Research review: Cognitive impairment in ME/CFS

Posted on 02/16/2022 by wames

Systematic review and meta-analysis of cognitive impairment in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), by Mehdi Aoun Sebaiti, Mathieu Hainselin, Yannick Gounden, Carmen Adella Sirbu, Slobodan Sekulic, Lorenzo Lorusso, Luis Nacul & François Jérôme Authier in Scientific 12: 2157 (2022) [doi.org/10.1038/s41598-021-04764-w]

 

Research abstract:

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is commonly associated with cognitive complaints. To bring out the neuropsychological symptomatology inherent to ME/CFS, we conducted a systematic review according to PRISMA and MOOSE guidelines of the literature through the analysis of 764 studies published between 1988 and 2019 by using PubMed Central website and Clarivate analytics platform.

We performed a meta-analysis to delineate an idea of the neuropsychological profile inherent in ME/CFS.

The clinical picture typically affects visuo-spatial immediate memory (g = − 0.55, p = 0.007), reading speed (g = − 0.82, p = 0.0001) and graphics gesture (g = − 0.59, p = 0.0001). Analysis also revealed difficulties in several processes inherent in episodic verbal memory (storage, retrieval, recognition) and visual memory (recovery) and a low efficiency in attentional abilities.

Executive functions seemed to be little or not affected and instrumental functions appeared constantly preserved. With regard to the complexity and heterogeneity of the cognitive phenotype, it turns out that determining a sound clinical picture of ME/CFS cognitive profile must go through a neuropsychological examination allowing a complete evaluation integrating the notion of agreement between the choice and the number of tests and the complexity intrinsic to the pathology.

Table 12 Take home message

1 Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) commonly associates with cognitive complaints
2 Neuropsychological testing is required for appropriately descripting and quantifying the cognitive impairment in ME/CFS patients
3 ME/CFS-associated cognitive impairment typically affects visuo-spatial immediate memory, reaction time, reading speed and the speed of the graphic gesture;
4 Episodic verbal and visual memories and attentional abilities may be also impaired
5 Instrumental functions appear constantly preserved

 

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Wales prioritises healthcare for post-viral condition Long COVID

Posted on 02/09/2022 by wames

Health Minister Eluned Morgan promises more help for people with Long COVID in Wales

 

Health Minister Eluned Morgan announced the findings of an independent review into Long COVID healthcare in Wales on 8th February 2022 and promised continued support.

We want everyone with Long COVID to know that we haven’t forgotten you.

Following a £5 million investment in the Adferiad Long COVID programme in 2021 the Health Minister announced in a Press Briefing that 2,400 people have accessed the programme.  2,226 have used services, with only 3.5% being referred to secondary services. Only a very small number are children.  The app has been downloaded over 10,000 times.

The ONS has reported that at least 60,000 people in Wales are suffering from some form of post COVID symptoms and the Health Minister acknowledged that some people during 2020, would have struggled to access support, but that the Welsh Government “can and will do better”.

Ms Morgan encouraged people with ongoing symptoms to contact their GP, who will make ‘a comprehensive assessment of their symptoms’, and provide ‘support and care which is tailored to their needs and symptoms, as close to home as possible.’

In addition, Wales is taking part in UK wide studies into Long COVID. Ms Morgan has set up a long COVID expert group ‘to consider the impact of the condition, treatment and referral methods’ and the COVID Evidence Centre has been established as part of Health and Care Research Wales. It will soon begin a Long COVID work programme to explore the specific needs in Wales.

What was missing from the Health Minister’s announcements was any understanding that:

  • Long COVID is only the most recent post-viral condition to require healthcare
  • Other conditions, like ME/CFS have been, and still are ‘forgotten’ or mismanaged
  • There is much to learn about Long COVID from people with ME/CFS and research into the illness
  • Long COVID should be seen, researched and managed in a wider post-viral context

WAMES is pleased that people with Long COVID are being acknowledged and offered some services less than 2 years after their post-viral illness was recognised.

WAMES will be asking the Welsh Government and NHS Wales for acknowledgement that the 13,500 plus people with post-viral ME/CFS in Wales should no longer be forgotten and also offered recognition, ‘comprehensive assessments’ and ‘support and care close to home’, even if it does come many years or even decades later than for those with Long COVID.

