Chronic Fatigue: A Brain on Fire Part 1 - The Neuroinflammation Hypothesis
Chronic Fatigue: Brain on Fire Part I
The Neuroinflammation Hypothesis
Neuroinflammation is likely at the core of Chronic Fatigue Syndrome.
What is Neuroinflammation?Neuro - brain, spinal cord, or spinal nerve structure Inflammation- biological process where the immune system makes a response to a potential threat (germs, unrecognized protein, or tissue damage) Neuroinflammation is a state where the immune system makes a response to a threat in proximity of the brain or spinal cord. In many ways, the inflammatory response is characterized by the immune system using heat and and white blood cells to attack an invader or to repair damaged tissue. Inflammation is important to the healing process, and there's even evidence that stopping inflammation in the brain after a concussion can actually slow down the healing process when inflammation is turned off at the wrong time (source). Inflammation is okay when it is appropriate. The problem is when inflammation lingers after the initial injury process has passed. While inflammation is necessary to help the body repair, the nature of inflammation can create damage in sensitive tissue at inappropriate times. In this way, I like to compare the inflammatory process to a fire. A controlled fire can help rejuvenate soil and clear out brush for the growth of new plants and trees. This is when fire is necessary for an ecosystem. However, when a fire grows out of control, it lays waste to the entire forest. When inflammation persists, it's like having a fire slowly and insidiously grow unchecked in the brain. This process holds true for all of the main illnesses that chronic fatigue is associated with. This includes:
Traumatic brain injury
Chronic Fatigue Syndrome
Chronic Fatigue and the Psychosomatic Stigma Before recent years, Chronic Fatigue Syndrome was often treated as a psychological disorder without a biological cause. Imaging and blood work were generally unremarkable which left doctors without a visible disease to combat. Antidepressants, sleep aids, and cognitive behavioral therapy were the tools of choice. Because doctors didn't know what they were supposed to look for, and there were no visible signs of pathology, the patient must be creating the problem in their minds. This left most patients with a feeling of dispair. Chronic fatigue patients are often looked down upon by family and friends as being frail and weak with a made up illness. The fact that doctors could not find a tangible reason for their illness just reinforced this idea. This was all before people started looking at the delicate relationship between the immune system and it's wide ranging effects on the gut and the brain.
What Lights the Fire in the Brain? Last month, a major paper was published that showed a specific immune pattern in patients with chronic fatigue syndrome. It's the first time a blood panel was able to identify a pattern unique to chronic fatigue. The paper showed that an immune chemical (cytokine) called interferon gamma was elevated in patients wtih the disease for 3 years or less. Cytokines are the chemicals that immune cells release to mount a response to invaders or tissue damage. They are powerful chemicals similar to neurotransmitters and hormones in that just a little bit in the blood stream can create a big change in bodily function.
But what is making the immune system pump out these chemicals into the blood stream? A history of previous infection with viruses like Epstein-Barr, Herpes, and Paro virus. Patients will report an a battle with mono or a flu-like illness with malaise that persists even when the infection is over. One of the dangerous tricks that some organisms employ to infect a carrier is called molecular mimicry. It basically means that the bug wears similar clothes as the cells of our body. This disguise system tricks the immune cells of the body to get armed even when the infectious agent is no longer present. The infection has trained the body to attack itself dumping cytokines into the bloodstream even though they are not necessary. This leads to a constant state of inflammation, and unfortunately there is only so much inflammation that the brain will take before it loses control of the body as a whole.
What to Do About Chronic Inflammation Chronic inflammation operates in an interesting physiological cycle between super systems of the body. This mainly pertains to:
Brain and nervous system
Immune System In an chronic inflammatory state, each system is dysregulated and is stuck in a cycle of creating continuous inflammation body. Part of helping a patient with chronic fatigue means that the cycle needs to be interrupted at one of these super systems.