Post-Exertional Malaise: Neurobiological Changes / Video 6 of 7

This video series is intended to review the clinical presentation, scientific underpinnings, and treatment approach for patients with post-exertional malaise (PEM)/post-exertional symptom exacerbation (PESE).
For an abbreviated version highlighting the clinical pearls, please watch videos 1, 2, and 7. Videos 3-6 offer a deeper dive into the scientific and evidence-based pathophysiology of PEM/PESE.
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Post-exertional malaise (PEM)/post-exertional symptom exacerbation (PESE) is an altered physiological state and pathognomonic finding unique to ME/CFS that is now being recognized in those with post-acute sequelae of COVID-19 (PASC), also known as Long COVID.
It is critical that healthcare professionals recognize PEM/PESE and support the patient in avoiding a push-crash-cycle which can exacerbate disease processes and contribute to worsened long-term functional prognoses.
In video six of this seven-part series Brayden Yellman, MD, and Lucinda Bateman, MD, examine the physiological happenings within the brains of those with ME/CFS.
Video details:
- Microglial cells & proinflammatory cytokines (IL-6, TNF-alpha, and interleukin-1-beta)
- Magnetic resonance spectroscopy & metabolic activity associated with neuroinflammation
- Brain lactate & Choline
- Brain thermometry
- Positron emission tomography (PET): measuring radio-labeled isotope ligand to the translocator protein (or TSPO)
- Default Mode Network (DMN) uncoupling in ME/CFS
This video was made possible by the OMF-funded Medical Education Resource Center (MERC) at BHC, our generous donors, and viewers like you.
Citations:
Torres-Platas, S.G., Comeau, S., Rachalski, A. et al. Morphometric characterization of microglial phenotypes in human cerebral cortex. J Neuroinflammation 11, 12 (2014). doi.org/10.1186/1742-2094-11-12
Mueller, C., Lin, J.C., Sheriff, S. et al. Evidence of widespread metabolite abnormalities in Myalgic encephalomyelitis/chronic fatigue syndrome: assessment with whole-brain magnetic resonance spectroscopy. Brain Imaging and Behavior 14, 562-572 (2020). doi.org/10.1007/s11682-018-00...
Nakatomi Y, Mizuno K, Ishii A, et al. Neuroinflammation in Patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: An ¹¹C-(R)-PK11195 PET Study. J Nucl Med. 2014;55(6):945‐950. doi:10.2967/jnumed.113.131045
Rayhan RU, Baraniuk JN. 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. Front Neurosci. 2021;15:748426. Published 2021 Dec 15. doi:10.3389/fnins.2021.748426

[@JenniferJacksonxminecraftlifex]

Thank you for your continuing research.

[@me-cfs-strategiesforhealing]

Very interesting. Wonderful research, thank you for what you are uncovering.

[@natashannmarieeklove]

It’s crazy because the frontal cortex is where I feel the swelling and burning

[@dshepherd107]

Excellent information

[@storiesuntoldunfold]

how are these changes viewed in our brains? i have all the symptoms and "normal" MRI.

[@dshepherd107]

A standard MRI wouldn’t show these changes. Sadly, most insurance companies won’t cover these tests. However, there is a set of diagnostic criteria.. if you watch this whole seven part series. Then I would suggest you look for a doctor of Functional, or Osteopathic medicine to help you. I would ask them about trying Low Dose Naltrexone (LDN). which has a completely different effect on the brain, than the much higher dose, used to treat certain addictions. It is a drug that’s been around 40 yrs. I’m not a doctor. I have a background and education in molecular genetics, & a bit of background and education in pharmacy. I have severe ME/CFS. I’m taking the low dose naltrexone. I’ve only been on 6 weeks, but I am feeling definite improvements. Best of luck to you

[@Spikypotato.]

Thank you❤️‍🩹

[@cwebbwash3]

These are great findings. How can this be treated?