Find out more:

Welsh Parliament Plenary 08/02/2022: Statement by the Minister for Health and Social Services: Long COVID

Wales Online video: Health Minister Long Covid Press Briefing [Statement: 8 mins followed by Q&A]

Wales Online: Wales’ health minister promises to ‘do better’ in helping long Covid sufferers 

Western Telegraph: Long Covid: Wales helps to treat and manage people’s needs

NHS Confederation: Long Covid care in Wales

ITV Wales: Long Covid: ‘I’m a shell of my former self’ says young woman among 60,000 living with syndrome

“One of the best quotes I’ve ever heard is that we’re flying the plane while we’re still building it, it’s massive in that sense, and we’re still waiting on all the evidence.

“We are hoping that in 12 to 24 months we will see a massive change in a patient’s condition with Long Covid, but certainly at the moment the jury is out on that one.”        (Nicola Perry-Gower, pulmonary rehabilitation clinical lead at Swansea Bay UHB)

BBC News: Long Covid: ‘My shame over 18-month work absence’

SBUHB: Health Minister visits Swansea Bay’s long Covid services

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Lessons from ME/CFS for long COVID: Postexertional Symptom Exacerbation (aka PEM)

Posted on 02/08/2022 by wames

Lessons from Myalgic Encephalomyelitis/Chronic Fatigue Syndrome for long COVID: Postexertional Symptom Exacerbation is an abnormal response to exercise/activity, by Todd E Davenport, Staci R Stevens, Jared Stevens, Christopher R Snell, J Mark Van Ness in JOSPT blog, February 2, 2022 [doi.org/10.2519/jospt.blog.20220202]

 

Researchers from the Workwell Foundation in California offer guidance for physical therapists with understanding and identifying PESE in patients with long COVID, following extensive research with patients with ME.

PESE – postexertional symptom exacerbation – is a constellation of unusual symptom responses to exercise/activity

 

Blog post extract:

What the Physical Therapist can do

Clinicians may ask evidence-based questions that may suggest PESE (TABLE). These questions may be used to direct clinical reasoning. They also can form the basis for collaborative treatment approaches that consider the patient’s perspective. Variability in PESE symptoms between patients/clients, during exercise/activity recovery, and according to disease staging reinforces there is no one-size-fits-all approach to working with patients who have PESE.

Identification of the patient/client’s top three symptoms, how much activity is necessary to provoke PESE, how long symptoms of PESE last, and how they change over time are critical to inform patient-centered approaches to PESE management.

 

Read full article

Read Part 2: Physiological characteristics during acute exercise are abnormal in people with PostExertional Symptom Exacerbation

Read Part 3: “Energy System First Aid” for people with Post Exertional Symptom Exacerbation

Read Part 4: Heart Rate Monitoring to manage PostExertional Symptom Exacerbation

 

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Long COVID research: Use of CPET to understand dyspnea & assess for ME/CFS

Posted on 02/04/2022 by wames

Use of cardiopulmonary stress testing for patients with unexplained dyspnea Ppost–Coronavirus Disease, by Donna M Mancini, Danielle L Brunjes, Anuradha Lala, Maria Giovanna Trivieri, Johanna P Contreras, and Benjamin H Natelson in J Am Coll Cardiol HF 2021 Dec, 9 (12) 927–937

 

Research abstract:

Objectives
The authors used cardiopulmonary exercise testing (CPET) to define unexplained dyspnea in patients with post-acute sequelae of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection (PASC). We assessed participants for criteria to diagnose myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

Background
Approximately 20% of patients who recover from coronavirus disease (COVID) remain symptomatic. This syndrome is named PASC. Its etiology is unclear. Dyspnea is a frequent symptom.

Methods
The authors performed CPET and symptom assessment for ME/CFS in 41 patients with PASC 8.9 ± 3.3 months after COVID. All patients had normal pulmonary function tests, chest X-ray, and chest computed tomography scans. Peak oxygen consumption (peak VO2), slope of minute ventilation to CO2 production (VE/VCO2 slope), and end tidal pressure of CO2 (PetCO2) were measured. Ventilatory patterns were reviewed with dysfunctional breathing defined as rapid erratic breathing.

