de Lange Floris P, Koers Anda, Kalkman Joke S, Bleijenberg Gijs, Hagoort Peter, van der Meer Jos W M, Toni Ivan
F.C. Donders Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Kapittelweg 29, 6500 HB Nijmegen, The Netherlands.
Brain. 2008 Aug;131(Pt 8):2172-80. doi: 10.1093/brain/awn140. Epub 2008 Jun 28.
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.
慢性疲劳综合征（CFS）是一种致残性疾病，其特征为持续性或复发性疲劳。最近的研究发现，CFS患者的皮质灰质体积减少，但尚不清楚这种脑萎缩是该疾病的病因还是后果。认知行为疗法（CBT）是一种针对CFS的有效行为干预方法，它将逐步增加体力活动的康复方法与解决可能妨碍康复的关于CFS的思维和信念的心理方法相结合。在此，我们检验这样一个假设，即脑萎缩可能是一种可逆状态，可通过成功的CBT得到改善。我们对22名接受CBT的CFS患者和22名健康对照参与者的脑结构变化进行了量化。在基线时，CFS患者的灰质体积显著低于健康对照参与者。CBT干预使健康状况、体力活动和认知表现得到显著改善。至关重要的是，CFS患者的灰质体积显著增加，位于外侧前额叶皮质。脑容量的这种变化与CFS患者认知速度的改善有关。我们的研究结果表明，与CFS相关的脑萎缩在有效的CBT后部分得到逆转。这一结果提供了成人大脑宏观皮质可塑性的一个例子，证明了行为状态与脑解剖结构之间存在惊人的动态关系。此外，我们的结果揭示了心理治疗的一种可能的神经生物学基础。
