Getting to grips with migraine

Researchers identify some of the biological roots of migraine from large-scale genome study

In the largest study of migraines, researchers have found 5 genetic regions that for the first time have been linked to the onset of migraine. This study opens new doors to understanding the cause and biological triggers that underlie migraine attacks.

The team identified 12 genetic regions associated with migraine susceptibility. Eight of these regions were found in or near genes known to play a role in controlling brain circuitries and two of the regions were associated with genes that are responsible for maintaining healthy brain tissue. The regulation of these pathways may be important to the genetic susceptibility of migraines.

Migraine is a debilitating disorder that affects approximately 14% of adults. Migraine has recently been recognised as the seventh disabler in the Global Burden of Disease Survey 2010 and has been estimated to be the most costly neurological disorder. It is an extremely difficult disorder to study because no biomarkers between or during attacks have been identified so far.

"This study has greatly advanced our biological insight about the cause of migraine," says Dr Aarno Palotie, from the Wellcome Trust Sanger Institute. "Migraine and epilepsy are particularly difficult neural conditions to study; between episodes the patient is basically healthy so it’s extremely difficult to uncover biochemical clues.

"We have proven that this is the most effective approach to study this type of neurological disorder and understand the biology that lies at the heart of it."

The team uncovered the underlying susceptibilities by comparing the results from 29 different genomic studies, including over 100,000 samples from both migraine patients and control samples.

They found that some of the regions of susceptibility lay close to a network of genes that are sensitive to oxidative stress, a biochemical process that results in the dysfunction of cells.

The team expects many of the genes at genetic regions associated with migraine are interconnected and could potentially be disrupting the internal regulation of tissue and cells in the brain, resulting in some of the symptoms of migraine.

"We would not have made discoveries by studying smaller groups of individuals," says Dr Gisela Terwindt, co-author from Leiden University Medical Centre. "This large scale method of studying over 100,000 samples of healthy and affected people means we can tease out the genes that are important suspects and follow them up in the lab."

The team identified an additional 134 genetic regions that are possibly associated to migraine susceptibility with weaker statistical evidence. Whether these regions underlie migraine susceptibility or not still needs to be elucidated. Other similar studies show that these statistically weaker culprits can play an equal part in the underlying biology of a disease or disorder.

"The molecular mechanisms of migraine are poorly understood. The sequence variants uncovered through this meta-analysis could become a foothold for further studies to better understanding the pathophysiology of migraine" says Dr Kári Stefánsson, President of deCODE genetics.

"This approach is the most efficient way of revealing the underlying biology of these neural disorders," says Dr Mark Daly, from the Massachusetts General Hospital and the Broad Institute of MIT and Harvard. "Effective studies that give us biological or biochemical results and insights are essential if we are to fully get to grips with this debilitating condition.

"Pursuing these studies in even larger samples and with denser maps of biological markers will increase our power to determine the roots and triggers of this disabling disorder."

Voices may not trigger brain’s reward centers in children with autism

In autism, brain regions tailored to respond to voices are poorly connected to reward-processing circuits, according to a new study by scientists at the Stanford University School of Medicine.

The research could help explain why children with autism struggle to grasp the social and emotional aspects of human speech. “Weak brain connectivity may impede children with autism from experiencing speech as pleasurable,” said Vinod Menon, PhD, senior author of the study, published online June 17 in Proceedings of the National Academy of Sciences. Menon is a professor of psychiatry and behavioral sciences at Stanford and a member of the Child Health Research Institute at Lucile Packard Children’s Hospital.

"The human voice is a very important sound; it not only conveys meaning but also provides critical emotional information to a child," said Daniel Abrams, PhD, a postdoctoral scholar in psychiatry and behavioral sciences who was the study’s lead author. Insensitivity to the human voice is a hallmark of autism, Abrams said, adding, "We are the first to show that this insensitivity may originate from impaired reward circuitry in the brain."

The study focused on children with a high-functioning form of autism. They had IQ scores in the normal range and could speak and read, but had difficulty holding a back-and-forth conversation or understanding emotional cues in another person’s voice.

