Aim: Whiplash trauma in one of the most frequent consequencesof motor vehicle accidents. While initial symptoms resolve withina few weeks in many cases, some patients develop persistentsymptoms that include pain, headache, visual, and/or psychologicaldisturbances, termed as Whiplash-associated disorder(WAD). Although there is evidence supporting tissue lesion andcentral hyperexcitability, the pathophysiology is not well understood.In the current study, possible alterations in the regionalcerebral blood flow (rCBF) were explored with PET imaging. Material and Methods: Twelve female patients diagnosed with WAD grade I/II were included 5±2 years after the accident, in addition to eight healthy matched volunteers. PET scans (ECAT HR+, Siemens) were acquired after injection of 500 MBq [15O]H2O for rCBF measurement. During acquisitions the volunteers received a non-painful electrical stimulation of theneck (DS7A, Digitimer). Sensitivity thresholds were individuallydetermined. Four condition were used: rest state, placebo-likestate (current was expected but not generated), stimulation aboveperception threshold, and stimulation below pain or muscularcontraction. These conditions were repeated three times, resultingin twelve scans. All participants completed a neurological interview,the Hospital Anxiety and Depression Scale, the Neck DisabilityIndex (NDI), the Whiplash Disability Questionnaire, andrated pain on the visual analogue scale. Voxel-based analysis wasperformed on the scans with SPM8 in combination with SwEtoolbox to account for repeated measurements. Level of significancewas set to p<0.005 uncorrected, with an extent threshold of100 voxels. Correlations between the rCBF of WAD patients inthe significant clusters and the scores from questionnaires wereanalyzed using the Generalized Estimating Equations model inSPSS, with p<0.05 considered significant (Bonferroni-Holm). Results: In all the questionnaires WAD patients scored higher(p<0.001) than healthy volunteers. No significant differences inrCBF were found between conditions. In WAD patients, comparedwith healthy controls, a significant increase in therCBF was found in the right superior parietal gyrus(T=3.52±0.51). In addition, a decreased rCBF was foundin the left insula (T=3.66±0.72), right insula (T=3.62±0.68), and right thalamus (T=3.54±0.47). Within theWAD group, a negative association (p<0.02) was foundin these regions between NDI scores and rCBF. Conclusion:WAD symptoms might be the result of a mismatchbetween the proprioceptive information from the cervicalspinal cord and the information integrated in regionssuch as mesencephalon, thalamus and insula. Further investigation of the functional brain alterations presentin WAD patients must, however, be performed for abetter understanding of the pathophysiology.
|Tijdschrift||European Journal of Nuclear Medicine and Molecular Imaging|
|Status||Published - okt-2015|
|Evenement||28th Annual Congress of the European-Association-of-Nuclear-Medicine (EANM) - Hamburg, Hamburg, Germany|
Duur: 10-okt-2015 → 14-okt-2015