Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Neurological Entity?
Open Access
- 27 September 2021
- Vol. 57 (10), 1030
- https://doi.org/10.3390/medicina57101030
Abstract
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a disorder of unknown physiopathology with multisystemic repercussions, framed in ICD-11 under the heading of neurology (8E49). There is no specific test to support its clinical diagnosis. Our objective is to review the evidence in neuroimaging and dysautonomia evaluation in order to support the neurological involvement and to find biomarkers serving to identify and/or monitor the pathology. The symptoms typically appear acutely, although they can develop progressively over years; an essential trait for diagnosis is “central” fatigue together with physical and/or mental exhaustion after a small effort. Neuroimaging reveals various morphological, connectivity, metabolic, and functional alterations of low specificity, which can serve to complement the neurological study of the patient. The COMPASS-31 questionnaire is a useful tool to triage patients under suspect of dysautonomia, at which point they may be redirected for deeper evaluation. Recently, alterations in heart rate variability, the Valsalva maneuver, and the tilt table test, together with the presence of serum autoantibodies against adrenergic, cholinergic, and serotonin receptors were shown in a subgroup of patients. This approach provides a way to identify patient phenotypes. Broader studies are needed to establish the level of sensitivity and specificity necessary for their validation. Neuroimaging contributes scarcely to the diagnosis, and this depends on the identification of specific changes. On the other hand, dysautonomia studies, carried out in specialized units, are highly promising in order to support the diagnosis and to identify potential biomarkers. ME/CFS orients towards a functional pathology that mainly involves the autonomic nervous system, although not exclusively.Keywords
This publication has 77 references indexed in Scilit:
- Myalgic encephalomyelitis/chronic fatigue syndrome and encephalomyelitis disseminata/multiple sclerosis show remarkable levels of similarity in phenomenology and neuroimmune characteristicsBMC Medicine, 2013
- In myalgic encephalomyelitis/chronic fatigue syndrome, increased autoimmune activity against 5-HT is associated with immuno-inflammatory pathways and bacterial translocationJournal of Affective Disorders, 2013
- Sleep Abnormalities in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A ReviewSleep Medicine, 2012
- Reduction of [11C](+)3-MPB Binding in Brain of Chronic Fatigue Syndrome with Serum Autoantibody against Muscarinic Cholinergic ReceptorPLOS ONE, 2012
- COMPASS 31: A Refined and Abbreviated Composite Autonomic Symptom ScoreMayo Clinic Proceedings, 2012
- Large-scale brain networks and psychopathology: a unifying triple network modelTrends in Cognitive Sciences, 2011
- Myalgic encephalomyelitis: International Consensus CriteriaJournal of Internal Medicine, 2011
- Cerebral blood flow is reduced in chronic fatigue syndrome as assessed by arterial spin labelingJournal of the Neurological Sciences, 2011
- The Economic impact of ME/CFS: Individual and societal costsDynamic Medicine, 2008
- Probing the Working Memory System in Chronic Fatigue Syndrome: A Functional Magnetic Resonance Imaging Study Using the n-Back TaskPsychosomatic Medicine, 2006