In a world first study, Australian researchers have found brain structure changes in people with long COVID similar to those with chronic fatigue.

A woman undergoing an MRI.

Both patients with myalgic encephalomyelitis/chronic fatigue syndrome and long COVID show significantly larger volumes in the pons and whole brainstem.

Long COVID is proving to be a challenge for health systems around the world, but new research has given clinicians and those suffering from the condition further insight in its effects on the body.


Published in Frontiers in Neuroscience, the findings show brain MRI changes are similar in people with long COVID and those with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).


Using ultra-high field strength MRI (7 Tesla), researchers from Griffith University found both groups show significantly larger volumes in the pons and whole brainstem, while long COVID patients also show larger volumes in the superior cerebella peduncle.


They compared the volumes of brainstem regions for 10 patients with ME/CFS: eight with long COVID and 10 healthy controls.


The research comes as the Inquiry into Long COVID and Repeated COVID Infections wrapped up public hearings last month.


Dr Ken McCroary, a GP who appeared at the Inquiry, told newsGP he welcomes the new findings.


‘It’s heartening to see some physical changes, because a lot of our medicine and acceptance of conditions is based upon physical evidence,’ he said.


Dr McCroary says when a condition has poor understanding in the medical and wider community, particularly if it is shrouded in stigma, patients can suffer.


‘This and other studies like it are good because it helps those people whose conditions have been shunned,’ he said. ‘The validation helps.’


Lead author of the study, Dr Kiran Thapaliya told newsGP the MRI brain changes are not surprising considering other work his team has done on ME/CFS and long COVID.


‘We have previously reported similar findings where ion channel dysfunction in both conditions is similar compared to healthy controls,’ he said.


‘MRI brain provides further scientific evidence between overlap between the two conditions.’


The research team demonstrated that subregion and whole brainstem volumes in ME/CFS and long COVID patients are significantly associated with clinical measures of pain and breathing difficulty, and that larger brainstem volumes are associated with higher pain severity.


Dr Thapaliya said the MRIs show the brainstem is significantly larger in ME/CFS and long COVID patients compared to those who do not suffer from the same ailments.


‘It also showed similar volumes of the brainstem in patients which could be the reason long COVID patients exhibit all common core symptoms of ME/CFS,’ he said.


‘We also discovered smaller midbrain volumes were associated with more severe breathing difficulty in ME/CFS and long COVID patients.


‘Therefore, brainstem dysfunction in ME/CFS and long COVID patients could contribute to their neurological, cardiorespiratory symptoms, and movement disorder.’


Studies show that up to 43% of people infected with COVID do not fully recover and go on to develop long COVID, while the Australian Institute of Health and Welfare (AIHW) currently puts the figure at between 5–10%. The most common symptoms are fatigue, pain, post-exertional malaise, breathing difficulties and cognitive dysfunction (brain fog). These are all common core symptoms of ME/CFS.


ME/CFS affects 17–24 million people worldwide and diagnosis is based on clinical case criteria and exclusion of other illnesses.


Breathing difficulty is a common symptom among both ME/CFS and long COVID patients, with approximately 30–50% of COVID patients experiencing breathing difficulty.


Dr McCroary sees this in his GP-led multidisciplinary primary care teams that deal with long COVID.


‘We try and improve the outcomes for people like this through nurse assessment, fatigue management, cognitive retraining, breathing therapies with pulmonary rehabilitation, exercise physiologists, CBT with psychology, social workers and dietitians,’ he said.


‘It’s tailored towards the patient’s needs.’


The World Health Organization (WHO) defines long COVID as the continuation or development of new symptoms three months after the initial infection, with these symptoms lasting for at least two months with no other explanation.


In promising news, research shows that vaccination reduces the risk of long COVID, while Israeli research shows most long COVID symptoms subside within a year of mild infection.


The RACGP’s submission to the Inquiry into Long COVID and Repeated COVID Infections is available on the college website.


The RACGP has created a patient resource for managing post-COVID symptoms and clinical resources to assist GPs caring for patients with post-COVID-19 conditions.

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