Results
Eighteen men and 23 women (average age: 45 ± 13 years) were studied. Left ventricular ejection fraction was 59% ± 9%. Peak VO2 averaged 20.3 ± 7 mL/kg/min (77% ± 21% predicted VO2). VE/VCO2 slope was 30 ± 7. PetCO2 at rest was 33.5 ± 4.5 mm Hg. Twenty-four patients (58.5%) had a peak VO2 <80% predicted. All patients with peak VO2 <80% had a circulatory limitation to exercise. Fifteen of 17 patients with normal peak VO2 had ventilatory abnormalities including peak respiratory rate >55 (n = 3) or dysfunctional breathing (n = 12). For the whole cohort, 88% of patients (n = 36) had ventilatory abnormalities with dysfunctional breathing (n = 26), increased VE/VCO2 (n = 17), and/or hypocapnia PetCO2 <35 (n = 25). Nineteen patients (46%) met criteria for ME/CFS.

Conclusions
Circulatory impairment, abnormal ventilatory pattern, and ME/CFS are common in patients with PASC. The dysfunctional breathing, resting hypocapnia, and ME/CFS may contribute to symptoms. CPET is a valuable tool to assess these patients.

 

Physicians weekly: Abnormal ventilatory patterns common after COVID-19

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Research review: The gut microbiome in ME/CFS

Posted on 01/31/2022 by wames

The gut microbiome in Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS), by Rahel S König, Werner C Albrich, Christian R Kahlert, Lina Samira Bahr, Ulrike Löber, Pietro Vernazza, Carmen Scheibenbogen, Sofia K Forslund in Front Immunol  2022 Jan 3;12:628741 [doi: 10.3389/fimmu.2021.628741]

 

Review abstract:

Myalgic encephalomyelitis (ME) or Chronic Fatigue Syndrome (CFS) is a neglected, debilitating multi-systemic disease without diagnostic marker or therapy. Despite evidence for neurological, immunological, infectious, muscular and endocrine pathophysiological abnormalities, the etiology and a clear pathophysiology remains unclear.

The gut microbiome gained much attention in the last decade with manifold implications in health and disease. Here we review the current state of knowledge on the interplay between ME/CFS and the microbiome, to identify potential diagnostic or interventional approaches, and propose areas where further research is needed. We iteratively selected and elaborated on key theories about a correlation between microbiome state and ME/CFS pathology, developing further hypotheses.

Based on the literature we hypothesize that antibiotic use throughout life favours an intestinal microbiota composition which might be a risk factor for ME/CFS.

Main proposed pathomechanisms include gut dysbiosis, altered gut-brain axis activity, increased gut permeability with concomitant bacterial translocation and reduced levels of short-chain-fatty acids, D-lactic acidosis, an abnormal tryptophan metabolism and low activity of the kynurenine pathway.

We review options for microbiome manipulation in ME/CFS patients including probiotic and dietary interventions as well as fecal microbiota transplantations. Beyond increasing gut permeability and bacterial translocation, specific dysbiosis may modify fermentation products, affecting peripheral mitochondria.

Table 2  Possible treatment affecting the microbiome in ME/CFS patients

1. FECAL MICROBIOTA TRANSPLANTATION (FMT)

Findings - A beneficial response in 70% of ME/CFS patients to a rectal infusion of a specific combination of bacteria has been reported, but all patients suffered from gastrointestinal symptoms (20). Massive improvement, also concerning energy levels of the patients, have been seen in patients undergoing FMT, also comparing to probiotics (31).

Ideas for future research -We recommend larger studies with more patients and at different stages of the disease undergoing FMT observing the energy level and other symptoms after the treatment.

2. PROBIOTICS

Q.  Are there any positive effects in the symptoms of ME/CFS by manipulating the gut microbiota of the patients?

Findings – Until now, there is no evidence for an amelioration of the core symptoms of ME/CFS patients through the use of probiotics, although significant changes in the gut have been observed in different probiotic studies (32).

Ideas for future research – In future probiotic studies it would be interesting to take biopsies of the gut instead of taking stool samples, as well as coupling metagenomic and transcriptomic analysis. In particular interventions increasing abundance of SCFA producers should be investigated.

3. FASTING DIETARY INTERVENTIONS    

Q. Are different modes of fasting able to improve symptoms in ME/CFS patients?

Findings – Until now there is no evidence for fasting dietary or fasting mimicking interventions in ME/CFS.

Ideas for future research – Projection of findings from fasting interventions in other diseases may motivate such trials also in ME/CFS.

