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

Jun 4
1) Some thoughts on this new paper and what it means for 2-day cardiopulmonary exercise testing (CPET) protocol in ME/CFS.

For a long time, this was one of the most valuable and replicated findings in ME/CFS research, with patients failing to replicate objective exercise values.
2) This new paper by Natelson’s team doesn’t fully reverse that. It’s not the biggest study on this topic and most previous studies did find an effect.

See reviews here and here:
pmc.ncbi.nlm.nih.gov/articles/PMC77…

tandfonline.com/doi/full/10.10…
3) That said, we did a deep-dive into the 2-day CPET literature in ME/CFS, and the evidence is not that strong. Most were small studies with some inconsistencies or retrospective data from clinical practice.

Link:
mecfsscience.org/discrepancies-…
Read 8 tweets
May 30
1) Impressive paper from Iwasaki’s lab pointing at autoimmunity in a subgroup of Long Covid patients. They replicated previous experiments of human antibody transfer causing symptoms in mice.

A couple of findings that stand out… Image
2) They extracted antibodies from blood and found that those from LC patients more often reacted to brain tissue such as the thalamus or locus coeruleus. However, after accounting for sex and age, only the results for mouse meninges were significant. Image
3) Next, they searched for the targets of the antibodies using the HuProt™ microarray which includes over 21.000 different human proteins. Unfortunately, there wasn’t a clear difference in positive response to proteins between LC and convalescent controls Image
Read 18 tweets
May 28
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. Self-made plot of the main results showing reduced cerebrospinal fluid concentration levels of norepinephrine + DHPG + MHPG in patients with ME/CFS and Long Covid.
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:

- DHPG (3,4-dihydroxyphenylglycol)
- MHPG (3-methoxy-4-hydroxyphenylglycol)
Read 10 tweets
May 26
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. Image
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
Read 28 tweets
May 19
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. Image
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.
Read 10 tweets
May 18
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. Image
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.
Read 17 tweets

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