{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T02:04:41Z","timestamp":1791857081527,"version":"4.3.4"},"reference-count":42,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,3,10]],"date-time":"2020-03-10T00:00:00Z","timestamp":1583798400000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ann Clin Transl Neurol"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the pathophysiology of visual snow (VS), through a combined functional neuroimaging and magnetic resonance spectroscopy (<jats:sup>1<\/jats:sup>H\u2010MRS) approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We applied a functional MRI block\u2010design protocol studying the responses to a visual stimulation mimicking VS, in combination with <jats:sup>1<\/jats:sup>H\u2010MRS over the right lingual gyrus, in 24 patients with VS compared to an equal number of age\u2010 and gender\u2010matched healthy controls.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We found reduced BOLD responses to the visual stimulus with respect to baseline in VS patients compared to controls, in the left (<jats:italic>k<\/jats:italic>\u00a0=\u00a0291; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.025; peak MNI coordinate [\u201034 12 \u20106]) and right (<jats:italic>k<\/jats:italic>\u00a0=\u00a0100; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.003; peak MNI coordinate [44 14 \u20102]) anterior insula. Our spectroscopy analysis revealed a significant increase in lactate concentrations in patients with respect to controls (0.66\u00a0\u00b1\u00a00.9\u00a0mmol\/L vs. 0.07\u00a0\u00b1\u00a00.2\u00a0mmol\/L; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001) in the right lingual gyrus. In this area, there was a significant negative correlation between lactate concentrations and BOLD responses to visual stimulation (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.004; <jats:italic>r<\/jats:italic>\u00a0=\u00a0\u22120.42), which was dependent on belonging to the patient group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>As shown by our BOLD analysis, VS is characterized by a difference in bilateral insular responses to a visual stimulus mimicking VS itself, which could be due to disruptions within the salience network. Our results also suggest that patients with VS have a localized disturbance in extrastriate anaerobic metabolism, which may in turn cause a decreased metabolic reserve for the regular processing of visual stimuli.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acn3.50986","type":"journal-article","created":{"date-parts":[[2020,3,10]],"date-time":"2020-03-10T10:23:21Z","timestamp":1583835801000},"page":"296-306","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":62,"title":["Insular and occipital changes in visual snow syndrome: a BOLD fMRI and MRS study"],"prefix":"10.1002","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1933-4049","authenticated-orcid":false,"given":"Francesca","family":"Puledda","sequence":"first","affiliation":[{"name":"Headache Group Department of Basic and Clinical Neuroscience Institute of Psychiatry, Psychology &amp; Neuroscience King\u2019s College London London United Kingdom"},{"name":"NIHR\u2010Wellcome Trust King\u2019s Clinical Research Facility King\u2019s College Hospital London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4214-9642","authenticated-orcid":false,"given":"Dominic","family":"Ffytche","sequence":"additional","affiliation":[{"name":"Department of Old Age Psychiatry Institute of Psychiatry, Psychology &amp; Neuroscience King\u2019s College London London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5078-9025","authenticated-orcid":false,"given":"David J.","family":"Lythgoe","sequence":"additional","affiliation":[{"name":"Centre for Neuroimaging Sciences Department of Neuroimaging Institute of Psychiatry, Psychology &amp; Neuroscience King\u2019s College London London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Owen","family":"O\u2019Daly","sequence":"additional","affiliation":[{"name":"Centre for Neuroimaging Sciences Department of Neuroimaging Institute of Psychiatry, Psychology &amp; Neuroscience King\u2019s College London London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Schankin","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital Bern University Hospital University of Bern Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven C. 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