Starr, A, Scalise, A, Gordon, R et al. · Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology · 2000 · DOI
This study used a technique called transcranial magnetic stimulation (TMS) to measure how the motor cortex—the part of the brain that controls movement—behaves in people with ME/CFS. Patients and healthy controls performed finger movements while researchers measured brain responses before, during, and after the exercise. People with ME/CFS showed abnormal brain responses compared to healthy people, suggesting their brains may not adapt normally to physical activity.
This study provides mechanistic evidence that ME/CFS involves abnormal central nervous system physiology beyond subjective reports of fatigue. The finding that motor cortex excitability fails to show normal exercise-induced changes may help explain why patients experience post-exertional malaise and could inform future therapeutic targets aimed at restoring normal brain adaptation to activity.
This study does not prove that motor cortex dysfunction *causes* ME/CFS symptoms or is specific to ME/CFS—similar abnormalities might exist in other conditions. It does not establish whether these neurophysiological changes correlate with symptom severity, disease duration, or post-exertional malaise, nor does it determine if the abnormality is primary or secondary to disease processes. The cross-sectional design precludes any causal inference.
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
Starr, A, Scalise, A, Gordon, R, Michalewski, H J, & Caramia, M D (2000). Motor cortex excitability in chronic fatigue syndrome.. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology. https://doi.org/10.1016/s1388-2457(00)00444-2
BibTeX
@article{mecfsatlas-starr-2000-motor-cortex,
author = {Starr, A and Scalise, A and Gordon, R and Michalewski, H J and Caramia, M D},
title = {Motor cortex excitability in chronic fatigue syndrome.},
journal = {Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology},
year = {2000},
doi = {10.1016/s1388-2457(00)00444-2},
note = {PubMed: 11068238},
url = {https://www.mecfsatlas.com/evidence/starr-2000-motor-cortex},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/starr-2000-motor-cortex
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