Brain

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Diagram of brain showing Corpus callosum, cerebral cortex, cerebellum, brainsteam, amydala, thalamus, basal ganglia
Diagram of Brain[1] License: CC-BY-4.0

The brain is an organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. The brain is located in the head, usually close to the sensory organs for senses such as vision. It is divided into three parts: the brainstem, cerebellum and cerebrum. The brain and spinal cord make up the central nervous system (CNS).

The brain and spinal cord have their own immune system.[2] Tissue-resident macrophages, known as microglia, are a part of that immune system.[3]

The brain also has its own lymphatic system which links directly to the blood-borne immune system.[4]

Injury to the brain or spinal cord, such as those caused by stroke or trauma, result in a considerable weakening of the immune system.[5]

ME/CFS[edit | edit source]

Anatomical changes[edit | edit source]

Significant changes in white and gray matter volumes have frequently been found in patients with ME/CFS but no consistent pattern has been found.[6][7][8][9][10]

Year Authors N Criteria Findings Ref
2004 Okada, et al 16 Reduced gray-matter volume in the bilateral prefrontal cortex. Volume reduction in the right prefrontal cortex correlated with fatigue severity. [11]
2016 Shan, et al Fukuda & CCC Decreases in white mattergray matter and blood volume deficits [12]
2012 Basan Puri, et al Reduced grey matter volume in the occipital lobes, the right angular gyrus and the posterior division of the left parahippocampal gyrus. [10]
2014 Zeineh, et al Diminished white matter, white matter abnormalities in the right hemisphere. [9]

Blood flow[edit | edit source]

Several studies have ME/CFS patients have found evidence of reduced cerebral blood flow,[13][14][15][16][17][18][19][20] including the brainstem[14][15] and cerebral cortex.[17]

A 1995 study found hypoperfusion (reduced blood flow) to the brainstem in patients with ME/CFS.[14] In 2011, a study of brain involvement in CFS found "a strong correlation" between brainstem gray matter volume and pulse pressure, "suggesting impaired cerebrovascular autoregulation."[15]

Unpublished work by Dr. Frans Visser has found that ME/CFS patients have reduced cerebral blood flow, even in the absence of Postural orthostatic tachycardia syndrome or Orthostatic hypotension.[21]

Metabolism[edit | edit source]

A 2003 study of cerebral glucose metabolism in 26 patients with chronic fatigue syndrome via 18-fluorodeoxyglucose positron emission tomography (FDG-PET) found evidence of hypometabolism (reduced glucose consumption) in approximately half of patients.[22] A 1998 PET study also found evidence of reduced metabolism in 18 patients.[23]

Patients with ME/CFS have also been found to have lower brain glutathione[13] and higher brain ventricular lactate[13]

2019, Evidence of widespread metabolite abnormalities in Myalgic encephalomyelitis/chronic fatigue syndrome: assessment with whole-brain magnetic resonance spectroscopy, Mueller, et al.[24]
This study is the first to investigate whole-brain MRS markers of neuroinflammation in ME/CFS. We report metaboliteand temperature abnormalities in ME/CFS patients in widely distributed brain areas, suggesting ME/CFS is driven by diffuse pathophysiological processes affecting the whole brain, rather than regionally limited, which is consistent with the heterogeneity of its clinical symptoms. Our findings add support to the hypothesis that ME/CFS is the result of chronic, low-level neuroinflammation. While the whole-brain results are preliminary, we note that they largely agree with past publications that use MRS in ME/CFS. These results should be replicated in future studies with larger samples to further establish the profile of pathophysiological abnormalities in the brains of ME/CFS patients. Ultimately, the development of sensitive MRI markers of ME/CFS could supplement clinical tests to help guide treatment decisions.[24]

abnormal distribution of acetyl-L-carnitine uptake, which is one of the biochemical markers of chronic fatigue syndrome, in the prefrontal cortex.[citation needed] 

Inflammation[edit | edit source]


Whole-brain MRS markers of neuroinflammation have been found in ME/CFS.[25] fMRI images document neuroinflammation.[26]

2014, A Japanese Positron emission tomography(PET) study looked at neuroinflammationin nine patients with ME/CFS and ten controls. They measured a protein expressed by activated microglia, and found that values in the cingulate cortexhippocampusamygdalathalamusmidbrain, and pons were 45%–199% higher in ME/CFS patients than in healthy controls. The values in the amygdala, thalamus, and midbrain positively correlated with cognitive impairment score, the values in the cingulate cortex and thalamus positively correlated with pain score, and the value in the hippocampus positively correlated with depression score.[27][28]

2019, Evidence of widespread metabolite abnormalities in Myalgic encephalomyelitis/chronic fatigue syndrome: assessment with whole-brain magnetic resonance spectroscopy, Mueller, et al.[24]
This study is the first to investigate whole-brain MRS markers of neuroinflammation in ME/CFS. We report metaboliteand temperature abnormalities in ME/CFS patients in widely distributed brain areas, suggesting ME/CFS is driven by diffuse pathophysiological processes affecting the whole brain, rather than regionally limited, which is consistent with the heterogeneity of its clinical symptoms. Our findings add support to the hypothesis that ME/CFS is the result of chronic, low-level neuroinflammation. While the whole-brain results are preliminary, we note that they largely agree with past publications that use MRS in ME/CFS. These results should be replicated in future studies with larger samples to further establish the profile of pathophysiological abnormalities in the brains of ME/CFS patients. Ultimately, the development of sensitive MRI markers of ME/CFS could supplement clinical tests to help guide treatment decisions.[24]

