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The brain

In discussing how the body is affected by CFS, Dr. Komaroff first focused on the brain. He cited six different areas of evidence that the brain is highly involved in the disease process of CFS, including both clinical manifestations and physiological abnormalities which have been demonstrated by brain imaging technologies: neuroendocrinological abnormalities, cognitive dysfunction, autonomic impairment, and abnormalities apparent in MRI, SPECT and EEG testing.

Neuroendocrine dysfunction: The neuroendocrine system in the brain controls and coordinates the glands elsewhere in the body that produce hormones. Neuroendocrine dysfunction in CFS is evident in the limbic-hypothalamic-pituitary axes—a complex system of interactions in the brain involving the limbic system, the hypothalamus and the pituitary gland. These together, in addition to fulfilling important functions such as regulation of the immune system and digestion, also control production of the hormones cortisol, prolactin, and growth hormone by glands elsewhere in the body. The serotonin (5-HT) system is also affected.

Cognitive (thinking) difficulty is apparent in neuropsychological studies of CFS patients. These tests demonstrate deficits in memory and attention as well as speed of information processing—deficits that cannot be accounted for by concomitant psychiatric disorders.

Autonomic dysfunction is found in 30% to 80% of those with CFS. This means that for those patients there is some level of impairment of the sympathetic and parasympathetic nervous systems.

MRI scans of CFS patients show punctate areas of high signal intensity in the white matter of the brain.

SPECT scans, which measure cerebral blood flow, indicate areas of decreased blood flow in CFS patients.

EEG tests, which measure electrical activity in the brain of CFS patients, show abnormal spikes and sharp waves and a spectral coherence pattern unique to CFS that Dr. Komaroff elaborated on a bit later.

At this point, Dr. Komaroff paused to emphasize that none of the brain studies just mentioned show chronic or progressive brain damage, but rather brain “abnormalities that come and go” and mirror the ebb and flow of symptom severity experienced by many of those with CFS.

Importantly, these brain abnormalities also clearly distinguish people with CFS from healthy people, people with depression, and people with other fatiguing illnesses.