Progressive Brain Changes in Patients with Chronic Fatigue Syndrome: Are our brains starved of oxygen?

A recent Australian study, Progressive Brain Changes in Patients With Chronic Fatigue Syndrome: A Longitudinal MRI Study finds that CFS patients meeting both Fukuda and CCC have decreased grey and white matter volumes in the areas of the brain we use for language processing.
Interestingly, patients had increased grey matter volume in the supplementary motor area, and this correlated with patients’ subjective scores gauging neurological symptom severity.  This supports CFS’s patients’ reports of requiring greater effort to coordinate movement: brain plasticity may allow CFS patients’ brains to compensate for loss in the parts of the brain that are usually primarily responsible for handling and coordinating these tasks.
Though many studies have examined MRI in ME/CFS patients, this is only the second longitudinal study that has been performed; the first, from the British Journal of Radiology, found no abnormalities (Perrin et al., 2010).  Though Perrin’s study eliminated patients with psychiatric conditions, CFS patients were recruited based on the broad-based Fukuda criteria, whereas in Shan’s Progressive Brain Changes, patients had to meet both Fukuda and the Canadian Consensus Criteria to be included.
25 patients and 25 controls were recruited.  CFS severity was measured by:

  • The Bell’s CFS disability score
  • A somatic symptom score
  • A neurological symptom score

Patients’ brains were scanned 6 years apart on the same 1.5-Tesla scanner, and voxel-based morphometry was used to examine the results.  Both T1- and T2-weighted signal intensities were examined.
CFS patients showed a decrease in white matter volume in the left IFOF (inferior fronto-occipital fasciculus) and arcuate fasciculus, while in controls, the white matter volume remained stable.
The IFOF is partly responsible for attention, language processing, and working memory; it also plays a role in goal orientation, ability to focus vision, and motor coordination.  The IFOF connects many areas of the brain, allowing them to communicate with one another (Ashtari, 2012).
The arcuate fasciculus is partially responsible for language expression; patients with damage there can understand speech well, but sometimes have difficulty with language expression and repetition (Bernal, 2009).  There is evidence this part of the brain is involved in short-term memory as well.
Inter-group comparisons also found decreased grey- and white matter volumes, coupled with increased white matter hyperintensities in and around the contralateral ILOF (left inferior longitudinal fasciculus), also thought to play a role in language processing (Mandonnet, 2007).  White matter hyperintensities may reflect ischemia and hypoperfusion in those areas.
Additionally, grey matter volume and blood flow to the brain were found to correlate to better self-reported scores on SSS and NSS.
Shan et al. posited that brain damage could potentially be due to long-term ‘functional hypoxia’, or oxygen starvation, in the brain.
Since the IFOF region of the brain is continually organized and re-organized into early adulthood, this may be one of the factors that contribute to the typical age of onset in CFS, and the increased potential for vascular irregularities that are often part of the illness.  Coupled with a finding of vascular endothelial growth factor (VEGF) as generally low in CFS (Landi, 2015), that may further increase patients’ vulnerability to incomplete or inappropriate vascular remodeling.


8 thoughts on “Progressive Brain Changes in Patients with Chronic Fatigue Syndrome: Are our brains starved of oxygen?”

  1. The increased gray matter volume in the Supplementary Motor Area (SMA) is interesting. It has been hypothesized that the SMA is the “last stop” in language production. It is where linear structure (syntax) and motor production come together to produce a string of intelligible words in a sentence. This may explain why people with ME/CFS often have comprehension problems (left temporal lobe), but their sentence production for the most part remains comprehensible. (As opposed to “word salad.”)

  2. This explains a lot. Although those of us who type do indeed get ‘Word Salad’ quite often and have to constantly correct things.

  3. I have had M.E for 25 years and my speech is particularly affected. It is worse during “crashes” and later in the day. I had an MRI scan 2 years ago as a result of increasing memory problems. The scan showed that I had “brain shrinkage out of keeping with age”.

