Virtual dynamic interaction games reveal impaired multisensory integration in women with migraine.

OBJECTIVE: In this cross-sectional observational study, we aimed to investigate sensory profiles and multisensory integration processes in women with migraine using virtual dynamic interaction systems. BACKGROUND: Compared to studies on unimodal sensory processing, fewer studies show that multisensory integration differs in patients with migraine. Multisensory integration of visual, auditory, verbal, and haptic modalities has not been evaluated in migraine. METHODS: A 12-min virtual dynamic interaction game consisting of four parts was played by the participants. During the game, the participants were exposed to either visual stimuli only or multisensory stimuli in which auditory, verbal, and haptic stimuli were added to the visual stimuli. A total of 78 women participants (28 with migraine without aura and 50 healthy controls) were enrolled in this prospective exploratory study. Patients with migraine and healthy participants who met the inclusion criteria were randomized separately into visual and multisensory groups: Migraine multisensory (14 adults), migraine visual (14 adults), healthy multisensory (25 adults), and healthy visual (25 adults). The Sensory Profile Questionnaire was utilized to assess the participants' sensory profiles. The game scores and survey results were analyzed. RESULTS: In visual stimulus, the gaming performance scores of patients with migraine without aura were similar to the healthy controls, at a median (interquartile range [IQR]) of 81.8 (79.5-85.8) and 80.9 (77.1-84.2) (p = 0.149). Error rate of visual stimulus in patients with migraine without aura were comparable to healthy controls, at a median (IQR) of 0.11 (0.08-0.13) and 0.12 (0.10-0.14), respectively (p = 0,166). In multisensory stimulation, average gaming score was lower in patients with migraine without aura compared to healthy individuals (median [IQR] 82.2 [78.8-86.3] vs. 78.6 [74.0-82.4], p = 0.028). In women with migraine, exposure to new sensory modality upon visual stimuli in the fourth, seventh, and tenth rounds (median [IQR] 78.1 [74.1-82.0], 79.7 [77.2-82.5], 76.5 [70.2-82.1]) exhibited lower game scores compared to visual stimuli only (median [IQR] 82.3 [77.9-87.8], 84.2 [79.7-85.6], 80.8 [79.0-85.7], p = 0.044, p = 0.049, p = 0.016). According to the Sensory Profile Questionnaire results, sensory sensitivity, and sensory avoidance scores of patients with migraine (median [IQR] score 45.5 [41.0-54.7] and 47.0 [41.5-51.7]) were significantly higher than healthy participants (median [IQR] score 39.0 [34.0-44.2] and 40.0 [34.0-48.0], p < 0.001, p = 0.001). CONCLUSION: The virtual dynamic game approach showed for the first time that the gaming performance of patients with migraine without aura was negatively affected by the addition of auditory, verbal, and haptic stimuli onto visual stimuli. Multisensory integration of sensory modalities including haptic stimuli is disturbed even in the interictal period in women with migraine. Virtual games can be employed to assess the impact of sensory problems in the course of the disease. Also, sensory training could be a potential therapy target to improve multisensory processing in migraine.

Clinical outcomes are associated with changes in ultrasonographic structural appearance after platelet-rich plasma treatment for knee osteoarthritis.

BACKGROUND: Hyaluronic acid (HA) and platelet-rich plasma (PRP) are two treatment options used for knee osteoarthritis (KOA) but studies comparing the efficacy of the two yield conflicting results. In addition, the association of clinical outcomes of PRP intra-articular injections with changes in the ultrasonography structural appearance of the knee has not been investigated. AIM: To compare the efficacy of PRP and HA intra-articular injections as mono-therapeutic options for primary KOA, and to determine whether the clinical outcomes are associated with changes in the ultrasonography structural appearance. SUBJECTS AND METHODS: A randomized clinical trial was conducted on 89 patients with KOA. The patients were given either PRP (n = 45) or HA (n = 44) intra-articular injections. The patients received three injections in the knee, which was more symptomatic at baseline evaluation, with a 2-week interval between injections. The outcome measures included visual analog score - pain, International Knee Documentation Committee Score, and assessment of synovial hypertrophy, synovial vascularity and knee effusion using ultrasonography. Outcome measures were assessed at baseline and at 3 and 6 months post-injection. RESULTS: While both PRP and HA injections resulted in the improvement of all outcome measures at 3 and 6 months follow up, they were significantly better in the PRP group than in the HA group. CONCLUSION: Intra-articular injection of PRP is an effective treatment that reduced pain and improved functional status in patients with KOA. The clinical outcomes of the intra-articular injections of PRP are associated with improved synovial hypertrophy and vascularity scores, and less effusion.