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Predictive value of brain perfusion SPECT for ketamine response in hyperalgesic fibromyalgia

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Abstract

Purpose

Ketamine has been used successfully in various proportions of fibromyalgia (FM) patients. However, the response to this specific treatment remains largely unpredictable. We evaluated brain SPECT perfusion before treatment with ketamine, using voxel-based analysis. The objective was to determine the predictive value of brain SPECT for ketamine response.

Methods

Seventeen women with FM (48 ± 11 years; ACR criteria) were enrolled in the study. Brain SPECT was performed before any change was made in therapy in the pain care unit. We considered that a patient was a good responder to ketamine if the VAS score for pain decreased by at least 50% after treatment. A voxel-by-voxel group analysis was performed using SPM2, in comparison to a group of ten healthy women matched for age.

Results

The VAS score for pain was 81.8 ± 4.2 before ketamine and 31.8 ± 27.1 after ketamine. Eleven patients were considered “good responders” to ketamine. Responder and non-responder subgroups were similar in terms of pain intensity before ketamine. In comparison to responding patients and healthy subjects, non-responding patients exhibited a significant reduction in bilateral perfusion of the medial frontal gyrus. This cluster of hypoperfusion was highly predictive of non-response to ketamine (positive predictive value 100%, negative predictive value 91%).

Conclusion

Brain perfusion SPECT may predict response to ketamine in hyperalgesic FM patients.

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Authors and Affiliations

  1. Service Central de Biophysique et de Médecine Nucléaire, Assistance Publique des Hôpitaux de Marseille, Centre Hospitalo-Universitaire de la Timone, 264 rue Saint Pierre, 13385, Marseille Cedex 5, France

    Eric Guedj, Serge Cammilleri, Cecile Colavolpe, David Taieb, Catherine de Laforte & Olivier Mundler

  2. Unité d’Etude et de Traitement de la Douleur, Clinique La Phocéanne, Marseille, France

    Jean Niboyet

Authors
  1. Eric Guedj
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  2. Serge Cammilleri
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  3. Cecile Colavolpe
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  4. David Taieb
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  5. Catherine de Laforte
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  6. Jean Niboyet
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  7. Olivier Mundler
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Corresponding author

Correspondence to Eric Guedj.

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Guedj, E., Cammilleri, S., Colavolpe, C. et al. Predictive value of brain perfusion SPECT for ketamine response in hyperalgesic fibromyalgia. Eur J Nucl Med Mol Imaging 34, 1274–1279 (2007). https://doi.org/10.1007/s00259-007-0392-7

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  • DOI: https://doi.org/10.1007/s00259-007-0392-7

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