Tag: 2021

An app to help assess the severity of symptoms in chronic fatigue syndrome

Press release Eurekalert:

Chronic fatigue syndrome / myalgic encephalomyelitis (CFS/ME) is a disabling disease, in which people have great difficulties in carrying out their daily activities. Despite its high prevalence, there are still no effective tools for its diagnosis, monitoring and treatment. To better understand and promote follow-up, as well as stratify fatigue in these patients, Vall d’Hebron, the Universitat Autònoma de Barcelona (UAB) and the Universitat Politècnica de Catalunya · BarcelonaTech (UPC) have developed a mobile application that could be useful in the assessment of the severity of fatigue in this syndrome, especially in women. The results of the study in which this technology has been tested have been published in the journal Sensors.

The technology developed by the UAB and UPC researchers consists of a chest strap with a sensor capable of measuring certain cardiac hemodynamic variables, connected via Bluetooth to a mobile app. The mobile application allows you to record and monitor heart rate variability and share the analyzed results with the medical staff who supervise patients.

Specifically, this study analyzed the relationship between heart rate variability and severity of symptoms among women and men with CFS/ME. This parameter is closely related to heart rate, that is, the number of beats per minute of the heart. However, the time that passes between two consecutive beats is not always exactly the same, but small differences that fall within normality can be detected: this is what is known as heart rate variability (HRV).

In previous studies published in the Journal of Translational Medicine, HRV had already been related to the assessment of the severity of fatigue in women with CFS/ME. “Specifically, we had observed that this variability was lower in patients with CFS/ME, especially in the most disabling cases”, explains Dr. Jesús Castro, coordinator of the laboratory in Chronic Fatigue Syndrome / Myalgic Encephalomyelitis of the Rheumatology group of the Vall d’Hebron Research Institute (VHIR). A priori, it is considered positive to have a high variability, as it is an indicator of the proper functioning of the autonomic nervous system. “In this work we wanted to verify the relationship between HRV and the syndrome in both women and men with CFS/ME compared to healthy controls and its usefulness for monitoring patients”, adds Dr. Castro.

In line with previous studies, it was found that HRV measurement with mobile app technology could predict the severity of disabling fatigue in patients with chronic fatigue syndrome/myalgic encephalomyelitis. This was especially observed in the case of women, but this relationship was not so clear in the case of men. “We demonstrated that the use of the app would be especially useful for the monitoring of women suffering from this syndrome, which clearly have a lower variability of heart rate compared to healthy women”, says Dr. Rosa M Escorihuela, from the Department of Psychiatry and Legal Medicine of the UAB. Thus, HRV would be a good predictor marker of the severity of fatigue during the clinical course of the disease.

The study was carried out with 77 patients with this CFS/ME (32 men and 45 women) and their results were compared with those of a control group. The HRV evaluation was carried out in 3 sessions of 5 minutes, separated between one and three weeks and under controlled conditions.

This study has been carried out, in part, thanks to the R&D project PID2019-107473RB-C21, coordinated by researchers from the UAB and the UPC, and funded by the Ministry of Science and Innovation.

An improved non-invasive technology

Dr. Juan Ramos Castro, from the Electronic and Biomedical Instrumentation group and the Department of Electronic Engineering at the UPC, comments that “the experience of the UAB and UPC research groups has made it possible to correct the most important limitations presented by this technology such as errors in the measurement of cardiac variability produced by incorrect placement of the chest strap and / or the movement and breathing of the patient during recording, and obtaining the records under controlled conditions to reduce the influence of other external factors. The results of the analysis are stored in a single and secure server and can be consulted through a specific platform”. Dr. Lluís Capdevila, researcher at the Department of Basic, Evolutionary and Educational Psychology and the Sports Research Institute of the UAB, adds that “it is a non-invasive technology that is easy to use by patients or users, through your mobile device. In this way, they can perform self-assessments in ecological situations and could be monitored in real time”.

