Abstract
Impairments in cognition, pain intolerance, and physical inactivity characterize adolescent chronic fatigue syndrome (CFS), yet little is known about its neurobiology. The right dorsal anterior insular (dAI) connectivity of the salience network provides a motivational context to stimuli. In this study, we examined regional functional connectivity (FC) patterns of the right dAI in adolescent CFS patients and healthy participants. Eighteen adolescent patients with CFS and 18 aged-matched healthy adolescent control participants underwent resting-state functional magnetic resonance imaging. The right dAI region of interest was examined in a seed-to-voxel resting-state FC analysis using SPM and CONN toolbox. Relative to healthy adolescents, CFS patients demonstrated reduced FC of the right dAI to the right posterior parietal cortex (PPC) node of the central executive network. The decreased FC of the right dAI–PPC might indicate impaired cognitive control development in adolescent CFS. Immature FC of the right dAI–PPC in patients also lacked associations with three known functional domains: cognition, pain and physical activity, which were observed in the healthy group. These results suggest a distinct biological signature of adolescent CFS and might represent a fundamental role of the dAI in motivated behavior.
Highlights
Estimates regarding the prevalence of Chronic Fatigue Syndrome (CFS) during adolescence ranges between, 1% and 2%, depending on methodology and diagnostic criteria [1,2,3,4]
Adolescent CFS patient and comparison groups were well matched for age, gender, body mass index (BMI) and IQ; patients scored higher on clinical symptom scales and had less physical activity, measured in steps/day (Table 1)
We controlled for the effects of group, age, and depression and found working memory, Pressure pain threshold (PPT), and physical activity were independent predictors of right dorsal anterior insular (dAI)–posterior parietal cortex (PPC) functional connectivity (Table 3)
Summary
Estimates regarding the prevalence of Chronic Fatigue Syndrome (CFS) during adolescence ranges between, 1% and 2%, depending on methodology and diagnostic criteria [1,2,3,4]. Autonomic nervous system dysfunction [6], alterations in facilitatory and inhibitory pathways [7, 8], and abnormalities of the neuroendocrine system [9,10,11] in CFS support the notion of a disorder in which an interplay of neural and endocrine factors might attribute to aberrant neurobiological stress responses— sustained arousal [12]. Our research group has further suggested that adolescent CFS is associated with alterations in brain connectivity, wherein abnormalities influence fatigue awareness [13].
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