RESEARCH - Migraine during SLE: findings from SPECT

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Journal of Rheumatology

November 2006

Migraine During Systemic Lupus Erythematosus: Findings from Brain Single

Photon Emission Computed Tomography

FLAVIO NOBILI, ALESSANDRO MIGNONE, EDOARDO ROSSI, SILVIA MORBELLI, ARNOLDO

PICCARDO, FRANCESCO PUPPO, FRANCESCO INDIVERI, GIANMARIO SAMBUCETI, and

GUIDO RODRIGUEZ

ABSTRACT.

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.

Conclusion. 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. (J Rheumatol 2006;33:2184-91)

http://www.jrheum.com/abstracts/abstracts06/2184.html

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