Balance deficits in Chronic Fatigue Syndrome with and without fibromyalgia.
Serrador, Jorge M, Quigley, Karen S, Zhao, Caixia et al. · NeuroRehabilitation · 2018 · DOI
Quick Summary
This study tested balance and dizziness in people with ME/CFS, comparing those with and without fibromyalgia. Researchers found that ME/CFS patients had measurably worse balance than healthy controls, and their balance problems were linked to how well they could function physically. Interestingly, people with both ME/CFS and fibromyalgia had the most severe balance problems, suggesting these conditions together may affect the body differently than ME/CFS alone.
Why It Matters
Balance problems and dizziness are common, often disabling symptoms in ME/CFS that have not been rigorously studied. This research provides objective evidence that balance deficits are measurable and real in ME/CFS, validating patient experiences and potentially opening avenues for rehabilitation interventions. The finding that ME/CFS+fibromyalgia may have distinct neurobiological mechanisms could inform more targeted treatment approaches.
Observed Findings
CFS patients had significantly lower overall balance scores than controls (69.0±1.4 vs 78.8±1.5, P<0.005) regardless of fibromyalgia status.
Balance scores in CFS patients correlated strongly with physical functional status (R²=0.43, P<0.001) but not mental functional status.
CFS+FM patients showed markedly worse vestibular (inner ear) function compared to CFS-only patients and controls (55.4±4.6 vs 67.9±3.8 vs 70.2±2.4, P=0.013).
All CFS patients preferentially relied on visual information for balance, even when that visual information was experimentally made incorrect.
Inferred Conclusions
Balance deficits are a genuine physiological finding in ME/CFS that correlate with physical disability severity.
CFS with comorbid fibromyalgia may represent a distinct pathophysiological condition with greater vestibular system involvement.
ME/CFS patients appear to use abnormal sensory weighting strategies for balance, over-relying on vision while under-relying on vestibular input.
Remaining Questions
What are the underlying neurobiological causes of these balance deficits and altered sensory integration in ME/CFS?
Do balance deficits persist or worsen over time, and is there any relationship between severity of balance problems and disease progression?
What This Study Does Not Prove
This study does not establish whether balance deficits are a primary cause or a consequence of ME/CFS, nor does it explain the underlying biological mechanisms. The cross-sectional design cannot determine whether balance problems develop before, during, or after ME/CFS onset. The small sample size and lack of longitudinal follow-up limit generalizability and prevent conclusions about disease progression or treatment response.
Could targeted balance training or vestibular rehabilitation improve functional outcomes in ME/CFS patients, particularly those with comorbid fibromyalgia?
Why does comorbid fibromyalgia specifically worsen vestibular function, and what does this suggest about the shared mechanisms between these conditions?