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British Journal Radiology: CFS/ME Structural Brain Changes

Discussion in 'Latest ME/CFS Research' started by Firestormm, Nov 30, 2011.

  1. Firestormm

    Firestormm Guest

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    29 November 2011: http://bjr.birjournals.org/cgi/content/abstract/93889091v1 Abstract ahead of print. Requires membership to read in full.

    Regional grey and white matter volumetric changes in myalgic encephalomyelitis (chronic fatigue syndrome): a voxel-based morphometry 3-T MRI study

    B K Puri, PhD, FRCPsych1, P M Jakeman, MSc, PhD2, M Agour, MB, MRCPsych3, K D R Gunatilake, MD, MRCPsych4, K A C Fernando, MBBS, MRCPsych5, A I Gurusinghe, MBBS, PGDPsych6, I H Treasaden, MRCS, FRCPsych7, A D Waldman, PhD, MRCP1,8 and P Gishen, DMRD, FRCR1

    1 Department of Imaging, Hammersmith Hospital, London, UK 2 Department of Physical Education and Sport Sciences, University of Limerick, Republic of Ireland 3 University of Hertfordshire, and Care Principles, Rose Lodge, Langley, West Midlands, UK 4 The Ridge Hill Centre, Dudley, UK 5 Brooklands Hospital, Birmingham, West Midlands, UK 6 Broadmoor Hospital, Berkshire, UK 7 Three Bridges Unit, WLMHT, Middlesex, UK 8 National Hospital for Neurology and Neurosurgery, Queen Square, London, UK

    Objective:

    It is not established whether myalgic encephalomyelitis/chronic fatigue syndrome (CFS) is associated with structural brain changes. The aim of this study was to investigate this by conducting the largest voxel-based morphometry study to date in CFS.

    Methods:

    High-resolution structural 3-T cerebral MRI scanning was carried out in 26 CFS patients and 26 age- and gender-matched healthy volunteers. Voxel-wise generalised linear modelling was applied to the processed MR data using permutation-based non-parametric testing, forming clusters at t > 2.3 and testing clusters for significance at p < 0.05, corrected for multiple comparisons across space.

    Results:

    Significant voxels (p < 0.05, corrected for multiple comparisons) depicting reduced grey matter volume in the CFS group were noted in the occipital lobes (right and left occipital poles; left lateral occipital cortex, superior division; and left supracalcrine cortex), the right angular gyrus and the posterior division of the left parahippocampal gyrus. Significant voxels (p < 0.05, corrected for multiple comparisons) depicting reduced white matter volume in the CFS group were also noted in the left occipital lobe.

    Conclusion:

    These data support the hypothesis that significant neuroanatomical changes occur in CFS, and are consistent with the complaint of impaired memory that is common in this illness; they also suggest that subtle abnormalities in visual processing, and discrepancies between intended actions and consequent movements, may occur in CFS.

    Without access to the full paper it is always difficult to read too much into research, but I think this is another piece of welcome news. Only 26 patients (don't know criteria) but the important part is the conclusion. This isn't the first time I have read about brain abnormalities being observed, but it is the most recent study; and one that points to cognitive dysfunction and related symptoms as being a possible result.

    If anyone can gain full access and is unable to post (due to copyright) would they PM me perhaps? I would really like to read it in full. If I obtain a copy and can repost I will. :cool:
     
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  2. Marco

    Marco Old blackguard

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    Hi Firestormm

    I can't help you with the full paper but did find this on a European site :


     
    Firestormm likes this.
  3. Holmsey

    Holmsey Senior Member

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    Obvious question first, anyone know how they picked the test subjects, it would be nice to know if we're looking at results for a nurological condition or depression? Correct me if I'm wrong but trying to find an e-mail address for Puri I found that Hammersmiths part of Royal College London, which if I'm not mistaken is also where Mr. Wessely hangs out.

    Assuming we're taking us, are they suggesting this leads to the illness or is a symptom of the illness, and more importantly, does this reflect pemanent damage or is it likely that post illness this damage can be repaired?
     
  4. kaffiend

    kaffiend Senior Member

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    I can't access this through the UC system but emailed a couple of people who can get it for me. 26 patients is a large sample for an MRI study (it's extraordinarily expensive research).

    Finding structural differences in visual cortical regions and the angular gyrus could go a long way in legitimizing this disease and distinguishing it from psychiatric conditions. Keep in mind, however, that brain imaging studies don't uncover causes or lead directly to improved treatments.
     
