Research Digest 21/02/20

Welcome to the 41st Emerge Australia Research Digest, where you will find summaries of some of the latest research and information about ME/CFS, with links to the complete articles.

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Cerebral blood flow is reduced in ME/CFS during head-up tilt testing even in the absence of hypotension or tachycardia: a quantitative, controlled study using Doppler echography

Author: van Campen, C.L.M.C., Verheugt, F.W.A., Rowe, P.C., Vissera, F.C.

Orthostatic intolerance (OI) is a common symptom amongst the ME/CFS patient population. It is hypothesised that OI symptoms are caused by a reduction in cerebral blood flow (CBF) however, previous attempts to test this hypothesis have utilised methods of measuring CBF that have provided inconsistent results. In this study, the authors used a more precise method of measuring blood flow velocity in the carotid and vertebral arteries in order to determine whether orthostatic symptoms in ME/CFS are associated with a cerebral blood flow reduction.

The study recruited 429 ME/CFS patients (Fukuda and International Consensus Criteria) and 44 healthy controls. Of the ME/CFS patients, 247 had a normal heart rate and blood pressure response to head-up tilt test (HUT), 62 had delayed orthostatic hypotension (dOH), and 120 had postural orthostatic tachycardia syndrome (POTS). Whilst performing a 30 minute head-up tilt test, extracranial Doppler measurements of cerebral blood flow were recorded at mid-tilt and end-tilt. Verbal questionnaires were administered to assess OI symptoms throughout.

The results showed that ME/CFS patients had a significant reduction in cerebral blood flow using the tilt test compared to healthy controls. Interestingly though this effect was seen in 90% ME/CFS patients regardless of whether they exhibited HR/BP abnormalities or not. These findings may have implications for the diagnosis and treatment of ME/CFS.

Post-exertional malaise is associated with greater symptom burden and psychological distress in patients diagnosed with Chronic Fatigue Syndrome

Author: May, M., Milrad. S.F., Perdomo, D.M., Czaja. S.J., Fletcher, M.A., Jutagir, D.R., Hall, D.L., Klimas, N., Antoni, M.H.

While post-exertional malaise (PEM) is considered a key feature of ME/CFS, not all diagnostic criteria require PEM for a diagnosis. In order to highlight the importance of PEM in ME/CFS diagnoses, this study aimed to investigate differences in ME/CFS patients according to PEM status.  

261 ME/CFS patients (Fukuda criteria) completed several measures of perceived stress, depression, and emotional distress, as well as inventory of ME/CFS symptom type, severity and illness burden. These researchers chose to use the Fukuda criteria because PEM isn’t a mandatory symptom, allowing them to study PEM differences between patients diagnosed with these criteria.

Patients that self-described their PEM as being severe or very severe (hiPEM group) reported greater symptom intensity, frequency, and interference than patients that described their PEM as being mild or moderate (loPEM group). Furthermore, hiPEM patients also reported greater social disruption, depressive symptoms, and mood disturbance.

This study replicates the association between PEM and symptom burden as well as expanding on current knowledge to show an association between PEM and psychological distress – an association that the authors believe could be consequential to the symptom burden. Furthermore, the authors believe that their results also highlight the heterogeneity of patients diagnosed using the Fukuda criteria.

Maximal handgrip strength can predict maximal physical performance in patients with chronic fatigue.

Author: Jammes Y, Stavris C, Charpin C, Rebaudet S, Lagrange G, Retornaz F.

Maximal handgrip strength is used to predict exercise performance in healthy older adults, and patients with COPD, breast cancer and liver cirrhosis. This study evaluated the ability of maximal handgrip strength testing to predict maximal exercise performance in patients with ME/CFS. 

This study included 66 ME/CFS patients (Fukuda criteria) and 32 patients with six months or more of chronic fatigue, but who didn’t meet the diagnostic criteria for ME/CFS. In addition to the handgrip test, a cycle ergometer test was used to measure peak oxygen uptake (VO2max). 

There were no significant differences in the relationship between handgrip strength and maximal exercise performance between the two patient groups, however maximal handgrip strength was found to be significantly and positively correlated with peak oxygen uptake and maximal work rate in all patients with chronic fatigue.

‘He was a kid who loved learning’ — chronic illness and missing school 

Dr Norman Swan presented the story of Ethan Waller on Health Report on the ABC’s Radio National this week. Ethan and his mother, Shelley, described the impact that ME/CFS has had on his life and schooling. Canberra based non profit MissingSchool works to investigate the impact of school absences caused by chronic illnesses such as ME/CFS. CEO Megan Gilmour described the significant social, academic and emotional toll young people experience when they are forced to miss school due to chronic illness. 

In an attempt to bring back a sense of normalcy & connectivity to these students, MissingSchool has launched a telepresence robot pilot in which two-way robot systems are used to provide real-time digital connection between seriously sick children and their classrooms. 

[Note from editor: Emerge Australia has provided two robots for the programme to support students with ME/CFS.]

This interview goes for approx. 7 minutes


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