Journal of IiME Volume 6 Issue 1 (June 2012) Introduction Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) designates a clinical condition characterized by a complex simptomatology that includes, but is not limited to, long-lasting disabling fatigue. According to the most recent classification, it is considered a neurological disease in the World Health Organization’s International Classification of Diseases (ICD G93.3) and it is characterized by widespread inflammation and multisystemic neuropathology (1). As of today, the aetiology of ME/CFS is unknown and, just like in any syndrome, it is quite likely that there may be multiple causes leading to a shared clinical picture. Several events may act as triggers, from external environmental or microbiological triggers, such as chemical exposure or infections, to psychological and social factors that may be critical in perpetuating the symptoms (2). It is worth noting that from the point of view of evolution of the human brain, ME/CFS may be defined as a “phylogenic disease” (3-7), according to principle of “integrated phylogeny” of the primate brain (8), because of its possible relation to evolution. For patients as well as for health care professionals, the issue of treatment of ME/CFS is a truly dramatic and controversial one. In fact, proposed treatments are as diverse as cognitive behavioral interventions (9), coiling dragon needling and moving cupping on back (10), treatment with Lactobacillus acidophilus (11), or with antipsychotics (12), just to name a few of the most recent studies. Oddly enough, among the variety of proposed treatments for ME/CFS, the application of transcranial ultrasounds by means of a common ultrasound imaging machine has not been evaluated so far. A search of the literature revealed that transcranial sonography had been used as a diagnostic tool only in one study describing cerebral and systemic hemodynamic changes during upright tilt in CFS (13). However, in that study, the Authors were focussed on observation of the middle cerebral artery using transcranial doppler monitoring, and did not use probes and techniques able to study in detail the cerebral cortex with particular reference to the gray matter of the temporal lobe. Based on our background in clinical radiology and anatomy, we were interested in studying the cerebral cortex of Invest in ME (Charity Nr. 1114035) the temporal lobe because of the well known involvement of the temporal lobe in the processing of functions, such as semantics and memory, that are often compromised in ME/CFS patients (14). To this end, we modified the conventional procedure for transcranial sonography and we used a linear probe that is normally used for muscle-skeletal ultrasound imaging. To our surprise, we observed that not only such a procedure allowed detailed visualization of the cortex of the temporal lobe, a finding potentially important for the diagnosis and follow-up of ME/CFS patients, but also affected brain function in such a way that it could be proposed as a safe and easy treatment for a variety of diseases including ME/CFS. Materials and Methods The ultrasounds used for imaging, also known as sub-thermal ultrasounds, are is considered safe and have been used for foetal imaging in utero, and virtually every part of the body, including brains of newborn babies through fontanelles. For transcranial sonography we used an Esaote MyLabFive ultrasound imaging machine approved for many applications including cephalic (brain) imaging. We used the default settings for adult transcranial imaging, but instead of a transcranial probe, we used a conventional linear probe for muscle-skeletal examination and we selected 7.5 MHz frequency. Acoustic power was set to 1.0. The length of the probe was about 4 cm, i.e. much less than the size of the temporal cortex that we examined that is 7-8 cm. The procedure was performed at the Laboratory for Exercise Sciences Applied to Medicine of the University of Firenze (LSMAM, Director, Prof. M. Gulisano). The volunteer healthy subject, a certified clinical radiologist (M.R.), sat in front of the imaging machine in the position he normally uses to perform an examination, and positioned the probe on his right temporal region in correspondence of the acoustic window of the temporal squama (Fig. 1). An improvised support to his right arm was provided to ensure stability. In this position, the subject was able to look at his own brain while performing the examination. Heart rate was recorded 10 min prior to the transcranial sonography procedure, immediately before, during the procedure at intervals of 30 s, at the end of the procedure that lasted 10 min, and 10 min after the end of the procedure. Systolic and www.investinme.org Page 24 of 108
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