The scientists compared functional magnetic resonance imaging brain scans from 20 of these children with scans from 19 typically developing children, paying particular attention to a portion of the brain that responds selectively to the sound of human voices. Prior research has shown that adults with autism had low voice-selective cortex activity in response to speech. But until this study by Menon and his colleagues, no one had looked at connections between the voice-selective cortex and other brain regions in individuals with autism.

The new study found that in children with a high-functioning form of autism, the voice-selective cortex on the left side of the brain was weakly connected to the nucleus accumbens and the ventral tegmental area — brain structures that release dopamine in response to rewards. The voice-selective cortex on the right side of the brain, which specializes in detecting vocal cues such as intonation and pitch, was weakly connected to the amygdala, which processes emotional cues.

The weaker these connections in children with autism, the worse their communication deficits, the study showed. The researchers were able to predict the children’s scores on the verbal portion of a standard test of autism severity by looking at the degree of impairment in these brain connections.

The findings may help to validate some autism therapies already in use, said co-author Jennifer Phillips, PhD, a clinical associate professor of psychiatry and behavioral sciences at Stanford who also treats children with autism at Packard Children’s. For instance, pivotal-response training aims to increase social use of language in children who can speak some words but who usually do not talk to others.

"Pivotal-response training goes after ways to naturally motivate kids to start using language and other forms of social interaction," Phillips said. Future studies could test whether brain connections leading from voice to reward centers are strengthened by autism therapies, she added.

The findings also help resolve a long-standing debate about why individuals with autism show less-than-normal interest in human voices. The team investigated two competing theories to explain the phenomenon: that individuals with autism have a deficit in their social motivation, or, alternatively, that they have sensory-processing deficits which impair their ability to fully hear human voices. The new study found normal connections between voice-selective cortex and primary auditory brain regions in children with high-functioning autism, suggesting that these children do not have sensory-processing deficits.

The next steps for researchers include studying the consequences of the weak voice-to-reward circuit in autism. “It is likely that children with autism don’t attend to voices because they are not rewarding or emotionally interesting, impacting the development of their language and social communication skills,” Menon said. “We have discovered an aberrant brain circuit underlying a core deficit in autism; our findings may aid the development of new treatments for this disorder.”

(Image: Getty Images)

Inside the Letterbox: How Literacy Transforms the Human Brain

Although I find the diversity of the world’s writing systems bewildering, there is also a striking regularity that remains hidden. Whenever we read—whether our language is Japanese, Hebrew, English, or Italian—each of us relies on very similar brain networks. In particular, a small region of the visual cortex becomes active with remarkable reproducibility in the brains of all readers. A brief localizer scan, during which images of brain activity are collected as a person responds to written words, faces, objects, and other visual stimuli, serves to identify this region. Written words never fail to activate a small region at the base of the left hemisphere, always at the same place, give or take a few millimeters.

Experts call this region the visual word form area, but in a recent book for the general public, I dubbed it the brain’s letterbox, because it concentrates much of our visual knowledge of letters and their configurations. Indeed, this site is amazingly specialized. The letterbox responds to written words more than it does to most other categories of visual stimuli, including pictures of faces, objects, houses, and even Arabic numerals.Its efficiency is so great that it even responds to words that we fail to recognize consciously—words made subliminal by flashing them for a fraction of a second. Yet it performs highly sophisticated operations that are indispensable to fluent reading. For instance, the letterbox is the first visual area that recognizes that “READ” and “read” depict the same word by representing strings of letters invariantly for changes in case, which is no small feat if you consider that uppercase and lowercase letters such as “A” and “a” bear very little similarity. Furthermore, if it is impaired or disconnected via brain surgery or a cerebral infarct (type of stroke), the patient may develop a syndrome called pure alexia. He or she will be unable to recognize even a single word, as well as faces, objects, digits, and Arabic numerals. Yet many of these patients can still speak and understand spoken language fluently, and they may even still write; only their visual capacity to process letter strings seems dramatically affected.

The brain of any educated adult contains a circuit specialized for reading. But how is this possible, given that reading is an extremely recent and highly variable cultural activity? The alphabet is only about 4,000 years old, and until recently, only a very small fraction of humanity could read. Thus, there was no time for Darwinian evolution to shape our genome and adapt our brain networks to the particularities of reading. How is it, then, that we all possess a specialized letterbox area?

