Brain Abnormalities Discovered in Patients with Chronic Fatigue Syndrome

cfs brain

The red, blue, and green spheres correspond to size and locations of increased cortical thickness in the right occipital, precentral, and middle temporal regions, respectively. The green arrows also point to the middle temporal region of increased thickness. Credit: Radiological Society of North America

 

A new study by Michael Zeineh of the Stanford University School of Medicine now proves that chronic fatigue syndrome (CFS) is not hypochondria or our imagination, it is a real disease. Zeineh and his team discovered brain abnormalities in CFS patients that will hopefully help doctors to better treat this debilitating disease. There is a lot of cross over between CFS and fibromyalgia, as anyone who suffers from one or both of these devastating diseases will tell you. Patients with one of these diseases (or both) battle chronic disease, chronic pain, micro-inflammation, environmental sensitivities (such as light, smells, foods, weather, etc.) and much more every single day. So the next time you think that just because you can’t see our illness it isn’t real, think again. Thanks to researchers like Zeineh we are slowly but surely getting proof that our diseases are real and terrible.

The entire article about Zeineh’s research continues below.

Study finds brain abnormalities in chronic fatigue patients

An imaging study by Stanford University School of Medicine investigators has found distinct differences between the brains of patients with chronic fatigue syndrome and those of healthy people. he findings could lead to more definitive diagnoses of the syndrome and may also point to an underlying mechanism in the disease process.

It’s not uncommon for CFS patients to face several mischaracterizations of their condition, or even suspicions of hypochondria, before receiving a diagnosis of CFS. The abnormalities identified in the study, to be published Oct. 29 in Radiology, may help to resolve those ambiguities, said lead author Michael Zeineh, MD, PhD, assistant professor of radiology.

“Using a trio of sophisticated imaging methodologies, we found that CFS patients’ brains diverge from those of healthy subjects in at least three distinct ways,” Zeineh said.

CFS affects between 1 million and 4 million individuals in the United States and millions more worldwide. Coming up with a more precise number of cases is tough because it’s difficult to actually diagnose the disease. While all CFS patients share a common symptom—crushing, unremitting fatigue that persists for six months or longer—the additional symptoms can vary from one patient to the next, and they often overlap with those of other conditions.

Scientific Challenge

“CFS is one of the greatest scientific and medical challenges of our time,” said the study’s senior author, Jose Montoya, MD, professor of infectious diseases and geographic medicine. “Its symptoms often include not only overwhelming fatigue but also joint and muscle pain, incapacitating headaches, food intolerance, sore throat, enlargement of the lymph nodes, gastrointestinal problems, abnormal blood-pressure and heart-rate events, and hypersensitivity to light, noise or other sensations.”

The combination of symptoms can devastate a patient’s life for 10, 20 or even 30 years, said Montoya, who has been following 200 CFS patients for several years in an effort to identify the syndrome’s underlying mechanisms. He hopes to accelerate the development of more-effective treatments than now exist. (A new Stanford Medicine magazine story describes the study in more detail.)

“In addition to potentially providing the CFS-specific diagnostic biomarker we’ve been desperately seeking for decades, these findings hold the promise of identifying the area or areas of the brain where the disease has hijacked the central nervous system,” Montoya said.

“If you don’t understand the disease, you’re throwing darts blindfolded,” said Zeineh. “We asked ourselves whether brain imaging could turn up something concrete that differs between CFS patients’ and healthy people’s brains. And, interestingly, it did.”

The Stanford investigators compared brain images of 15 CFS patients chosen from the group Montoya has been following to those of 14 age- and sex-matched healthy volunteers with no history of fatigue or other conditions causing symptoms similar to those of CFS.

Three Key Findings

The analysis yielded three noteworthy results, the researchers said. First, an MRI showed that overall white-matter content of CFS patients’ brains, compared with that of healthy subjects’ brains, was reduced. The term “white matter” largely denotes the long, cablelike nerve tracts carrying signals among broadly dispersed concentrations of “gray matter.” The latter areas specialize in processing information, and the former in conveying the information from one part of the brain to another.

That finding wasn’t entirely unexpected, Zeineh said. CFS is thought to involve chronic inflammation, quite possibly as a protracted immunological response to an as-yet unspecified viral infection. Inflammation, meanwhile, is known to take a particular toll on white matter.

But a second finding was entirely unexpected. Using an advanced imaging technique—diffusion-tensor imaging, which is especially suited to assessing the integrity of white matter—Zeineh and his colleagues identified a consistent abnormality in a particular part of a nerve tract in the right hemisphere of CFS patients’ brains. This tract, which connects two parts of the brain called the frontal lobe and temporal lobe, is called the right arcuate fasciculus, and in CFS patients it assumed an abnormal appearance.

