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]

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. [10]
2016 Shan, et al Fukuda & CCC Decreases in white mattergray matter and blood volume deficits [6]
2012 Basant Puri, et al Reduced grey matter volume in the occipital lobes, the right angular gyrus and the posterior division of the left parahippocampal gyrus. [9]
2014 Zeineh, et al Diminished white matter, white matter abnormalities in the right hemisphere. [8]

Blood flow[edit | edit source]

Several studies have ME/CFS patients have found evidence of reduced cerebral blood flow,[11][12][13][14][15][16][17][18] including the brainstem[12][13] and cerebral cortex.[15]

A 1995 study found hypoperfusion (reduced blood flow) to the brainstem in patients with ME/CFS.[12] 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."[13]

A study of 429 ME/CFS patients by found that 90% ME/CFS patients had reduced cerebral blood flow with a head-up tilt test, even in the absence of Postural orthostatic tachycardia syndrome or Orthostatic hypotension.[19][20]

Metabolism[edit | edit source]

A 2003 study of cerebralglucose 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.[21] A 1998 PET study also found evidence of reduced metabolism in 18 patients.[22]

Patients with ME/CFS have also been found to have lower brain glutathione[11] and higher brain ventricular lactate.[11]

Abnormal distribution of acetyl-L-carnitine uptake, which is one of the biochemical markers of chronic fatigue syndrome, in the prefrontal cortex.[citation needed][10]

Inflammation[edit | edit source]

Whole-brain MRS markers of neuroinflammation have been found in ME/CFS.[23] fMRI images document neuroinflammation.[24]

In 2014, A Japanese positron emission tomography (PET) study looked at neuroinflammation in nine patients with ME/CFS and ten controls. They measured a protein expressed by activated microglia, and found that values in the cingulate cortex, hippocampus, amygdala, thalamus, midbrain, 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.[25]

2019, Evidence of widespread metabolite abnormalities in Myalgic encephalomyelitis/chronic fatigue syndrome: assessment with whole-brain magnetic resonance spectroscopy.[23]
This study is the first to investigate whole-brain MRS markers of neuroinflammation in ME/CFS. We report metabolite and 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.[23]

Several neurochemicals have been studied in relation to ME patients. Myoinositol is thought to be involved in astrocyte function (Albrecht et al. 2016) and trended to be higher in ME patients compared to controls.[26]

N-acetylacetate (NAA) shows neuron density, which has been found in other neurological disorders[27]and has been shown to be lower in ME patients,[28][26]but this was not found in all studies.[29][30]

Choline is linked to activation of glia, loss of energy and expression of macrophages in the brain[27]and has been shown to change compared to controls.[28][26][30][31]

Lactate increases when more energy is being expended and has been shown to be higher than controls,[32][33][34][35]and significantly differs from lactate levels in people with psychological disorders.[32][35]Both ME patients and fibromyalgia patients were found to have similar levels of elevated lactate, so more tests would be needed to differentiate the two.[34]

Though contrasts were found between patients with ME and healthy controls in many of these biomarker studies, researchers are not sure what the changes mean.

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."[36]

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".[37]

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).[37]

T2 Hyperintensities in MRI[edit | edit source]

Shortcut:
  • T2 hyperintensity
MRI image with small white T2 hyperintensities, which are labelled as "Virchow-Robin spaces". Use allowed for educational purposes, courtesy of radiologyassistant.nl

Possible white matter abnormalities of unknown etiology are found on MRIs of some ME/CFS patients.[6][38][39] White matter abnormalities identified by T2 hyperintensities might indicate lesions or abnormally dilated perivascular spaces (also known as Virchow-Robin spaces).[40]

  • 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.[38]
  • 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.[39]

Since T2 hyperintensities are found in many different neurological conditions, some neurologists consider them to be diagnostically insignificant. Others point out that perhaps they should not be ignored, as they are correlated with cognitive disability and poor motor function.[41][42][43]

UNSORTED/unincorporated articles[edit | edit source]

  • more abnormal spinal fluids[11], and psychiatric comorbidity does not influence any of these potential biological markers of CFS, [11]
  • a subgroup of CFS patients with brain abnormalities may have an underlying encephalopathy producing their illness.[11]
  • 2017, A study, using segmented anatomical MRI brain scans showed that, adjusting for total intracranial volumeCFS patients (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 amygdala and insula cortex. The decreased white matter was predominantly found in the midbrain and temporal lobe.[45]
  • 2020, Exercise alters brain activation in Gulf War Illness and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome[46] - (Full text) - see images folder

Chronic pain[edit | edit source]

In 2015, Loggia's team[47] successfully imaged neuroinflammation— specifically the activation of glial cells — in the brains of patients with chronic pain using a new imaging approach — a combination of magnetic resonance imaging (MRI) and positron emission tomography (PET), or MR/PET scanning.[48] MR/PET blends the structural and functional detail of tissues that an MRI gives with the sensitivity and metabolic function 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]

News and articles[edit | edit source]

Talks and interviews[edit | edit source]

Notable studies[edit | edit source]

