Cerebral and Systemic Hemodynamics Changes During Upright Tilt in Chronic Fatigue Syndrome

Razumovsky, Alexander Y.; DeBusk, Karen; Calkins, Hugh; Snader, Sally; Lucas, Katherine E.; Vyas, Pranav; Hanley, Daniel F.; Rowe, Peter C.

doi:10.1177/1051228402239719

Cited by 5 publications

(6 citation statements)

References 23 publications

(32 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Deficits in these regions may correlate to the persistent visceral symptoms experienced in CFS. The general trend for lower BOLD signal at rest in CFS compared to controls is consistent with the general reduction in cerebral blood flow and reports of orthostatic intolerance that are recurrent findings in CFS ( Razumovsky et al, 2003 ; Yoshiuchi, 2006 ; Pardini et al, 2010 ; Tajima et al, 2010 ; Biswal et al, 2011 ; Stewart et al, 2011 ; Ocon et al, 2012 ; Medow et al, 2014 ; Gay et al, 2016 ; Finkelmeyer et al, 2018 ; van Campen et al, 2020a , b , c ).…”

Section: Discussionsupporting

confidence: 87%

Submaximal Exercise Provokes Increased Activation of the Anterior Default Mode Network During the Resting State as a Biomarker of Postexertional Malaise in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Rayhan

Baraniuk

2021

Front. Neurosci.

View full text Add to dashboard Cite

Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is characterized by disabling fatigue and postexertional malaise. We developed a provocation paradigm with two submaximal bicycle exercise stress tests on consecutive days bracketed by magnetic resonance imaging, orthostatic intolerance, and symptom assessments before and after exercise in order to induce objective changes of exercise induced symptom exacerbation and cognitive dysfunction.Method: Blood oxygenation level dependent (BOLD) scans were performed while at rest on the preexercise and postexercise days in 34 ME/CFS and 24 control subjects. Seed regions from the FSL data library with significant BOLD signals were nodes that clustered into networks using independent component analysis. Differences in signal amplitudes between groups on pre- and post-exercise days were determined by general linear model and ANOVA.Results: The most striking exercise-induced effect in ME/CFS was the increased spontaneous activity in the medial prefrontal cortex that is the anterior node of the Default Mode Network (DMN). In contrast, this region had decreased activation for controls. Overall, controls had higher BOLD signals suggesting reduced global cerebral blood flow in ME/CFS.Conclusion: The dynamic increase in activation of the anterior DMN node after exercise may be a biomarker of postexertional malaise and symptom exacerbation in CFS. The specificity of this postexertional finding in ME/CFS can now be assessed by comparison to post-COVID fatigue, Gulf War Illness, fibromyalgia, chronic idiopathic fatigue, and fatigue in systemic medical and psychiatric diseases.

show abstract

Section: Discussionsupporting

confidence: 87%

Submaximal Exercise Provokes Increased Activation of the Anterior Default Mode Network During the Resting State as a Biomarker of Postexertional Malaise in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Rayhan

Baraniuk

2021

Front. Neurosci.

View full text Add to dashboard Cite

show abstract

“…These findings reject our hypothesis that a smaller CBF increase could explain the intolerance for physical exertion in CFS patients. This is in line with previous findings showing no altered CBF in CFS patients in supine position or in response to orthostatic stress (9,28). However, the study of Stewart et al (9) observed a lower absolute CBF velocity in response to incremental upright tilt combined with cognitive activation.…”

Section: E21supporting

confidence: 91%

Cerebral Blood Flow and Heart Rate Variability in Chronic Fatigue Syndrome: A Randomized Cross-Over Study