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Insomnia may cause dysfunction in emotional brain circuitry

A new study provides neurobiological evidence for dysfunction in the neural circuitry underlying emotion regulation in people with insomnia, which may have implications for the risk relationship between insomnia and depression.

“Insomnia has been consistently identified as a risk factor for depression,” said lead author Peter Franzen, PhD, an assistant professor of psychiatry at the University of Pittsburgh School of Medicine. “Alterations in the brain circuitry underlying emotion regulation may be involved in the pathway for depression, and these results suggest a mechanistic role for sleep disturbance in the development of psychiatric disorders.”

The study involved 14 individuals with chronic primary insomnia without other primary psychiatric disorders, as well as 30 good sleepers who served as a control group. Participants underwent an fMRI scan during an emotion regulation task in which they were shown negative or neutral pictures. They were asked to passively view the images or to decrease their emotional responses using cognitive reappraisal, a voluntary emotion regulation strategy in which you interpret the meaning depicted in the picture in order to feel less negative.

Results show that in the primary insomnia group, amygdala activity was significantly higher during reappraisal than during passive viewing.  Located in the temporal lobe of the brain, the amygdala plays an important role in emotional processing and regulation.

In analysis between groups, amygdala activity during reappraisal trials was significantly greater in the primary insomnia group compared with good sleepers. The two groups did not significantly differ when passively viewing negative pictures.

“Previous studies have demonstrated that successful emotion regulation using reappraisal decreases amygdala response in healthy individuals, yet we were surprised that activity was even higher during reappraisal of, versus passive viewing of, pictures with negative emotional content in this sample of individuals with primary insomnia,” said Franzen.

The research abstract was published recently in an online supplement of the journal SLEEP, and Franzen will present the findings Wednesday, June 5, in Baltimore, Md., at SLEEP 2013, the 27th annual meeting of the Associated Professional Sleep Societies LLC.

The American Academy of Sleep Medicine reports that about 10 to 15 percent of adults have an insomnia disorder with distress or daytime impairment. According to the National Institute of Mental Health, 6.7 percent of the U.S. adult population suffers from major depressive disorder. Both insomnia and depression are more common in women than in men.

Scientists pinpoint brain’s area for numeral recognition

Scientists at the Stanford University School of Medicine have determined the precise anatomical coordinates of a brain “hot spot,” measuring only about one-fifth of an inch across, that is preferentially activated when people view the ordinary numerals we learn early on in elementary school, like “6” or “38.”

Activity in this spot relative to neighboring sites drops off substantially when people are presented with numbers that are spelled out (“one” instead of “1”), homophones (“won” instead of “1”) or “false fonts,” in which a numeral or letter has been altered.

“This is the first-ever study to show the existence of a cluster of nerve cells in the human brain that specializes in processing numerals,” said Josef Parvizi, MD, PhD, associate professor of neurology and neurological sciences and director of Stanford’s Human Intracranial Cognitive Electrophysiology Program. “In this small nerve-cell population, we saw a much bigger response to numerals than to very similar-looking, similar-sounding and similar-meaning symbols.

“It’s a dramatic demonstration of our brain circuitry’s capacity to change in response to education,” he added. “No one is born with the innate ability to recognize numerals.”

The finding pries open the door to further discoveries delineating the flow of math-focused information processing in the brain. It also could have direct clinical ramifications for patients with dyslexia for numbers and with dyscalculia: the inability to process numerical information.

The cluster Parvizi’s group identified consists of perhaps 1 to 2 million nerve cells in the inferior temporal gyrus, a superficial region of the outer cortex on the brain. The inferior temporal gyrus is already generally known to be involved in the processing of visual information.

The new study, published April 17 in the Journal of Neuroscience, builds on an earlier one in which volunteers had been challenged with math questions. “We had accumulated lots of data from that study about what parts of the brain become active when a person is focusing on arithmetic problems, but we were mostly looking elsewhere and hadn’t paid much attention to this area within the inferior temporal gyrus,” said Parvizi, who is senior author of the study.

