Achieving symptom relief in ME/CFS with INMEST
A small Swedish study used intranasal mechanical stimulation (INMEST) to target symptoms in people with ME of autonomic dysregulation e.g. dizziness, fainting when standing up, digestive problems, sweating, vision problems. Participants received 20 minutes of INMEST twice a week for 1 month, or placebo treatment.
“The INMEST device consists of a thin plastic probe placed in the nose that vibrates at a set frequency to mimic turbulent airflow within the nasal cavity and induces a nerve reflex, likely mediated via the trigeminal nerve and transmitted to brainstem with possible effects on the vagus nerve.”
INMEST produced a 30% reduction in symptom intensity after 8 weeks. There were also measurable changes in immune measurements.
ME patients were required to visit the clinic twice weekly for 8 weeks in order to receive treatments and provide blood samples as well as respond to questionnaires. All of these activities were very demanding and caused deterioration in some patients that obscure some of the possible benefits of the therapy. No significant improvement in fatigue was found. In the future a more sustainable way of using INMEST
would be in the form of a self-treatment device used by subjects and care takers at home.
Achieving symptom relief in patients with Myalgic encephalomyelitis by targeting the neuro-immune interface and optimizing disease tolerance, by Lucie Rodriguez, Christian Pou, Tadepally Lakshmikanth, Jingdian Zhang, Constantin Habimana Mugabo, Jun Wang, Jaromir Mikes, Axel Olin, Yang Chen, Joanna Rorbach, Jan-Erik Juto, Tie Qiang Li, Per Julin, Petter Brodin in Oxford Open Immunology [doi.org/10.1093/oxfimm/iqad003] 17 April 2023
Myalgic encephalomyelitis, ME, previously also known as chronic fatigue syndrome (CFS) is a heterogeneous, debilitating syndrome of unknown etiology responsible for long-lasting disability in millions of patients worldwide.
The most well-known symptom of ME is post-exertional malaise, but many patients also experience autonomic dysregulation, cranial nerve dysfunction and signs of immune system activation. Many patients also report a sudden onset of disease following an infection.
The brainstem is a suspected focal point in ME pathogenesis and patients with structural impairment to the brainstem often show ME-like symptoms. The brainstem is also where the vagus nerve originates, a critical neuro-immune interface and mediator of the inflammatory reflex which regulate systemic inflammation.
Here we report the results of a randomized, placebo-controlled trial using intranasal mechanical stimulation (INMEST) targeting nerve endings in the nasal cavity, likely from the trigeminal nerve, possibly activating additional centers in the brainstem of ME-patients and correlating with a ∼30% reduction in overall symptom scores after eight weeks of treatment.
By performing longitudinal, systems-level monitoring of the blood immune system in these patients, we uncover signs of chronic immune activation in ME, as well as immunological correlates of improvement that center around gut-homing immune cells and reduced inflammation.
The mechanisms of symptom relief remains to be determined, but transcriptional analyses suggest an upregulation of disease tolerance mechanisms. We believe that these results are suggestive of ME as a condition explained by a maladaptive disease tolerance response following infection.