4. OTHER POTENTIALLY GUT MICROBIOME MEDIATED APPROACHES

Q.  Is Vitamin B1 and Ginseng supplementation safe and effective in ME/CFS?

Findings – A double-blind randomized-controlled cross-over study with 40 IBD patients suffering from severe fatigue investigated the effects of a 20-day high dose thiamine (Vitamin B1) supplementation and showed a significant treatment effect regarding fatigue (33)

- Oral administration of ginseng has been shown to have anti-fatigue properties in ME/CFS, MS-related fatigue and cancer-related fatigue in several blinded randomized-controlled studies (34–37)

- Acupuncture and moxibustion (traditional Chinese medicine practices) to relieve symptoms of fatigue have been extensively investigated, but study quality is partially low (38–40)

Considering the gut-brain axis we strongly suspect that the microbiome may contribute to neurocognitive impairments of ME/CFS patients. Further larger studies are needed, above all to clarify whether D-lactic acidosis and early-life antibiotic use may be part of ME/CFS etiology and what role changes in the tryptophan metabolism might play.

An association between the gut microbiome and the disease ME/CFS is plausible. As causality remains unclear, we recommend longitudinal studies. Activity levels, bedridden hours and disease progression should be compared to antibiotic exposure, drug intakes and alterations in the composition of the microbiota. The therapeutic potential of fecal microbiota transfer and of targeted dietary interventions should be systematically evaluated.

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Hypothesis: Circadian rhythm disruption in ME/CFS: implications for the post-acute sequelae of COVID-19

Posted on 01/28/2022 by wames

Circadian rhythm disruption in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Implications for the post-acute sequelae of COVID-19, by Michael J McCarthy in Brain, Behavior, & Immunity – Health, Vol 20, March 2022, [doi.org/10.1016/j.bbih.2022.100412]

 

Highlights

  • Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is characterized by ​disrupted ​sleep ​and activity ​implicating ​circadian clocks.
  • The incidence of ME/CFS is expected to increase as a result of the post-acute sequelae of COVID-19.
  • Biomarker studies in ME/CFS patients implicate Transforming Growth Factor B (TGFB).
  • TGFB has roles in synchronizing circadian rhythms in peripheral cells.
  • Identification of biomarkers and new methodologies may facilitate progress in the chronobiological basis of ME/CFS.

Abstract

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a common and disabling disorder primarily characterized by persistent fatigue and exercise intolerance, with associated sleep disturbances, autonomic dysfunction, and cognitive problems. The causes of ME/CFS are not well understood but may coincide with immune and inflammatory responses following viral infections.

During the current SARS-CoV2 coronavirus pandemic, ME/CFS has been increasingly reported to overlap with persistent “long COVID” symptoms, also called the post-acute sequelae of COVID-19 (PASC).

Given the prominence of activity and sleep problems in ME/CFS, circadian rhythm disruption has been examined as a contributing factor in ME/CFS. While these studies of circadian rhythms have been pursued for decades, evidence linking circadian rhythms to ME/CFS remains inconclusive.

A major limitation of older chronobiology studies of ME/CFS was the unavailability of modern molecular methods to study circadian rhythms and incomplete understanding of circadian rhythms outside the brain in peripheral organ systems. Major methodological and conceptual advancements in chronobiology have since been made. Over the same time, biomarker research in ME/CFS has progressed. Together, these new developments may justify renewed interest in circadian rhythm research in ME/CFS.

Presently, we review ME/CFS from the perspective of circadian rhythms, covering both older and newer studies that make use of modern molecular methods. We focus on transforming growth factor beta (TGFB), a cytokine that has been previously associated with ME/CFS and has an important role in circadian rhythms, especially in peripheral cells.

We propose that disrupted TGFB signaling in ME/CFS may play a role in disrupting physiological rhythms in sleep, activity, and cognition, leading to the insomnia, energy disturbances, cognition problems, depression, and autonomic dysfunction associated with ME/CFS.

Since SARS-like coronavirus infections cause persistent changes in TGFB and previous coronavirus outbreaks have caused ME/CFS-like syndromes, chronobiological considerations may have immediate implications for understanding ME/CFS in the context of the COVID-19 pandemic and possibly suggest new avenues for therapeutic interventions.

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Biomarker research: Submaximal exercise provokes increased activation of the anterior DMN during the resting state as a biomarker of PEM in ME/CFS

Posted on 01/19/2022 by wames

Submaximal exercise provokes increased activation of the anterior default mode network during the resting state as a biomarker of postexertional malaise in Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome, by Rakib U Rayhan and  James N Baraniuk in Front. Neurosci., 15 Dec 2021 [doi.org/10.3389/fnins.2021.748426]

 

Research abstract:

Background: 

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is characterized by disabling fatigue and postexertional malaise. We developed a provocation paradigm with two submaximal bicycle exercise stress tests on consecutive days bracketed by magnetic resonance imaging, orthostatic intolerance, and symptom assessments before and after exercise in order to induce objective changes of exercise induced symptom exacerbation and cognitive dysfunction.

