title: The neural correlates of fatigue: an exploratory imaginal fatigue provocation study in chronic fatigue syndrome.
abstract: BACKGROUND
  Fatigue is the central symptom in chronic fatigue syndrome (CFS) and yet very little is known about its neural correlates. The aim of this study was to explore the functional brain response, using functional magnetic resonance imaging (fMRI), to the imaginal experience of fatigue in CFS patients and controls.
  
  
  METHODS
  We compared the blood oxygen level dependent (BOLD) responses of 12 CFS patients and 11 healthy controls to a novel fatigue provocation procedure designed to mimic real-life situations. A non-fatiguing anxiety-provoking condition was also included to control for the non-specific effects of negative affect.
  
  
  RESULTS
  During the provocation of fatigue, CFS patients reported feelings of both fatigue and anxiety and, compared to controls, they showed increased activation in the occipito-parietal cortex, posterior cingulate gyrus and parahippocampal gyrus, and decreased activation in dorsolateral and dorsomedial prefrontal cortices. The reverse pattern of findings was observed during the anxiety-provoking scenarios.
  
  
  CONCLUSIONS
  The results may suggest that, in CFS patients, the provocation of fatigue is associated with exaggerated emotional responses that patients may have difficulty suppressing. These findings are discussed in relation to the cognitive-behavioural model of CFS.
authors.affiliation: Unitat de Psicologia Mèdica, Institut de Neurociències, Universitat Autònoma de Barcelona, Catalonia, Spain. xavier.caseras@iop.kcl.ac.uk
authors.forename: X
authors.initials: X
authors.lastname: Caseras
authors.forename: D
authors.initials: D
authors.lastname: Mataix-Cols
authors.forename: K A
authors.initials: KA
authors.lastname: Rimes
authors.forename: V
authors.initials: V
authors.lastname: Giampietro
authors.forename: M
authors.initials: M
authors.lastname: Brammer
authors.forename: F
authors.initials: F
authors.lastname: Zelaya
authors.forename: T
authors.initials: T
authors.lastname: Chalder
authors.forename: E
authors.initials: E
authors.lastname: Godfrey
mesh_terms: D000328:Adult; D001007:Anxiety; D016022:Case-Control Studies; D002531:Cerebellum / Q000503:physiopathology; D015928:Cognitive Behavioral Therapy; D005221:Fatigue / Q000503:physiopathology*; D015673:Fatigue Syndrome, Chronic / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D010865:Pilot Projects; D011597:Psychomotor Performance / Q000502:physiology; D011930:Reaction Time; D014796:Visual Perception / Q000502:physiology