SPECT imaging of the brain: regional cerebral blood flow before and after treatment of patients with primary fibromyalgia

ABSTRACT

Whether regional cerebral blood flow [rCBF] is affected by Duloxitine Hcl in Egyptian women with primary fibromyalgia [FM] and if it correlates with clinical findings. Thirty untreated women with FM [group I] and ten apparently healthy controls [group II] were studied with single photon emission computed tomography of the brain [brain SPECT] after IVI of Tc-99[m] HMPAO as a cerebral perfusion agent. The resting state [rCBF] was measured for the deep structures [thalamus and caudate] and cerebral cortices [anterior, lateral, posterior] of both sides. Fifteen patients[group Ia] received the conventional therapy of fibromyalgia and the other fifteen [group Ib] received a Duloxitine Hcl 60 mg daily for 3 months followed by measuring rCBF. There was a statistically highly significant lower [rCBF] in the thalamus and caudate nucleus in patients as compared to controls [p<0.01] but no such difference in the anterior, lateral and posterior cerebral cortices [p>0.05]. No significant difference clinically or radiologically was found comparing group Ia results before and after 12 weeks. There was a highly significant difference with fatigue and a significant difference as regard neck pain, headache, generalized body ache and morning stiffness when comparing group lb results before and after 12 weeks. The rCBF to thalamus and caudate nucleus showed a highly significant increase in group lb after 3 months. There was a significant difference in number of tender points, the duration of morning stiffness as well as thalamic and caudate blood flow comparing the change in Ia and lb. The decrease of regional cerebral blood flow to the thalamus and caudate nucleus in patients with primary FM may be the cause of their symptoms. Improvement of the symptoms by administration of duloxitine Hcl may be due to improvement of the cerebral blood flow