Method: 

Blood oxygenation level dependent (BOLD) scans were performed while at rest on the preexercise and postexercise days in 34 ME/CFS and 24 control subjects. Seed regions from the FSL data library with significant BOLD signals were nodes that clustered into networks using independent component analysis. Differences in signal amplitudes between groups on pre- and post-exercise days were determined by general linear model and ANOVA.

Results:

The most striking exercise-induced effect in ME/CFS was the increased spontaneous activity in the medial prefrontal cortex that is the anterior node of the Default Mode Network (DMN). In contrast, this region had decreased activation for controls. Overall, controls had higher BOLD signals suggesting reduced global cerebral blood flow in ME/CFS.

Conclusion: 

The dynamic increase in activation of the anterior DMN node after exercise may be a biomarker of postexertional malaise and symptom exacerbation in CFS. The specificity of this postexertional finding in ME/CFS can now be assessed by comparison to post-COVID fatigue, Gulf War Illness, fibromyalgia, chronic idiopathic fatigue, and fatigue in systemic medical and psychiatric diseases.

 

Health Rising: Exercise Challenge Reveals a “Remarkable Discordance” in the Brains of People with ME/CFS

  • Using a two-day exercise challenge, Georgetown researchers found a part of the brain that gets turned off in the post-exercise period actually gets turned on in people with ME/CFS.
  • The authors proposed that something called the default mode network which is associated with rumination and internal assessments had become activated in the post-exercise period in ME/CFS. (It was not activated in the pre-exercise period.
  • Because the DMN has to be turned off in order for action to take place, its activation in ME/CFS made tasks more difficult to complete. The authors called the process task-related deactivation.
  • As similar findings have shown up in Gulf War Illness, it’s possible that DMN activation post-exercise is a feature of all fatiguing and exertionally intolerant diseases.
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Research review: Brainstem abnormalities in ME/CFS… evaluation of MRI findings

Posted on 01/12/2022 by wames

Brainstem abnormalities in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A scoping review and evaluation of Magnetic Resonance Imaging findings, by Todd Nelson, Lan-Xin Zhang, Hui Guo, Luis Nacul, Xiaowei Son in Frontiers in Neurology Vol 12, p 769511, Dec 2021 [doi:10.3389/fneur.2021.769511]

 

Review abstract:

Background

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a multisystem medical condition with heterogeneous symptom expression.

Currently, there is no effective cure or treatment for the standard care of patients. A variety of ME/CFS symptoms can be linked to the vital life functions of the brainstem, the lower extension of the brain best known as the hub relaying information back and forth between the cerebral cortex and various parts of the body.

Objective/Methods

Over the past decade, Magnetic Resonance Imaging (MRI) studies have emerged to understand ME/CFS with interesting findings, but there has lacked a synthesized evaluation of what has been found thus far regarding the involvement of the brainstem. We conducted this study to review and evaluate the recent MRI findings via a literature search of the MEDLINE database, from which 11 studies met the eligibility criteria.

Findings

Data showed that MRI studies frequently reported structural changes in the white and gray matter. Abnormalities of the functional connectivity within the brainstem and with other brain regions have also been found.

The studies have suggested possible mechanisms including astrocyte dysfunction, cerebral perfusion impairment, impaired nerve conduction, and neuroinflammation involving the brainstem, which may at least partially explain a substantial portion of the ME/CFS symptoms and their heterogeneous presentations in individual patients.

Conclusions

This review draws research attention to the role of the brainstem in ME/CFS, helping enlighten future work to uncover the pathologies and mechanisms of this complex medical condition, for improved management and patient care.

Excerpts from paper:

Taken together, the present review highlights the brainstem as a potential brain centre that may have a key role in the physiological defects in ME/CFS and recommends future MRI on ME/CFS studies to make the brainstem a specific target. Given the close association between the brainstem function impairments and the complex clinical expression of the disease, MRI, with its relatively high spatial and temporal resolutions for non-invasive in vivo applications, holds promise to uncover the mechanisms of the disease, and in turn enlightens effective strategies for improved patient care.