  • 2016, Relative increase in choline in the occipital cortex in chronic fatigue syndrome[29]
  • 2017, CNS findings in chronic fatigue syndrome and a neuropathological case report[49]
  • 2017, Grey and white matter differences in Chronic Fatigue Syndrome – A voxel-based morphometry study[45]
  • 2018, Structural brain changes versus self-report: machine-learning classification of chronic fatigue syndrome patients[50](Abstract)
  • 2018, Cortical hypoactivation during resting EEG suggests central nervous system pathology in patients with chronic fatigue syndrome[51](Abstract)
  • 2018, Brain function characteristics of chronic fatigue syndrome: A task fMRI study[52](Full Text)
Brain function characteristics of chronic fatigue syndrome: A task fMRI study (2018) [52]
  • 2018, Neuroinflammation in the Brain of Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome[53]
  • 2018, Hyperintense sensorimotor T1 spin echo MRI is associated with brainstem abnormality in chronic fatigue syndrome[54](Full Text)
  • 2018, Brain abnormalities in myalgic encephalomyelitis/chronic fatigue syndrome: Evaluation by diffusional kurtosis imaging and neurite orientation dispersion and density imaging[55](Abstract)
  • 2019, Intra brainstem connectivity is impaired in chronic fatigue syndrome[56](Full text)
  • 2016, A multi-modal parcellation of human cerebral cortex - (Full text)[57]

See also[edit | edit source]

Learn more[edit | edit source]

  • Neuroquant Triage Brain Atrophy Report (MRI) - 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) - Neuroscientifically Challenged (YouTube)

References[edit | edit source]

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cerebellum A part of the brain at the back of the skull in vertebrates, beneath the occipital lobe of the cerebrum. Its name reflects the fact that it looks like a smaller version of the cerebrum. Its main known functions are the coordination of unconscious muscle movements and the maintenance of body positional equilibrium.

central nervous system (CNS) - One of the two parts of the human nervous system, the other part being the peripheral nervous system. The central nervous system consists of the brain and spinal cord, while the peripheral nervous system consists of nerves that travel from the central nervous system into the various organs and tissues of the body.

Canadian Consensus Criteria (CCC) - A set of diagnostic criteria used to diagnose ME/CFS, developed by a group of practicing ME/CFS clinicians in 2003. The CCC is often considered to be the most complex criteria, but possibly the most accurate, with the lowest number of patients meeting the criteria. Led to the development of the International Consensus Criteria (ICC) in 2011.

cerebral blood flow (CBF) - the amount of blood that goes through the arterial tree in the brain in a given amount of time

cerebral blood flow (CBF) - the amount of blood that goes through the arterial tree in the brain in a given amount of time

brainstem Region of the midbrain in adults, includes midbrain, pons, and medulla oblongata and develops.

cerebral 1. of or relating to the brain or the intellect 2. of, relating to, affecting, or being the cerebrum.

amygdala Part of the brain, within the temporal lobe. Related to memory and emotional behavior.

metabolite A chemical compound produced by, or involved in, metabolism. The term is often used to refer to the degradation products of drugs in the body.

β β / Β. Greek letter beta (symbol), equivalent to "b".

T2 hyperintensity An unusual bright spot on a T2-weighted MRI of the brain. Also known as an Unidentified Bright Object (UBO). T2 hyperintensities are often found in the periventricular region, where they may be referred to as "white matter hyperintensities" or "leukoaraiosis". They may also be found in the basal ganglia or brainstem, where they are sometimes referred to as "gray matter hyperintensities", or "subcortical hyperintensities". T2 hyperintensities can represent different things: lesions, dilated Virchow-Robin spaces, or demyelination. They are commonly found in elderly individuals and in neurological disorders. (Learn more: www.ncbi.nlm.nih.gov)

T2 hyperintensity An unusual bright spot on a T2-weighted MRI of the brain. Also known as an Unidentified Bright Object (UBO). T2 hyperintensities are often found in the periventricular region, where they may be referred to as "white matter hyperintensities" or "leukoaraiosis". They may also be found in the basal ganglia or brainstem, where they are sometimes referred to as "gray matter hyperintensities", or "subcortical hyperintensities". T2 hyperintensities can represent different things: lesions, dilated Virchow-Robin spaces, or demyelination. They are commonly found in elderly individuals and in neurological disorders. (Learn more: www.ncbi.nlm.nih.gov)

Virchow-Robin space A space inside the blood-brain barrier that surrounds blood vessels. They are also known as perivascular spaces. Immune cells from the blood often enter the Virchow-Robin space, but are unable to enter the brain. In cases of neuroinflammation, immune cells may accumulate in the Virchow-Robin space, unable to enter the brain. This accumulation of immune cells (called perivascular cuffing) may lead to an enlarged Virchow-Robin space. Enlarged Virchow-Robin spaces may be visible in an MRI image of the brain.

Virchow-Robin space A space inside the blood-brain barrier that surrounds blood vessels. They are also known as perivascular spaces. Immune cells from the blood often enter the Virchow-Robin space, but are unable to enter the brain. In cases of neuroinflammation, immune cells may accumulate in the Virchow-Robin space, unable to enter the brain. This accumulation of immune cells (called perivascular cuffing) may lead to an enlarged Virchow-Robin space. Enlarged Virchow-Robin spaces may be visible in an MRI image of the brain.

Fukuda criteria The most commonly used diagnostic criteria for chronic fatigue syndrome, created by the United States Centers for Disease Control (CDC).

myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

central nervous system (CNS) - One of the two parts of the human nervous system, the other part being the peripheral nervous system. The central nervous system consists of the brain and spinal cord, while the peripheral nervous system consists of nerves that travel from the central nervous system into the various organs and tissues of the body.

The information provided at this site is not intended to diagnose or treat any illness.
From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history.