Mae dwsin o wahanol afiechydon? Yr Athro Stephen Holgate yn galw am newid radical mewn ME / CFS ymchwil

ME/CFS probably isn’t one disease, or even a few different ones – but could be as many as fifteen. So said Professor Stephen Holgate, Chair of the UK Research Collaborative (CMRC), when he addressed the Forward ME Group in the House of Lords on 2nd July. He also argued that a radical New Science was needed to tackle ME/CFS and said patients must be partners in research.

…To have any hope of identifying many different diseases (or causative pathways) within the umbrella definition, a lot of patients are needed; and there are early plans for a study involving a 5,000-strong cohort of patients. The idea is to explore everything: phenotypes, genotypes, gene expression, cells, cytokines, metabolites and more. Some of these individual features have been researched before, but not all together: and never on such a scale. High quality scientists would then have to be involved to look at applying the new technologies to the data generated from patients. But there has to be a multi-disciplinary approach, and nurses, for example, would be just as important as mathematicians in this operation.

New computer technology would be used to probe the mass of data, with the aim of finding distinct groups of patients who ‘cluster’ together with similar features, which should make it easier to home in on different causal molecular pathways in different types of patients. It is identifying causal pathways that will lead to a much deeper understanding of ME/CFS and, hopefully, provide targets for drug therapy too.

Stephen Holgate’s vision for ME/CFS research requires a radical change. The majority of research funded in the UK to date assumes that whatever triggers ME/CFS, it is perpetuated by patients’ flawed beliefs and behaviours. The new approach focuses instead on differences between patients, to see what this might reveal about different underlying causal mechanisms.

[Excerpts from Simon McGrath’s article in Phoenix rising]

Minutes of the Forward ME group July 2013

Report of Prof Holgate’s talk in Phoenix Rising 

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Valganciclovir yn driniaeth bosibl ar gyfer CFS is-set

Research abstract 

There is no known treatment for chronic fatigue syndrome (CFS). Little is known about its pathogenesis. Human herpesvirus 6 (HHV-6) and Epstein–Barr virus (EBV) have been proposed as infectious triggers.

Method:

Thirty CFS patients with elevated IgG antibody titers against HHV-6 and EBV were randomized 2:1 to receive valganciclovir (VGCV) or placebo for 6 months in a double-blind, placebo-controlled trial. Clinical endpoints aimed at measuring physical and mental fatigue included the Multidimensional Fatigue Inventory (MFI-20) and Fatigue Severity Scale (FSS) scores, self-reported cognitive function, and physician-determined responder status. Biological endpoints included monocyte and neutrophil counts and cytokine levels.

Results:

VGCV patients experienced a greater improvement by MFI-20 at 9 months from baseline compared to placebo patients but this difference was not statistically significant. However, statistically significant differences in trajectories between groups were observed in MFI-20 mental fatigue subscore (P = 0.039), FSS score (P = 0.006), and cognitive function (P = 0.025). VGCV patients experienced these improvements within the first 3 months and maintained that benefit over the remaining 9 months. Patients in the VGCV arm were 7.4 times more likely to be classified as responders (P = 0.029). In the VGCV arm, monocyte counts decreased (P < 0.001), neutrophil counts increased (P = 0.037) and cytokines were more likely to evolve towards a Th1-profile (P < 0.001). Viral IgG antibody titers did not differ between arms.

Conclusion:

VGCV may have clinical benefit in a subset of CFS patients independent of placebo effect, possibly mediated by immunomodulation and/or antiviral effect. Further investigation with longer treatment duration and a larger sample size is warranted.

Randomized clinical trial to evaluate the efficacy and safety of valganciclovir in a subset of patients with chronic fatigue syndrome by JG Montoya et al in J. Med. Virol. 9999:1–9, 2013.

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ME digwyddiad yng Ngorllewin Cymru 12 Medi – cleifion a gofalwyr yn cael eu gwahodd

Hywel Dda LHB (Local Health Board) is holding an event to discuss the development of ME services, from 1 – 4.30pm on the afternoon of Sep 12th at the Police HQ near Carmarthen. Professionals, patients and carers from Ceredigion, Carmarthenshire and Pembrokeshire are invited to discuss service provision and the development of a care pathway for West Wales. Some patients, carers and health professionals will be speaking about their experiences of having or caring for ME. This will be followed by discussion groups.

