E3 PreliminaryPreliminaryPEM unclearPeer-reviewedMachine draft
Static and Kinetic Disequilibrium are Central Neural Signs in Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome-Therapeutic Effect of Repetitive Transcranial Magnetic Stimulation.
Miwa, Kunihisa · Journal of integrative neuroscience · 2025 · DOI
Quick Summary
This study found that nearly half of ME/CFS patients experience balance problems—either when standing still (static disequilibrium) or when walking (kinetic disequilibrium). These balance issues were linked to difficulty standing upright and limitations in daily activities. When researchers used a brain stimulation treatment called repetitive transcranial magnetic stimulation (rTMS) on specific brain regions, most patients' balance problems improved, suggesting the root cause is in the central nervous system rather than the inner ear alone.
Why It Matters
Balance problems are underrecognized but functionally significant symptoms in ME/CFS that directly limit patients' independence. This study provides objective neurological evidence that disequilibrium is a measurable central nervous system dysfunction rather than a functional or psychological symptom. The finding that rTMS effectively treats these balance problems offers potential for a novel therapeutic intervention targeting underlying CNS pathology.
Observed Findings
- 25% of ME/CFS patients showed static disequilibrium (inability to maintain balance while standing with feet together); 44% showed kinetic disequilibrium (gait instability), with 36% failing the straight tandem gait test
- Patients with static and/or kinetic disequilibrium had significantly higher rates of orthostatic intolerance (inability to stand for 10 minutes) compared to those without balance problems
- 98% of patients with static disequilibrium also had kinetic disequilibrium, suggesting these are related manifestations
- 85% (11 of 13) of patients treated with rTMS showed recovery of both types of disequilibrium
- Patients with balance problems had significantly higher functional disability scores, indicating greater restriction in daily activities
Inferred Conclusions
- Static and kinetic disequilibrium are common central neural signs in ME/CFS that reflect CNS dysfunction in vestibular processing and motor control
- Postural disequilibrium is functionally significant and contributes to orthostatic intolerance and limitations in activities of daily living
- rTMS targeting the left dorsolateral prefrontal cortex and primary motor area can effectively reverse postural instability, suggesting these brain regions are involved in pathological disequilibrium
- Balance dysfunction in ME/CFS has a central vestibular origin rather than peripheral vestibular pathology
What This Study Does Not Prove
This study does not prove that rTMS is a cure for ME/CFS or that all patients will benefit equally—the treatment sample was small (13 patients) without a control group. It does not establish that balance dysfunction causes orthostatic intolerance or vice versa, only that they co-occur. The findings cannot yet be generalized beyond the specific population studied or confirm rTMS as standard clinical practice without larger randomized controlled trials.
Tags
Symptom:Orthostatic IntoleranceFatigue
Biomarker:Neuroimaging
Method Flag:PEM Not DefinedWeak Case DefinitionNo ControlsSmall Sample
Metadata
- DOI
- 10.31083/JIN25488
- PMID
- 40302262
- Review status
- Machine draft
- Evidence level
- Early hypothesis, preprint, editorial, or weak support
- Last updated
- 10 April 2026
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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