ME/CFS Science Profile picture
Jun 27, 2019 7 tweets 2 min read Read on X
1) There’s a new interesting study out by a collaboration of ME/CFS patients and scientists.

They’ve sent Freedom of Information requests to 38 NHS specialist centers for ME/CFS and asked them about their information on harms by rehabilitative therapies such as GET or CBT.
2) The results are striking. Among the ME/CFS clinics surveyed, there was an almost universal absence of criteria for detecting harm, and no clinic reported any harm to have occurred in their patients, despite acknowledging that many dropped out of treatment.
3) No clinic reported telling patients explicitly that they could be worse after therapy than before. They only said that setbacks were possible (but temporary) or that the reported harms of GET are due to the treatment being wrongly executed.
4) So patients getting worse during treatment might think that their decline is due to something else.

The authors suggest this can result in a “misinformation loop”: the clinics say GET is safe, patients believe that and do not report harm, clinics think GET is really safe...
5) Or as the authors put it more eloquently: “if clinics presume that treatments are harmless, they will inevitably fail to record harms accurately.”

Another possibility is of course that patients do report harms but that clinics do not use or record this information.
6) The solution the authors propose is a national system for collecting information from patients who think they have been harmed by rehabilitative therapies such as GET, something similar to the Yellow Card Scheme for adverse effects arising from medical drugs or devices.
7) The study was published in The Journal of Health Psychology and can be found here: journals.sagepub.com/doi/abs/10.117…

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More from @mecfsskeptic

May 16
1) With genetic evidence pointing to the brain, there is renewed interest on the S4ME forum for the buspirone tests done in the 1990s.

A couple of small studies found an increased prolactin response in ME/CFS patients but these findings were never studied further. Graph showing prolactin responses for evening, morning and one hour after buspirone are shown for ME/CFS patients and controls. Bars indicate standard error.
2) Buspirone activates serotonin receptors in the hypothalamus and hippocampus. At the time, ME/CFS was often (but incorrectly) viewed as an atypical form of depression where the serotonin pathway was already implicated.

Suspect that was one reason for doing this test.
3) But ME/CFS patients had an unexpected response.

Everyone produces the hormone prolactin after buspirone intake, but in ME/CFS patients the response was much higher than in controls. In people with depression it was lower.

So ME/CFS and depression showed opposite patterns.
Read 10 tweets
May 7
Michelle James from Harvard says the TPSO whole body imaging results were very striking and blew her away. Says there's undeniably something significant going on.

Most signal is found in the shoulders, postural muscles, the neck, glutes but also in the bone marrow. Image
Image
Surprisingly: she found a decreased TPSO signal in the brain in ME/CFS, while they expected an increased signal due to microglia activation Image
James said this has been observed before in schizophrenia and depression. She thinks this is due to peripheral inflammation inhibiting the TSPO tracer from going to the brain.

Their plasma proteomics analysis showed an increase in inflammatory markers in these patients. Image
Read 4 tweets
May 5
1) The Selin lab has received Solve ME/CFS grant to continue its work on T-cell receptors in ME/CFS. They have formed a collaboration with Harvard immunologist Ayano Kohigruber to study what the T-cells are responding to. Image
2) Dr. Lisa Selin has been studying T-cells in ME/CFS for a long time, finding subtle clues that point to T-cell exhaustion and Increased ratio of CD4+CD8+ T cells. She suspects this reflects problems keeping persistent pathogens such as Epstein-Barr virus under control.
3) With this new grant, they want to zoom in on the T-cell signatory, in particular of CD8 T-cells. They want to know what is causing their reprogramming: what are they responding to that explains the changes.
Read 6 tweets
May 2
1) There's a new review on Long Covid by Mark Faghy and (many familiar) co-authors.

I wanted to zoom in on their section on post-exertional malaise (PEM). I'm a bit skeptical, for example, about their statement that 50-80% of Long Covid patients experience PEM. Image
2) The review makes clear that most guidelines from the WHO, CDC, NICE and World Physiotherapy do not recommend graded exercise therapy (GE) for Long Covid patients with PEM.
3) It states: "Prior studies supporting GET have been subject to extensive critique due to issues such as vague inclusion criteria, high drop-out rates, unclear exercise prescriptions, and failure to measure PEM-related outcomes."
Read 11 tweets
Apr 1
1) 🇧🇷 A big trial from Brazil reports that the antidepressant fluvoxamine improved fatigue in Long Covid patients while the diabetes drug Metformin had no effect.

The effect of fluvoxamine unfortunately looks quite small and it's unclear if it is clinically significant.
2) This was a big trial with 150 participants getting fluvoxamine (100 mg twice daily), 111 metformin (750 mg twice daily), and 138 a matched placebo pill.

The trial used Bayesian analysis with early stopping; they collected data until interim analyses showed a clear result.
3) The primary outcome was the fatigue severity scale (FSS) which has 9 questions about fatigue scored on a 7-item scale. Scores are averaged over the 9 questions so that the range of possible FSS scores is 1-7. Image
Read 10 tweets
Mar 23
1) Two age peaks: a fascinating paper confirmed two peaks for when people get ME/CFS: around 16 years old and in the mid thirties.

The early onset in adolescence was associated with severe ME/CFS, an infectious onset, and having relatives with the disease.

A brief summary... Image
2) Healthcare data from Norway had previously suggests that Incidence age is bimodal for ME/CFS. This study checked this pattern using two big sources: the DecodeME study and a large European survey with more than 8000 respondents.
3) They tried to fit a unimodal normal curve to the onset data but that didn't fit well (Hartigan's Dip Test was significant). Using three modes also caused problems but if they used a bimodal distribution, the means and standard deviations were almost the same in all countries. Image
Read 10 tweets

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