Severe ME Day – 8 August 2020

A day to remember everyone who is suffering or who has ever suffered from Severe and Very Severe Myalgic Encephalomyelitis.

 


Severe ME Understanding & Remembrance Day :

This day aims to bring public attention to the illness for the sake of all those presently suffering from Severe Myalgic Encephalomyelitis and to remember all those who have died from ME.

A day to honour the strength of spirit of all those who have endured and continue to endure decades of suffering and profound physical dysfunction and yet receive little, or no recognition or help, but rather continue to experience gross misrepresentation and misinterpretation of their illness and profound disability.

 

What’s the significance of 8th August?

This is the birth date of Sophia Mirza.  Sophia was bed-bound with severe Myalgic Encephalomyelitis and was a victim of medical abuse.  Her doctors did not believe that Myalgic Encephalomyelitis was a physical disease and so she was forcibly taken from her bed/home by social workers, police officers and doctors, and kept in a psychiatric facility where she received inappropriate treatment and care.  Sophia subsequently died of ME at the age of 32.  Her post-mortem revealed widespread inflammation in the spinal cord.  This same inexcusable abuse still goes on.

 

We remember all those died of ME/CFS in Wales, and those who gave up the fight:

  • Annabel Senior , 2003 – first known person in the UK to have CFS on the death certificate
  • Sarah Ann Tyler, 2017
  • Dr Martin Rhisiart, 2017

Please let us know if you’d like someone’s name to be added to the list.

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Autonomic phenotypes in CFS are associated with illness severity: a cluster analysis

Autonomic phenotypes in Chronic Fatigue Syndrome (CFS) are associated with illness severity: a cluster analysis, by Joanna Słomko, Fernando Estevez-Lopez, Sławomir Kujawski, Monika Zawadka-Kunikowska, Małgorzata Tafil-Klawa, Modra Murovska, Julia L Newton, Paweł Zalewski on behalf of the European Network on ME/CFS (EUROMENE) in J. Clin. Med. 2020, 9(8), 2531; [doi.org/10.3390/jcm9082531]

 

Research abstract:

In this study we set out to define the characteristics of autonomic subgroups of patients with Chronic Fatigue Syndrome (CFS). The study included 131 patients with CFS (Fukuda criteria).

Participants completed the following screening symptom assessment tools: Chalder Fatigue Scale, Fatigue Impact Scale, Fatigue Severity Scale, Epworth Sleepiness Scales,
the self-reported Composite Autonomic Symptom Scale.

Autonomic parameters were measured at rest with a Task Force Monitor (CNS Systems) and arterial stiffness using an Arteriograph (TensioMed Kft.).

Principal axis factor analysis yielded four factors: fatigue, subjective and objective autonomic dysfunction and arterial stiffness. Using cluster analyses, these factors were grouped in four autonomic profiles: 34% of patients had sympathetic symptoms with dysautonomia, 5% sympathetic alone, 21% parasympathetic and 40% had issues with sympathovagal balance.

Those with a sympathetic-dysautonomia phenotype were associated with more severe disease, reported greater subjective autonomic symptoms with sympathetic over-modulation and had the lowest quality of life. The highest quality of life was observed in the balance subtype where subjects were the youngest, had lower levels of fatigue and the lowest values for arterial stiffness. Future studies will aim to design autonomic profile-specific treatment interventions to determine links between autonomic phenotypes CFS and a specific treatment.

 

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Autoantibodies to Beta-Adrenergic & muscarinic cholinergic receptors in ME patients – a validation study in plasma & cerebrospinal fluid from two Swedish cohorts

Autoantibodies to Beta-Adrenergic and Muscarinic cholinergic receptors in Myalgic Encephalomyelitis (ME) patients – a validation study in plasma and cerebrospinal fluid from two Swedish cohorts, by Annie Bynke, Per Julin, Carl-Gerhard Gottfries, Harald Heidecke, Carmen Scheibenbogen, Jonas Bergquist in Brain, Behavior, & Immunity – Health Vol 7, August 2020 [doi.org/10.1016/j.bbih.2020.100107]

 

HIGHLIGHTS

  • Myalgic Encephalomyelitis (ME) is a devastating disorder (with millions of patients worldwide) with unclear etiology and no clear diagnostic biomarker available.
  • This study support previous findings that there exists a general pattern of increased antibody levels to adrenergic and muscarinic receptors within the ME patient group.
  • No evidence for intrathecal antibody production was found in cerebrospinal fluid. The role of increased autoantibodies in the pathogenesis of ME is still uncertain and further research is needed to evaluate the clinical significance of these findings.

Research abstract:

Myalgic encephalomyelitis (ME) also known as ME/CFS (Chronic Fatigue Syndrome) or ME/SEID (Systemic Exertion Intolerance Disorder), is a disabling and often long-lasting disease that can drastically impair quality of life and physical/social functioning of the patients.

Muscarinic acetylcholine receptor

Underlying pathological mechanisms are to a large extent unknown, but the presence of autoantibodies, cytokine pattern deviations and the presentation of cognitive and autonomic nervous system related symptoms provide evidence for ME being an immunological disorder with elements of autoimmunity. Increased levels of autoantibodies binding to adrenergic and muscarinic receptors in ME-patients have been reported. It is hypothesized that these autoantibodies have pathological significance and contribute to the ME-specific symptoms, however, these observations need to be validated.

This study was designed to investigate potential differences in adrenergic and muscarinic receptor autoantibody levels in plasma and cerebrospinal fluid (CSF) samples between ME patients and gender and age-matched healthy controls, and to correlate the autoantibody levels to disease severity.

We collected body fluids and health-related questionnaires from two Swedish ME cohorts, plasma and CSF from one of the cohorts (n=24), only plasma from the second cohort (n=24) together with plasma samples (n=24) and CSF (n=6) from healthy controls.

All samples were analyzed for IgG autoantibodies directed against Alpha- (α1, α2) and Beta- (β1-3) adrenergic receptors and Muscarinic (M) 1-5 acetylcholine receptors using an ELISA technique. The questionnaires were used as measures of disease severity.

Significant increases in autoantibody levels in ME patients compared to controls were found for M3 and M4 -receptors in both cohorts and β1, β2, M3 and M4- receptors in one cohort. No significant correlations were found between autoantibody levels and disease severity. No significant levels of autoantibodies were detected in the CSF samples. These findings support previous findings that there exists a general pattern of increased antibody levels to adrenergic and muscarinic receptors within the ME patient group. However, the role of increased adrenergic and muscarinic receptor autoantibodies in the pathogenesis of ME is still uncertain and further research is needed to evaluate the clinical significance of these findings.

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ME/CFS: efficacy of repeat immunoadsorption

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: efficacy of repeat Immunoadsorption, by  Markus Tölle, Helma Freitag, Michaela Antelmann, Jelka Hartwig, Mirjam Schuchardt, Markus van der Giet, Kai-Uwe Eckardt, Patricia Grabowski, and Carmen Scheibenbogen in J. Clin. Med. 2020, 9(8), 2443; [doi.org/10.3390/jcm9082443] Published: 30 July 2020

 

Research abstract:

(1) Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex neuroimmunological disease.

There is evidence for an autoimmune mechanism for ME/CFS with an infection-triggered onset and dysfunction of ß2-adrenoreceptor antibodies (ß2AR-AB). In a first proof-of-concept study, we could show that IA was effective to reduce ß2AR-AB and led to improvement of various symptoms. (2)

Five of the ME/CFS patients who had clinical improvement following treatment with a five-day IA were retreated in the current study about two years later with a modified IA protocol. The severity of symptoms was assessed by disease specific scores during a follow-up period of 12 months. The antibodies were determined by ELISA. (3)

The modified IA treatment protocol resulted in a remarkable similar clinical response. The treatment was well tolerated and 80–90% decline of total IgG and ß2AR-AB was achieved. Four patients showed a rapid improvement in several clinical symptoms during IA therapy, lasting for six to 12 months. One patient had no improvement. (4)

We could provide further evidence that IA has clinical efficacy in patients with ME/CFS. Data from our pilot trial warrant further controlled studies in ME/CFS.

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Inclusion of family members without ME/CFS in research studies promotes discovery of biomarkers specific for ME/CFS

Inclusion of family members without ME/CFS in research studies promotes discovery of biomarkers specific for ME/CFS, by  in Work 2020 [DOI: 10.3233/WOR-203177]

 

Research abstract:

BACKGROUND:

The search for a biomarker specific for ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) has been long, arduous and, to date, unsuccessful. Researchers need to consider their expenditures on each new candidate biomarker. In a previous study of antibody-dependent cell-mediated cytotoxicity (ADCC) by natural killer lymphocytes, we found lower ADCC for ME/CFS patients vs. unrelated donors but ruled against low ADCC as a biomarker because of similar ADCC for patients vs. their family members without ME/CFS.

OBJECTIVE:

We applied inclusion of family members without ME/CFS, from families with multiple CFS patients, as a second non-ME/CFS control group in order to re-examine inflammation in ME/CFS.

METHOD:

Total and CD16A-positive ‘non-classical’ anti-inflammatory monocytes were monitored.

RESULTS:

Non-classical monocytes were elevated for patients vs. unrelated healthy donors but these differences were insignificant between patients vs. unaffected family members.

CONCLUSIONS:

Inclusion of family members ruled against biomarker considerations for the monocytes characterized. These pilot findings for the non-classical monocytes are novel in the field of ME/CFS. We recommend that occupational therapists advocate and explain to family members without ME/CFS the need for the family members’ participation as a second set of controls in pilot studies to rapidly eliminate false biomarkers, optimize patient antibody-dependent cell-mediated cytotoxicity participation, and save researchers’ labor.

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Impact of ME on treatment of comorbidities: a lived experience

Impact of myalgic encephalomyelitis on treatment of  comorbidities: a lived experience, by Denise Lopez-Majano in Work vol. 66, no. 2, pp. 309-313, 20 Jul 2020 [DOI: 10.3233/WOR-203175]

 

Abstract:

Myalgic Encephalomyelitis (ME) is a complex, chronic, disabling, multi-system disease with no FDA-approved treatments.

ME greatly impacts quality of life (QoL) with studies showing that people with ME often have worse quality of life than people with sickle cell anemia and cystic fibrosis, among other chronic diseases.

People with ME frequently have comorbidities, which, if treated, could improve quality of life. However, the pervasive impact of ME makes treatment of comorbidities difficult. When trying to treat comorbidities it is therefore important for rehabilitation specialists to understand the impact of ME on day-to-day life in order to avoid treatment-related harms or exacerbation of ME symptoms.

This article details the lived experience of one family in which both siblings have ME and comorbidities.

6   Recommendations based on our experiences

Because ME impacts every moment of the lives of people with ME, rehabilitation specialists (physical therapists, occupational therapists, etc.) must do the following in order to help people with ME:

  • understand PEM, hypersensitivities, reduced cognitive and physical resources, unrefreshing sleep, and pervasive exhaustion

  • streamline therapy for people with ME

  • reduce frequency/appointment duration/intensity of treatment but also expect treatment to take much longer than usual

  • be mindful that if the person with ME does not have a caregiver to help convey things, progress may be even slower due to the dual effort of communication and therapy

  • anticipate periods of time during which people with ME cannot attend appointments because of physical and cognitive limitations

  • ensure people with ME are not penalized for missed appointments

  • know that because of limited cognitive and physical resources it may be necessary to repeat exercises/activities and rephrase instructions to ensure they are accurately learned

  • keep in mind that each person with ME has different limits and these may also vary from one moment/hour/day to the next

  • know that when it comes to exertion, the person with ME must be the one to determine each time if exertion is in any way feasible

  • understand that assessment and treatment of comorbidities in people with ME requires flexibility on the part of rehabilitation specialists.

Conclusion

To ensure the greatest chance of successful treatment of comorbidities in people with ME, rehabilitation specialists must be cognizant of the impact of ME on cognitive and physical function and must individualize treatment modalities in order to accommodate persons with ME. Careful adaptation of treatment modalities will increase the possibility of successful treatment of comorbidities in people with ME.

 

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A proposal for explaining progression from light/moderate to severe chronic fatigue

A proposal for explaining progression from light/moderate to severe chronic fatigue, by Anna Dorothea Höck in ES Journal of Nutritional Health vol 1, no.2 Jun 11 2020

 

Research abstract:

Background:

Chronic mild to moderate fatigue is also called chronic idiopathic fatigue. Physicians at best consider psychotherapy for treatment. But most physicians do not view this condition as a real disease.

In contrast, debilitating chronic severe disease has been termed chronic fatigue syndrome (CFS), or if more severe, myalgic encephalopathy (CFS/ME). Meanwhile published metabolic aberrations in CFS/ME suggest estimating these diseases no longer as mere psychiatric diseases. The metabolic results inspire to further exploration of cell stress response mechanisms, which are summarized in this paper.

Interestingly, cell stress responses were tightly linked to vitamin D3 – mediated effects, such as homeostatic regulation of metabolism, energy and redox balance, as well as defense against pathogens and toxins. Specific personality traits, prevalence of indoor activities, latitude and climate predispose to vitamin D3 deficiency, which is supposed to represent a missing link for a comprehensive model of disease progression from mild chronic fatigue to most severe forms.

By diagnosing vitamin D deficiency in early stages of chronic fatigue, the progression to severe and debilitating chronic fatigue may be prevented. In more severe stages of chronic fatigue, such as CFS/ME, resistance against mere vitamin D replenishment seems to be the rule. Some causal mechanisms for this resistance and potential treatment options are shown.

Conclusion:

Scientific insight to the biomolecular mechanisms of cell homeostasis helps to understand and treat all clinically manifestations associated with different stages of chronic fatigue.

 

Excerpt from conclusion:

Physicians could be stimulated to revise their treatment regimens by omitting all interventions which induce further redox stress and xenobiotic burden. The drug
and chemical intolerances of CFS/ME patients call for only minor dosages of pain and psychoactive substances. Instead, restoration of effective VDR activity should be
targeted. This is assumed to stabilize a SIRT1/Nrf2-driven stress response.

This might be achieved by plant based diets and/or supplementations, such as those recommended by Naviaux et al. [8], and Xiao W 2018 [31], 8/10 including all B vitamins, and by supplements of vitamin D3 and minerals, which include calcium and magnesium,
in particular. Phosphate deficiency through long-standing vitamin D deficiency should be considered as well.

Due to presumed vitamin D3 resistance and to distinct genomic and translational vitamin D3 responses, personalized high doses such as 250 mcg cholecalciferol and up to 2400 mg calcium per day should be applied [57,58]. Careful clinical observations should clarify the potential reversibility of very severe and long-standing CFS/ME stages. In any case, any sort of stressful challenge, such as xenobiotics, drugs, nutrient additions, microwaves, and psychosocial stress, should be avoided as much as possible.

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What ME/CFS caregivers want you to know

What ME/CFS caregivers want you to know, by Bobbie Ausubel in Work vol. 66, no. 2, pp. 361-364, 2020 July 20 [DOI: 10.3233/WOR-203171]

 

Eight stories comprise this paper:

Stories were written in 2019 from caregivers, parents, and spouses, most of whom live with a pwME (person with ME). To protect those in our care, some authors have not used their full names.

Each patient suffers from Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), a neuro-immune disease which affects each person differently, with a great variety of symptoms and a wide spectrum of disease burden. The National Academy of Medicine says ME/CFS is three times more common in women than men (1), and they estimate that 80% of patients have not yet received a diagnosis (2).

Through their experiences caring for loved ones with ME/CFS, these caregivers have anecdotes and requests for future doctors and occupational therapists to assist with servicing their suffering pwMEs.

  • J., Mother and at-home caregiver of a pwME
  • Courtney Miller, at-home caregiver and wife of Robert Miller, an ME/CFS patient of 30 years
  • Elizabeth B. Burlingame, mother and at-home caregiver of a pwME
  • Katy C., mother of a pwME
  • Bev., mother of a pwME
  • Martin W., father of a pwME
  • B., mother of a pwME
  • MLiz C., friend of two pwME

Read the stories

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Graded Exercise Therapy doesn’t restore the ability to work in ME/CFS. Rethinking of a Cochrane Review

Graded Exercise Therapy doesn’t restore the ability to work in ME/CFS. Rethinking of a Cochrane review, by Mark Vink, Friso Vink-Niese in Work vol. 66, no. 2, pp. 283-308, 20 July 2020 [doi:10.3233/WOR-203174]

 

Research abstract:

Background:

Cochrane recently amended its exercise review for myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS) in response to an official complaint.

Objective:

To determine if the amended review has addressed the concerns raised about the previous review and if exercise is an effective treatment that restores the ability to work in ME/CFS.

Method:

The authors reviewed the amended Cochrane exercise review and the eight trials in it by paying particular interest to the objective outcomes. We also summarised the recently published review of work rehabilitation and medical retirement for ME/CFS.

Results:

The Cochrane review concluded that graded exercise therapy (GET) improves fatigue at the end of treatment compared to no-treatment. However, the review did not consider the unreliability of subjective outcomes in non-blinded trials, the objective outcomes which showed that GET is not effective, or the serious flaws of the studies included in the review. These flaws included badly matched control groups, relying on an unreliable fatigue instrument as primary outcome, outcome switching, p-hacking, ignoring evidence of harms, etc. The review did also not take into account that GET does not restore the ability to work.

