RSNA Press Release: MRI Identifies Brain Abnormalities in Chronic Fatigue Syndrome Patients

@ RSNA (Radiological Society of North America):

RSNA Press Release

MRI Identifies Brain Abnormalities in Chronic Fatigue Syndrome Patients

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Released: October 29, 2014

At A Glance

• MRI showed that patients with chronic fatigue syndrome (CFS) had lower white matter volume and other abnormalities in their brains.
• CFS is a debilitating disease, characterized by profound fatigue and brain fog that do not improve with bed rest, lasting for at least six months.
• Currently, there is no standalone test for diagnosing CFS.

RSNA Media Relations
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Linda Brooks
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Emma Day
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eday@rsna.org

OAK BROOK, Ill. — Researchers using a combination of different imaging techniques have found structural abnormalities in the brains of people with chronic fatigue syndrome (CFS), according to a new study published online in the journal Radiology. The results suggest a potential role for imaging in diagnosing and treating the condition.

CFS is characterized by profound fatigue and "brain fog" that do not improve with bed rest, lasting for at least six months. The condition affects more than 1 million adults and children in the United States, according to the Centers for Disease Control and Prevention. Diagnosis is complicated and usually involves ruling out many other conditions. There is no standalone test to diagnose CFS.

download full-size photo

Michael M. Zeineh, M.D., Ph.D.

"This is a very common and debilitating disease," said the study lead author Michael M. Zeineh, M.D., Ph.D., assistant professor of radiology at Stanford University School of Medicine in Stanford, Calif. "It's very frustrating for patients, because they feel tired and are experiencing difficulty thinking, and the science has yet to determine what has gone wrong."

For the new study, Dr. Zeineh worked with a Stanford CFS and infectious disease expert, Jose G. Montoya, M.D., to perform magnetic resonance imaging (MRI) on 15 CFS patients and 14 age- and gender-matched controls. They applied three different MRI techniques: volumetric analysis to measure the size of different compartments of the brain, diffusion tensor imaging (DTI) to assess the integrity of the signal-carrying white matter tracts of the brain, and arterial spin labeling (ASL) to measure blood flow.

When they compared results between the CFS patients and the controls, they found that the CFS group had slightly lower white matter volume, meaning there was less overall white matter in the brain. The CFS group also had abnormally high fractional anisotropy (FA) values—a DTI measure of the diffusion of water— in a specific white matter tract called the right arcuate fasciculus, suggesting something was going on in the white matter in the right hemisphere.

"Within CFS patients, right anterior arcuate FA increased with disease severity," Dr. Zeineh said. "The differences correlated with their fatigue—the more abnormal the tract, the worse the fatigue."

The results suggest that FA at the right arcuate fasciculus may serve as a biomarker for CFS that can help track the disease.

The imaging study also found abnormalities among CFS patients at the two points in the brain that connect the right arcuate fasciculus. Each connection point, known as a cortex, was thicker in CFS patients.

"This is the first study to look at white matter tracts in CFS and correlate them with cortical findings," Dr. Zeineh said. "It's not something you could see with conventional imaging."

Although the study involved only 15 CFS patients, the technique already shows tremendous promise as a diagnostic tool for identifying people with CFS, according to Dr. Zeineh.

"We used automated techniques to look at these tracts and were able to achieve 80 percent accuracy for CFS detection," he said.

Dr. Zeineh added that the findings need to be replicated and expanded upon in future studies to refine understanding of the relationship between brain structure and CFS.

"Right Arcuate Fasciculus Abnormality in Chronic Fatigue Syndrome." Collaborating with Drs. Zeineh and Montoya were James Kang, M.D., Scott W. Atlas, M.D., Mira M. Raman, M.S., Allan L. Reiss, M.D., Jane L Norris, P.A., and Ian Valencia, B.S.

Radiology is edited by Herbert Y. Kressel, M.D., Harvard Medical School, Boston, Mass., and owned and published by the Radiological Society of North America, Inc. (http://radiology.rsna.org/)

RSNA is an association of more than 53,000 radiologists, radiation oncologists, medical physicists and related scientists, promoting excellence in patient care and health care delivery through education, research and technologic innovation. The Society is based in Oak Brook, Ill. (RSNA.org)

For patient-friendly information on MRI of the brain, visit RadiologyInfo.org.

Stanford University: Right Arcuate Fasciculus Abnormality in Chronic Fatigue Syndrome

@ pubmed:

Radiology. 2014 Oct 29:141079. [Epub ahead of print]

Right Arcuate Fasciculus Abnormality in Chronic Fatigue Syndrome.

Zeineh MM1, Kang J, Atlas SW, Raman MM, Reiss AL, Norris JL, Valencia I, Montoya JG.

Author information

• 1From the Department of Radiology, Lucas Center for Imaging, Stanford University School of Medicine, 1201 Welch Rd, Room P271, Stanford, CA 94305-5488.

Abstract

Purpose To identify whether patients with chronic fatigue syndrome ( CFS chronic fatigue syndrome ) have differences in gross brain structure, microscopic structure, or brain perfusion that may explain their symptoms. Materials and Methods Fifteen patients with CFS chronic fatigue syndrome were identified by means of retrospective review with an institutional review board-approved waiver of consent and waiver of authorization. Fourteen age- and sex-matched control subjects provided informed consent in accordance with the institutional review board and HIPAA. All subjects underwent 3.0-T volumetric T1-weighted magnetic resonance (MR) imaging, with two diffusion-tensor imaging ( DTI diffusion-tensor imaging ) acquisitions and arterial spin labeling ( ASL arterial spin labeling ). Open source software was used to segment supratentorial gray and white matter and cerebrospinal fluid to compare gray and white matter volumes and cortical thickness. DTI diffusion-tensor imaging data were processed with automated fiber quantification, which was used to compare piecewise fractional anisotropy ( FA fractional anisotropy ) along 20 tracks. For the volumetric analysis, a regression was performed to account for differences in age, handedness, and total intracranial volume, and for the DTI diffusion-tensor imaging , FA fractional anisotropy was compared piecewise along tracks by using an unpaired t test. The open source software segmentation was used to compare cerebral blood flow as measured with ASL arterial spin labeling . Results In the CFS chronic fatigue syndrome population, FA fractional anisotropy was increased in the right arcuate fasciculus (P = .0015), and in right-handers, FA fractional anisotropy was also increased in the right inferior longitudinal fasciculus ( ILF inferior longitudinal fasciculus ) (P = .0008). In patients with CFS chronic fatigue syndrome , right anterior arcuate FA fractional anisotropy increased with disease severity (r = 0.649, P = .026). Bilateral white matter volumes were reduced in CFS chronic fatigue syndrome (mean ± standard deviation, 467 581 mm3 ± 47 610 for patients vs 504 864 mm3 ± 68 126 for control subjects, P = .0026), and cortical thickness increased in both right arcuate end points, the middle temporal (T = 4.25) and precentral (T = 6.47) gyri, and one right ILF inferior longitudinal fasciculus end point, the occipital lobe (T = 5.36). ASL arterial spin labeling showed no significant differences. Conclusion Bilateral white matter atrophy is present in CFS chronic fatigue syndrome . No differences in perfusion were noted. Right hemispheric increased FA fractional anisotropy may reflect degeneration of crossing fibers or strengthening of short-range fibers. Right anterior arcuate FA fractional anisotropy may serve as a biomarker for CFS chronic fatigue syndrome . © RSNA, 2014 Online supplemental material is available for this article.

PMID:

 

25353054

Patients with CFS found to have reduced white matter and other brain abnormalities

By LIZZIE PARRY, 30 October 2014, @ dailymail.co.uk

• Study at Stanford University examined MRI scans of CFS patients comparing them to those of healthy volunteers
• Found three distinct differences in different parts of the brain 
• CFS patients found to have lower levels of white matter - which carries information and signals between different parts of the brain 
• A tract connecting the frontal and temporal lobes was found to be abnormal
• And grey matter - which processes information - in those two areas of the brain was thicker in CFS patients 
• Hopes the discovery will lead to better diagnosis and treatment of condition
• Adds weight to debate over legitimacy of the condition, which is constantly questioned and mistaken as being hypochondria  

By LIZZIE PARRY FOR MAILONLINE

PUBLISHED: 10:28 GMT, 30 October 2014 | UPDATED: 12:50 GMT, 30 October 2014

The brains of those diagnosed with chronic fatigue syndrome are distinctly different to those of healthy people, scientists have discovered.

The study promises to add weight to the debate over the legitimacy of the condition, which is repeatedly called into question.

A team of researchers at Stanford University School of Medicine believe their findings could lead to more definitive diagnoses of the syndrome and better treatments.

And it is thought the study could help point to an underlying mechanism governing the disease.

It is not uncommon for CFS patients to face misunderstanding of their condition, plagued by suspicions of hypochondria.

But the abnormalities identified in this study, published in the journal Radiology, will, it is hoped, go some way to helping resolve those ambiguities.

Lead author Michael Zeineh, assistant professor of radiology, said: 'This is a very common and debilitating disease.

'It's very frustrating for patients, because they feel tired and are experiencing difficulty thinking, and the science has yet to determine what has gone wrong.

'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.'

The condition affects between one and four million in the US and millions more worldwide.

Putting a definitive figure on the number of sufferers is difficult, because CFS can be difficult to diagnose.

