Research abstract:
Structural and functional abnormalities of the prefrontal cortex seem to correlate with fatigue in patients with chronic fatigue syndrome (CFS).
We consecutively applied facilitatory high-frequency repetitive transcranial magnetic stimulation (rTMS) to the dorsolateral prefrontal cortex (DLPFC) of seven CFS patients over three days. Five patients completed the 3-day protocol without any adverse events.
For the other two patients, we had to reduce the stimulation intensity in response to mild adverse reactions. In most of the patients, treatment resulted in an improvement of fatigue symptoms. High-frequency rTMS applied over the DLPFC can therefore be a potentially useful therapy for CFS patients.
High-frequency rTMS for the Treatment of Chronic Fatigue Syndrome: A Case Series. by W Kakuda, R Momosaki, N Yamada, M Abo in Intern Med. 2016;55(23):3515-3519. [Epub 2016 Dec 1.]
Extract from the full text:
The present study has certain limitations.
First, this is a case-series pilot study with only a small number of patients that lacked a control group. Comparative studies, such as randomized controlled design studies that include a large number of patients, are needed to confirm the efficacy of rTMS in CFS patients.
Second, although all patients met the inclusion criteria for rTMS application, they were a heterogeneous group based on the wide variability of age, duration of illness and severity of the fatigue symptoms. The identification of the clinical factors that correlate with the efficacy of rTMS can help in the selection of patients who will best benefit from the treatment.
Third, although it is difficult to stimulate deep brain lesions using the currently available technology, the stimulation of other brain areas with functional or structural abnormalities in CFS, such as the cingulate cortex and brainstem, may produce a better clinical improvement.
Furthermore, for one left-handed patient, we applied high-frequency rTMS to the right hemisphere unlike the other six patients. The appropriateness of this therapeutic strategy of rTMS depending on whether patients were righthanded or left-handed should be also confirmed.