Conclusion:

GET not only fails to objectively improve function significantly or to restore the ability to work, but it’s also detrimental to the health of≥50% of patients, according to a multitude of patient surveys. Consequently, it should not be recommended.

 

Excerpts from paper:

5. Conclusion

The recently amended Cochrane exercise review for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) concluded that graded exercise therapy (GET) improves fatigue at the end of treatment compared to no-treatment. Larun et al. also concluded that there is no evidence that GET is safe. However, the review continues to ignore the unreliability of subjective outcomes in non-blinded studies and fails to address other key flaws of the studies in the review. These flaws included:

1) using criteria that also select people who do not have the disease;
2) not excluding patients with a psychiatric or self-limiting illness;
3) badly matched control groups;
4) relying on an unreliable fatigue instrument as primary outcome;
5) not using objective outcomes and/or ignoring them;
6) outcome switching;
7) p-hacking;
8) ignoring evidence of multi-system biological pathologies that can not be explained by their psychological treatment rationale;
9) ignoring evidence of harms.

Analysis of the objective outcomes shows that GET does not lead to clinically significant objective improvement. It also does not lead to improvement of CFS symptoms count or quality of life measurements, which remains lower for those with ME/CFS, than in many other debilitating illnesses.

Only 5% of patients recover. Many patients are unable to work and those who can work, often need a reduction in hours and/or reduction of physical intensity. Unfortunately, GET doesn’t restore the ability to work. Instead, more patients are unable to work and more are reliant on illness benefits after being treated with GET than before treatment with it.

Finally, to use the words of three leading exercise physiologists in the field of ME/CFS, “graded exercise [therapy]…not only fails to improve function, but is detrimental to the health of [ME/CFS] patients and should not be recommended” [106]

 

3.6 Important factors enabling a return to work

According to a report by NIVEL, the Netherlands Institute for Health Services Research [92], there are a number of important things which enabled ME/CFS patients to (return to) work. For 92%, the most important thing was support in finding the right balance between work and spare time. The second most important thing (84%), was support and cooperation from the employer to enable patients to continue to work. Other important things were the following:

• supplying information about ME/CFS to colleagues and superiors (62%);
• changing tasks (61%);
• reducing the number of hours they had to work (61%);
• more rest periods during working times (60%);
• the availability of a special rest place at work (45%);
• working from home (52%);
• individual support and coaching in general (51%);
• and by an occupational health physician in particular (44%);
• adjustments to working conditions (furniture, physical aids) (38%);
• and a regulation or provision for commuting to work (36%).

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Properties of measurements obtained during Cardiopulmonary Exercise Testing in individuals with ME/CFS

Properties of measurements obtained during Cardiopulmonary Exercise Testing in individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, by Todd E Davenport, Staci R Stevens, M A Jared Stevens, Christopher R Snell, J Mark VanNess in Work vol. 66, no. 2, pp. 247-256, 2020 Jul 20 [doi: 10.3233/WOR-203170]

 

Research abstract:

Background:

Diminished cardiopulmonary exercise test (CPET) performance indicates the physiological basis for reduced capacity for activities of daily living and work. Thus, it may be a biomarker for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

Objective:

To determine statistical properties of cardiac, pulmonary, and metabolic measurements obtained during CPET in people with ME/CFS.

Methods:

Fifty-one females with ME/CFS and 10 sedentary females with similar age and body mass received cardiac, pulmonary, and metabolic measurements during 2 CPETs separated by 24 hours. Two-way analysis of variance and effect size calculations (Cohen’s d) were used to assess the magnitude and statistical significance of differences in measurements between groups. Reliability of CPET measurements was estimated using intraclass correlation coefficients (formula 2,1; ICC2,1). Responsiveness of CPET measurements was assessed using minimum detectable change outside the 95% confidence interval (MDC95) and coefficients of variation (CoV).

Results:

CPET measurements demonstrated moderate to high reliability for individuals with ME/CFS. Comparing subjects with ME/CFS and control subjects yielded moderate to large effect sizes on all CPET measurements. MDC95 for all individuals with ME/CFS generally exceeded control subjects and CoVs for CPET measurements were comparable between groups.

Conclusions:

CPET measurements demonstrate adequate responsiveness and reproducibility for research and clinical applications.

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