Migraine during systemic lupus erythematosus: findings from brain single photon emission computed tomography.
OBJECTIVE
Headache in systemic lupus erythematosus (SLE) is controversial, as is evidence of brain impairment in patients with SLE and headache. Perfusion single photon emission computed tomography (SPECT) was performed to investigate brain impairment in SLE patients with migraine-like headache either from the period of diagnosis or later in the course of disease.


METHODS
Eighteen patients with SLE (mean age 40.8 +/- 13.6 yrs) matching these characteristics underwent brain SPECT with 99mTc-HMPAO in the interictal period. Electroencephalography (EEG) and magnetic resonance imaging (MRI) were performed in 12 and 10 patients, respectively. SPECT was analyzed through visual and asymmetry combined analysis as well as by voxel-based statistical analysis compared to a control group of matched healthy subjects (statistical threshold: p = 0.01).


RESULTS
Focal hypoperfusion was evidenced in 15 (83%) patients, often matching the main side of pain location, whereas EEG and MRI each gave a positive result in 50% of cases. Using voxel-based analysis, significant hypoperfusion was found in 8 (44%) patients, either lateralized to one side or localized to the anterior cingulate cortex, independent of pain location.


CONCLUSIONS
Brain perfusion SPECT is a sensitive tool for identifying brain impairment in SLE-related migraine, although the mechanisms of brain damage remain to be elucidated. Besides confirming focal hypoperfusion in some patients, in 4 patients statistical analysis revealed interictal hypofunction of the anterior cingulate cortex, a key structure for cortical elaboration of pain in the midline network.
Nobili
Flavio
F
Department of Clinical Neurophysiology, Azienda Ospedale-Universita S. Martino, Viale Benedetto XV 6, I-16132 Genoa, Italy. flaviomariano.nobili@hsanmartino.it
Mignone
Alessandro
A
Rossi
Edoardo
E
Morbelli
Silvia
S
Piccardo
Arnoldo
A
Puppo
Francesco
F
Indiveri
Francesco
F
Sambuceti
Gianmario
G
Rodriguez
Guido
G
D000328:Adult; D001921:Brain / Q000098:blood supply*; D016022:Case-Control Studies; D002560:Cerebrovascular Circulation; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon
D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime