Conference Paper

Cortical hypoactivation during resting eLORETA suggests central nervous system pathology in patients with chronic fatigue syndrome

Authors:
  • The NeuroCognitive Research Institute
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Abstract

Patients with chronic fatigue syndrome (CFS) are known to have chronic cognitive impairment known as brain fog accompanied by persistent fatigue. To gain insight into how cognitive impairment is produced, EEG was recorded from 19 scalp locations with link-ear reference during a 3-minute, eyes-closed task in 50 patients with CFS and 50 healthy control subjects, matched for age (range 28 to 74 years), gender, and educational level. The Multidimensional Fatigue Inventory (MFI-20) and the Fatigue Severity Scale (FSS) were likewise administered to the same group of patients. Using the EEG data, current densities were localized and computed from 1-30 Hz with exact low-resolution electromagnetic tomography (eLORETA). Non-parametric statistical mapping (SnPM) and linear regression analyses were used to evaluate the differences in current densities in each Brodmann area grouping of cortical grey matter voxels. Results: Frontal, temporal, parietal, limbic and sub-lobar regions of interest (ROI’s) demonstrated significantly different current densities in CFS patients when compared to healthy controls (HC). Statistically significant differences were found in the delta (1-3 Hz) and in the beta-2 (19-21 Hz) frequency bands in both the left and right hemisphere. Delta sources were found predominately in the frontal and limbic regions of interest (ROI) with beta-2 sources found predominately in central and superior parietal ROIs. Linear regression models, predicting current density from the MFI-20 reduced motivation subscale, found increased delta in the left frontal, temporal, parietal, limbic and sub-lobar ROIs. eLORETA was able to detect evidence of widespread cortical hypoactivation in CFS patients as demonstrated by increased delta and decreased beta-2 sources. Taken together, our findings provide objective quantification of central nervous system dysregulation in CFS sufferers. A model of prolonged subcortical deregulation is hypothesized to explain the results.

