Brainstem abnormalities in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A scoping review and evaluation of Magnetic Resonance Imaging findings, by Todd Nelson, Lan-Xin Zhang, Hui Guo, Luis Nacul, Xiaowei Son in Frontiers in Neurology Vol 12, p 769511, Dec 2021 [doi:10.3389/fneur.2021.769511]
Review abstract:
Background
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a multisystem medical condition with heterogeneous symptom expression.
Currently, there is no effective cure or treatment for the standard care of patients. A variety of ME/CFS symptoms can be linked to the vital life functions of the brainstem, the lower extension of the brain best known as the hub relaying information back and forth between the cerebral cortex and various parts of the body.
Objective/Methods
Over the past decade, Magnetic Resonance Imaging (MRI) studies have emerged to understand ME/CFS with interesting findings, but there has lacked a synthesized evaluation of what has been found thus far regarding the involvement of the brainstem. We conducted this study to review and evaluate the recent MRI findings via a literature search of the MEDLINE database, from which 11 studies met the eligibility criteria.
Findings
Data showed that MRI studies frequently reported structural changes in the white and gray matter. Abnormalities of the functional connectivity within the brainstem and with other brain regions have also been found.
The studies have suggested possible mechanisms including astrocyte dysfunction, cerebral perfusion impairment, impaired nerve conduction, and neuroinflammation involving the brainstem, which may at least partially explain a substantial portion of the ME/CFS symptoms and their heterogeneous presentations in individual patients.
Conclusions
This review draws research attention to the role of the brainstem in ME/CFS, helping enlighten future work to uncover the pathologies and mechanisms of this complex medical condition, for improved management and patient care.
Excerpts from paper:
Taken together, the present review highlights the brainstem as a potential brain centre that may have a key role in the physiological defects in ME/CFS and recommends future MRI on ME/CFS studies to make the brainstem a specific target. Given the close association between the brainstem function impairments and the complex clinical expression of the disease, MRI, with its relatively high spatial and temporal resolutions for non-invasive in vivo applications, holds promise to uncover the mechanisms of the disease, and in turn enlightens effective strategies for improved patient care.
This review contributes to the research line by bringing the existing studies together and integrating them while highlighting the potential for more. As the big questions around ME/CFS remain unanswered (e.g., why does an initial viral event result in a debilitating ongoing life-long disease in some people, why does it not resolve like a typical infectious illness, and why are ME/CFS patients subject to frequent relapses), highlighting of the brainstem as a specific target is meaningful from both research and clinical practice perspectives.
…The paper draws increased attention to brainstem research in ME/CFS using multi-modality MRI, calling for improved experimental design, and increased sample size and follow-up duration. Targeting the brainstem abnormalities in relation to the heterogeneous symptoms has implications for uncovering ME/CFS mechanisms and thus improving management and patient care.
