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A prospective observational within-person MRI morphometric study comparing ictal and interictal brain volumes in
Jennifer Robblee1, Timothy Noah Hutson1, Susan Criswell1
1Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
Objectives:
To assess whether total masked brain volume differs during status migrainosus (SM) compared to post-SM interictal baseline using structural MRI.
Methods:
This prospective within-person study included 11 participants scanned during an SM attack and post-SM interictal baseline using T1-weighted MRI. FreeSurfer-based volumetric analysis was performed. Linear mixed effect models evaluated global and regional brain volume comparing SM and interictal baseline. The primary outcome (total brain volume) was adjusted for age and interictal pain severity; secondary grouped regional analyses (cerebral cortex, subcortical white matter, and subcortical gray matter) were adjusted for age.
Results:
Participants had a mean age of 50.1 (SD 17.6) years and 91% (10/11) were female. Median SM attack duration was 600 (IQR 264-936) hours. Total brain volume was higher during SM compared with interictal baseline (β = 8897.000 mm3, 95% CI 2478-15,317 mm3; p = 0.012). The cerebral cortex and deep gray matter both showed a non-significant decrease in volume. Subcortical white matter showed a non-significant increase in volume.
Discussion:
This within-person study demonstrates that total brain volume is higher during SM compared with the post-SM interictal state. The cause is unknown, but possible mechanisms include subclinical cytotoxic edema. Larger studies with more granular analyses are needed to clarify the mechanisms and clinical significance of these findings.