Not, that is, until fourth-year medical student Jennifer Shum, who also is doing research in Parvizi’s lab, noticed that, among some subjects in the first study, a spot in the inferior temporal gyrus seemed to be substantially activated by math exercises. Charged with verifying that this observation was consistent from one patient to the next, Shum, the study’s lead author, reported that this was indeed the case. So, Parvizi’s team designed a new study to look into it further.

The new study relied on epileptic volunteers who, as a first step toward possible surgery to relieve unremitting seizures that weren’t responding to therapeutic drugs, had a small section of their skulls removed and electrodes applied directly to the brain’s surface. The procedure, which doesn’t destroy any brain tissue or disrupt the brain’s function, had been undertaken so that the patients could be monitored for several days to help attending neurologists find the exact location of their seizures’ origination points. While these patients are bedridden in the hospital for as much as a week of such monitoring, they are fully conscious, in no pain and, frankly, a bit bored.

Over time, Parvizi identified seven epilepsy patients with electrode coverage in or near the inferior temporal gyrus and got these patients’ consent to undergo about an hour’s worth of tests in which they would be shown images presented for very short intervals on a laptop computer screen, while activity in their brain regions covered by electrodes was recorded. Each electrode picked up activity from an area corresponding to about a half-million nerve cells (a drop in the bucket in comparison to the brain’s roughly 100 billion nerve cells).

To make sure that any numeral-responsive brain areas identified were really responding to numerals — and not just generic lines, angles and curves — these tests were carefully calibrated to distinguish brain responses to visual presentations of the classic numerals taught in Western schools, such as 3 or 50, as opposed to squiggly lines, letters of the alphabet, number-denoting words such as “three” or “fifty,” and symbols that in fact were also numerals but — because they were drawn from the Thai, Tibetan and Devanagari languages — were extremely unlikely to be recognized as such by this particular group of volunteers.

In the first test, subjects were shown series of single numerals and letters — along with false fonts, in which the component parts of numerals or letters had been scrambled but defining curves and angles were retained, and the foreign-number symbols just described. A second test, controlling for meaning and sound, included numerals and their spelled-out versions (for instance, “1” and “one,” or “3” and “three”) and other words with the same sound or a similar one (“won” and “tree,” respectively).

All of our brains are shaped slightly differently. But in almost the identical spot within each study subject’s brain, the investigators observed a significantly larger response to numerals than to similar-shaped stimuli, such as letters or scrambled letters and numerals, or to words that either meant the same as the numerals or sounded like them.

Interestingly, said Parvizi, that numeral-processing nerve-cell cluster is parked within a larger group of neurons that is activated by visual symbols that have lines with angles and curves. “These neuronal populations showed a preference for numerals compared with words that denote or sound like those numerals,” he said. “But in many cases, these sites actually responded strongly to scrambled letters or scrambled numerals. Still, within this larger pool of generic neurons, the ‘visual numeral area’ preferred real numerals to the false fonts and to same-meaning or similar-sounding words.”

It seems, Parvizi said, that “evolution has designed this brain region to detect visual stimuli such as lines intersecting at various angles — the kind of intersections a monkey has to make sense of quickly when swinging from branch to branch in a dense jungle.” The adaptation of one part of this region in service of numeracy is a beautiful intersection of culture and neurobiology, he said.

Having nailed down a specifically numeral-oriented spot in the brain, Parvizi’s lab is looking to use it in tracing the pathways described by the brain’s number-processing circuitry. “Neurons that fire together wire together,” said Shum. “We want to see how this particular area connects with and communicates with other parts of the brain.”

Alzheimer’s risk gene discovered using imaging method that screens brain’s connections

Scientists at UCLA have discovered a new genetic risk factor for Alzheimer’s disease by screening people’s DNA and then using an advanced type of scan to visualize their brains’ connections.

Alzheimer’s disease, the most common cause of dementia in the elderly, erodes these connections, which we rely on to support thinking, emotion and memory. With no known cure for the disease, the 20 million Alzheimer’s sufferers worldwide lack an effective treatment. And we are all at risk: Our chance of developing Alzheimer’s doubles every five years after age 65.

The UCLA researchers discovered a common abnormality in our genetic code that increases the risk of Alzheimer’s. To find the gene, they used a new imaging method that screens the brain’s connections — the wiring, or circuitry, that communicates information. Switching off such Alzheimer’s risk genes (nine of them have been implicated over the last 20 years) could stop the disorder in its tracks or delay its onset by many years.

