Evidence browser

E2 ModerateCohortPEM not requiredCross-Sectional

A Machine Learning Approach to the Differentiation of Functional Magnetic Resonance Imaging Data of Chronic Fatigue Syndrome (CFS) From a Sedentary Control.

Provenzano, Destie, Washington, Stuart D, Baraniuk, James N·Frontiers in computational neuroscience·2020

Researchers used a computer algorithm to analyze brain scans from ME/CFS patients and healthy controls while they performed a memory task, both before and after exercise. The algorithm was able to correctly identify which scans came from ME/CFS patients 80% of the time on the first day and 76% on the second day, suggesting that ME/CFS may create a distinctive pattern of brain activity that could eventually be used as an objective diagnostic test.

Biomarkers

A Cross-National Comparison of Myalgic Encephalomyelitis and Chronic Fatigue Syndrome at Tertiary Care Settings from the US and Spain.

Bhatia, Shaun, Olczyk, Nicole, Jason, Leonard A et al.·American journal of social sciences and humanities·2020

This study compared ME/CFS patients in the United States and Spain to see if the disease affects people differently depending on where they live. Researchers found that Spanish patients reported worse overall health and more severe symptoms, particularly pain and hormone-related problems, compared to American patients. The differences may be due to how each country handles disability benefits, how doctors view ME/CFS, and how easily patients can see specialists.

E2 ModerateBehavioralPEM unclearCross-Sectional

Prevalence and treatment of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis and co-morbid severe health anxiety.

Daniels, Jo, Parker, Hannah, Salkovskis, Paul Martin·International journal of clinical and health psychology : IJCHP·2020

This study found that about 42% of people with ME/CFS also experience significant health anxiety—excessive worry about their health and symptoms. When people have both ME/CFS and health anxiety together, they tend to report worse fatigue and more difficulty with physical activities. The researchers tested whether cognitive behavioral therapy (a type of talking therapy) could help reduce health anxiety in ME/CFS patients, and found it produced meaningful improvements.

Hospital Records of Pain, Fatigue, or Circulatory Symptoms in Girls Exposed to Human Papillomavirus Vaccination: Cohort, Self-Controlled Case Series, and Population Time Trend Studies.

Thomsen, Reimar Wernich, Öztürk, Buket, Pedersen, Lars et al.·American journal of epidemiology·2020

This large Danish study looked at whether the HPV vaccine (which prevents cervical cancer) was linked to symptoms like pain, fatigue, or heart problems in girls. Researchers compared vaccinated and unvaccinated girls over 14 years and found no increase in hospital visits for these symptoms in vaccinated girls. The symptoms they tracked increased over time in both vaccinated and unvaccinated children, suggesting other factors were responsible.

E2 ModerateCohortPEM unclearObservational

Plasma proteomic profiling suggests an association between antigen driven clonal B cell expansion and ME/CFS.

Milivojevic, Milica, Che, Xiaoyu, Bateman, Lucinda et al.·PloS one·2020

Researchers studied blood proteins in ME/CFS patients and healthy controls to look for disease markers. They found that certain immune-related proteins, particularly immunoglobulin proteins (which are part of the immune system), were abnormal in ME/CFS patients and could help identify who has the disease. The results suggest ME/CFS involves an overactive or dysregulated immune response.

BiomarkersImmune System

Resting-state functional connectivity, cognition, and fatigue in response to cognitive exertion: a novel study in adolescents with chronic fatigue syndrome.

Josev, Elisha K, Malpas, Charles B, Seal, Marc L et al.·Brain imaging and behavior·2020

Researchers compared how the brains of teenagers with ME/CFS and healthy teenagers responded to a mentally demanding task using brain imaging. Both groups showed similar changes in brain activity and felt more tired after the mental effort. However, teenagers with ME/CFS started out more fatigued, performed worse on thinking tasks overall, and may have less energy available to draw from when their brain works hard.

Cognitive Impairment

E2 ModerateCohortPEM not requiredCase-Control

Reduced heart rate variability predicts fatigue severity in individuals with chronic fatigue syndrome/myalgic encephalomyelitis.

