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Familial painful restless legs syndrome correlates with pain dependent variation of blood flow to the caudate, thalamus, & anterior cingulate gyrus

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By San Pedro EC, Mountz JM, Mountz JD, Liu HG, Katholi CR, Deutsch G • www.ProHealth.com • November 8, 1998


To understand the relationship of caudate, thalamic, and
anterior cingulate perfusion to pain states, we investigated
familial restless legs syndrome in a father and daughter
during the state of pain induced by immobility using
semiquantitative regional cerebral blood flow (rCBF) brain
single photon emission computed tomography (SPECT). The father
underwent 4 brain SPECT scans using the rCBF tracer
99mTc-HMPAO several weeks apart, at different pain levels and
after treatment with L-dopa. Caudate, thalamic, and anterior
cingulate rCBF indices were measured. The caudate nuclei
showed a 13% reduction in rCBF with increasing pain. The
thalami and anterior cingulate showed a 7 and 6.6% increase in
rCBF, respectively, with increasing pain. Compared to normal
controls at rest, there was a decrease in caudate rCBF by 13%
and an increase in thalamic rCBF by 3%. Linear regression for
the caudate nuclei revealed a significant reduction in rCBF (p
< 0.05), as pain increased. The daughter underwent an
identical rCBF brain SPECT scan procedure at a high pain level
induced by immobilization. Her scan showed a 12% reduction in
caudate rCBF and a 1.2% increase in the anterior cingulate
rCBF compared to healthy controls. The study supports the
association between pain and decreased regional cerebral blood
flow to the caudate nucleus as reported in fibromyalgia
syndrome. There is increase in anterior cingulate rCBF with
increasing pain. Our findings also corroborate that there is
increased thalamic rCBF with pain stimulation.




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