Friday, October 12, 2012

Is Myalgic Encephalomyelitis (ME) an Neurological Disease?

First of all, let me say that Myalgic Encephalomyelitis (ME) is classified as a Neurological Disease (ICD 10 G93.3, or F286).

And I don't want to change that.

At least not now. Not until we know whether ME is one disease, or several distinct diseases, and until we know what the pathological processes at the root of ME are.

So regardless how ME is classified, what is the reality of ME? About that I want to speculate a bit.

Personally, I think it will turn out that the ME patient population, very much like CFS, will be composed of several diseases. Maybe there are, compared to CFS, less people who are (mis-)diagnosed with ME but have actually something else – but I doubt that ME is only one disease.

From the Norwegian Rituxan study by Fluge and Melle we know that a sizable portion of ME/CFS patients may have an autoimmune condition – which may or may not exclude neurologic problems to be the root cause. We can't tell from the Norwegian study one way or the other.

From the studies by Christopher Snell we know that VO2 max and exercise tolerance are reduced in a CFS patient population, which would point to cardiovascular causes, lung causes, or muscle-metabolic causes – a neurological root cause seems IMHO unlikely in the sub-group characterized by Dr. Snell, but still possible. The results from Dr. Snell are not particular specific and can be caused by different pathological processes, so there could be several diseases out there having the same VO2 max presentation (as seems already to be the case with other known non-CFS diseases).

From the studies by Kathleen and Alan Light we know that there are at least two sub-groups in the ME/CFS (and FM) patient population:
  • People with a specific presentation of POTS like gene-expression
  • People with a nonspecific presentation of fatigue and pain gene-expression
The specific POTS presentation may be indicative of a cardiovascular orgin, possibly with the involvement of endocrine system (beta-receptors seem to be implicated in a sub-group in the Lights studies). So the POTS sub-group IMHO may be one distinct disease, and I think it is unlikely to be several diseases.

The later sub-group (fatigue/pain) may IMHO most likely originate from metabolic problems in the muscle. It could be possibly caused by several pathways, which would possibly mean several distinct diseases.

These problems could in turn affect the brain in a negative way, showing up as neurological symptoms ("brain fatigue" or "brain fog", etc.)

So in conclusion, at the moment a sizable portion of patients seem to have a non-neurological root cause, especially hinted by the work of Kathleen and Alan Light.

Still, a minority of ME/CFS patients may be suffering from one (or more) – as of now – unknown and/or poorly understood neurological diseases – though it seems unlikely to me that a majority of ME/CFS patients have a neurological problem as root cause.

Of course, this does not preclude an neurological involvement in ME/CFS patients with non-neurological root causes.

This picture may change when more research brings us more data, until then we have to consider non-neurolgical etiologies for a majority of ME/CFS patients – I would not cling on to the neurological label forever.

No comments:

Post a Comment

Comments are most welcome! But please:

- No SPAM whatsoever, no supplements, no pharmaceuticals, no herbs or any other advertisements

- Absolutely no quack-doctors pushing their quack-BS websites (and if you are a quack, I will call you out)

- Be critical if you want to, but try to be coherent

Comments are moderated, because I am tired of Gerwyn-V99-The-Idiot and his moronic sockpuppets, and tired of the story of the two dogs, but I will try to publish everything else.

If you are not Gerwyn (and want to tell me something other than the story of the two dogs), then relax and write something! :-)


5-AZA A. Melvin Ramsay Acne Advocacy Alan Light Alternative medicine is an untested danger Ampligen Andrew Wakefield Anecdote Anthony Komaroff Antibiotics Antibodies Anxiety Aphthous Ulcers Apnea Asthma Autism Autoimmune Disease Behçet’s Ben Katz Bertrand Russell Biology Blood sugar Bruce Carruthers Caffeine Calcium Cancer Capitalism Cardiology Carmen Scheibenbogen CBT/GET CDC Celiac Disease Cereal Grains CFIDS Chagas Charité Charles Lapp Christopher Snell Chronix Clinician Coconut Milk Cognition Common Sense and Confirmation Bias Conversion Disorder Coxiella Burnetii Coxsackie Criteria Crohn's Cushing's Syndrome Cytokine Daniel Peterson Darwinism David Bell Depression Diabetes Diagnostic Differential Disease Diseases of Affluence DNA DNA Sequencing Dog DSM5 EBV EEG Eggs Elaine DeFreitas Elimination Diet Enterovirus Epstein-Barr ERV Etiology Evolution Exercise Challenge Faecal Transplant Fame and Fraud and Medical Science Fatigue Fatty Acids Fibromyalgia Francis Ruscetti Fructose Gene Expression Genetics Giardia Gordon Broderick Gulf War Illness Gut Microbiome Harvey Alter Health Care System Hemispherx Hemolytic Uremic Syndrome Herpesviridae High Blood Pressure Historic Outbreaks HIV HPV Hyperlipid Ian Hickie Ian Lipkin Immune System Infection Intermittent Fasting It's the environment stupid Jacob Teitelbaum Jamie Deckoff-Jones Jo Nijs John Chia John Coffin John Maddox José Montoya Judy Mikovits Karl Popper Kathleen Light Kenny De Meirleir Lactose Lamb Laszlo Mechtler LCMV Lecture Leonard Jason Leukemia Life Liver Loren Cordain Low Carb Low-Dose Naltrexone (LDN) Luc Montagnier Lucinda Bateman Ludicrous Notions Lumpers and Splitters Lyme Mady Hornig Mark Hasslett Martin Lerner Mary Schweitzer MCS ME/CFS Medical Industry Medicine is not based on anecdotes Michael Maes Migraine Milk and Dairy Mitochondria MMR Money and Fame and Fraud MRI Multiple Chemical Sensitivity Multiple Sclerosis Mutton My Symptoms n-1 Nancy Klimas Narcolepsy Neurodermitis Neuroscience NK-Cell Nocebo NSAID Nutrition Obesity On Nutrition Pain Paleo Parathyroid Pathogen Paul Cheney PCR Pharmaceutical Industry Picornavirus Placebo Polio Post Exertional Malaise POTS/OI/NMH PTSD PUFA Q Fever Quote Rare Disease Research Retrovirus Rheumatoid Arthritis Rituximab RNA Robert Gallo Robert Lustig Robert Silverman Robert Suhadolnik Rosario Trifiletti Sarah Myhill Sarcasm Science Sequencing Seth Roberts Shrinks vs. Medicine Shyh-Ching Lo Simon Wessely Sinusitis Sjögren's Somnolence Sonya Marshall-Gradisnik Speculation Stanislaw Burzynski Statins Stefan Duschek Study Sucrose Sugar Supplements Symptoms T1DM T2DM There is no such thing as Chronic Lyme There is no such thing as HGRV Thyroid Tinitus To Do Toni Bernhard Tourette's Treatment Tuberculosis Vaccine Video Vincent Lombardi Vincent Racaniello Virus Vitamin B Vitamin D VP62 When Evidence Based Medicine Isn't Whooping Cough Wolfgang Lutz WPI XMRV You fail science forever