Escorihuela, Rosa María, Capdevila, Lluís, Castro, Juan Ramos et al.·Journal of translational medicine·2020

This study measured how the heart rate varies between beats in people with ME/CFS compared to healthy people. Researchers found that people with ME/CFS have less variation in their heart rate and that this reduced variation is connected to how severe their fatigue is. The findings suggest that an overactive stress response in the nervous system may contribute to fatigue severity.

E2 ModerateCohortPEM unclearCase-Control

Using Plasma Autoantibodies of Central Nervous System Proteins to Distinguish Veterans with Gulf War Illness from Healthy and Symptomatic Controls.

Abou-Donia, Mohamed B, Lapadula, Elizabeth S, Krengel, Maxine H et al.·Brain sciences·2020

Researchers tested blood samples from Gulf War veterans with Gulf War Illness (GWI) and compared them to healthy veterans and people with ME/CFS or irritable bowel syndrome. They found that GWI veterans had higher levels of autoantibodies—proteins the immune system makes that mistakenly attack the brain and nervous system—compared to all three control groups. This suggests that a blood test measuring these autoantibodies could potentially help doctors diagnose Gulf War Illness objectively.

NeuroinflammationBiomarkers

E2 ModerateCohortPEM unclearObservational

Intravenous Cyclophosphamide in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. An Open-Label Phase II Study.

Rekeland, Ingrid G, Fosså, Alexander, Lande, Asgeir et al.·Frontiers in medicine·2020

Researchers tested whether cyclophosphamide, a chemotherapy drug, could help people with ME/CFS based on observations that some patients improved after cancer treatment. Forty patients received six infusions of this drug over six months, with check-ins lasting up to four years. More than half the patients reported meaningful improvements in fatigue and physical activity, with many staying better even years later.

Interventions

E2 ModerateCohortPEM requiredObservational

Epidemiological and clinical factors associated with post-exertional malaise severity in patients with myalgic encephalomyelitis/chronic fatigue syndrome.

Ghali, Alaa, Richa, Paul, Lacout, Carole et al.·Journal of translational medicine·2020

This study looked at 197 ME/CFS patients to understand which people are more likely to experience severe post-exertional malaise (PEM)—the symptom crash that happens after physical or mental activity. Researchers found that patients who developed ME/CFS after age 32, those who had recurring infections during their illness, and those whose ME/CFS started after a stomach infection were more likely to have severe PEM. Understanding these risk factors could help doctors better predict and manage PEM in individual patients.

Post-Exertional Malaise

E2 ModerateBehavioralPEM not requiredCross-Sectional

Attentional Processing and Interpretative Bias in Functional Neurological Disorder.

Keynejad, Roxanne C, Fenby, Edward, Pick, Susannah et al.·Psychosomatic medicine·2020

This study looked at how people with ME/CFS and a related condition called functional neurological disorder (FND) process information and interpret bodily sensations differently than healthy people. Researchers gave participants three types of tests: one measuring whether they automatically notice illness-related information, another testing how well they can control their attention, and a third examining whether they interpret unclear bodily sensations as signs of illness. The findings suggest that both ME/CFS and FND involve similar difficulties with attention control and a tendency to interpret bodily sensations as illness-related.

Cognitive Impairment

Comprehensive Circulatory Metabolomics in ME/CFS Reveals Disrupted Metabolism of Acyl Lipids and Steroids.

Germain, Arnaud, Barupal, Dinesh K, Levine, Susan M et al.·Metabolites·2020

Researchers studied the chemicals in blood samples from 26 ME/CFS patients and 26 healthy controls to understand what might be different in ME/CFS. They found that ME/CFS patients have lower levels of certain fats (especially acyl cholines) and hormones (including some involved in stress response and reproduction) compared to healthy people. These chemical differences might help explain why ME/CFS causes such widespread symptoms affecting many body systems.

