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

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
Mar 21
1) 🔬🦠New article: we've made a comprehensive overview of the immune system in ME/CFS, analyzing major studies of the past 40 years.

A longread with separate chapters on:

- viral persistence
- cytokines
- neuroinflammation
- antibodies
- immune cells such as NK, B, and T cells Image
2) One of the major findings is that current evidence in blood does not point to (low-grade) inflammation as driving ME/CFS symptoms.

This probably means that it’s either hidden (in tissue) or involves an entirely different immune pathway.
3) This may come as a surprise because numerous studies talk about (low-grade) inflammation as being key in ME/CFS. We found that there’s a contradiction between what papers claim in this regard and what the actual evidence shows.
Read 18 tweets
Mar 8
1) 🇩🇪 This German study will test the feasibility of home-based diagnostics in patients with severe and very severe ME/CFS (Bell score < 30).

They plan to take blood and saliva samples, questionnaires and measurements such as ECG, ultrasound, pupillary responses, HRV, etc. Image
2) The authors argue that this is urgently needed because these patients are often excluded from research:
"A central limitation of the current body of research is the insufficient inclusion of patients with severe and very severe ME/CFS into clinical studies."
3) They also note that home-based testing could lead to more reliable measurements: "Home-based assessments may reduce noise from clinic-induced stress, providing more ecologically valid data."
Read 10 tweets
Feb 21
1) The ME Association collaborated with the research team of Prof. Sarah Tyson to develop a new questionnaire for assessing ME/CFS symptoms: The Index of ME Symptoms (TIMES).

It assesses 58 symptoms grouped into 9 domains. Image
2) The TIMES questionnaires is based on the DePaul Symptom Questionnaire (DSQ) but the authors adapted it to make it more suitable for clinical assessment (rather than diagnosis).

The goal is to make this part of a suitable ME/CFS toolkit for healthcare professionals.
3) The researchers validated their changes to the questionnaire in a large online sample of patients (n1=721 and n2 =354, for the second round).

The full questionnaire is available here in supplementary file 4:
medrxiv.org/content/10.648…
Read 9 tweets
Feb 18
1) The ME Association is funding a new study on neuroimmune biomarkers for ME/CFS and Long Covid.

It will use the new NULISA technology to measure hundreds of proteins linked to the immune system and brain, including many that are too few to detect with standard tests. Image
2) The project will be based at the UK Dementia Research Institute’s Fluid Biomarker Laboratory.

It's led by Sophie Hicks, Research Assistant at UCL Institute of Neurology, who has family members with ME/CFS and Long Covid.
3) Samples will be sourced from the UK ME/CFS Biobank and the UCLH STIMULATEICP Long Covid study. It hopes to find biomarkers that are specific to each condition and to better understand similarities and differences between ME/CFS and Long Covid.
Read 7 tweets

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