Latent class analysis of migraine associated vestibular-auditory symptoms.

OBJECTIVE: This study aimed to identify the potential subgroups of migraines based on the patterns of migraine associated symptoms, vestibular and auditory symptoms using latent class analysis and to explore their characteristics. METHOD: A total of 555 patients with migraine participated in the study. Symptoms such as nausea, vomiting, photophobia, phonophobia, osmophobia, visual symptoms, vestibular symptoms (dizziness, vertigo), and auditory symptoms (tinnitus, hearing loss, aural fullness) were assessed. Latent class analysis was performed to identify subgroups of migraines. Covariates such as gender, age of migraine onset, frequency of migraine attacks per month, and family history were also considered. RESULTS: The analysis revealed four latent classes: the Prominent Vestibular; Prominent Nausea; Presenting Symptoms but not prominent or dominant; and Sensory Hypersensitivity groups. Various covariates, such as gender, age of migraine onset, and frequency of migraine attacks, demonstrated significant differences among the four groups. The Sensory Hypersensitivity group showed the presence of multiple sensory symptoms, earlier age of migraine onset, and higher proportion of females. The Prominent Vestibular group had the highest probability of dizziness or vertigo but lacked the presence of auditory symptoms. The Prominent Nausea group exhibited prominent nausea. The Presenting Symptoms but not prominent or dominant group comprised individuals with the highest migraine attacks per month and proportion of chronic migraine. CONCLUSION: This study identifies four subgroups of migraines based on the patterns of symptoms. The findings suggest potential different but overlapped mechanisms behind the vestibular and auditory symptoms of migraine. Considering the different patterns of migraine-related symptoms may provide deeper insights for patients' prognosis and clinical decision-making.

Cluster and network analysis of non-headache symptoms in migraine patients reveals distinct subgroups based on onset age and vestibular-cochlear symptom interconnection.

Objective: The present study endeavors to identify natural subgroups of migraine patients based on the patterns of non-headache symptoms, utilizing cluster analysis. Subsequently, network analysis was performed to estimate the structure of symptoms and explore the potential pathophysiology of these findings. Method: A total of 475 patients who met the diagnostic criteria for migraine were surveyed face-to-face during the period of 2019 to 2022. The survey included collecting demographic and symptom data. Four different solutions were generated by the K-means for mixed large data (KAMILA) clustering algorithm, from which the final cluster solutions were selected based on a series of cluster metrics. Subsequently, we performed network analysis using Bayesian Gaussian graphical models (BGGM) to estimate the symptom structure across subgroups and conducted global and pairwise comparisons between structures. Result: Cluster analysis identified two distinct patient groups, and the onset age of migraine proved to be an effective characteristic differentiating the two patient groups. Participants assigned to late-onset group showed a longer course of migraine, higher frequency of monthly headache attacks, and greater tendency toward medication overuse. In contrast, patients in early-onset group exhibited a higher frequency of nausea, vomiting, and phonophobia compared to their counterparts in the other group. The network analysis revealed a different symptom structure between the two groups globally, while the pairwise differences indicated an increasing connection between tinnitus and dizziness, and a decreasing connection between tinnitus and hearing loss in the early-onset group. Conclusion: Utilizing clustering and network analysis, we have identified two distinct non-headache symptom structures of migraine patients with early-onset age and late-onset age. Our findings suggest that the vestibular-cochlear symptoms may differ in the context of different onset ages of migraine patients, which may contribute to a better understanding of the pathology of vestibular-cochlear symptoms in migraine.

[Clinical outcomes of Hybrid-surgery to treat the two-level cervical disease].

OBJECTIVE: To evaluate the clinical and radiologic outcomes of the Hybrid surgery (cervical artificial disc replacement combined with anterior cervical discectomy and fusion (ACDF)) and the effective of the adjacent segment. METHODS: Between December 2007 to June 2010, 34 patients underwent 2-level cervical disc surgery. There were 17 patients underwent Hybrid surgery (Hybrid group), 17 patients underwent 2-level ACDF (ACDF group). Japanese orthopaedic association (JOA), neck disability index (NDI), and Odom's standards were evaluated. Dynamic flexion and extension lateral cervical radiographs were obtained in the standing position before surgery and at routine postoperative intervals of 1, 3, 6 months. RESULTS: Both of the two groups had significantly improvement than preoperative in JOA (t = -8.790 - -5.803, P < 0.05) and NDI scores (t = 10.717 - 13.514, P < 0.05), but no significantly difference between the two groups (P > 0.05). Both of the two groups had significantly decreased in the mean C(2-7) range of motion (ROM). The Hybrid group decreased from 46° ± 11° preoperative to 41° ± 8° at the 6 mouths after surgery (t = 3.170, P < 0.05). The ACDF group decreased from 45° ± 13° preoperative to 38° ± 15° at the 6 mouths after surgery (t = 6.709, P < 0.05). But there were no significantly difference between the two groups (P > 0.05). In the Hybrid group, both the superior adjacent segment ROM and the inferior adjacent segment ROM were decreased in the follow-up, there had significantly difference at the 1 and 3 months after surgery (superior adjacent segment: t = 5.622 and 4.032, P < 0.05; inferior adjacent segment: t = 2.879 and 2.207, P < 0.05), but no significantly difference after 6 months (P > 0.05). In the ACDF group, the ROM of the inferior adjacent segment was significantly increased at 3 and 6 months after surgery (t = -7.038 and -13.540, P < 0.05), the ROM of the superior adjacent segment was significantly increased at 6 months after surgery (t = -2.453, P < 0.05). CONCLUSIONS: Hybrid surgery has excellent clinical results and decreases the ROM of the adjacent segment in the following 6 months, meanwhile 2-level ACDF increases the ROM of the adjacent segment. The long-term clinical outcomes of the Hybrid surgery need more study.