Hier het artikel uit Brain:
http://www.ncbi.nlm.nih.gov/pubmed/18587150
Brain. 2008 Jun 28
Increase in prefrontal cortical volume following cognitive
behavioural therapy in patients with chronic fatigue syndrome.
Lange FP, Koers A, Kalkman JS, Bleijenberg G, Hagoort P, van de Meer
JW, Toni I.
F.C. Donders Centre for Cognitive Neuroimaging, Radboud University
Nijmegen, Expert Center Chronic Fatigue, Radboud University Nijmegen
Medical Center, Nijmegen Institute for Cognition and Information,
Radboud University Nijmegen and Department of General Internal
Medicine, Radboud University Nijmegen Medical Center, Netherlands.
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.
Limitations
Although there was a significant increase in GMV in the CFS patient
group, this increase in GMV was a relatively modest portion (12%) of
the overall difference in GMV between CFS patients and controls. This
finding does not necessarily imply that a substantial portion of the
GMV reduction observed in CFS patients is irreversible, even after
disease recovery. Namely, not all patients benefited from CBT, and
some patients were not yet fully recovered at the time of scanning.
Moreover, the GMV increase was dependent on the age of the
participant: older CFS patients did not show any increase in GMV,
thereby attenuating the GMV increase observed in the group. Finally,
it is conceivable that the cellular and neurophysiological changes
follow a slower dynamic than the behavioural improvements. Future
studies are needed that follow patients in different age categories
at multiple time points over several years to quantify the
reversibility of GMV changes following disease recovery. Another
limitation of this study is that we did not compare CFS patients
treated with CBT with CFS patients that did not undergo CBT
treatment. Therefore, we cannot exclude that the cerebral alterations
are due to non-specific factors other than the CBT treatment.
However, the specific effectivity of CBT, compared to other
treatments, has been well-established earlier (Prins et al., 2001;
Whiting et al., 2001; Edmonds et al., 2004; Stulemeijer et al.,
2005), suggesting that the behavioural effects are likely to be the
result of CBT, rather than other unspecific factors.