Sacco, P, Hope, P A, Thickbroom, G W et al. · Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology · 1999 · DOI
This study examined whether the fatigue and exercise difficulty in ME/CFS comes from the brain and nervous system rather than just muscle weakness. Researchers used magnetic stimulation to measure how the motor cortex (the brain region controlling movement) responds during sustained muscle contractions in ME/CFS patients and healthy controls. They found that people with ME/CFS had shorter exercise endurance, felt more exhausted during effort, and showed different patterns of brain-to-muscle signaling compared to healthy people.
This study provides objective neurophysiological evidence that ME/CFS-related exercise intolerance may involve dysfunction in how the brain controls muscles, rather than being purely psychological or due to muscle pathology alone. Understanding the central nervous system basis of fatigue could guide development of more targeted therapeutic approaches and validate patient experiences of disproportionate effort during exercise.
This study does not prove that central motor dysfunction is the sole cause of ME/CFS fatigue, only that it is associated with exercise intolerance in this small sample. It does not establish whether this neurophysiological pattern is specific to ME/CFS or present in other fatiguing illnesses. The cross-sectional design cannot determine whether the observed changes are primary causative mechanisms or secondary consequences of the disease.
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
Sacco, P, Hope, P A, Thickbroom, G W, Byrnes, M L, & Mastaglia, F L (1999). Corticomotor excitability and perception of effort during sustained exercise in the chronic fatigue syndrome.. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology. https://doi.org/10.1016/s1388-2457(99)00144-3
BibTeX
@article{mecfsatlas-sacco-1999-corticomotor-excitability,
author = {Sacco, P and Hope, P A and Thickbroom, G W and Byrnes, M L and Mastaglia, F L},
title = {Corticomotor excitability and perception of effort during sustained exercise in the chronic fatigue syndrome.},
journal = {Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology},
year = {1999},
doi = {10.1016/s1388-2457(99)00144-3},
note = {PubMed: 10576483},
url = {https://www.mecfsatlas.com/evidence/sacco-1999-corticomotor-excitability},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/sacco-1999-corticomotor-excitability
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