The neural correlates of fatigue: an exploratory imaginal fatigue provocation study in chronic fatigue syndrome

• Published in: Psychological medicine Vol. 38; no. 7; pp. 941 - 951
• Main Authors: Caseras, X., Mataix-Cols, D., Rimes, K. A., Giampietro, V., Brammer, M., Zelaya, F., Chalder, T., Godfrey, E.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.07.2008
• Subjects: Adult; Adult and adolescent clinical studies; Anxiety; Biological and medical sciences; Brain; Case-Control Studies; Cerebellum - physiopathology; Chronic fatigue syndrome; Cognition; Cognitive Therapy; Cognitive-behavioral factors; Cortex; Emotional responses; Fatigue; Fatigue - physiopathology; Fatigue Syndrome, Chronic - physiopathology; Fatigue Syndrome, Chronic - psychology; Female; fMRI; Functional magnetic resonance imaging; Humans; Magnetic Resonance Imaging - methods; Medical sciences; Middle Aged; Negative emotions; Organic mental disorders. Neuropsychology; Oxygen; Parietal cortex; Pilot Projects; Provocation; Psychology. Psychoanalysis. Psychiatry; Psychomotor Performance - physiology; Psychopathology. Psychiatry; Reaction Time; Studies; Visual Perception - physiology; chronic fatigue syndrome; fMRI; fatigue; Anxiety; Human; Affect affectivity; Topography; Fatigue; Emotion emotionality; Experimental study; Nuclear magnetic resonance imaging; Chronic fatigue syndrome; Functional imaging
• ISSN: 0033-2917; 1469-8978
• DOI: 10.1017/S0033291708003450

Fatigue is the central symptom in chronic fatigue syndrome (CFS) and yet very little is known about its neural correlates. The aim of this study was to explore the functional brain response, using functional magnetic resonance imaging (fMRI), to the imaginal experience of fatigue in CFS patients and controls. We compared the blood oxygen level dependent (BOLD) responses of 12 CFS patients and 11 healthy controls to a novel fatigue provocation procedure designed to mimic real-life situations. A non-fatiguing anxiety-provoking condition was also included to control for the non-specific effects of negative affect. During the provocation of fatigue, CFS patients reported feelings of both fatigue and anxiety and, compared to controls, they showed increased activation in the occipito-parietal cortex, posterior cingulate gyrus and parahippocampal gyrus, and decreased activation in dorsolateral and dorsomedial prefrontal cortices. The reverse pattern of findings was observed during the anxiety-provoking scenarios. The results may suggest that, in CFS patients, the provocation of fatigue is associated with exaggerated emotional responses that patients may have difficulty suppressing. These findings are discussed in relation to the cognitive-behavioural model of CFS.