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.
1) An NIH study found that ME/CFS and Long Covid patients have reduced levels of norepinephrine and its metabolites in the cerebrospinal fluid.
The norepinephrine reduction correlated with clinical measures such as fatigue, handgrip strength, and general health.
2) This was first reported in the famous intramural NIH study on ME/CFS. Unfortunately, the sample size of that study was tiny (n = 16), so they also tested it in Long Covid patients from the Neuro-PASC study.
Patients with Parkinson's were included as disease controls.
3) The authors didn't simply test for norepinephrine (NE) itself because much of it gets recycled before it reaches the cerebrospinal fluid. So they included metabolites of NE namely:
1) There's an interesting lead in the ME/CFS genetic data: the eccentric medium spiny neuron (eMSN), a cell type in the brain discovered only a couple of years ago.
All based on preliminary findings, but the data looks rather interesting.
2) We have previously discussed how genetic data strongly points towards the brain in ME/CFS to synapses, neuronal communication, and even glutamatergic signals
But this is still quite vague and nonspecific.
3) The eMSN finding is more specific because it points to a particular cell type that isn’t very common and is concentrated in certain parts of the brain, mostly the striatum and amygdala
1) Researchers from the Department of Psychiatry and Psychotherapy in Leipzig highlight that evidence for psychological factors in ME/CFS and Long Covid remains limited and speculative.
They warn that psychologising these conditions carries significant risks.
2) The first risk caused by activation, such as graded activity. Psychological models often assume a vicious cycle of deconditioning. So treatment consists of pushing patients to extend their perceived limits.
In ME/CFS and Long Covid, however, this may cause deterioriation.
3) The second risk is invalidation of patients' experience of illness. Psychological models are often incongruent with patients' views of their illness, and it causes them to doubt their own illness experience and body perception.
1) Independent researcher Paolo Maccalini published an impressive paper implicating synaptic function in various brain regions in the pathology of ME/CFS. It’s based on three major genetic studies, including DecodeME.
The most replicated signal was for glutamatergic synapses.
2) He used the DNA results of more than 15.000 ME/CFS patients from DecodeME, but managed to add genetic data on 3891 ME/CFS cases from the Million Veteran Program (MVP) using a meta-analysis.
3) Paolo wanted to add cases from other genetic databases as well, such as the UK Biobank or FinnGen, but this gave the issue that some of the controls overlapped.
So for now, DecodeME + MVP was the best he could do, totalling around 19.000 patients.
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.
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.
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.
Surprisingly: she found a decreased TPSO signal in the brain in ME/CFS, while they expected an increased signal due to microglia activation
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.