Neural dysregulation in post-COVID fatigue

The Oxford Academic have published the following research ‘Neural dysregulation in post-COVID fatigue' which discusses dysautonomia and myopathic changes in skeletal muscle in Long Covid.


Following infection from SARS-CoV-2, a substantial minority of people develop lingering after-effects known as ‘long COVID’. Fatigue is a common complaint with substantial impact on daily life, but the neural mechanisms behind post-COVID fatigue remain unclear.

We recruited 37 volunteers with self-reported fatigue after a mild COVID infection and carried out a battery of behavioural and neurophysiological tests assessing the central, peripheral and autonomic nervous systems.

In comparison to age and sex matched volunteers without fatigue (n = 52), we show underactivity in specific cortical circuits, dysregulation of autonomic function, and myopathic change in skeletal muscle.

Cluster analysis revealed no sub-groupings, suggesting post-COVID fatigue is a single entity with individual variation, rather than a small number of distinct syndromes.

Based on our analysis we were also able to exclude dysregulation in sensory feedback circuits and descending neuromodulatory control.

These abnormalities on objective tests may aid in the development of novel approaches for disease monitoring.

The ME Association Comment

Dr Charles Shepherd, Honorary Medical Adviser to the ME Association says:

“Good to see some serious biomedical research taking place into the possible cause of debilitating fatigue in Long Covid, and the research group appreciating that central (brain), peripheral (muscle) and infective components may all be involved. But disappointing to find that they didn't appear to appreciate that the same complex picture is occurring in ME/CFS and that it would have been useful to compare these findings in a cohort of people with ME/CFS.”

Dr Charles Shepherd,
Trustee and
Hon. Medical Adviser
to the ME Association.
Member of the 2018-2021 NICE Guideline Committee.
Member of the 2002 Independent Working Group on ME/CFS.

Dr Charles Shepherd
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