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.
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.
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
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.