Thapaliya, Kiran, Marshall-Gradisnik, Sonya, Staines, Donald et al. · The European journal of neuroscience · 2021 · DOI
This study used a specialized brain imaging technique called diffusion tensor imaging (DTI) to look for structural changes in the brains of ME/CFS patients compared to healthy people. The researchers found subtle differences in how water moves through certain nerve fiber pathways in the brains of patients who met strict diagnostic criteria for ME/CFS, particularly in areas controlling movement, coordination, and breathing. These brain changes were linked to patient symptoms like difficulty processing information, fatigue, and sleep problems.
This study provides objective neuroimaging evidence that ME/CFS involves measurable physical changes in brain structure, helping validate that the condition is biological rather than purely psychological. The identification of DTI as a potential biomarker could eventually improve diagnosis and help researchers understand what goes wrong in ME/CFS brains. These findings support the need for strict diagnostic criteria in future research to ensure studies examine the same patient population.
This study does not prove that the observed brain changes *cause* ME/CFS symptoms—only that they are associated with the condition. The cross-sectional design cannot determine whether these microstructural changes develop before, during, or after symptom onset. The study cannot explain the biological mechanisms behind these changes, and findings apply specifically to patients meeting ICC criteria, not necessarily all individuals with ME/CFS-like symptoms.
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, Donald, & Barnden, Leighton (2021). Diffusion tensor imaging reveals neuronal microstructural changes in myalgic encephalomyelitis/chronic fatigue syndrome.. The European journal of neuroscience. https://doi.org/10.1111/ejn.15413
BibTeX
@article{mecfsatlas-thapaliya-2021-diffusion-tensor,
author = {Thapaliya, Kiran and Marshall-Gradisnik, Sonya and Staines, Donald and Barnden, Leighton},
title = {Diffusion tensor imaging reveals neuronal microstructural changes in myalgic encephalomyelitis/chronic fatigue syndrome.},
journal = {The European journal of neuroscience},
year = {2021},
doi = {10.1111/ejn.15413},
note = {PubMed: 34355438},
url = {https://www.mecfsatlas.com/evidence/thapaliya-2021-diffusion-tensor},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/thapaliya-2021-diffusion-tensor
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