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RESEARCH PRODUCT

Impaired Glutamatergic Neurotransmission in Migraine With Aura? Evidence by an Input-Output Curves Transcranial Magnetic Stimulation Study

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(Headache 2011;51:726-733) Objective.— An imbalance between activity of inhibitory and facilitatory intracortical circuits could play a central role in migraine etiology. We used input–output curves to achieve further information about intracortical excitability of motor cortex in migraine with aura. Methods.— Input–output curves were measured in the right abductor pollicis brevis muscle at rest in 12 patients suffering from migraine with aura and 8 healthy subjects. Stimuli were delivered at intensity ranging from 100% to 160% of resting motor threshold with 10-second inter-stimulus intervals. Seven patients were studied before and during treatment with levetiracetam. Results.— Results showed a greater motor-evoked potential amplitude in response to increasing intensity of stimuli in patients compared to controls (P < .02). This increased facilitatory effect was abolished by levetiracetam (P < .005). Conclusions.— Our findings support the hypothesis of an interictal cortical hyper-responsivity in migraine patients that appears to be normalized by levetiracetam. This effect could support the potential therapeutic role of levetiracetam in migraine with aura prevention.