As Dr. Lluís Capdevila comments, “the same system originated and has been used successfully for real-time monitoring and follow-up of the relationship between physical effort and recovery, both in athletes and in the general population. For example, sports clubs such as Futbol Club Barcelona (women’s basketball and soccer sections) or New York City FC have used this system, and national teams such as the Spanish Basketball Federation, the Spanish Field Hockey Federation (men’s and female), or the Spanish Federation of Mountain Sports and Climbing”.

Vall d’Hebron, member of the European Network on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

In Catalonia it is estimated that there are currently between 350,000 and 500,000 people affected by chronic fatigue syndrome / myalgic encephalomyelitis, and 2 out of 3 affected people are women. Worldwide, a prevalence of between 17 and 25 million people with this affectation is estimated. In addition, these numbers are predicted to double by 2030 due to persistent COVID-19, a condition in which patients have similar symptoms: this is known as postviral chronic fatigue syndrome, which has been previously described in other coronaviruses (SARS-CoV-1 and MERS) for other viruses such as Ebola, Epstein-Barr and Cytomegalovirus.

Severe fatigue is the main symptom of CFS/ME, in addition to problems with immediate memory and speed of information processing and concentration, intolerance to physical / mental exercise, pain and dizziness. This syndrome can be very disabling, but even so, there are currently no diagnostic biomarkers or specific therapeutic options, so it is important that experts in the field work in a coordinated way to improve the care and management of these patients.

In this sense, Drs. José Alegre and Jesús Castro, both from Vall d’Hebron, are members for Spain in the European Network on Chronic Fatigue Syndrome / Myalgic Encephalomyelitis (EUROMENE), which includes 55 professionals from 22 European countries. A consensus document on therapeutic and diagnostic approaches for this syndrome was recently published in the journal Medicina.

This document brings together the diagnostic criteria used in the participating countries as well as the experience of professionals in the management and treatment of patients, taking into account both pharmacological and non-pharmacological therapies. In addition, experts present recommendations, from Europe and internationally, for the care of these patients. “It is necessary to have a health system that takes into account patients with chronic fatigue syndrome / myalgic encephalomyelitis, a pathology that has a great socioeconomic impact”, says Dr. José Alegre, from the Experience Unit in Syndromes of Central Awareness of the Rheumatology Service of the Vall d’Hebron University Hospital. Experts consider that it would be necessary to have between 2 and 4 specialist doctors for every million inhabitants with the support of a multidisciplinary team, such as nurses, physiotherapists, rehabilitators, occupational therapists, psychologists, nutritionists, social workers, etc.

It should be noted that not all countries have the same services for the care of patients with CFS/ME. In this sense, Catalonia is leading in terms of the care of these patients, since in our territory there are various units formed in this area to diagnose and treat this syndrome. Specifically, Vall d’Hebron has an Experience Unit in Central Sensitization Syndromes, within the Rheumatology Service, which works on both chronic fatigue syndrome / myalgic encephalomyelitis and fibromyalgia.

Insights from myalgic encephalomyelitis/chronic fatigue syndrome may help unravel the pathogenesis of postacute COVID-19 syndrome

Abstract:

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause chronic and acute disease. Postacute sequelae of SARS-CoV-2 infection (PASC) include injury to the lungs, heart, kidneys, and brain that may produce a variety of symptoms. PASC also includes a post-coronavirus disease 2019 (COVID-19) syndrome (‘long COVID’) with features that can follow other acute infectious diseases and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

Here we summarize what is known about the pathogenesis of ME/CFS and of ‘acute’ COVID-19, and we speculate that the pathogenesis of post-COVID-19 syndrome in some people may be similar to that of ME/CFS. We propose molecular mechanisms that might explain the fatigue and related symptoms in both illnesses, and we suggest a research agenda for both ME/CFS and post-COVID-19 syndrome.