While all patients share a common symptom - crushing, unremitting fatigue that persists for six months or longer - additional symptoms can vary from one patient to the next, often overlapping with other conditions. 

Professor Jose Montoya, the study's senior author, said: 'CFS is one of the greatest scientific and medical challenges of our time.

'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.' 

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 combination of symptoms can devastate a patient's life for decades.

In an effort to identify the syndrome's underlying mechanisms, Professor Montoya has been following 200 CFS patients for several years.

'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,' he said.

Dr Zeineh added: 'If you don't understand the disease, you're throwing darts blindfolded.

'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 researchers compared brain images of 15 CFS patients chosen from the group Professor Montoya has been following, to those of 14 age and sex-matched healthy volunteers.

The volunteers had no history of fatigue or other conditions causing symptoms similar to those of CFS. 

Their analysis yielded three noteworthy results.

First, an MRI scan showed that overall white matter content of CFS patients' brains was reduced compared to that of healthy participants' brains.

+2

Researchers at Stanford University found three differences after performing MRIs on a group of CFS patients and a control group of healthy volunteers with no history of CFS. File picture

The term 'white matter' denotes the long, cable-like nerve tracts carrying signals and information through dispersed concentrations of 'grey matter' - which specialise in processing information.

While Dr Zeineh said the first finding wasn't entirely unexpected, the second was.

Using advanced imaging techniques, he and his colleagues identified a consistent abnormality in a particular part of a nerve tract in the right hemisphere of CFS patients' brains.

The tract, which connects the frontal lobe with the temporal lobe, assumed an abnormal appearance in CFS patients. 

Furthermore, Dr Zeineh said the study identified a strong link between the degree of abnormality in the patient's tract and the severity of their CFS.

The third finding highlighted a thickening of the grey matter in the frontal lobe and temporal lobe in CFS patients, compared with the control group.

Dr Zeineh said while their results are 'quite robust', more research is needed. 

'This study was a start. It shows us where to look,' he said, adding the team are planning a substantially larger study.

   

October 29, 2014 | by Lisa Winter @ iflscience.com

Brain Abnormalities Discovered in Patients With Chronic Fatigue Syndrome

photo credit: Radiological Society of North America

Up to 4 million Americans experience Chronic Fatigue Syndrome (CFS), which are periods of extreme fatigue lasting at least 6 months. A recent study published in Radiology by lead author Michael Zeineh of the Stanford University School of Medicine found that patients with CFS have a reduced amount of white matter in their brains, as well as abnormalities in both the white and gray matter of the right hemisphere. 

CFS has been notoriously difficult to diagnose, as the symptoms are obscure and could apply to many other disorders. Though the symptoms can be intense and severely reduce quality of life, it is hard to definitively name CFS as the culprit.

“CFS is one of the greatest scientific and medical challenges of our time,” senior author Jose Montoya said in a press release. “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 researchers have been involved in long-term study of 200 CFS patients in hopes of developing new effective treatments. This quest has been difficult, as the disease had not previously turned up physical markers that medication would be able to target. 

“If you don’t understand the disease, you’re throwing darts blindfolded,” Zeineh added. “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.”

In fact, the team found three critical commonalities between the brains of CFS patients that set them apart from those without the disorder. Interestingly, the intensity of the brain abnormalities correlated with the intensity of their condition.

Compared to healthy individuals, people with CFS have a diminished amount of white matter in the brain. White matter is composed of nerve fibers, which help connect the neurons in the gray matter that actually process information. CFS is believed to be associated with inflammation, which would cause this effect.

The team also found that white matter in the right hemisphere of the brain appears abnormal in the region of the brain that connects the frontal lobe and temporal lobe, called the right arcuate fasciculus. The frontal lobe has a wide range of functions including using dopamine to regulate attention, motivation, and reward. The temporal lobe is responsible for processing sensory information, storing memories, and controlling emotions. 

In addition to the abnormal white matter, the right arcuate fasciculus was also shown to have additional gray matter among CFS patients compared to healthy individuals. 

“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,” Montoyaexplained.

While the team got a lot of great data from this study, further analysis is needed in order to confirm the findings. The researchers will need to fully understand the mechanism behind these abnormalities before potential treatments can be explored

 “This study was a start,” Zeineh concluded. “It shows us where to look.”

Professor Michael Zeineh, radiologist, Stanford University: Brain scans show brain Changes in ME/CFS

By Michelle Fay Cortez @ bloomberg.com:

Brain Changes Point to Root of Chronic Fatigue in Study

By Michelle Fay Cortez  Oct 29, 2014 5:00 AM GMT+0100 

Brain scans may identify people with chronic fatigue syndrome, 
a finding that might point toward potential treatment targets for 
the mysterious ailment marked by unrelenting exhaustion, 
researchers said.