This review contributes to the research line by bringing the existing studies together and integrating them while highlighting the potential for more. As the big questions around ME/CFS remain unanswered (e.g., why does an initial viral event result in a debilitating ongoing life-long disease in some people, why does it not resolve like a typical infectious illness, and why are ME/CFS patients subject to frequent relapses), highlighting of the brainstem as a specific target is meaningful from both research and clinical practice perspectives.

…The paper draws increased attention to brainstem research in ME/CFS using multi-modality MRI, calling for improved experimental design, and increased sample size and follow-up duration. Targeting the brainstem abnormalities in relation to the heterogeneous symptoms has implications for uncovering ME/CFS mechanisms and thus improving management and patient care.

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Research: Experiences…on educational adaptations for students with CFS/ME (Norway)

Posted on 01/10/2022 by wames

Experiences among school personnel and school nurses on educational adaptations for students with CFS/ME: A qualitative interview study, by Wenche Ann Similä,  Torstein Baade Rø and  Torunn Hatlen Nøst in Front. Pediatr., 11 November 2021 [doi.org/10.3389/fped.2021.756963]

 

Research abstract:

Introduction:

Chronic fatigue syndrome (CFS/ME) is a disabling disease severely impacting school attendance, education, and social life in young students. Uncertainties surrounding CFS/ME etiology may impact the interpretation of CFS/ME in schools. Thus, school personnel need information from health care providers to make adequate adaptations to education and social life at school for these students.

Objectives:

To explore teachers, counselors, and school nurses’ experiences with adapting education for students with CFS/ME aged 13–19 in secondary and high schools.

Design:

A qualitative study with focus group interviews and individual interviews performed face-to-face or digitally between November 2020 and March 2021. Data were analyzed using Systematic text condensation.

Participants:

Six teachers, two counselors, and four school nurses in secondary and high school participated.

Results:

Adapting education for students with CFS/ME was challenging, especially before the students received a diagnosis. The challenges were related to identifying the students’ adaptational needs, maintaining a teacher-student relationship due to school absence, difficulties in maintaining continuity of education, and uncertainty regarding the diagnosis. Successful adaptations were related to quickly reacting to school absence, early referral to educational, psychological services, a close collaboration with the school management, and the development of digital teaching for students with CFS/ME. Interdisciplinary collaboration and a clear, constructive plan with adaptive measures, including maintained teacher-student communication and educational and social adaptations, may be useful in preventing the losses young people, with CFS/ME experience.

Conclusion:

Early interdisciplinary collaboration to adapt education and social life at school for students with CFS/ME, may support teachers, counselors, and school nurses in their efforts to adapt education and prevent losses related to academic and social development in students with CFS/ME.

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Research review: ME/CFS & POTS proposed as sub-types of long COVID

Posted on 01/06/2022 by wames

Proposed subtypes of post-COVID-19 syndrome (or long-COVID) and their respective potential therapies, by Shin Jie Yong, Shiliang Liu in Rev Med Virol. 2021 Dec 9; [doi: 10.1002/rmv.2315]

 

Review abstract:

The effects of coronavirus disease 2019 (COVID-19), a highly transmissible infectious respiratory disease that has initiated an ongoing pandemic since early 2020, do not always end in the acute phase. Depending on the study referred, about 10%-30% (or more) of COVID-19 survivors may develop long-COVID or post-COVID-19 syndrome (PCS), characterised by persistent symptoms (most commonly fatigue, dyspnoea, and cognitive impairments) lasting for 3 months or more after acute COVID-19.

While the pathophysiological mechanisms of PCS have been extensively described elsewhere, the subtypes of PCS have not. Owing to its highly multifaceted nature, this review proposes and characterises six subtypes of PCS based on the existing literature.

The subtypes are:

  1. non-severe COVID-19 multi-organ sequelae (NSC-MOS) [3.1]
  2. pulmonary fibrosis sequelae (PFS) [3.2]
  3. myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS) [3.3]
  4. postural orthostatic tachycardia syndrome (POTS) [3.4]
  5. post-intensive care syndrome (PICS) [3.5]
  6. medical or clinical sequelae (MCS) [3.6]

Original studies supporting each of these subtypes are documented in this review, as well as their respective symptoms and potential interventions. Ultimately, the subtyping proposed herein aims to provide better clarity on the current understanding of PCS.

One of the phenotypes is ME/CFS, which was two-fold more likely to happen to COVID-19-positive than—negative patients, especially among women younger than 65 years, at 6- to 9-month post-infection. [from section 3.3]

Read full paper

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