The weekly research round-up includes recent publications about ME/CFS and Long Covid. We highlight the studies that have particularly caught our interest and follow these with the full list of publications together with their abstracts (summaries).
All research relating to ME/CFS can be located in the ME Association: Index of ME/CFS Published Research. It is a FREE resource, available to anyone, and updated at the beginning of each month.
The Index provides an A-Z of published research studies, selected key documents and articles, listed by subject matter, on myalgic encephalomyelitis, myalgic encephalopathy, and/or chronic fatigue syndrome (ME/CFS).
You can use it to easily locate and read any research that you might be interested in regard to, e.g., epidemiology, infection, neurology, post-exertional malaise etc.
You can also find the Research Index in the Research section of the website together with a list of Research Summaries that provide more detailed lay explanations of the more interesting work that has been published to date.
There’s only been two new research studies on ME/CFS but twelve studies on Long Covid. None of the studies really caught our eyes this week, therefore, we have briefly covered each one below:
The first paper (1) was a very small study using 22 people with ME/CFS and 13 controls to detect any changes in neurochemicals in the brain, such as, those responsible for oxidative stress and mitochondrial dysfunction. The study found that compared to healthy controls ME/CFS patients had lower levels of:
- Glutathione – a substance made from amino acids and produced by the liver. Glutathione is in many processes, such as: involved in repairing tissues and immune system function.
- Total creatine – an amino acid found in muscles and brain, where it is used for energy, it is thoughts to improve strength and muscle. The body can synthesise creatine as well as getting it from meat. Creatine is often taken my athletes to improve performance
- Myo-inositol – a vitamin like substance and a carbocyclic sugar, used for mediating cell signals. Myo-inositol is made by the body (such as in the kidneys) but the highest concentration is found in the brain. It is thought to help balance certain chemicals in the body and help with depression and anxiety.
The authors of the paper conclude that:
“The changes in glutathione and creatine are consistent with the presence of oxidative and energetic stress in CFS patients and are potentially remediable by nutritional intervention. A reduction in myo-inositol would be consistent with glial dysfunction. However, the relationship of the neurochemical abnormalities to the causation of CFS remains to be established, and the current findings require replication in a larger sample.”
These findings are interesting as all three substances highlighted above can be taken in supplement form. Although it should be noted, that almost half the patients in this study were taking antidepressants so this could have important implications on chemicals in the brain.
The second paper (2) is on severe ME/CFS, this paper is definitely worth a read and looks into the recommendations for caring for someone with severe ME. This paper describes the clinical features, how to provide compassionate care, diagnosis and assessment, and gives recommendations for caring for someone. The paper is set out in mostly a bullet point format making it easy to read and has a table with practical recommendations for energy conservation and management of daily activities such as washing, dressing and toileting.
The authors conclude that: “Caring for such vulnerable patients requires a patient-centred, collaborative approach in all clinical interactions, one that is grounded in compassion, humility, and respect for the nature and severity of the patient’s disease. Use of carefully selected pharmacological and non-pharmacological treatments and management approaches can help protect against worsening of the patient’s health while decreasing symptom burden and improving the patient’s quality of life.”
ME/CFS Research References and Abstracts
Godlewska BR, Williams S, Emir UE, Chen C, Sharpley AL, Goncalves AJ, Andersson MI, Clarke W, Angus B, Cowen PJ.
Psychopharmacology (Berl). 2021 Oct 5. [Epub ahead of print.]
Abstract
Rationale: Chronic fatigue syndrome (CFS) is a common and burdensome illness with a poorly understood pathophysiology, though many of the characteristic symptoms are likely to be of brain origin. The use of high-field proton magnetic resonance spectroscopy (MRS) enables the detection of a range of brain neurochemicals relevant to aetiological processes that have been linked to CFS, for example, oxidative stress and mitochondrial dysfunction.
Methods: We studied 22 CFS patients and 13 healthy controls who underwent MRS scanning at 7 T with a voxel placed in the anterior cingulate cortex. Neurometabolite concentrations were calculated using the unsuppressed water signal as a reference.
Results: Compared to controls, CFS patients had lowered levels of glutathione, total creatine and myo-inositol in anterior cingulate cortex. However, when using N-acetylaspartate as a reference metabolite, only myo-inositol levels continued to be significantly lower in CFS participants.
Conclusions: The changes in glutathione and creatine are consistent with the presence of oxidative and energetic stress in CFS patients and are potentially remediable by nutritional intervention. A reduction in myo-inositol would be consistent with glial dysfunction. However, the relationship of the neurochemical abnormalities to the causation of CFS remains to be established, and the current findings require prospective replication in a larger sample.
2. Caring for the Patient with Severe or Very Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Montoya, J.G.; Dowell, T.G.; Mooney, A.E.; Dimmock, M.E.; Chu, L.
Healthcare 2021, 9, 1331.
Abstract:
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) can cause a wide range of severity and functional impairment, leaving some patients able to work while others are homebound or bedbound.
The most severely ill patients may need total care. Yet, patients with severe or very severe ME/CFS struggle to receive appropriate medical care because they cannot travel to doctors’ offices and their doctors lack accurate information about the nature of this disease and how to diagnose and manage it.
Recently published clinical guidance provides updated information about ME/CFS but advice on caring for the severely ill is limited.
This article is intended to fill that gap. Based on published clinical guidance and clinical experience, we describe the clinical presentation of severe ME/CFS and provide patient-centered recommendations on diagnosis, assessment and approaches to treatment and management. We also provide suggestions to support the busy provider in caring for these patients by leveraging partnerships with the patient, their caregivers, and other providers and by using technology such as telemedicine.
Combined with compassion, humility, and respect for the patient’s experience, such approaches can enable the primary care provider and other healthcare professionals to provide the care these patients require and deserve.
Long-COVID Research References
Katrina Pears, Research Correspondent, ME Association