    Firestormm likes this.
  5. HowToEscape?

    HowToEscape? Senior Member

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    "subtle abnormalities in visual processing, and discrepancies between intended actions and consequent movements,"

    That's interesting. When I'm in an impaired state but still mobile I've had a few occasions of bumping into people or things. I one case I sat on bench but missed the spot, and hit someone's arm. Fortunately I was using a cane that day and it was understood to be an accident... could have gotten ugly.
     
  6. oceanblue

    oceanblue Senior Member

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    Yes, 26 is very big by MRI standards but it is, still, a small sample. I know other, smaller, studies have also found changes in white and grey matter but I think the changes were in different areas to this study.

    Puri's big interest seems to be in phospolipds/fatty acids, has published quite a bit on CFS, including a 2002 paper finding differences in choline - also in the occipital cortex.
     
  7. snowathlete

    snowathlete

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    I worry about this too. Somewhat reasuringly, my father suffered from migrains very badly for about 30 years and in the end it affected his speech quite badly - he would often come out with gobbeldy-goop - but then he found a cure and now he is better. He then went to see a specialist who ran a bunch of tests on his brain and how he used it, and the results showed high scored across the board, which he told him was very unusual, something he said never happened. Most people score high only in one or two areas. So he told him that had his migraines caused damage, then in fact he would not have got those results.

    Obviously, migraines and ME are different illnesses but the point is that damage doesnt always occur even though you would think it would - lets hope we are so lucky!

    Also, from a testing point of view, its not a fair test. People with ME typically dont work because they are ill, and perhaps, you might argue, are therefore less stimulated mentally, and therefore the brain doesnt need to be as 'big' (if thats the right word here). If the healthy controls stayed at home, unable to engage their brains in much interesting then who is to say their brain wouldnt also react like this?
     
  8. Dolphin

    Dolphin Senior Member

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    A Dutch (Nijmegen) study claimed to show CBT increased Grey Matter Volume in CFS. Here's a letter that challenged that Nijmegen paper:

     
  9. Annesse

    Annesse Senior Member

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    Here is some recent research on the brain and low B12 levels. I believe in autoimmune disease and CFS the problem lies partially in the metabolism of B12. No matter how much we take in supplement form, with certain nutrients, we will not be able to bind or transport them. I will find and post some additional studies on MS and the inabililty to metabolize B12. MS is also associated with white matter lesions.
    http://www.medpagetoday.com/Neurology/GeneralNeurology/28740
     
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  10. Enid

    Enid Senior Member

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    Very interesting indeed - thanks Firestorm - I always wanted to know more about the "high spots" on my MRI brain scan and reported by my Neurologist 10 years ago. Looking as if this too is being unravelled. And yes the processing of perceptual information was very much impaired. The research findings now (with Norway) finally remove the W school from ME.
     
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  11. kaffiend

    kaffiend Senior Member

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    I just read the paper. Not much can be taken away other than some structural differences were found in the areas reported in the abstract. They don't do a very thorough job of reporting the results and I'm guessing this is their first attempt at this type of brain imaging analysis.

    It is however the first and largest study of its kind in ME/CFS and so hopefully will encourage follow up studies that correlate structural changes with behavioral scores from perceptual and movement tests.

    I found the discussion interesting. I have significant problems with performing intended actions and also lose a sense of where I am in space...how close or far away things are (kind of a fun-house effect as I walk around).

    From the discussion...

    "The right angular gyrus has now been shown to have a critical role in perceptual sequence learning [15]. It also computes action awareness representation; in particular, it is associated with both awareness of discrepancy between intended and movement consequences, and awareness of action authorship [16]. Farrer et al have proposed that the right angular gyrus is involved in higher-order aspects of one's own action; specifically, it processes discrepancies between intended action and movement consequences in such a way that these will be consciously detected by the subject: this joint processing is at the core of experiences used to interpret one's actions [16]. On the basis of our results in the occipital lobes and right angular gyrus, we would suggest that subtle abnormalities in visual processing, and discrepancies between intended actions and consequent movement, should be investigated in CFS patients."
     
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  12. allyb

    allyb Senior Member

    Proff Basant Puri, is a research psychiatrist he specialises in magnetic resonance studies. He has published extensively. Good question Holmsey, since he writes prolifically on both.
    I recognised his name from a book that I'd had recommended and read whilst on a course in London in 2004 called The Natural Way to Beat Depression, (you can buy it on Amazon for a penny) This was long before I became ill and I was interested in his work on EPA.