Source: Komaroff AL, Lipkin WI. Insights from myalgic encephalomyelitis/chronic fatigue syndrome may help unravel the pathogenesis of postacute COVID-19 syndrome. Trends Mol Med. 2021 Jun 7:S1471-4914(21)00134-9. doi: 10.1016/j.molmed.2021.06.002. Epub ahead of print. PMID: 34175230. https://pubmed.ncbi.nlm.nih.gov/34175230/

Broadband electrical impedance as a novel characterization of oxidative stress in single L6 skeletal muscle cells

Abstract:

Oxidative stress (OS) is one of the leading causes of cytotoxicity and is linked to many human physio-pathological conditions. In particular, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) induced by OS is debilitating to quality of life, while no clear biological markers have been identified for diagnostic measures. Recently, impedance measurements of peripheral blood cells of ME/CFS patients have been shown as a promising approach to diagnose the disease. Inspired by this study and aiming to interrogate muscle cells directly, we investigated if broadband measurements of single muscle cells could differentiate normal and oxidatively stressed cell populations.

We first optimized a protocol through H2O2 treatment to introduce oxidative stress to cultured rat L6 skeletal muscle cells. The treated cells were further characterized through broadband impedance spectroscopy of single cells using a microfluidic lab-on-a-chip system. The resulting dielectric properties of cytoplasm permittivity and conductivity are electrically distinct from normally cultured cells. The reflection and transmission coefficients, ΔS11 and ΔS21, of the normal cells are tightly clustered and closely resemble those of the cell-free solution across the frequency range of 9 kHz to 9 GHz. On the other hand, dielectric properties of the oxidized cells have a wide distribution in the GHz range, deviating both in the positive and negative directions from the normally cultured cells.

Simulation results guide our hypothesis that the dielectric differences could be linked to ion alterations, while calcium imaging directly supports the contribution of calcium flux to the observed deviation of S parameters. The unique electrical profile associated with oxidized cells in the GHz frequencies provide a framework for future development of technologies to diagnose oxidative-stress related diseases such as ME/CFS.

Source: Ferguson C, Pini N, Du X, Farina M, Hwang JMC, Pietrangelo T, Cheng X. Broadband electrical impedance as a novel characterization of oxidative stress in single L6 skeletal muscle cells. Anal Chim Acta. 2021 Aug 15;1173:338678. doi: 10.1016/j.aca.2021.338678. Epub 2021 May 25. PMID: 34172152. https://pubmed.ncbi.nlm.nih.gov/34172152/

Documenting disability in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)

Abstract:

BACKGROUND: According to the 2015 National Academy of Medicine report, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) “is a serious, chronic, complex, and systemic disease that frequently and dramatically limits the activities of affected patients.” ME/CFS affects between 1 and 2.5 million Americans, leaving as many as 75% unable to work due to physical, cognitive and functional impairment. Unfortunately, many doctors and lawyers lack the knowledge of how to properly document an ME/CFS disability claim, leaving patients unable to access disability benefits.

OBJECTIVE: The goal of this article is to summarize the approaches used by experienced clinicians and lawyers in successful ME/CFS disability claims.

METHODS: The authors reviewed the types of US disability insurance programs and the evidence commonly required by these programs to demonstrate ME/CFS disability.

RESULTS: This article summarizes the range of methods used in successful US disability claims, which include documentation of the functional impact of post-exertional malaise and the use of methods that provide objective evidence of impairment.

CONCLUSIONS: Medical providers and lawyers can use these tested methods to obtain disability benefits for people with ME/CFS. Physical therapists, occupational therapists, and other specialists play an important role in providing objective evidence for ME/CFS disability claims.

Source: Podell, Richard, Dimmock, Mary E., and Comerford, Barbara B. ‘Documenting Disability in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)’. 1 Jan. 2020 : 339 – 352. https://content.iospress.com/articles/work/wor203178 (Full text)

Physical and Mental Fatigue in Subjects Recovered from COVID-19 Infection: A Case–Control Study

Abstract:

Purpose: Much effort has been directed toward studying COVID-19 symptoms; however, the post–COVID-19 phase remains mysterious. The aim of this work was to conduct a clinical and neurophysiological evaluation of physical and mental fatigue in COVID-19 long-haulers and to study whether markers of COVID-19 severity are able to predict the likelihood of developing postinfectious fatigue syndrome (PIFS) in such patients.