  4. Audrey Scougall

    Dr Muckarjee (? correct spelling) a researcher in RAH Adelaide SA, in the 1980’s reported that during a ‘reaction’ in ME/CFS with MFCS, the red blood cells became distorted and caused blockage in small blood vessels. In muscle capilliaries, the anoxia contributed to the build up of lactic acid. Similar to Marathon runners but lasting days rather than 4 hours. My experience was that the anoxia was widespread throughout the body so why not in the brain too? The neck and headaches were extreme as though iron bands were progressively constricting around my skull.

    1. I did a lot of research on what you’re talking about, Audrey. The ‘red blood cell theory’ was unusual in that it surfaced, there seemed to be some evidence to support it, and then there was research for a few years (limited to mostly Australia) before research halted abruptly. I remember talking about this to a researcher, asking if this path had hit a dead end or been discredited, but he said that if so, he wasn’t aware of it. “The researcher who’s working in that direction passes away or moves to a new institution less interested in that theory,” he said.
      Weird how a positive path can be held back by something as simple as lack of interest.

  5. I have a Associates Degree w/Honors – Computer Science and a BA w/honors in Management (overall GPA 3,789 out of 4.0). And in 2004 the neurological psychologist I had been seen did, at my request (he had mention this testing (for validation in prev. years) did a 2-full days of Neuro-psychological testing. Which resulted – strangely enough as has shown up in the studies mentioned here (but before brain imagine became a norm) I was nearly retarded in the language/words/putting together/organizing section of my brain – although some days I can be fine with words, writing, completing tasks and then most other days I am almost brain dead – with eyes open, mouth taking – but not saying what I mean and unable to bring forth in my brain the correction. I have lost many friends (actually have a 2-3 now compared to a friend showing up whenever I turned around – I had a very likable personality, open door policy and a pool. I am fortunate to still have my husband of almost 41 years. Although I think today we both want to leave each other – been a rough day of running around and getting info to replace the once beautiful teeth I had. I guess to summarize my long ramblings – I was tested the “old” fashion way in 2004 by a Licence Neurological psychologist for 2 full days (altho no brain imaging available at the time) – the end result was the same as this article mentioned several times. My eye is on Dr. Jarred Younger – formally of Stanford who left a year ago to accept the position to received the $2 million dollar grant for NIH (and recently read NIH was adding additional funding to those already awarded). All I can say is that I never thought I would see a light at the end of the tunnel….but there is and it feels as if a race is going on seeing who can figure out CFS before the next (most perceiving it in the brain – as Dr. Younger believes and has given himself a 5 year deadline (that I can live with an d first year was impressive)…now if the NIH and other funding’s would continue and NOT STOP THE TRAIN…..we might see a cure or at least the right medication to bring us back to 100% capacity (Dr, at Stanford (Convention) .in 2011 admitted this is a real disease that we the sufferers should receive a formal apology form the overall Medical Community for turning a blind eye at us all this time (“it’s in your head….”) and he also said the case he followed and moire are finding out that she was like most of us (overly) productive in life and wham – He stated she had lost 70% of the capabilities she had prior to onset if CFS. IT IS A REAL “COMPLEX” DISEASE that is forcing doctors to look at several organs at one time, vs the normal 1 organ of the past diseases. U just pray ho one stops the train (funding and researchers that want to find out this mysterious but debilitating disease.. 1990’s- early 2000’s – they didn’t call it a disease – it was a called a “condition” and if I heard “syndrome” one more time I was going to blow. Good Luck All and may people like Dr. Jarred Younger meet their goals and are successful or come together and all share their knowledge and skills to make this a story years later like polio (that generation prior to mine and for me it is
    – “What is that?”
    I read in as book in 1999 that stated then that this would become an economical disaster and it has – look at us – still were in our productive years and getting SS Disability – would have much rather had my health (as overall it is quite good for my age) – I do really miss me and my previous life that might have changed, at my own choosing, next year (w/100% retirement benefits) even if still too young for SS. FOOD LUCK ALL and let’s stay behind these researchers that are putting their heart and soul into discovering where it originates in order to stop – finally!

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