Regional cerebral bloodflow in chronic fatigue syndrome (CFS)

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Regional cerebral bloodflow in chronic fatigue syndrome (CFS)

R. Casse, P. Delfante, L.Barnden, R. Burnett, M. Kitchener, R Kwiatek

The Queen Hospital,

Adelaide, 5011

Australia

Chronic fatigue syndrome (CFS) is a debilitating and complex disorder

characterised by profound fatigue and neuropsychiatric dysfunction. The

neuropsychiatric symptoms are often associated with a mental fatigue,

consisting of impaired concentration and slowness of thinking. Patients

with this disorder have been studied with radionuclide cerebral perfusion

scans with conflicting results. Most previous studies were performed with

inhomogeneous patient populations and were not analysed with Statistical

Parametric Mapping (SPM). We performed a pilot study to address these

issues with Tc-99m HMPAO SPECT and a triple head gamma-camera. A uniform

group of 13 female subjects (16-53y) with moderate CFS based on established

criteria, pain free, not on medication and not depressed was compared with

a group of 11 patients (18-60y) who were scanned for other conditions and

reported as normal. Visually, a deficit in regional cerebral bloodflow

(rCBF) in the medial temporal lobe was definite in 7 (5L, 1R, 1 bilateral)

and equivocal in 3 CFS patients. SPM99 with proportional scaling to the

global mean was applied for quantitative analysis. The location, amplitude

and corrected p-value of significant focal deficits in CFS were: brainstem

(19%, 0.009), left medial temporal lobe (17%, 0.004), right medial temporal

lobe (22%, 0.002), frontal lobe (17%, 0.002) and anterior cingulate gyrus

(12%, 0.001). These results are to be confirmed against a " true normal "

group of volunteers. There appears to be objective evidence that patients

with moderately severe CFS have focal cortical and brainstem hypoperfusion.