This is an important opportunity to influence the way that services are developed. The event is free but you need to book in advance. Please contact Jan for more information if you would like to attend.

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ME profiad o wasanaethau iechyd niwrolegol Alban yn wael

The Neurological Alliance of Scotland undertook a survey of people affected by neurological conditions in 2011 in order to capture information on people’s most recent encounter of their neurological health service. The final report sets out the findings of the survey and discusses some of the implications and limitations of the information gathered.

Comments from people with ME/CFS are presented separately on p46-50 as they identified a different profile of responses which highlight lack of recognition and legitimacy of ME and lack of access to neurological health services.

Neurological Health Service Experience Survey

Past surveys and anecdotal reports from people with ME indicate a similar picture in Wales.

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Parlys mewn ME

Study abstract

Paralysis is a symptom that is rarely highlighted in the literature for ME, yet is found amongst the most severely ill ME population and even some of those not so severely affected. My wife has experienced it for almost two decades, without adequate exploration, alongside exposure to denial and dismissal, ignorance and neglect as well as harmful treatment.

We wanted to find out if there was anyone else with a similar experience to my wife’s or if she was a rare and very severe case. We wanted to highlight the seriousness of this symptom and ask why it is being ignored and down played not only by the medical profession, with its inappropriate focus on fatigue and the psychosocial response, but also by the main charities, none of whom, flag it up as a main symptom.

This qualitative research study indicates that there are significant others experiencing apparently similar paralysis and that my wife is not unique. It begs the question why are they being neglected and why is there not urgent research into the understanding and alleviation of this devastating physical symptom? What is the mechanism, are there different mechanisms at play and are there any possible ways to treat it?

Greg Crowhurst

Paralysis, a qualitative study of people with Severe Myalgic Encephalomyelitis

Stonebird website: The Lived experience of Severe ME

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Gall hunan-reoli gwella lludded

Research abstract

Objective:

To assess the efficacy of brief fatigue self-management (FSM) for medically unexplained chronic fatigue (UCF) and chronic fatigue syndrome (CFS) in primary care.

Methods:

A randomized controlled design was used wherein 111 patients with UCF or CFS were randomly assigned to two sessions of FSM, two sessions of symptom monitoring support (attention control; AC), or a usual care control condition (UC). Participants were assessed at baseline and at 3 and 12 months after treatment. The primary outcome, the Fatigue Severity Scale, measured fatigue impact on functioning. Analysis was by intention to treat (multiple imputation) and also by per protocol.

Results:

A group × time interaction across the 15-month trial showed significantly greater reductions in fatigue impact in the FSM group in comparison with the AC group (p < .023) and the UC group (p < .013). Medium effect sizes for reduced fatigue impact in the FSM group were found in comparison with the AC group (d = 0.46) and the UC group (d = 0.40). The per-protocol analysis revealed large effect sizes for the same comparisons. Clinically significant decreases in fatigue impact were found for 53% of participants in the FSM condition, 14% in the AC condition, and 17% in the UC condition. Dropout rates at the 12-month follow-up were high (42%–53%), perhaps attributable to the burden of monthly telephone calls to assess health care use.

Conclusion:

A brief self-management intervention for patients with UCF or CFS seemed to be clinically effective for reducing the impact of fatigue on functioning.

Chronic Fatigue Self-Management in Primary Care: A Randomized Trial in Psychosomatic Medicine August 6, 2013, by Fred Friedberg, PhD et al

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Camweithrediad symudiad y llygaid yn ME / CFS

Research abstract

Background: People who suffer from myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) often report that their eye movements are sluggish and that they have difficulties tracking moving objects. However, descriptions of these visual problems are based solely on patients’ self-reports of their subjective visual experiences, and there is a distinct lack of empirical evidence to objectively verify their claims. This paper presents the first experimental research to objectively examine eye movements in those suffering from ME/CFS.

Methods: Patients were assessed for ME/CFS symptoms and were compared to age, gender, and education matched controls for their ability to generate saccades and smooth pursuit eye movements.