Several neurochemicals have been studied in relation to ME patients. Myo-inositol is thought to be involved in astrocyte function (Albrecht et al. 2016) and trended to be higher in ME patients compared to controls.[29]

N-acetylacetate (NAA) shows neuron density, which has been found in other neurological disorders[30]and has been shown to be lower in ME patients,[31][29]but this was not found in all studies.[32][33]

Cholineis linked to activation of glia, loss of energy and expression of macrophages in the brain[30]and has been shown to change compared to controls.[31][29][33][34]

Lactate increases when more energy is being expended and has been shown to be higher than controls,[35][36][37][38]and significantly differs from lactate levels in people with psychological disorders.[35][38]Both ME patients and fibromyalgiapatients were found to have similar levels of elevated lactate, so more tests would be needed to differentiate the two.[37]

Though contrasts were found between ME people and controls in many of these biomarkerstudies, researchers are not sure what the changes mean specifically because the 

Electrical activity[edit | edit source]

2016, A qEEG/LORETA study of nine controls and nine CFS patients (per DePaul Symptom Questionnaire(DSQ) and Canadian Consensus Criteria(CCC) definitions), found significantly decreased eLORETA source analysis oscillations in the occipital, parietal, posterior cingulate, and posterior temporal lobes in Alpha and Alpha-2. This research suggests that "disruptions in these regions and networks could be a neurobiological feature of the disorder, representing underlying neural dysfunction."[39]

2016, A qEEG/LORETA study of one CFS patient (per DSQ and CCC definitions), found deregulation of the functional connectivity networks. This may explain the common symptom of perceived cognitive deficits such as slow thinking, difficulty in reading comprehension, reduced learning and memory abilities and an overall feeling of being in a “fog".

[40]
Figure 1: Results of LORETA current source density in a case with CFS showing widespread decreased current density for delta at 2 Hz and beta (12- 15 Hz) demonstrating a global reduction in brain functioning (blue). The higher frequencies (beta) have been shown to be a function of delta frequencies. In other words, local oscillations are under constant influence of global brain dynamics (Buzsaki, 2006).[41]

Other: T2 Hyperintensities in MRI[edit | edit source]

Possible white matter abnormalities of unknown etiology are found on MRIs of some ME/CFS patients. These are identified by T2 hyperintensities, which might indicate lesions or Virchow-Robin spaces.[42][43]

  • 1993, A comparison of brain MRI scans from 52 CFS patients and 52 controls found that 27% of CFS patients had findings considered abnormal, while only 2% of controls had findings considered abnormal. Abnormalities included T2 hyperintensities and ventricular enlargement.[42]
  • 1999, A comparison of brain MRI scans from 39 CFS patients and 19 controls found that the 21 CFS patients who did not have a psychiatric diagnosis had significantly more T2 hyperintensities, compared to either controls or the 18 CFS patients with a psychiatric diagnosis.[43]

UNSORTED/unincorporated articles[edit | edit source]

  • more abnormal spinal fluids[13], and psychiatric comorbidity does not influence any of these potential biological markers of CFS, [13]
  • a subgroup of CFS patients with brain abnormalities may have an underlying encephalopathy producing their illness.[13]
  • 2017, A study, using segmented anatomical MRIbrain scansshowed that, adjusting for total intracranial volumeCFSpatients (as per Fukuda diagnostic criteria) had larger gray matter volume and lower white matter volume. The increased gray matter volume was predominantly found in the amygdalaand insulacortex. The decreased white matter was predominantly found in the midbrain and temporal lobe.[45]

Chronic pain[edit | edit source]

In 2015, Loggia’s team[46]successfully imaged neuroinflammation— specifically the activation of glial cells — in the brains of patients with chronic painusing a new imaging approach — a combination of magnetic resonance imaging(MRI) and positron emission tomography(PET), or MR/PET scanning.[47] MR/PET blends the structural and functional detail of tissues that an MRI gives with the sensitivity and metabolicfunction that PET scans provide.[48]Specifically, PET scanning detects the radiation given off by a substance injected into a person, called a radiotracer, following its distribution throughout the body.[48]

Notable studies[edit | edit source]

Brain function characteristics of chronic fatigue syndrome: A task fMRI study (2018) [54]


  • 2018, Neuroinflammation in the Brain of Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome[55]
  • 2018, Hyperintense sensorimotor T1 spin echo MRI is associated with brainstem abnormality in chronic fatigue syndrome[56](Full Text)
  • 2018, Brain abnormalities in myalgic encephalomyelitis/chronic fatigue syndrome: Evaluation by diffusional kurtosis imaging and neurite orientation dispersion and density imaging[57](Abstract)

Notable studies[edit | edit source]

Talks and interviews[edit | edit source]

See also[edit | edit source]

Learn more[edit | edit source]

  • Neuroquant Triage Brain Atrophy Report (MRI)[67] - Provides physicians a quick reference and in-depth look on regional and global brain structure volumes, which could occur as a result of a brain injury or in neurodegenerative disease, by providing volume measurements of 44 brain structures for both the right and left hemisphere, total structure  – all sorted by lobe and region. With a detailed table of intracranial volume and right, left and total values for normative percentile of ICV. Resulting values are automatically compared to gender and age-appropriate reference distribution.
  • 2-Minute Neuroscience: Lobes and Landmarks of the Brain Surface (Lateral View)[68]

References[edit | edit source]

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Myalgic encephalomyelitis or chronic fatigue syndrome, often used when both illnesses are considered the same.

Myalgic encephalomyelitis or M.E. has different diagnostic criteria to chronic fatigue syndrome; neurological symptoms are required but fatigue is an optional symptom.<ref name="ICP2011primer">{{Citation

The information provided at this site is not intended to diagnose or treat any illness.
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