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This study evaluated its clinical effectiveness and feasibility, as well as associated functional brain changes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Thirty patients with ME\/CFS (mean age 42.3\u2009\u00b1\u200911.7\u2009years; 7 males, 23 females) received 40 HBOT sessions. Clinical outcomes were assessed at baseline, during treatment, and four weeks post-treatment. The primary outcome was change in the physical functioning subscale of the Short Form-36 Health Survey (SF-36 PF). Secondary outcomes included severity of core symptoms assessed via questionnaires, exercise capacity, handgrip strength, cognitive performance, orthostatic intolerance, and brain magnetic resonance imaging (MRI; volumetry and functional connectivity [FC]). Thirty age- and sex-matched healthy controls (mean age 42.3\u2009\u00b1\u200911.3\u2009years; 7 males, 23 females) were included for MRI comparison.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      SF-36 PF significantly improved during HBOT compared with baseline (g\u2009=\u20090.71,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006). SF-36 pain (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002, g\u2009=\u20090.79) and Chalder Fatigue Scale also showed clinically meaningful reductions (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001, g\u2009=\u2009\u22120.87). Exercise capacity (g\u2009=\u20090.66), muscle strength (g\u2009=\u20090.40), and information processing speed (g\u2009=\u20090.52) improved significantly after treatment (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Treatment adherence was high and tolerability was favorable, with no major adverse events reported. Functional MRI analyses revealed increased thalamic FC in ME\/CFS patients compared to healthy controls in bilateral sensorimotor (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001,\n                      <jats:italic>t<\/jats:italic>\n                      \u2009=\u20095.65, FDR-corrected) and visuo-occipital regions (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001,\n                      <jats:italic>t<\/jats:italic>\n                      \u2009=\u20095.40, FDR-corrected) at baseline. Following HBOT, thalamic hyperconnectivity shifted toward patterns observed in healthy controls. Responders, defined as a\u2009\u2265\u200910 points increase in SF-36 PF, showed greater reductions in thalamic hyperconnectivity than non-responders (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001,\n                      <jats:italic>t<\/jats:italic>\n                      \u2009=\u2009\u22124.34 to \u22125.18, FDR-corrected).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HBOT was well tolerated and associated with significant improvements in physical functioning, fatigue, pain, and cognitive performance in ME\/CFS. The post-treatment shift in thalamocortical connectivity toward healthy control patterns and its association with clinical response support the hypothesis that functional thalamic dysregulation contributes to ME\/CFS pathophysiology and may be modulated by HBOT. This provides a network-level rationale for controlled trials to confirm therapeutic efficacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov NCT06118138. Registered 01 November 2023 \u2013 Retrospectively registered,\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT06118138?cond=ME%2FCFSamp;term=HBOTamp;rank=1\" ext-link-type=\"uri\">https:\/\/clinicaltrials.gov\/study\/NCT06118138?cond=ME%2FCFSamp;term=HBOTamp;rank=1<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12967-026-08324-6","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T12:34:32Z","timestamp":1780662872000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Hyperbaric oxygen therapy improves clinical symptoms and functional capacity and modulates thalamic connectivity in ME\/CFS: a prospective cohort study"],"prefix":"10.1186","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4909-2805","authenticated-orcid":false,"given":"Laura","family":"Kim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Camm\u00e0","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia Kedor","family":"Peters","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maron","family":"Mantwill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"M\u00fcller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nad\u00e8ge","family":"Lepr\u00eatre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelia","family":"Heindrich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebekka","family":"Rust","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritz","family":"Krill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim J.","family":"Hartung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas G.","family":"Ree\u00df","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Krohn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian von","family":"Heymann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten","family":"Wittke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Finke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Scheibenbogen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"8324_CR1","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1016\/j.cnp.2020.01.003","volume":"5","author":"MC van Campen","year":"2020","unstructured":"van Campen MC, Verheugt FWA, Rowe PC, Visser FC Rowe, and F. 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Written informed consent was obtained from all subjects involved in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"LK, GC, CKP, MM, NL, CH, RR, MK, TH, LR, SK, and KW declare no conflicts of interest. OM is an unpaid assessor on the Board of Directors of the German Society for Diving and Hyperbaric Medicine. CvH received consulting fees, support for traveling and honoraria for lectures from Daiichi Sankyo, NovoNordisk GmbH unrelated to the submitted work. CvH is a participant on an advisory board at Artcline GmbH. CF received grants from the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) and the German Ministry of Education and Research (BMBF). CS received grants from the Federal Ministry of Health (BMG). CS received consulting fees from Celltrend and payment or honoraria from Bayer, Fresenius, Roche, Celltrend, Haus\u00e4rzteverband Berlin, AGBAN AKADEMIE, Berufsverband Dt. 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