Furthermore, there was a fairly strong correlation between the degree of abnormality in a CFS patient’s right arcuate fasciculus and the severity of the patient’s condition, as assessed by performance on a standard psychometric test used to evaluate fatigue.

Right vs. Left

Although the right arcuate fasciculus’s function is still somewhat mysterious, its counterpart in the brain’s left hemisphere has been extensively explored. The left arcuate fasciculus connects two critical language areas of the left side of the brain termed Wernicke’s and Broca’s areas, which are gray-matter structures several centimeters apart. These two structures are important to understanding and generating speech, respectively. Right-handed people almost always have language organized in this fashion exclusively in the left side of the brain, but the precise side (left or right) and location of speech production and comprehension are not so clear-cut in left-handed people. (It’s sometimes said that every left-hander’s brain is a natural experiment.) So, pooling left- and right-handed people’s brain images can be misleading. And, sure enough, the finding of an abnormality in the right arcuate fasciculus, pronounced among right-handers, was murky until the two left-handed patients and four left-handed control subjects’ images were exempted from the analysis.

Bolstering these observations was the third finding: a thickening of the gray matter at the two areas of the brain connected by the right arcuate fasciculus in CFS patients, compared with controls. Its correspondence with the observed abnormality in the white matter joining them makes it unlikely that the two were chance findings, Zeineh said.

Although these results were quite robust, he said, they will need to be confirmed. “This study was a start,” he said. “It shows us where to look.” The Stanford scientists are in the planning stages of a substantially larger study.

More information: “Right Arcuate Fasciculus Abnormality in Chronic Fatigue Syndrome” Radiology, 2014.

FibroGuide Resource

neck pain

Thanks to Seeking Equilibrium, I discovered FibroGuide. FibroGuide has a modules with great information for those newly diagnosed and those of us who have had fibromyalgia for what feels like forever. You take a simple quiz and it points you to the modules you may find most helpful. Examples of modules are Understanding Fibromyalgia, Fibro Fog, Being Active, Communicating, Sleep, Pacing Yourself, and more. It’s got a lot of great information and I really like how it’s organized. With the quiz, you are quickly pointed to the resources you may find most helpful and don’t have to go digging through a ton of information for the tidbits that are the most relevant for you. I don’t know about you, but my attention span is short and my thoughts are easily scattered so I found the way this site is organized to be very helpful. Check it out!

The Roadkill Comparison

Reblogged from Seeking Equilibrium

I don’t know why.
Lately, I’ve been tired.
Roadkill tired

I’ve gone through a “roadkill tired” spell myself of late. I think I’m finally coming out of it. Adding a Vitamin B and iron supplements to my daily mix of supplements seems to be helping me feel a more normal level of tired, not the bad roadkill tired I’ve been doing. My brother actually figured out that it sounded like I was iron deficient. I definitely notice a difference now that I’m taking it. Thanks brother!

This post on chronic fatigue as it relates to fibromyalgia and other chronic illnesses is really great. She highlights ten common suggestions doctors make to help decrease fatigue and how most of them really work for fibro sufferers. Our brains just don’t work like “normal” brains and until doctors realize that and modify their recommendations accordingly, we’re stuck with getting the same unhelpful advice over and over. My favorite tip she makes is:

Point number 10: Be good to yourself. There is a lot of guilt and problems that go with chronic illness. We do need to be good to ourselves. This will be with us until there is a cure so we shouldn’t be too hard on ourselves.

 So remember, be good to yourself. That’s really the best thing we can do for ourselves, both physically and mentally.

Fibromyaglia is Real

fibro graphic

I love these graphics. Sometimes the best way to understand a bunch of statistics and data is visually. I  know I’m a visual learner. The only thing I don’t like about these graphics is that the statistic on how many women have fibromyalgia should be how many people. Men get fibromyalgia too. This is not just a “woman’s disease.”

Image and statistics courtesy of MBA Healthcare Management and Seeking Equilibrium.

Chronic Illness Poem

I came across this poem by Joanetta Hendel today and had to share it. It’s a great description of what it’s like when you are feeling totally beaten down by pain and illness. I know I’ve been at the low point this poem describes many times. Hang in there everyone! It does get better.

 

pain poem

Recovery 101

Recovery 101

I’ve been working through a lot the past year and a half, and perhaps most especially the last few months. I came across this this morning and it struck a chord so I wanted to share. I think of all the lessons I have learned, “You will relapse and that’s okay – as long as you keep fighting,” is the most important. I’ve been frustrated by the feeling that I recover from one physical ailment just to have another one come at me that I have to deal with. Life is a rollercoaster sometimes and sometimes all you can do is roll with the ups and downs as they come. I’ve also learned to get the most enjoyment out of the “ups” as I can. It’s important to enjoy those times while they last. They help you get through the “downs.”