Volume 14 Supplement 1

Proceedings of the 8th Global Arthritis Research Network (GARN) Meeting and 1st Bio-Rheumatology International Congress (BRIC)

Open Access

Brain perfusion in fibromyalgia patients and its differences between responders and poor responders to gabapentin

  • Chie Usui1,
  • Kotaro Hatta1,
  • Nagafumi Doi2,
  • Atsushi Nakanishi3,
  • Hiroyuki Nakamura4 and
  • Kusuki Nishioka5
Arthritis Research & Therapy201214(Suppl 1):P72

DOI: 10.1186/ar3673

Published: 29 February 2012

Purpose

The aim of the present study was to determine the brain areas associated with fibromyalgia, and whether pretreatment regional cerebral blood flow (rCBF) can predict response to gabapentin treatment.

Methods

A total of 29 women with fibromyalgia and 10 healthy women without pain matched for age were finally enrolled in the study. Technetium-99 m ethyl cysteinate dimer single photon emission computed tomography (99 mTc-ECD SPECT) was performed in the fibromyalgia patients and controls. A voxel-by-voxel group analysis was performed using SPM2. After treatment with gabapentin, 16 patients were considered "responders", with decrease in pain of greater than 50% as evaluated by visual analogue scale (VAS). The remaining 13 patients were considered "poor responders".

Results

Compared to control subjects, we observed rCBF abnormalities in fibromyalgia including hypoperfusion in the left culmen and hyperperfusion in the right precentral gyrus, right posterior cingulate, right superior occipital gyrus, right cuneus, left inferior parietal lobule, right middle temporal gyrus, left postcentral gyrus, and left superior parietal lobule (Table 1, Figure 1). Compared to responders, poor responders exhibited hyperperfusion in the right middle temporal gyrus, left middle frontal gyrus, left superior frontal gyrus, right postcentral gyrus, right precuneus, right cingulate, left middle occipital gyrus, and left declive (Table 2). The right middle temporal gyrus, left superior frontal gyrus, right precuneus, left middle occipital gyrus, and left declive exhibited high positive likelihood ratios.
Table 1

Regions of significant hyperperfusion and hypoperfusion in the FM group.

 

κ

Z score

x(mm)

y(mm)

z(mm)

Localisation

Hyperperfusion

134

4.55

66

-10

30

R Precentral Gyrus

 

262

4.16

2

-62

14

R Posterior Cingulate

 

824

3.98

36

-82

32

R Superior Occipital Gyrus

 

429

3.95

18

-96

-6

R Cuneus

 

220

3.57

50

-38

52

L Inferior Parietal Lobule

 

55

3.54

52

-46

6

R Middle Temporal Gyrus

 

113

3.52

-30

-42

68

L Postcentral Gyrus

  

3.74

-14

-74

56

L Superior Parietal Lobule

 

709

4.66

-2

56

-22

L Superior Frontal Gyrus

Hypoperfusion

1111

4.38

-12

-32

-18

L Culmen

Results are listed by clusters.κvalue, Z score, Talairach coordinates of peak voxel, and anatomic localization are provided for each cluster.

https://static-content.springer.com/image/art%3A10.1186%2Far3673/MediaObjects/13075_2012_Article_3417_Fig1_HTML.jpg
Figure 1

Comparison of rCBF between patients with FM and age-matched healthy controls. Maximum intensity projections of SPM2 results from comparison of rCBF between patients with FM and age-matched healthy controls. a, b The FM patient group exhibited significant hypoperfusion in the left culmen. c, d The FM patient group exhibited significant hyperperfusion in the right precentral gyrus, right posterior cingulate, right superior occipital gyrus, right cuneus, left inferior parietal lobule, right middle temporal gyrus, left postcentral gyrus, and left superior parietal lobule. Height threshold is < 0.001, corrected for multiple comparison.

Table 2

Regions of significant hyperperfusion in the poor responder group compared to the responder group.

 

κ

Z score

x(mm)

y(mm)

z(mm)

Localisation

Hyperperfusion

1260

4.08

42

-62

16

R Middle Temporal Gyrus

 

95

3.88

-46

6

50

L Middle Frontal Gyrus

 

95

3.88

-20

38

52

L Superior Frontal Gyrus

 

69

3.67

56

-12

56

R Postcentral Gyrus

 

578

3.67

14

-76

28

R Preuneus

 

59

3.58

4

20

36

R Cingulate

 

70

3.54

-20

-80

4

L Middle Occipital Lobule

 

77

3.51

-20

-80

-26

L Declive

Results are listed by clusters. κvalue, Z score, Talairach coordinates of peak voxel, and anatomic localization are provided for each cluster.

Conclusion

The present study revealed brain regions with significant hyperperfusion associated with the default-mode network, in addition to abnormalities in the sensory dimension of pain processing and affective-attentional areas in fibromyalgia patients. Furthermore, hyperperfusion in these areas was strongly predictive of poor response to gabapentin.

Authors’ Affiliations

(1)
Department of Psychiatry, Juntendo University School of Medicine
(2)
Ibaraki Prefectural Tomobe Hospital
(3)
Department of Radiology, Juntendo University School of Medicine
(4)
Department of Environmental and Preventive Medicine, Graduate School of Medical Science, Kanazawa University, kakuma-cho
(5)
Institute of Innovative Medical Science and Education, Tokyo Medical University

References

  1. Usui C, Hatta K, Doi N, Nakanishi A, Nakamura H, Nishioka K, Arai H: Brain perfusion in fibromyalgia patients and its differences between responders and poor responders to gabapentin. Arthritis Res Ther. 2010, 12: R64-10.1186/ar2980.PubMed CentralView ArticlePubMedGoogle Scholar

Copyright

© Usui et al.; licensee BioMed Central Ltd. 2012

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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