Abstract
Introduction
Fibromyalgia (FM) is a clinical syndrome defined by the presence of chronic widespread musculoskeletal pain and the presence of at least 11 of 18 body tender points and these features are often accompanied by other symptoms such as fatigue, poor sleep quality, loss of memory, and mood disturbance. The aim of this work was to investigate the role of magnetic resonance spectroscopy (MRS) to detect the differences in cerebral chemical changes between FM patients and control participants. Thirty patients with primary FM (27 females and three males) were selected from the outpatient clinic of the Department of Rheumatology and Rehabilitation, Faculty of Medicine, Zagazig University Hospitals. Patients with primary FM fulfill the American College of Rheumatology criteria for diagnosis of FM. Ten persons were needed as healthy control participants with the same age and sex as the included patients. 1H-MRS unit was used to assess N-acetyl aspartate (NAA), choline (Cho), creatine (Cr), and their ratios from both hippocampi. Our results showed the following: there was a significant difference in the level of l-hippocampal (NAA) and right hippocampus Cho and the levels of hippocampal glutamate/glutamine (Glx) in the patient group compared with the control group. There is a highly significant difference between the level of Rt and Lt hippocampal Glx in the same patient, highly significant difference in the level of Rt and Lt hippocampal NAA/Cr, NAA/ Cho, and left hippocampal Cho/Cr ratios between cases and controls, and there was a negative correlation between the number of tender points and the level of Lt hippocampal Cr. Moreover, there was a significant difference between the number of tender points and the level of Rt hippocampal NAA and Lt hippocampal Ch/Cr ratios, highly significant difference between the level of Rt hippocampal NAA/Cho, NAA/Cr, and Lt NAA/Cr and number of tender points, and a highly significant difference between the level of Rt hippocampal NAA/Cho, Rt NAA/Cr, Lt NAA/Cr, and number of tender points (P < 0.001). There was a highly significant difference between the level of Rt hippocampal NAA/Cho, Lt hippocampal NAA/Cr, and visual analogue scale, and there was a significant difference between the level of Rt hippocampal NAA/Cho, Lt hippocampal NAA/Cr, and fibromyalgia impact questionnaire.
Conclusion
These findings outline the possible nature of FM as a systemic disorder that is mainly expressed through sensorineural dysfunction and abnormal neuroendocrine stress responses.
Article PDF
Similar content being viewed by others
References
Smith HS, Harris R, Clauw D. Fibromyalgia: an afferent processing disorder leading to a complex pain generalized syndrome. Pain Physician 2011; 14:E217–E245.
Becker S, Schweinhardt P. Dysfunctional neurotransmitter system in fibromyalgia, their role in central stress circuitry and pharmacological actions on these system. Hindawi Publishing Corporation. Pain Res Treat 2012; 2012:10. Article ID 741746.
Feraco P, Bacci A, Pedrabissi F, et al. Metabolic abnormalities in pain-processing regions of patients with fibromyalgia: A3T MR spectroscopy study. Am J Neuroradial 2011; 32:1585–1590.
Fayed N, Garcia-Campayo J, Magallón R, Andrés-Bergareche H, Luciano JV, Andres E, Beltrán J. Localized 1H-NMR spectroscopy in patients with fibromyalgia: a controlled study of changes in cerebral glutamate/glutamine, inositol, choline, and N-acetylaspartate. Arthritis Res Ther 2010; 12:R134.
Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990;33:160–72.
Bennett RM. The fibrositis–fibromyalgia syndrome in primer on rheumatic diseases. Edited by Schumacher HK, Klippel JH, Robinsons DR. 11th ed. Atlanta, GA: Arthritis Foundation; 1988. p. 247–249.
Tejero A, Guimera E, Farre JM, et al. Clínico use of HADS (Hospital Anxiety and Depression Scale) in psiquiátricapoblación : a study of sensitivity, reliability and validity. Rev Fac Med Psiquiatr Barna 1986; 12:233–238.
Rivera J, Gonzalez T. The Fibromyalgia Impact Questionnaire: a validated Spanish version to assess the health status in women with fibromyalgia. Clin Exp Rheumatol 2004; 22:554–560.
Barker P, Gillard J, Waldman A, et al. Fundamentals of MR spectroscopy. Cambrig University Press: Cambridge, England. 2005. p. 7–26.
Chang KH, Song IC, Kim SH, Han MH, Kim HD, Seong SO, et al. In vivo single-voxel proton MR spectroscopy in intracranial cystic masses. Am J Neuroradiol 1998; 19:401–405.
Norusis MJ. Statistical package for social Science (SPSS) base 10 for windows, user’s guide. Chicago: IL-SPSS; 1997.
Jane C, Ballantyne, Micheal J, et al. Fibromyalgia. A clinical update pain medicine, International Association for The Study of Pain. IASP. 2010. Vol. XV III, Issue 4:1206–1208.
Schuff N, Amend DL, Knowlton R, Norman D, Fein G, Weiner MW. Age-related metabolite changes and volume loss in the hippocampus by magnetic resonance spectroscopy and imaging. Neurobiol Aging 1999; 20:279–285.
Brooks JC, Roberts N, Whitehouse G, Majeed T. Proton magnetic resonance spectroscopy and morphometry of the hippocampus in chronic fatigue syndrome. Br J Radiol 2000; 73:1206–1208.
Mullins PG, Rowland LM, Jung RE, et al. A novel technique to study the brain’s response to pain: proton magnetic resonance spectroscopy. Neuroimage 2005; 26:642–646.
Weybright P, Sundgren PC, Maly P, Hassan DG, Nan B, Rohrer S, Junck L. Differentiation between brain tumor recurrence and radiation injury using MR spectroscopy. Am J Roentgenol 2005; 185:1471–1476.
Harris RE, Sundgren PC, Pang Y, Hsu M, Petrou M, Kim SH, et al. Dynamic levels of glutamate within the insula are associated with improvements in multiple pain domains in fibromyalgia. Arthritis Rheum 2008; 58:903–907.
Valdes M, Collado A, Bargalló N, Vázquez M, Rami L, Gómez E, Salamero M. Increased glutamate/glutamine compounds in the brains of patients with fibromyalgia: a magnetic resonance spectroscopy study. Arthritis Rheum 2010; 62:1829–1836.
Lutz J, Jäger L, de Quervain D, Krauseneck T, Padberg F, Wichnalek M, et al. White and gray matter abnormalities in the brain of patients with fibromyalgia: a diffusion-tensor and volumetric imaging study. Arthritis Rheum 2008; 58:3960–3969.
Emad Y, Ragab Y, Zeinhom F, El-Khouly G, Abou-Zeid A, Rasker JJ. Hippocampus dysfunction may explain symptoms of fibromyalgia syndrome. A study with single-voxel magnetic resonance spectroscopy. J Rheumatol 2008; 35:1371–1377.
Petrou M, Harris RE, Foerster BR, McLean SA, Sen A, Clauw DJ, Sundgren PC. Proton MR. spectroscopy in the evaluation of cerebral metabolism in patients with fibromyalgia: comparison with healthy controls and correlation with symptom severity. Am J Neuroradiol 2008; 29:913–918.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Elhewala, A.E.I., Emerah, A.A., Elqresh, A.A. et al. Magnetic resonance spectroscopy in evaluation of cerebral chemical changes in fibromyalgia patients. Egypt Rheumatol Rehabil 43, 7–13 (2016). https://doi.org/10.4103/1110-161X.177420
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.4103/1110-161X.177420