Brainstem Abnormalities in [ME/CFS]: A Scoping Review and Evaluation of Magnetic Resonance Imaging Findings, 2021, Nelson et al

Nelson T, Zhang LX, Guo H, Nacul L,

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.

https://www.frontiersin.org/articles/10.3389/fneur.2021.769511/full

 

I hope there's some good followup research on this.

 

This paragraph was interesting to me, as it tries to explain the role of Peroxynitrite nitrite in generating ME and the associated damage: all this a consequence of infection.

Anxious to hear what others here think of this paper. Thanks.

"The review is in favor of the hypothesis that ME/CFS involves brainstem specific astrocyte dysfunctions, contributing to impaired brainstem cerebrovascular autoregulation and reduced blood flow (36, 56). Oxidative stress appears to induce ME/CFS symptoms, associated with reduced blood flow and neuroinflammation. An infection (the most frequently reported trigger for ME/CFS onset) has been linked to peroxynitrite production, a proinflammatory oxygen/nitrogen species (57, 58), triggering neuroinflammation. This can lead to the production of isoprostanes and cause vasoconstriction when the level of antioxidants is insufficient (59). Oxidative stress and increased isoprostanes in ME/CFS have been correlated with clinical symptoms (60). Reduced brain blood flow is common in ME/CFS patients, accompanied by lowered circulation and nutrient/waste exchange (61–65)."

 

Almost becoming a standard reply from me but the GWAS study (Chris Ponting - sampling starting in May) might provide a way to test hypothesis like this. E.g. presumably if this was a common mechanism then there would be clues in the GWAS results.

@Simon M

 

Highlighting some quotes read against the concepts of:

1) Lipid metabolism is critical for myelination maintenance (see Myelin lipid metabolism and its role in myelination and myelin maintenance)
2) Impaired myelination in one area of the brain can be compensated in another (see Anti-Correlated Myelin-Sensitive MRI Levels Consistent with Subcortical to Sensorimotor Regulatory Process)

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* Brain Structural and Functional Connectivity: A Review of Combined Works of Diffusion Magnetic Resonance Imaging and Electro-Encephalography (2021)