A small study using advanced imaging techniques showed chronic fatigue patients had less white matter than a healthy comparison group, as well as structural variations in the right hemisphere of the brain. The finding released today in the journal Radiology is one of the first that shows a concrete difference in people with the condition, which is currently diagnosed only by ruling out other ailments.

More work is needed to understand why the changes occur and determine whether they can be used to help fashion treatments for the ailment that affects as many as 4 million Americans, the researchers said. The findings may offer relief to patients who can struggle for years to get a diagnosis and are often told the cause is psychological, said lead researcher Michael Zeineh.

“We wanted to see what’s going on with chronic fatigue syndrome in the brain,” Zeineh, an assistant professor of radiology at Stanford University School of Medicine, said in a telephone interview. “We know these patients are suffering and traditional methods don’t show anything.”

The researchers examined brain scans of 15 patients and compared the results with 14 healthy people the same age and gender without the condition. The decrease in white matter makes sense because some scientists believe the disease stems from chronic inflammation. Inflammation can harm white matter, the brain tissue composed of nerve fibers that carry signals and connect the brain’s different regions.

Brain Connector

They also got abnormal readings when they looked at the right arcuate fasciculus, which

Professor r u a psychopath ??

psychopath-test

Megan Arroll, Psychologist UEL: many ME/CFS pts have found CBT and graded exercise therapy damaging

Megan Arroll, Psychologist, University of East London:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4159366/

"Abstract Background Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a long-term, debilitating condition that impacts numerous areas of individuals’ lives. The two predominant treatment options for ME/CFS are cognitive behavioral therapy and graded exercise therapy; however, many people have found these techniques unacceptable or even damaging. "

Yeah.... I think its time 4 CBT‏

Doctor treats Ebola successfully with HIV drug in Liberia

* http://edition.cnn.com/2014/09/27/health/ebola-hiv-drug/  

(CNN) - A doctor in rural Liberia inundated with Ebola patients says he's had good results with a treatment he tried out of sheer desperation: an HIV drug.

Dr. Gorbee Logan has given the drug, lamivudine, to 15 Ebola patients, and all but two survived. That's about a 13% mortality rate. Across West Africa, the virus has killed 70% of its victims."

"Doctor treats Ebola with HIV drug in Liberia -- seemingly successfullyA doctor in rural Liberia inundated with Ebola patients says he's had good results with a treatment he tried out of sheer desperation: an HIV drug.

Chalder: 19% recovery from chronic fatigue with CBT, and 15% in CDC defined CFS, a placebo is MORE effective !!

"While 72.2% met the Oxford criteria for CFS at pre-treatment assessment, 53.1% did so at the 6-month follow-up (Pearson chi square = 19.5, df = 1, p < 0.001).

Likewise, chi-square revealed a significant reduction in prevalence from 52.6% of the participants meeting the CDC criteria at the pre-treatment assessment to 37.5% at the 6-month follow-up (Pearson chi square = 16.8, df = 1, p < 0.001).

my PS:  Oxford criteria  = chronic fatigue, not CFS or ME !!
CDC criteria = CFS, not ME !! *

So Chalder admits, CBT is useless !!

@ pubmed:

Behav Res Ther. 2014 Aug 26;63C:1-8. doi: 10.1016/j.brat.2014.08.013. [Epub ahead of print]

Prevalence and predictors of recovery from chronic fatigue syndrome in a routine clinical practice.

Flo E1, Chalder T2.

Author information

Abstract

Cognitive behavioural therapy (CBT) is one of the treatments of choice for patients with chronic fatigue syndrome (CFS). However, the factors that predict recovery are unknown. The objective of this study was to ascertain the recovery rate among CFS patients receiving CBT in routine practice and to explore possible predictors of recovery. Recovery was defined as no longer meeting Oxford or CDC criteria for CFS measured at 6 months follow-up. A composite score representing full recovery additionally included the perception of improvement, and normal population levels of fatigue and of physical functioning. Logistic regression was used to examine predictors of recovery. Predictors included age, gender, cognitive and behavioural responses to symptoms, work and social adjustment, beliefs about emotions, perfectionism, anxiety and depression at baseline. At 6 months follow-up 37.5% of the patients no longer met either the Oxford or the CDC criteria for CFS while 18.3% were fully recovered. Multivariate analyses showed that worse scores on the work and social adjustment scale, unhelpful beliefs about emotions, high levels of depression and older age were associated with reduced odds for recovery. Recovery rates in this routine practice were comparable to previous RCTs. There was a wide spectrum of significant predictors for recovery.

Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

KEYWORDS:

Chronic fatigue syndrome; Cognitive behavioural therapy; Follow-up; Longitudinal; Recovery

PMID:

 

25222752

 

[PubMed - as supplied by publisher]

Professor Wessely: A placebo is MORE effective than CBT‏