Fibromyalgia: Guedj E

Guedj E. · No affiliation provided · Joint Bone Spine. · Pubmed #19369105 No free full text.

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Guedj E, Cammilleri S, Niboyet J, Mundler O. · AP-HM Timone, France. · Arthritis Rheum. · Pubmed #19116918 No free full text.

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Guedj E, Cammilleri S, Niboyet J, Dupont P, Vidal E, Dropinski JP, Mundler O. · Service Central de Biophysique et de Médecine Nucléaire, AP-HM Timone, Marseille, France. · J Nucl Med. · Pubmed #18927329 No free full text.

Abstract: The purpose of this study was to investigate the specific clinical correlate of brain SPECT perfusion abnormalities reported in fibromyalgia. METHODS: We performed a whole-brain voxel-based correlation analysis involving regional cerebral blood flow and various parameters related to pain (Visual Analog Scale, Tubingen Pain Behavior Scale, and Questionnaire Douleur de Saint-Antoine Scale), disability (Fibromyalgia Impact Questionnaire [FIQ]), and anxiety and depression status (Hospital Anxiety and Depression scale) in 20 patients with fibromyalgia (P voxel < 0.005). Ten healthy control women were also included, in order to determine areas of significant hypo- and hyperperfusions in patients. RESULTS: FIQ total score was positively correlated with bilateral parietal perfusion, including postcentral cortex. These clusters of correlation were included in the areas of significant hyperperfusion. FIQ total score was also negatively correlated with perfusion of a left anterior temporal cluster, included in the areas of significant hypoperfusions. No other clinical correlation was observed with regional cerebral blood flow. CONCLUSION: These results show that brain perfusion abnormalities in patients with fibromyalgia are correlated with the clinical severity of the disease.

Guedj E, Cammilleri S, Colavolpe C, de Laforte C, Niboyet J, Mundler O. · Service Central de Biophysique et de Médecine Nucléaire, Assistance Publique des Hôpitaux de Marseille, Centre Hospitalo-Universitaire de la Timone, 264 rue Saint Pierre, Marseille Cedex 5, France. · Eur J Nucl Med Mol Imaging. · Pubmed #18278530 No free full text.

Abstract: PURPOSE: The aim of this study was to determine whether the follow-up of pain processing recovery in hyperalgesic fibromyalgia (FM) could be objectively evaluated with brain perfusion ethyl cysteinate dimer single photon computerized tomography (ECD-SPECT) after administration of ketamine. MATERIALS AND METHODS: We enrolled 17 hyperalgesic FM women patients (48.5 +/- 11 years, range 25-63). After treatment with subcutaneous ketamine, 11 patients were considered as "good responders", with a decrease in pain intensity, evaluated by visual analog scale (VAS), greater than 50%. On the other hand, six patients were considered as "poor responders". A voxel-based analysis of regional cerebral blood flow (rCBF) was conducted (p (voxel) < 0.001uc), in the two subgroups of patients, before and after treatment, in comparison to a group of ten healthy subjects, matched for age and gender. RESULTS: In comparison to baseline brain SPECT, midbrain rCBF showed a greater increase after ketamine in the responder group than in the nonresponder group (p (cluster) = 0.016c). In agreement with the clinical response, the change in midbrain rCBF after ketamine was highly correlated with the reduction of VAS pain score (r = 0.7182; p = 0.0041). CONCLUSION: This prospective study suggests that blockade of facilitatory descending modulation of pain with ketamine can be evaluated in the periaqueductal grey with brain perfusion SPECT.

Guedj E, Cammilleri S, Colavolpe C, Taieb D, de Laforte C, Niboyet J, Mundler O. · Service Central de Biophysique et de Médecine Nucléaire, Assistance Publique des Hôpitaux de Marseille, Centre Hospitalo-Universitaire de la Timone, 264 rue Saint Pierre, 13385 Marseille Cedex 5, France. · Eur J Nucl Med Mol Imaging. · Pubmed #17431615 No free full text.

Abstract: PURPOSE: Ketamine has been used successfully in various proportions of fibromyalgia (FM) patients. However, the response to this specific treatment remains largely unpredictable. We evaluated brain SPECT perfusion before treatment with ketamine, using voxel-based analysis. The objective was to determine the predictive value of brain SPECT for ketamine response. METHODS: Seventeen women with FM (48 +/- 11 years; ACR criteria) were enrolled in the study. Brain SPECT was performed before any change was made in therapy in the pain care unit. We considered that a patient was a good responder to ketamine if the VAS score for pain decreased by at least 50% after treatment. A voxel-by-voxel group analysis was performed using SPM2, in comparison to a group of ten healthy women matched for age. RESULTS: The VAS score for pain was 81.8 +/- 4.2 before ketamine and 31.8 +/- 27.1 after ketamine. Eleven patients were considered "good responders" to ketamine. Responder and non-responder subgroups were similar in terms of pain intensity before ketamine. In comparison to responding patients and healthy subjects, non-responding patients exhibited a significant reduction in bilateral perfusion of the medial frontal gyrus. This cluster of hypoperfusion was highly predictive of non-response to ketamine (positive predictive value 100%, negative predictive value 91%). CONCLUSION: Brain perfusion SPECT may predict response to ketamine in hyperalgesic FM patients.

Guedj E, Taieb D, Cammilleri S, Lussato D, de Laforte C, Niboyet J, Mundler O. · Service Central de Biophysique et de Médecine Nucléaire, Assistance Publique des Hôpitaux de Marseille, Centre Hospitalo-Universitaire de la Timone, 264 rue Saint Pierre, 13385, Marseille Cedex 05, France. · Eur J Nucl Med Mol Imaging. · Pubmed #16933135 No free full text.

Abstract: PURPOSE: Neuro-imaging studies with (99m)Tc-HMPAO SPECT in fibromyalgia (FM) patients have reported only limited subcortical hypoperfusion. (99m)Tc-ECD SPECT is known to provide better evaluation of areas of high cerebral blood flow and regional metabolic rate. We evaluated a homogeneous group of hyperalgesic patients with FM using (99m)Tc-ECD SPECT. The aim of this study was to investigate brain processing associated with spontaneous pain in FM patients. METHODS: Eighteen hyperalgesic FM women (mean age 49 years, range 25-63 years; American College of Rheumatology criteria) and ten healthy women matched for age were enrolled in the study. A voxel-by-voxel group analysis was performed using SPM2 (p<0.05, corrected for multiple comparisons). Visual Analogue Scale score for pain was 82+/-4 at the time of the SPECT study. RESULTS: Compared with control subjects, we observed individual brain SPECT abnormalities in FM patients, confirmed by SPM2 analysis, with hyperperfusion of the somatosensory cortex and hypoperfusion of the frontal, cingulate, medial temporal and cerebellar cortices. CONCLUSION: In the present study, performed without noxious stimuli in hyperalgesic FM patients, we found significant hyperperfusion in regions of the brain known to be involved in the sensory dimension of pain processing and significant hypoperfusion in areas assumed to be associated with the affective-attentional dimension. As current pharmacological and non-pharmacological therapies act differently on the two components of pain, we hypothesise that SPECT could be a valuable and readily available tool to guide individual therapeutic strategy and provide objective follow-up of pain processing recovery under treatment.