Energy Metabolism

Cerebral blood flow is reduced in ME/CFS during head-up tilt testing even in the absence of hypotension or tachycardia: A quantitative, controlled study using Doppler echography.

van Campen, C Linda M C, Verheugt, Freek W A, Rowe, Peter C et al.·Clinical neurophysiology practice·2020

This study measured blood flow to the brain in ME/CFS patients while they were tilted upright for 30 minutes. Researchers found that blood flow to the brain dropped significantly more in ME/CFS patients (24-29%) compared to healthy people (7%), even in patients whose heart rate and blood pressure stayed normal. The more symptoms patients experienced from standing, the greater their blood flow reduction.

Evaluation of Fatigue in Cancer Patients in An Area Affected by The Great East Japan Earthquake.

Sato, Daisuke·Asia-Pacific journal of oncology nursing·2020

This study looked at fatigue in cancer patients receiving chemotherapy who lived in an area affected by a major earthquake in Japan. Researchers measured both what patients reported about their tiredness and objective measurements of nervous system function and activity levels. The main finding was that patients showed changes in how their nervous system was functioning, with their stress-response system becoming more dominant over time.

E2 ModerateMechanismPEM requiredMechanistic

Identification of actin network proteins, talin-1 and filamin-A, in circulating extracellular vesicles as blood biomarkers for human myalgic encephalomyelitis/chronic fatigue syndrome.

Eguchi, Akiko, Fukuda, Sanae, Kuratsune, Hirohiko et al.·Brain, behavior, and immunity·2020

This study found that people with ME/CFS have higher levels of tiny particles called extracellular vesicles in their blood, which contain specific proteins (talin-1 and filamin-A) that appear to be unique markers of the disease. By measuring these particles and proteins in a simple blood test, researchers were able to correctly identify ME/CFS patients about 90-94% of the time, suggesting this could become a useful diagnostic tool.

BiomarkersImmune System

Unravelling myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): Gender-specific changes in the microRNA expression profiling in ME/CFS.

Cheema, Amanpreet K, Sarria, Leonor, Bekheit, Mina et al.·Journal of cellular and molecular medicine·2020

This study looked at tiny molecules called microRNAs in the blood of people with ME/CFS to understand how their immune system responds to exercise. The researchers discovered that men and women with ME/CFS show different patterns in these molecules, and they also found that nutritional status affects these patterns. These findings could help explain why some people experience worsening symptoms after exercise (post-exertional malaise) and suggest that treatment approaches may need to differ between men and women.

Immune SystemPost-Exertional Malaise

E2 ModerateCohortPEM requiredCross-Sectional

Mapping of pathological change in chronic fatigue syndrome using the ratio of T1- and T2-weighted MRI scans.

Thapaliya, Kiran, Marshall-Gradisnik, Sonya, Staines, Don et al.·NeuroImage. Clinical·2020

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.

Validation of the Severity of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome by Other Measures than History: Activity Bracelet, Cardiopulmonary Exercise Testing and a Validated Activity Questionnaire: SF-36.

van Campen, C Linda M C, Rowe, Peter C, Visser, Frans C·Healthcare (Basel, Switzerland)·2020

This study tested whether doctors can accurately grade how severe a patient's ME/CFS is based on what patients tell them. Researchers compared clinical severity grades (mild, moderate, or severe) with three objective measures: a questionnaire about physical function, a wristband that counts daily steps, and a heart/lung exercise test. The results confirmed that the clinical grades matched up well with these objective measurements, suggesting that doctors' assessments based on patient reports are reasonably accurate.

Post-Exertional Malaise

Prediction of Discontinuation of Structured Exercise Programme in Chronic Fatigue Syndrome Patients.

Kujawski, Sławomir, Cossington, Jo, Słomko, Joanna et al.·Journal of clinical medicine·2020

This study looked at why some people with ME/CFS could complete a gradual exercise programme while others had to stop. Researchers measured several body functions—like nervous system activity, reaction time, and heart rate—before the programme started. They found that people whose bodies showed higher stress responses and slower reaction times were more likely to drop out of the exercise programme.