Malfliet¹,

Pas

Brouns

et al. 2018

Pain Phys

View full text Add to dashboard Cite

Background: Pain, fatigue, and concentration difficulties are typical features of chronic fatigue syndrome (CFS). The exact underlying mechanisms of these symptoms are still unknown, but available evidence suggests an important role for impaired pain modulation. As evidence also suggests that pain modulation is related to cardiovascular mechanisms, it seems logical to investigate whether cerebral blood flow (CBF) and heart rate variability (HRV) are altered in these patients. Objectives: We aimed to investigate the role of the cardiovascular system in pain modulation and symptoms of CFS; the response of CBF and HRV to physical stress and their relation to the change in temporal summation (TS) of pressure pain and selfreported symptoms was evaluated. Study Design: A controlled, randomized cross-over trial. Setting: University Hospital Brussels. Methods: Twenty CFS patients and 20 sedentary healthy controls were included in this study. In both of the groups, the change in TS of pressure pain, CBF (using transcranial Doppler), and HRV (using finger plethysmography) was examined during physical and emotional stress (to control for potential bias), as well as their association mutually and with self-reported symptoms of pain, fatigue, and concentrations difficulties. Results: There was no significant interaction or group (F-values ranging from .100 to 1.862, P-values ranging from .754 to .181) effect in CBF or HRV parameters. HRV and CBF did change during physical exercise, but the changes did not differ between patients and controls. While pain scores during TS at the trapezius site reduced in the control group after the physical exercise protocol (P = .037), they did not change in the CFS group (P = .108), suggesting impaired pain modulation. There were no significant correlations between CBF, HRV, TS, and self-reported symptoms (all P-values of correlation analyses > .01). Limitations: Although effect sizes were medium to large, the study sample was relatively low. Also, the mild nature of the exercise bout is discussable. Nonetheless, this mild exercise was able to provoke endogenous pain modulation in the control group, which endorsed a proper execution of the cycling exercise. Moreover, mild exercises are more applicable to daily physical activities in CFS patients than vigorous exercises. Conclusion: These results seem to refute the previously suggested alterations of CBF/ HRV in CFS patients. These cardiovascular parameters appear not to explain pain before, during, and following exercise. Key words: Chronic pain, physical exercise, emotional stress, pain modulation, cardiovascular systems, temporal summation, pain pressure thresholds, transcranial Doppler, plethysmography

show abstract

“…Most studies of passive tilting to 60°demonstrate no change in mean arterial pressure (MAP) (Pawelczyk et al 1988;Sagawa et al 1993;Tuckman and Shillingford 1966) most likely due to the regulatory effects of baroreceptors. In contrast, two studies have found increased MAP, which would result in increased baroreceptor firing, with HUT (Laszlo et al 2001;Razumovsky et al 2003). However, data from animal studies suggest that this would reduce V T and f (Brunner et al 1982;Grunstein et al 1975;Saupe et al 1995).…”

Section: Possible Mechanisms For the Increase In Ventilation With Hutmentioning

confidence: 80%

Ventilatory changes following head-up tilt and standing in healthy subjects

et al. 2005

View full text Add to dashboard Cite

Passive tilting increases ventilation in healthy subjects; however, controversy surrounds the proposed mechanism. This study is aimed to evaluate the possible mechanism for changes to ventilation following passive head-up tilt (HUT) and active standing by comparison of a range of ventilatory, metabolic and mechanical parameters. Ventilatory parameters (V (T), V (E), V (E)/VO(2), V (E)/VCO(2), f and PetCO(2)), functional residual capacity (FRC), respiratory mechanics with impulse oscillometry; oxygen consumption (VO(2)) and carbon dioxide production (VCO(2)) were measured in 20 healthy male subjects whilst supine, following HUT to 70 degrees and unsupported standing. Data were analysed using a linear mixed model. HUT to 70 degrees from supine increased minute ventilation (V (E)) (P<0.001), tidal volume (V (T)) (P=0.001), ventilatory equivalent for O(2) (V (E)/VO(2)) (P=0.020) and the ventilatory equivalent for CO(2) (V (E)/VCO(2)) (P<0.001) with no change in f (P=0.488). HUT also increased FRC (P<0.001) and respiratory system reactance (X5Hz) (P<0.001) with reduced respiratory system resistance (R5Hz) (P=0.004) and end-tidal carbon dioxide (PetCO(2)) (P<0.001) compared to supine. Standing increased V (E) (P<0.001), V (T) (P<0.001) and V (E)/VCO(2) (P=0.020) with no change in respiratory rate (f) (P=0.065), V (E)/VO(2) (P=0.543). Similar changes in FRC (P<0.001), R5Hz (P=0.013), X5Hz (P<0.001) and PetCO(2) (P<0.001) compared to HUT were found. In contrast to HUT, standing increased VO(2) (P=0.002) and VCO(2) (P=0.048). The greater increase in V (E) in standing compared to HUT appears to be related to increased VO(2) and VCO(2) associated with increased muscle activity in the unsupported standing position. This has implications for exercise prescription and rehabilitation of critically ill patients who have reduced cardiovascular and respiratory reserve.

show abstract

Cerebral and Systemic Hemodynamics Changes During Upright Tilt in Chronic Fatigue Syndrome

Abstract: The results of this study are not consistent with the hypothesis that patients with CFS have a distinctive pattern of MCA CBFV changes in response to orthostatic stress.

Cited by 5 publications

References 23 publications

Submaximal Exercise Provokes Increased Activation of the Anterior Default Mode Network During the Resting State as a Biomarker of Postexertional Malaise in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Submaximal Exercise Provokes Increased Activation of the Anterior Default Mode Network During the Resting State as a Biomarker of Postexertional Malaise in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Cerebral Blood Flow and Heart Rate Variability in Chronic Fatigue Syndrome: A Randomized Cross-Over Study

Ventilatory changes following head-up tilt and standing in healthy subjects

Contact Info

Product

Resources

About