Increase in prefrontal cortical volume following cognitive behavioural therapy in patients with chronic fatigue syndrome

Abstract

Chronic fatigue syndrome (CFS) is a disabling disorder, characterized by persistent or relapsing fatigue. Recent studies have detected a decrease in cortical grey matter volume in patients with CFS, but it is unclear whether this cerebral atrophy constitutes a cause or a consequence of the disease. Cognitive behavioural therapy (CBT) is an effective behavioural intervention for CFS, which combines a rehabilitative approach of a graded increase in physical activity with a psychological approach that addresses thoughts and beliefs about CFS which may impair recovery. Here, we test the hypothesis that cerebral atrophy may be a reversible state that can ameliorate with successful CBT. We have quantified cerebral structural changes in 22 CFS patients that underwent CBT and 22 healthy control participants. At baseline, CFS patients had significantly lower grey matter volume than healthy control participants. CBT intervention led to a significant improvement in health status, physical activity and cognitive performance. Crucially, CFS patients showed a significant increase in grey matter volume, localized in the lateral prefrontal cortex. This change in cerebral volume was related to improvements in cognitive speed in the CFS patients. Our findings indicate that the cerebral atrophy associated with CFS is partially reversed after effective CBT. This result provides an example of macroscopic cortical plasticity in the adult human brain, demonstrating a surprisingly dynamic relation between behavioural state and cerebral anatomy. Furthermore, our results reveal a possible neurobiological substrate of psychotherapeutic treatment.

Long-term Cognitive and Behavioral Therapies, Combined with Augmentative Communication, are Related to Uncinate Fasciculus Integrity in Autism

“…Furthermore, cognitive behavioral therapy (CBT) techniques have been correlated with neuroplastic changes in different pathological conditions using neuroimaging techniques (Linden 2006;de Lange et al 2008). The potential of MRI techniques to measure CBT impact on brain architecture has been shown also in a recent study on chronic fatigue syndrome patients, in which CBT has been correlated with prefrontal cortex gray matter modulation (de Lange et al 2008).…”

Associations between cognitive performance and pain in chronic fatigue syndrome: comorbidity with fibromyalgia does matter

“…Indeed, an overlap exists in components of the pain neuromatrix and brain regions involved in cognitive processing (e.g., anterior cingulate cortex, insular cortex, periaqueductal gray) (14). Together with the demonstrated changes in neuroplasticity [e.g., gray matter volume reduction (15)(16)(17)] and dysregultated neurochemistry [e.g., decreased levels of brain-derived neurotrophic factor (18), increased levels of gamma-aminobutric acid (19), increased levels of pro-inflammatory cytokines (20)], these pain-induced changes in resource utilization may (in part) explain (pain-related) cognitive impairment in chronic pain patients.…”

Progressive brain changes in patients with chronic fatigue syndrome: A longitudinal MRI study

“…One intervention study reported increased gray matter (GM) volume in the lateral frontal lobe in CFS patients who underwent cognitive behavioral therapy (CBT) 10 months after baseline 10. The authors interpreted this change to be a result of CBT.…”