TY  - JOUR
A1  - Üçeyler, Nurcan
A1  - Schließer, Mira
A1  - Evdokimov, Dimitar
A1  - Radziwon, Jakub
A1  - Feulner, Betty
A1  - Unterecker, Stefan
A1  - Rimmele, Florian
A1  - Walter, Uwe
T1  - Reduced midbrain raphe echogenicity in patients with fibromyalgia syndrome
JF  - PloS One
N2  - Objectives
The pathogenesis of fibromyalgia syndrome (FMS) is unclear. Transcranial ultrasonography revealed anechoic alteration of midbrain raphe in depression and anxiety disorders, suggesting affection of the central serotonergic system. Here, we assessed midbrain raphe echogenicity in FMS.

Methods
Sixty-six patients underwent transcranial sonography, of whom 53 were patients with FMS (27 women, 26 men), 13 patients with major depression and physical pain (all women), and 14 healthy controls (11 women, 3 men). Raphe echogenicity was graded visually as normal or hypoechogenic, and quantified by digitized image analysis, each by investigators blinded to the clinical diagnosis.

Results
Quantitative midbrain raphe echogenicity was lower in patients with FMS compared to healthy controls (p<0.05), but not different from that of patients with depression and accompanying physical pain. Pain and FMS symptom burden did not correlate with midbrain raphe echogenicity as well as the presence and severity of depressive symptoms.

Conclusion
We found reduced echogenicity of the midbrain raphe area in patients with FMS and in patients with depression and physical pain, independent of the presence or severity of pain, FMS, and depressive symptoms. Further exploration of this sonographic finding is necessary before this objective technique may enter diagnostic algorithms in FMS and depression.
KW  - midbrain
KW  - fibromyalgia
KW  - depression
KW  - pain
KW  - ultrasound imaging
KW  - neuropathic pain
KW  - diagnostic medicine
KW  - migraine
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300639
VL  - 17
IS  - 11
ER  - 
TY  - JOUR
A1  - Evdokimov, Dimitar
A1  - Frank, Johanna
A1  - Klitsch, Alexander
A1  - Unterecker, Stefan
A1  - Warrings, Bodo
A1  - Serra, Jordi
A1  - Papagianni, Aikaterini
A1  - Saffer, Nadine
A1  - Meyer zu Altenschildesche, Caren
A1  - Kampik, Daniel
A1  - Malik, Rayaz A.
A1  - Sommer, Claudia
A1  - Üceyler, Nurcan
T1  - Reduction of skin innervation is associated with a severe fibromyalgia phenotype
JF  - Annals of Neurology
N2  - Objective: To assess patterns and impact of small nerve fiber dysfunction and pathology in patients with fibromyalgia syndrome (FMS).

Methods: One hundred seventeen women with FMS underwent neurological examination, questionnaire assessment, neurophysiology assessment, and small fiber tests: skin punch biopsy, corneal confocal microscopy, microneurography, quantitative sensory testing including C-tactile afferents, and pain-related evoked potentials. Data were compared with those of women with major depressive disorder and chronic widespread pain (MD-P) and healthy women.

Results: Intraepidermal nerve fiber density (IENFD) was reduced at different biopsy sites in 63% of FMS patients (MDP: 10%, controls: 18%; p < 0.001 for each). We found 4 patterns of skin innervation in FMS: normal, distally reduced, proximally reduced, and both distally and proximally reduced (p < 0.01 for each compared to controls). Microneurography revealed initial activity-dependent acceleration of conduction velocity upon low frequencies of stimulation in 1A fibers, besides 1B fiber spontaneous activity and mechanical sensitization in FMS patients. FMS patients had elevated warm detection thresholds (p < 0.01), impaired C-tactile afferents (p < 0.05), and reduced amplitudes (p < 0.001) of pain-related evoked potentials compared to controls. Compared to FMS patients with normal skin innervation, those with generalized IENFD reduction had higher pain intensity and impairment due to pain, higher disease burden, more stabbing pain and paresthesias, and more anxiety (p < 0.05 for each). FMS patients with generalized IENFD reduction also had lower corneal nerve fiber density (p < 0.01) and length (p < 0.05).

Interpretation: The extent of small fiber pathology is related to symptom severity in FMS. This knowledge may have implications for the diagnostic classification and treatment of patients with FMS.
KW  - fibromyalgia
Y1  - 2019
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-206168
VL  - 86
IS  - 4
ER  -