Deficit of Brain and Skeletal Muscle Bioenergetics and Low Brain Magnesium in Juvenile Migraine: An in Vivo 31P Magnetic Resonance Spectroscopy Interictal Study

Abstract

We used phosphorus magnetic resonance spectroscopy (31P MRS) to investigate in vivo the brain and skeletal muscle energy metabolism of 15 children with migraine with aura in interictal periods. Brain 31P MRS disclosed low phosphocreatine and high inorganic phosphate contents, and high intracellular pH in all patients. Calculated [ADP] and the relative rate of mitochondrial oxidation were higher in the brain of patients than in control subjects, whereas the phosphorylation potential was lower. Brain intracellular free Mg2+ concentration was reduced by 25% in patients. Abnormal skeletal muscle mitochondrial respiration was also disclosed in 7 of 15 patients as shown by the slow rate of phosphocreatine postexercise recovery. The multisystem bioenergetic failure found in patients with juvenile migraine is comparable to that found in adults with different types of migraine.

Magnetic resonance spectroscopy in migraine: What have we learned so far?

“…One study, Boska et al, reported only a depletion of PCr in anterior brain regions of MwA and the occipital cortex of FHM patients (11). The calculated value of the phosphorylation potential was significantly decreased in migraine patients, as reported in a number of studies (8,9,(12)(13)(14)(15) hence has a lower energy reserve, was also frequently observed (8,9,(13)(14)(15)18). The percentage of v/v max was found to be significantly increased in migraine patients (8,9,14,15).…”

“…First of all, a significant decrease in [PCr] (8,9,(12)(13)(14)(15)17) and an increase in [P i ] (13-15, 17) resulting in a reduced PCr/P i ratio (5,16,17,19,20) were the most generalized observations, regardless of the brain region. One study, Boska et al, reported only a depletion of PCr in anterior brain regions of MwA and the occipital cortex of FHM patients (11).…”

“…The pH i -changes found in these studies should be regarded carefully, though, because of the presence of large standard deviations (13), borderline significance (14) or migrainous stroke (18). The same remark holds true for Mg 2+ , an essential cofactor for mitochondrial membrane stability and in oxidative phosphorylation, which was found significantly decreased in a minority of studies (7,10,11,14).…”

“…pH i was measured in all abovementioned studies and no significant pH i -changes were observed in all but three studies (13,14,18). The pH i -changes found in these studies should be regarded carefully, though, because of the presence of large standard deviations (13), borderline significance (14) or migrainous stroke (18).…”

Skeletal muscle energetics assessed by 31P-NMR in prepubertal girls with a familial predisposition to obesity

“…1 Many previous studies 2 -11 have used 31 P-NMR to examine skeletal muscle energetics during different types of exercise (eg, aerobic and anaerobic) and in different adult populations (eg normal healthy adults, athletes, or patients with heart failure, hyperthyroidism, chronic respiratory impairment, malignant hyperthermia and malnutrition). Fewer studies using exercise protocols with 31 P-NMR have been completed in children and adolescents who are healthy, 12 -14 or diagnosed with migraines 15 or alternating hemiplegia, 16 although sample sizes in prepubertal children have been small (n ¼ 1; 16 n ¼ 2; 15 n ¼ 10 14 ). Children and adolescents have been reported to have a higher pH at the end of exercise 12 -14 and less glycolytic ability 12,14 than adults.…”