The research is published in the March 4 online edition of the journal Proceedings of the National Academy of Sciences.

"We found a change in our genetic code that boosts our risk for Alzheimer’s disease," said the study’s senior author, Paul Thompson, a UCLA professor of neurology and a member of the UCLA Laboratory of Neuro Imaging. "If you have this variant in your DNA, your brain connections are weaker. As you get older, faulty brain connections increase your risk of dementia."

The researchers, Thompson said, screened more than a thousand people’s DNA to find the common “spelling errors” in the genetic code that might heighten their risk for the disease later in life. The new study was the first of its kind to also give each person a “connectome scan,” a special type of scan that measures water diffusion in the brain, allowing scientists to map the strength of the brain’s connections.

The new scan reveals the brain’s circuitry and how information is routed around the brain, in order to discover risk factors for disease. The researchers then combined these connectivity scans with the extensive genomic screening to pinpoint what causes faulty wiring in the brain.

Hundreds of computers, calculating for months, sifted through more than 4,000 brain connections and the entire genetic code, comparing connection patterns in people with different genetic variations. In people whose genetic code differed in one specific gene called SPON1, weaker connections were found between brain centers controlling reasoning and emotion. The rogue gene also affects how senile plaques build up in the brain — one of the hallmarks of Alzheimer’s disease.

"Much of your risk for disease is written in your DNA, so the genome is a good place to look for new drug targets," said Thompson, who in 2009 founded a research network known as Project ENIGMA to pool brain scans and DNA from 26,000 people worldwide. "If we scan your brain and DNA today, we can discover dangerous genes that will undermine your ability to think and plan and will make you ill in the future. If we find these genes now, there is a better chance of new drugs that can switch them off before you or your family get ill."

Developing new therapeutics for Alzheimer’s is a hot area for pharmaceutical research, Thompson said.

It has also been found that the SPON1 gene can be manipulated to develop new treatments for the devastating disease, Thompson noted. When the rogue gene was altered in mice, it led to cognitive improvements and fewer plaques building up in the brain. Alzheimer’s patients show an accumulation of these senile plaques, which are made of a sticky substance called amyloid and are thought to kill brain cells, causing irreversible memory loss and personality changes.

Screening genomes has led to many new drug targets in the treatment of cancer, heart disease, arthritis and brain disorders such as epilepsy. But the UCLA team’s approach — screening genomes and performing brain scans of the same people — promises a faster and more efficient search.

"With a brain scan that takes half an hour and a DNA scan from a saliva sample, we can search your genes for factors that help or harm your brain’s connections," Thompson said. "This opens up a new landscape of discovery in medical science."

Human Connectome Project releases major data set on brain connectivity

The Human Connectome Project, a five-year endeavor to link brain connectivity to human behavior, has released a set of high-quality imaging and behavioral data to the scientific community. The project has two major goals: to collect vast amounts of data using advanced brain imaging methods on a large population of healthy adults, and to make the data freely available so that scientists worldwide can make further discoveries about brain circuitry.

The initial data release includes brain imaging scans plus behavioral information — individual differences in personality, cognitive capabilities, emotional characteristics and perceptual function — obtained from 68 healthy adult volunteers. Over the next several years, the number of subjects studied will increase steadily to a final target of 1,200. The initial release is an important milestone because the new data have much higher resolution in space and time than data obtained by conventional brain scans.

The Human Connectome Project (HCP) consortium is led by David C. Van Essen, PhD, Alumni Endowed Professor at Washington University School of Medicine in St. Louis, and Kamil Ugurbil, PhD, Director of the Center for Magnetic Resonance Research and the McKnight Presidential Endowed Chair Professor at the University of Minnesota.

“By making this unique data set available now, and continuing with regular data releases every quarter, the Human Connectome Project is enabling the scientific community to immediately begin exploring relationships between brain circuits and individual behavior,” says Van Essen. “The HCP will have a major impact on our understanding of the healthy adult human brain, and it will set the stage for future projects that examine changes in brain circuits underlying the wide variety of brain disorders afflicting humankind.”

