Changes in hippocampal metabolites after effective treatment for fibromyalgia: a case study.
BACKGROUND
Fibromyalgia has been associated with disrupted hippocampal brain metabolite ratios by studies using single voxel magnetic resonance spectroscopy (1H-MRS). Exposure to stress is considered a risk factor for the development and exacerbation of fibromyalgia symptoms. Basic science has demonstrated the hippocampus to be exquisitely sensitive to the effects of stressful experience, which results in changes including alterations in metabolite content and frank atrophy.


METHODS
This report details the case of a 47-year-old woman with fibromyalgia who was originally found to have a profound depression of the ratio of N-acetylaspartate to creatine in her right hippocampus during participation in a study to assess brain metabolite disturbances in fibromyalgia utilizing single voxel proton magnetic resonance spectroscopy. An individualized treatment strategy was developed based both on physiological abnormalities associated with the disorder and symptoms that characterized the patient's unique clinical profile.


RESULTS
Clinical and spectroscopic evaluation following nine months of treatment demonstrated both an improvement in her clinical profile and normalization of the NAA/Cr ratio within her right hippocampus.


CONCLUSIONS
Therapeutic strategies aimed at demonstrable lesions associated with fibromyalgia appear to represent rational targets for pharmacological intervention. The rationale for development of novel pharmacotherapies for this unusual disorder is discussed.
Department of Family Medicine, Anesthesiology and Psychiatry, LSU Health Sciences Center, Biomedical Research Institute of NW Louisiana, Shreveport, USA. pwood@anglerbiomedical.com
Patrick B
PB
Wood
Christina R
CR
Ledbetter
James C
JC
Patterson
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D003401:Creatine / Q000378:metabolism; D004965:Estrogen Antagonists / Q000627:therapeutic use; D005260:Female; D005356:Fibromyalgia / Q000188:drug therapy / Q000473:pathology*; D005500:Follow-Up Studies; D006624:Hippocampus / Q000187:drug effects / Q000378:metabolism*; D006801:Humans; D007211:Indoles; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D011433:Propranolol / Q000627:therapeutic use; D011522:Protons
D000319:Adrenergic beta-Antagonists; D004965:Estrogen Antagonists; D007211:Indoles; D011522:Protons; D001224:Aspartic Acid; C000179:N-acetylaspartate; D011433:Propranolol; C016517:indole-3-carbinol; D003401:Creatine