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Magnetic resonance spectroscopy in evaluation of cerebral chemical changes in fibromyalgia patients



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.


These findings outline the possible nature of FM as a systemic disorder that is mainly expressed through sensorineural dysfunction and abnormal neuroendocrine stress responses.


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Correspondence to Ahmad A. Emerah.

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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).

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  • brain metabolites
  • fibromyalgia
  • MRI spectroscopy