The consortium includes more than 100 investigators and technical staff at 10 institutions in the United States and Europe (www.humanconnectome.org). It is funded by 16 components of the National Institutes of Health via the Blueprint for Neuroscience Research (www.neuroscienceblueprint.nih.gov).

“The high quality of the data being made available in this release reflects an intensive, multiyear effort to improve the data acquisition and analysis methods by this dedicated international team of investigators,” says Ugurbil.

The data set includes information about brain connectivity in each individual, using two distinct magnetic resonance imaging (MRI) approaches. One, called resting-state functional connectivity, is based on spontaneous fluctuations in functional MRI signals that occur in a complex pattern in space and time throughout the gray matter of the brain. Another, called diffusion imaging, provides information about the long-distance “wiring” – the anatomical pathways traversing the brain’s white matter. Each method has its own limitations, and analyses of both functional connectivity and structural connectivity in each subject should allow deeper insight than by either method alone.

Each subject is also scanned while performing a variety of tasks within the scanner, thereby providing extensive information about “Task-fMRI” brain activation patterns. Behavioral data using a variety of tests performed outside the scanner are being released along with the scan data for each subject. The subjects are drawn from families that include siblings, some of whom are twins. This will enable studies of the heritability of brain circuits.

The imaging data set released by the HCP takes up about two terabytes (2 trillion bytes) of computer memory — the equivalent of more than 400 DVDs — and is stored in a customized database called “ConnectomeDB.”

“ConnectomeDB is the next-generation neuroinformatics software for data sharing and data mining. It’s a convenient and user-friendly way for scientists to explore the available HCP data and to download data of interest for their research,” says Daniel S. Marcus, PhD, assistant professor of radiology and director of the Neuroinformatics Research Group at Washington University School of Medicine. “The Human Connectome Project represents a major advance in sharing brain imaging data in ways that will accelerate the pace of discovery about the human brain in health and disease.”

The brain circuit that makes it hard for obese people to lose weight

Imagine you are driving a car, and the harder you press on the accelerator, the harder an invisible foot presses on the brake. That’s what happens when obese people diet – the less food they eat, the less energy they burn, and the less weight they lose.

While this phenomenon is known, scientists at Sydney’s Garvan Institute of Medical Research and the University of NSW have pinpointed the exact brain circuitry behind it and have published their findings in the prestigious international journal Cell Metabolism, now online.

Dr Shu Lin, Dr Yanchuan Shi and Professor Herbert Herzog and his team have been studying the complex processes behind energy balance using various mouse models. They have shown that the neurotransmitter Neuropeptide Y (NPY), known for stimulating appetite, also plays a major role in controlling whether the body burns or conserves energy.

The researchers found that NPY produced in a particular region of the brain – the arcuate nucleus (Arc) of the hypothalamus – inhibits the activation of ‘brown fat’, one of the primary tissues where the body generates heat.

“This study is the first to identify the neurotransmitters and neural pathways that carry signals generated by NPY in the brain to brown fat cells in the body. It is also the first to show a direct connection between Arc NPY, the sympathetic nervous system and the control of energy expenditure.” said Professor Herzog.

“We know that NPY also influences other aspects of the sympathetic nervous system – such as heart rate and gut function – but its control of heat generation through brown fat seems to be the most critical factor in the control of energy expenditure.”

“When you don’t eat, or dramatically curtail your calorie intake, levels of NPY rise sharply. High levels of NPY signal to the body that it is in ‘starvation mode’ and should try to replenish and conserve as much energy as possible. As a result, the body reduces processes that are not absolutely necessary for survival.”

“Evolution has provided us with these mechanisms to help us survive famine, and they are strictly controlled. When people had to survive by finding food or hunting game, they could not afford to run out of energy and die of exhaustion, so their bodies evolved to cope.”

“Until the twentieth century, there were no fast food chains and people did not have ready access to high fat, high sugar, foods. So in evolutionary terms, it was unlikely that people were going to get very fat and mechanisms were only put in place to prevent you losing weight.”

“Obesity is a modern epidemic, and the challenge will be to find ways of tricking the body into losing weight – and that will mean somehow circumventing or manipulating this NPY circuit, probably with drugs.”