From BMJ Open, 19 November 2012.
A preliminary prospective study of nutritional, psychological and combined therapies for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in a private care setting.
Arroll MA, Howard A
Department of Research, The Optimum Health Clinic, London, UK.
Abstract
BACKGROUND
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a condition characterised by severe and persistent fatigue, neurological disturbances, autonomic and endocrine dysfunctions and sleep difficulties that have a pronounced and significant impact on individuals' lives.
Current National Institute for Health and Clinical Excellence guidelines within the UK suggest that this condition should be treated with cognitive behavioural therapy and/or graded exercise therapy, where appropriate.
There is currently a lack of an evidence base concerning alternative techniques that may be beneficial to those with ME/CFS.
OBJECTIVES
This study aimed to investigate whether three modalities of psychology, nutrition and combined treatment influenced symptom report measures in those with ME/CFS over a 3-month time period and whether there were
significant differences in these changes between groups.
DESIGN AND SETTING
This is a preliminary prospective study with one follow-up point conducted at a private secondary healthcare facility in London, UK.
PARTICIPANTS
138 individuals (110 females, 79.7%; 42 participants in psychology, 44 in nutrition and 52 in combined) participated at baseline and 72 participants completed the battery of measures at follow-up (52.17% response rate; 14, 27 and 31 participants in each group, respectively).
OUTCOME MEASURES
Self-reported measures of ME/CFS symptoms, functional ability, multidimensional fatigue and perceived control.
RESULTS
Baseline comparisons showed those in the combined group had higher levels of fatigue. At follow-up, all groups saw improvements in fatigue, functional ability and symptomatology; those within the psychology group also experienced a shift in perceived control over time.
CONCLUSIONS
This study provides early evidence that psychological, nutritional and combined techniques for the treatment of ME/CFS may influence symptomatology, fatigue, function and perceived control.
However, these results must be viewed with caution as the allocation to groups was not randomised, there was no control group and the study suffered from high drop-out rates.
From the International Journal of Clinical Medicine, published online November 2012 (link downloads full paper).
The Effects of Influenza Vaccination on Immune Function in Patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis
E.W. Brenu(1,2*), M. van Driel(1,4), D.R. Staines(1,5), S. Kreijkamp-Kaspers(1,2), S. L. Hardcastle(1,2), S.M.Marshall-Gradisnik(1,2,3).
(1) Faculty of Health Science and Medicine, Population Health and Neuroimmunology Unit, Bond University, Robina, QLD, Australia;
(2) Faculty of Health Science and Medicine, Bond University, Robina, QLD, Australia;
(3) School of Medical Science, Griffith Health Institute, Griffith University, Gold Coast Campus, Gold Coast, QLD, Australia;
(4) Discipline of General Practice, School of Medicine, University of Queensland, Brisbane, Australia; (5) Queensland Health, Gold Coast Public Health Unit, Robina, Gold Coast, QLD, Australia.
Abstract
Immune dysfunction is a hallmark of Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis (CFS/ME). The purpose of this pilot study was to identify the effects of influenza vaccination on immune function in patients with CFS/ME. We included 7 patients meeting the Centre for Disease Control and Prevention criteria (CDC 1994) for ME/CFS and 8 control subjects.
Bloods were collected from all participants prior to vaccination with Influvac a trivalent inactivated influenza vaccine (TIV), 14 and 28 days following vaccination. The immune parameters examined include Natural Killer (NK) phenotypes, NK cytotoxic activity, FOXP3 and Th1/Th2/Th17 related cytokines. Flow cytometric protocols were employed.
There was no significant difference in NK phenotypes and Tregs numbers between CFS/ME patients and healthy controls. However, NK activity was significantly decreased at baseline and at 28 days while at 14 days it was significantly increased in the CFS/ME patients compared to the healthy controls.
Th1 pro-inflammatory cytokines were much more increased in the CFS/ME patients at 28 days compared to the non-fatigued controls. Only one Th2 cytokine, IL-4, was increased in the CFS/ME participants. FOXP3 expressing Tregs were significantly increased only at day 28 post vaccination in the CFS/ME patients compared to the healthy controls.
Self-rated wellbeing was lower for patients at day 28 while at baseline and day 14 no differences were observed. In this pilot study immunization with influenza vaccine is accompanied by a degree of immune dysregulation in CFS/ME patients compared with controls.
While vaccination may protect CFS/ME patients against influenza, it has the ability to increase cytotoxic activity and pro-inflammatory reactions post vaccination. The role of Tregs in promoting a toxic effect at 28 days post-vaccination in our patient group cannot be ruled out.
The benefits of influenza vaccine still likely outweigh the risks CFS/ME patients experience following vaccination.
From the British Medical Journal, 22 October 2012. Full paper online.
A patient's journey: Fatigue in primary biliary cirrhosis
Matilda Hale, patient(1), Julia L Newton, professor of ageing and medicine(2), David E J Jones, professor of liver immunology(2)
(1) Cramlington, Northumberland, UK
(2) Newcastle University and Newcastle Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK
This is one of a series of occasional articles by patients about their experiences that offer lessons to doctors. The BMJ welcomes contributions to the series. Please contact Peter Lapsley (plapsley@bmj.com) for guidance.
MEA note: Our medical adviser, Dr Charles Shepherd, comments: “As is pointed out in the clinical assessment/diagnosis section of the MEA purple booklet, primary biliary cirrhosis is an important part of the differential diagnosis of an ME/CFS like illness. Professor Newton has done important work on autonomic dysfunction in ME/CFS and it is interesting to note that people with PBC also have autonomic dysfunction. Professor Newton is being funded by the MRC to carry out further research into ANS dysfunction in ME/CFS. She has also been funded by the MEA Ramsay Research Fund to carry out research into the role of muscle energy metabolism abnormalities in ME/CFS.”
Julia Newton, Professor of Ageing and Medicine at the School of Clinical Medical Sciences of Newcastle University, gave a talk on ‘Standing up for fatigue' at Action for M.E.'s Annual General Meeting on 15 November 2012.
presentation slides w/audio commentary: http://vimeo.com/53777108
video of lecture: http://vimeo.com/53729624
Isn’t it true that David Jones (Newtons collaborator) has patients who meet the Fukuda criteria that also have biliary cirrhosis, which would explain their fatigue. Since when can you select biliary cirrhosis patients using the Fukuda criteria?
Fatigue is a undefined symptom with many causes. Biliary cirrhosis is known to cause fatigue. Why is this anything to do with ME?
Gut. 1998 Nov;43(5):705-10.
Fatigue in primary biliary cirrhosis.
“Poor sleep quality and depression were commonly associated with fatigue.”
http://www.ncbi.nlm.nih.gov/pubmed/9824355