TBSS Method Was Used To Evaluate The Microstructural Changes Of White Matter In Patients With Vestibular Migraine

Objective The microstructural changes of white matter in vestibular migraine were investigated using tract-based spatial statistics(TBSS),and their possible relationship with clinically relevant variables was described.The purpose of this study was to explore its diagnostic value in two diseases and to further clarify its pathogenesis.Materials and Methods A total of 35 patients with vestibular migraine(VM)(male: 4 cases vs female: 31 cases)and 36 patients with migraine without aura(MWo A)(male: 8 cases vs female: 28 cases)were enrolled in the Department of Neurology,Affiliated Hospital of Qingdao University from July 2018 to December 2021,all in interictal phase.Thirty-six patients were included in the healthy control(HC),which were matched with the age and sex of patients with VM and MWo A.The clinical manifestations and related questionnaires were evaluated by two senior neurologists.Subjects in VM,MWo A and HC groups were examined by brain DTI.TBSS method was used to analyze and compare the differences of anisotropy fraction(FA)values in different brain regions.FA values of different brain regions in VM group were extracted and Pearson correlation analysis was conducted with Migraine disability assessment(MIDAS)、 Dizziness handicap inventory(DHI)、 headache and vertigo Visual analogue score(VAS).The duration of migraine,duration of VM,headache frequency,vertigo frequency and DHI score,MIDAS score,headache and vertigo VAS score in VM group were analyzed by Pearson correlation.Results(1)There was no statistical difference in age and gender of subjects in the three groups(P>0.05).(2)There were differences in FA values among VM,MWo A and HC groups(P<0.05),and the differences were mainly in the left inner capsule forelimb/hind limb,cranium,sagittal layer,posterior inner capsular nucleus,domus/terminal striae,right outer capsule,domus/terminal striae,sagittal layer,posterior inner capsular nucleus,and left cranium.Pairwise comparison between VM and HC group showed that FA value was significantly decreased in the left anterior limb/posterior limb of inner capsule,cranial foot,sagittal layer,posterior inner capsular nucleus,dome/terminal striatum and right outer capsule,dome/terminal striatum,sagittal layer,posterior inner capsular nucleus(P<0.05).Pairwise comparison between MWo A group and HC group showed that FA value decreased mainly in the forelimb/hind limb of the left inner capsule and the cerebral-foot region(P<0.05).The pairwise comparison between VM and MWo A group showed that the main brain regions with significantly decreased FA value were the posterior part of the left inner pachycardia nucleus and the vault/terminal striatum region(P<0.05).(3)In the VM group,migraine duration was moderately correlated with MIDAS score and headache VAS score(r=0.450,P=0.007;r= 0.447,P=0.007).Headache frequency was strongly correlated with MIDAS score(r =0.701,P<0.001),and negatively correlated with vertigo VAS score(r=-0.368,P=0.030).No correlation was found between FA value of different brain regions in VM group and DHI score,MIDAS score,headache and vertigo VAS score(P>0.05).Conclusions(1)Patients with VM and MWo A had white matter damage in multiple brain regions,and the damage range of white matter fiber bundles was more extensive in patients with VM.(2)DTI index can sensitively detect the extent of white matter injury in patients with VM,especially in the sagittal layer,dome/terminal striatum,inner capsule forelimb/hind limb which is an important clue of the pathogenesis of VM,providing theoretical basis for elucidate its pathophysiology.