Thapaliya, Kiran, Marshall-Gradisnik, Sonya, Staines, Don et al. · NeuroImage. Clinical · 2020 · DOI
Researchers used a special type of brain imaging (MRI scans) to look for physical changes in the brains of people with ME/CFS compared to healthy people. They found that people with ME/CFS had higher levels of myelin (the protective covering around nerve fibers) and/or iron in specific brain regions, particularly in areas deep in the brain and in white matter tracts. These changes were linked to ME/CFS symptoms like cognitive problems, heart rate variability, breathing patterns, and physical well-being.
This study provides objective neuroimaging evidence of physical brain changes in ME/CFS, supporting the biological basis of cognitive symptoms that patients commonly report. By identifying specific brain regions affected and linking these changes to measurable clinical symptoms, the research validates ME/CFS as a neurological condition and may help guide future therapeutic targets and diagnostic approaches.
This study does not prove that elevated myelin and iron *cause* ME/CFS symptoms; the relationship could be secondary to the disease process or represent compensation mechanisms. The cross-sectional design cannot establish temporal relationships or causation. Additionally, the study does not explain the mechanisms driving these tissue-level changes or whether they are reversible with treatment.
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
Thapaliya, Kiran, Marshall-Gradisnik, Sonya, Staines, Don, & Barnden, Leighton (2020). Mapping of pathological change in chronic fatigue syndrome using the ratio of T1- and T2-weighted MRI scans.. NeuroImage. Clinical. https://doi.org/10.1016/j.nicl.2020.102366
BibTeX
@article{mecfsatlas-thapaliya-2020-mapping-pathological,
author = {Thapaliya, Kiran and Marshall-Gradisnik, Sonya and Staines, Don and Barnden, Leighton},
title = {Mapping of pathological change in chronic fatigue syndrome using the ratio of T1- and T2-weighted MRI scans.},
journal = {NeuroImage. Clinical},
year = {2020},
doi = {10.1016/j.nicl.2020.102366},
note = {PubMed: 32777701},
url = {https://www.mecfsatlas.com/evidence/thapaliya-2020-mapping-pathological},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/thapaliya-2020-mapping-pathological
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