Results: Patients and controls exhibited similar error rates and saccade latencies (response times) on prosaccade and antisaccade tasks. Patients showed relatively intact ability to accurately fixate the target (prosaccades), but were impaired when required to focus accurately in a specific position opposite the target (antisaccades). Patients were most markedly impaired when required to direct their gaze as closely as possible to a smoothly moving target (smooth pursuit).

Conclusions: It is hypothesised that the effects of ME/CFS can be overcome briefly for completion of saccades, but that continuous pursuit activity (accurately tracking a moving object), even for a short time period, highlights dysfunctional eye movement behaviour in ME/CFS patients. Future smooth pursuit research may elucidate and improve diagnosis of ME/CFS.

Characterising eye movement dysfunction in myalgic encephalomyelitis/chronic fatigue syndrome, in Graefe’s Archive for Clinical and Experimental Ophthalmology August 2013, by Stephen P. Badham, Claire V. Hutchinson

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Canllawiau NICE CFS / ME adolygiad Awst 2013

The CFS/ME NICE guidelines were due to be reviewed in August 2013, but this was believed to have been put on hold by NICE, who have suspended all reviews for the next two years.

According to NICE the review is still going ahead but under the National Clinical Guidelines Centre for Acute and Chronic Conditions (NCGCACC), which is hosted by the Royal College of Physicians.

“Responsibility for undertaking a review of this guidance at the designated review date has passed to the National Clinical Guidelines Centre for Acute and Chronic Conditions (NCGCACC). The National Collaborating Centre for Primary Care is no longer active.”

Further details may be found at the National Clinical Guidelines Centre.

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Delayed recovery in CFS can affect exercise testing results

Research abstract

Objectives  –  Reduced functional capacity and post-exertional fatigue following physical activity are hallmark symptoms of chronic fatigue syndrome (CFS) and may even qualify for biomarker status. That these symptoms are often delayed may explain the equivocal results for clinical cardiopulmonary exercise testing among individuals with CFS.

Test reproducibility in healthy subjects is well documented. This may not be the case with CFS due to delayed recovery symptoms. The objectives for this study was to determine the discriminative validity of objective measurements obtained during CPET to distinguish individuals with CFS from non-disabled sedentary individuals.

Methods –  Gas exchange data, workloads and related physiological parameters were compared between 51 individuals with CFS and 10 control subjects, all females, for two maximal exercise tests separated by 24 hours.

Results –  Multivariate analysis showed no significant differences between controls and CFS for Test 1. However, for Test 2 the individuals with CFS achieved significantly lower values for oxygen consumption and workload at peak exercise and at the ventilatory/anaerobic threshold. Follow-up classification analysis differentiated between groups with an overall accuracy of 95.1%.

Conclusions  –  The lack of any significant differences between groups for the first exercise test would appear to support a deconditioning hypothesis for CFS symptoms. However, results from the second test indicate the presence of a CFS related post-exertional fatigue. It might be concluded that a single exercise test is insufficient to reliably demonstrate functional impairment in individuals with CFS. A second test may be necessary to document the atypical recovery response and protracted fatigue possibly unique to CFS, which can severely limit productivity in the home and workplace.

Discriminative validity of metabolic and workload measurements to identify individuals with Chronic Fatigue Syndrome  in Physical Therapy July 2013, Volume 93, Issue 7 (published online ahead of print) Christopher R. Snell, Staci R. Stevens, Todd E. Davenport, J. Mark Van Ness  P

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Gwent Codi Arian ar gyfer FM / ME / CFS 7 Gorffennaf

Fundraiser for FM/ ME/ CFS 7 July

Graig Community Hall Bassaleg, Caerphilly Road, Newport Gwent NP10 8LG

Sun 7 July 2013 2.30-5.30pm

Tea & coffee, cakes, raffle, stalls, face painting, nail painting, games

For all – families and kids welcome

Donations gratefully received for stalls: Brick a brack, CDs, Clothes, Homeware, Homeware, Jewellry, DVDs etc

Contact Natasha on 07969 994 643

Article about Natasha in South Wales Argus: Bassaleg woman in constant pain with Fibromyalgia and ME

 

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