Miwa, Kunihisa · Journal of integrative neuroscience · 2025 · DOI
This study found that nearly half of ME/CFS patients experience balance problems—either when standing still (static disequilibrium) or when walking (kinetic disequilibrium). These balance issues were linked to difficulty standing upright and limitations in daily activities. When researchers used a brain stimulation treatment called repetitive transcranial magnetic stimulation (rTMS) on specific brain regions, most patients' balance problems improved, suggesting the root cause is in the central nervous system rather than the inner ear alone.
Balance problems are underrecognized but functionally significant symptoms in ME/CFS that directly limit patients' independence. This study provides objective neurological evidence that disequilibrium is a measurable central nervous system dysfunction rather than a functional or psychological symptom. The finding that rTMS effectively treats these balance problems offers potential for a novel therapeutic intervention targeting underlying CNS pathology.
This study does not prove that rTMS is a cure for ME/CFS or that all patients will benefit equally—the treatment sample was small (13 patients) without a control group. It does not establish that balance dysfunction causes orthostatic intolerance or vice versa, only that they co-occur. The findings cannot yet be generalized beyond the specific population studied or confirm rTMS as standard clinical practice without larger randomized controlled trials.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Miwa, Kunihisa (2025). Static and Kinetic Disequilibrium are Central Neural Signs in Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome-Therapeutic Effect of Repetitive Transcranial Magnetic Stimulation.. Journal of integrative neuroscience. https://doi.org/10.31083/JIN25488
BibTeX
@article{mecfsatlas-miwa-2025-static-kinetic,
author = {Miwa, Kunihisa},
title = {Static and Kinetic Disequilibrium are Central Neural Signs in Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome-Therapeutic Effect of Repetitive Transcranial Magnetic Stimulation.},
journal = {Journal of integrative neuroscience},
year = {2025},
doi = {10.31083/JIN25488},
note = {PubMed: 40302262},
url = {https://www.mecfsatlas.com/evidence/miwa-2025-static-kinetic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/miwa-2025-static-kinetic
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