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... The EEG data and exact low-resolution electromagnetic tomography (eLORETA) results showed widespread cortical hypoactivation in CFS patients as demonstrated by increased delta and decreased beta2 frequency bands. These findings provided objective quantification of central nervous system dysregulation in CFS patients (99). ...
... qEEG measures for connectivity analysis lack the spatial resolution of LORETA source analysis, but have the same temporal resolution, providing inexpensive and easy to interpret brain function [20]. qEEG and eLORETA measures21222324 have found significantly deregulated delta sources (1-4 Hz) in widespread bi-lateral portions of the frontal lobe and limbic lobe regions as well as deregulated beta activity in posterior parietal regions in CFS. The co-occurrence of cortical hypoactivation in these brain regions provides empirical evidence for a neurobiological basis pertaining to patient symptomology including impairment in higher brain functions. ...
Article
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Importance: Chronic Fatigue Syndrome (CFS) is a chronic disease resulting in considerable and widespread cognitive deficits. Accurate and accessible measurement of the extent and nature of these deficits can aid healthcare providers and researchers in the diagnosis of this condition, choosing interventions and tracking treatment effects. Here, we present a case of a middle-aged man diagnosed with CFS which began following a typical viral illness. Observations: LORETA source density measures of surface EEG connectivity at baseline were performed on 3 minutes of eyes closed deartifacted19-channel qEEG. The techniques used to analyze the data are described along with the hypothesized effects of the deregulation found in this data set. Nearly all (>90%) patients with CFS complain of cognitive deficits such as slow thinking, difficulty in reading comprehension, reduced learning and memory abilities and an overall feeling of being in a “fog.”Therefore, impairment may be seen in deregulated connections with other regions (functional connectivity); this functional impairment may serve as one cause of the cognitive decline in CFS. Here, the functional connectivity networks of this patient were sufficiently deregulated to cause the symptoms listed above. Conclusions and significance: This case report increased our understanding of CFS from the perspective of brain functional networks by offering some possible explanations for cognitive deficits in patients with CFS. There are only a few reports of using source density analysis or qEEG connectivity analysis for cognitive deficits in CFS. While no absolute threshold exists to advise the physician as to when to conduct such analyses, the basis of his or her decision whether or not to use these tools should be a function of clinical judgment and experience. These analyses may potentially aid in clinical diagnosis, symptom management, treatment response and can alert the physician as to when intervention may be warranted.
... The EEG data and exact low-resolution electromagnetic tomography (eLORETA) results showed widespread cortical hypoactivation in CFS patients as demonstrated by increased delta and decreased beta2 frequency bands. These findings provided objective quantification of central nervous system dysregulation in CFS patients (99). ...
Article
Full-text available
This review was written from the viewpoint of the treating clinician to educate health care professionals and the public about Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). It includes: the clinical definition of ME/CFS with emphasis on how to diagnose ME/CFS; the etiology, pathophysiology, management approach, long-term prognosis and economic cost of ME/CFS. After reading this review, you will be better able to diagnose and treat your patients with ME/CFS using the tools and information provided. Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex, chronic medical condition characterized by symptom clusters that include: pathological fatigue and malaise that is worse after exertion, cognitive dysfunction, immune dysfunction, unrefreshing sleep, pain, autonomic dysfunction, neuroendocrine and immune symptoms. ME/CFS is common, often severely disabling and costly. The Institute of Medicine (IOM) reviewed the ME/CFS literature and estimates that between 836,000 and 2.5 million Americans have ME/CFS at a cost of between 17 and 24 billion dollars annually in the US. The IOM suggested a new name for ME/CFS and called it Systemic Exertion Intolerance Disease (SEID). SEID's diagnostic criteria are less specific and do not exclude psychiatric disorders in the criteria. The 2010 Canadian Community Health Survey discovered that 29% of patients with ME/CFS had unmet health care needs and 20% had food insecurity - lack of access to sufficient healthy foods. ME/CFS can be severely disabling and cause patients to be bedridden. Yet most patients (80%) struggle to get a diagnosis because doctors have not been taught how to diagnose or treat ME/CFS in medical schools or in their post-graduate educational training. Consequently, the patients with ME/CFS suffer. They are not diagnosed with ME/CFS and are not treated accordingly. Instead of compassionate care from their doctors, they are often ridiculed by the very people from whom they seek help. The precise etiology of ME/CFS remains unknown, but recent advances and research discoveries are beginning to shed light on the enigma of this disease including the following contributors: infectious, genetic, immune, cognitive including sleep, metabolic and biochemical abnormalities. Management of patients with ME/CFS is supportive symptomatic treatment with a patient centered care approach that begins with the symptoms that are most troublesome for the patient. Pacing of activities with strategic rest periods is, in our opinion, the most important coping strategy patients can learn to better manage their illness and stop their post-exertional fatigue and malaise. Pacing allows patients to regain the ability to plan activities and begin to make slow incremental improvements in functionality.
Article
Full-text available
Exact low resolution electromagnetic tomography (eLORETA) was recorded from nineteen EEG channels in nine patients with myalgic encephalomyelitis (ME) and 9 healthy controls to assess current source density and functional connectivity, a physiological measure of similarity between pairs of distributed regions of interest, between groups. Current source density and functional connectivity were measured using eLORETA software. We found significantly decreased eLORETA source analysis oscillations in the occipital, parietal, posterior cingulate, and posterior temporal lobes in Alpha and Alpha-2. For connectivity analysis, we assessed functional connectivity within Menon triple network model of neuropathology. We found support for all three networks of the triple network model, namely the central executive network (CEN), salience network (SN), and the default mode network (DMN) indicating hypo-connectivity in the Delta, Alpha, and Alpha-2 frequency bands in patients with ME compared to controls. In addition to the current source density resting state dysfunction in the occipital, parietal, posterior temporal and posterior cingulate, the disrupted connectivity of the CEN, SN, and DMN appears to be involved in cognitive impairment for patients with ME. This research suggests that disruptions in these regions and networks could be a neurobiological feature of the disorder, representing underlying neural dysfunction.
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