation), and dhyana (meditation) as defined in yoga texts. Meditation is a self-regulated mental process associated with deep relaxation and increased internalized attention. ⋯ Focused meditation practice involves awareness on a single object and open monitoring meditation is a non-directive meditation involved attention in breathing, mantra, or sound. Therefore, results of few empirical studies of advanced meditators or beginners remain tentative. This is an attempt to compile the meditation-related changes in electrophysiological and neuroimaging processes among experienced and novice practitioners.
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Several studies have demonstrated that meditation naïve subjects can, in just a few weeks, become proficient enough in meditation to show cognitive improvements accompanied with functional and structural changes in the brain. Would long-term exposure to qualitatively different levels of meditative training bring about differences in cognitive processing? Would meditation prior to task performance help separate out these differences? Could the nature of the task influence the findings related to cognitive enhancements? To address these questions, we evaluated cognitive functions in three groups of experienced Vipassana practitioners (Novices: n=22, Mean±SD meditation experience=989±595h; Senior practitioners: 21, 10,510±5313; Teachers: 16, 14,648±9623) who differed in terms of duration and quality of meditative practice. Specifically, we employed "ANGEL" a gamified multilevel oddball paradigm, to assess P3 event-related potentials (ERPs) and associated EEG dynamics-power spectra, event related spectral perturbations (ERSP) and inter-trial coherence (ITC). ⋯ Specifically, we found reduced theta synchrony, enhanced alpha de-synchrony and lesser theta-alpha coherence in the more proficient meditators. Post hoc analyses revealed several differences between the novice and teacher groups but not as many between novice and seniors suggesting that the senior meditators formed an intermediate group. Our study demonstrates that both quantity and quality of meditation influence EEG dynamics during cognitive processing and that meditation prior to a task can provide additional state-trait effects involved in meeting the specific cognitive demands.