    I have just realised that he also wrote Chronic Fatigue Syndrome: A Natural Way to Treat M.E. in the same year. Interesting reviews on Amazon. Also the same year he wrote a book; Revision Notes in Psychiatry and in 2008 an E-book Pocket Essentials of Psychiatry.
    Maybe he is looking at damage limitation or repair through 'eicosapentaenoic acid?' EPA.


    Oceanblue, this does seem to be his area.
    --------------------------------------------------------------------------------
     
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  13. Snow Leopard

    Snow Leopard Senior Member

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    Has anyone compared this directly to the 2011 Barnden et al study? It is also funny how they do a 26/26 study and then proclaim it is the largest yet (the Barnden study was 25/25).
     
  14. kaffiend

    kaffiend Senior Member

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    The study in this thread (Puri) didn't look at the brainstem so they can't be compared.
     
  15. Marco

    Marco Old blackguard

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    These preliminary results are being reported in the media today :


    This report looks as if it has been sourced from our old friends the Science Media Centre with (this time) appropriate comments and caveats :

    http://www.halifaxcourier.co.uk/news/health/can_eating_fish_prevent_alzheimer_s_1_4019974
     
  16. Holmsey

    Holmsey Senior Member

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    Read a paper posted on the ME Associations site regarding endothelial dysfunction in ME/CFS, again no indication of the cohort used and no reply from any of the authors when I enquired. Reason I mention it is that in scanning for endothelial dysfunction I find that there's also been conclusive studies involving depressives. Yesterday I scanned for reduced grey / white brain matter and find there's also been longitudinal studies attempting to match depression to that reduction.

    On first seeing both papers my thoughts were, great, someone's proving physical abnormalities, but now I'm wondering if it's simply, 'oh, this shows up for depression, lets see if it shows up under ME/CFS', I'd hate to think that was the driver for the research.

    Plus note on the longitudinal study though, the conclusion seemed to be that depression begins/intensifies due to the loss of grey/white matter, the study was for otherwise healthy people who were lossing matter due to natural wastage with age, and I think they said all depressions were sub-clinical, I take it that means they're not clinically depressed, but just not as perky as they once were.

    So, is it the case that even if they can associate some sub-clinical depression with 'ME/CFS' this is due to the disease itself reducing grey/white matter, or fatiuge / fog reducing use and so natural reduction. If it is then the cascade would be - illness onset leads to a reduction in congnitive ability, leads to a reduction in grey/white matter, leads to mild depressive symptoms, leads to sceptisicm, ignorane, miss diagnossis and the sense your MP is fed up from hearing from you?

    Just a thought.
     
  17. Holmsey

    Holmsey Senior Member

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    Marco, do you know what the science behind this is, is it the omega oils in the fish or the whole package? Not a big fish eater, and when I do it's probably the wrong kind, I'm also skeptical about eating anything caught off the coast of a western country given what we pump into the water, not to mention the nuclear power stations sprinkled around the UK coast.
     
  18. Firestormm

    Firestormm Guest

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    Thank you. This explanation is in part a good reason to gain access to full research papers. Was there any mention of how they determined patient suitability i.e. the criteria for 'CFS'? I know it matters little in terms of the results but it is perhaps important.

    I note the concerns expressed above about this possibly being used in relation to 'depression' though I noted also on the MEA Facebook page that Dr Shepherd was thinking along the lines that it might also be used to support the neurological disease case:

    'Many thanks for posting this abstract. I have not yet seen the full paper but it looks as though the results should further strengthen the case for neurological classification.'

    Personally, I suppose I hope that this research will add further legitimacy to the condition as well as greater understanding and might spawn similar research. Whether or not the reason behind such a change in one's brain and function can be established is for me secondary; I would rather hope they could use this finding to better direct therapy and/or treatment (assuming of course either are indeed possible).

    Edit: I wonder if - in the future - such observable physical abnormality could feature in the diagnosis of 'CFS/ME'? I mean it could well increase the argument for a MRI at the point of diagnosis. If the one's doctor suspects 'CFS/ME' along similar lines as they do now, then perhaps a MRI could confirm the diagnosis along similar lines as happens for Multiple Sclerosis (though for MS they do not look at the brain obviously).
     
  19. Marco

    Marco Old blackguard

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    I presume that's what its about Holmsey but as its just an abstract at the moment there's no way of telling.
     
  20. Dolphin

    Dolphin Senior Member

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    From paper:
     

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