Patients and Methods: This case–control study was conducted on 46 COVID-19 long-haulers who met the criteria for PIFS and 46 recovered COVID-19 subjects without any residuals. Clinical assessment of fatigue was done using a fatigue questionnaire. Repetitive nerve stimulation and single-fiber electromyography were done after excluding neuropathy and myopathy.

Results: The median value for physical fatigue was 4 (IQR 2– 7), while that for mental fatigue was 2 (IQR 0– 3). Each day’s increase in the period of COVID-19 illness increased the odds of PIFS in COVID-19 long-haulers 1.104-fold, and each unit increase in ferritin increased the odds of PIFS 1.006-fold. A significant decrement in at least one muscle was observed in 50% of patients. Patients with PIFS had significantly higher mean consecutive difference (MCD) in the extensor digitorum communis than the control group. There were statistically significant positive correlations between MCD values and physical, mental, and total fatigue scores.

Conclusion: Higher ferritin levels and prolonged COVID-19 infection were independent predictors of PIFS in COVID-19 long-haulers. There was electrophysiological evidence of abnormalities in the peripheral portion of the motor unit in COVID-19 long-haulers with PIFS.

Source: Elanwar R, Hussein M, Magdy R, Eid RA, Yassien A, Abdelsattar AS, Alsharaway LA, Fathy W, Hassan A, Kamal YS. Physical and Mental Fatigue in Subjects Recovered from COVID-19 Infection: A Case–Control Study. Neuropsychiatr Dis Treat. 2021;17:2063-2071 https://doi.org/10.2147/NDT.S317027 https://www.dovepress.com/physical-and-mental-fatigue-in-subjects-recovered-from-covid-19-infect-peer-reviewed-fulltext-article-NDT (Full text)

Migraine Is More Than Just Headache: Is the Link to Chronic Fatigue and Mood Disorders Simply Due to Shared Biological Systems?

Abstract:

Migraine is a symptomatically heterogeneous condition, of which headache is just one manifestation. Migraine is a disorder of altered sensory thresholding, with hypersensitivity among sufferers to sensory input. Advances in functional neuroimaging have highlighted that several brain areas are involved even prior to pain onset. Clinically, patients can experience symptoms hours to days prior to migraine pain, which can warn of impending headache. These symptoms can include mood and cognitive change, fatigue, and neck discomfort. Some epidemiological studies have suggested that migraine is associated in a bidirectional fashion with other disorders, such as mood disorders and chronic fatigue, as well as with other pain conditions such as fibromyalgia. This review will focus on the literature surrounding alterations in fatigue, mood, and cognition in particular, in association with migraine, and the suggested links to disorders such as chronic fatigue syndrome and depression.

We hypothesize that migraine should be considered a neural disorder of brain function, in which alterations in aminergic networks integrating the limbic system with the sensory and homeostatic systems occur early and persist after headache resolution and perhaps interictally. The associations with some of these other disorders may allude to the inherent sensory sensitivity of the migraine brain and shared neurobiology and neurotransmitter systems rather than true co-morbidity.

Source: Karsan N, Goadsby PJ. Migraine Is More Than Just Headache: Is the Link to Chronic Fatigue and Mood Disorders Simply Due to Shared Biological Systems? Front Hum Neurosci. 2021 Jun 3;15:646692. doi: 10.3389/fnhum.2021.646692. PMID: 34149377; PMCID: PMC8209296. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8209296/ (Full text)

Chronic post-COVID-19 syndrome and chronic fatigue syndrome: Is there a role for extracorporeal apheresis?

Abstract:

As millions of patients have been infected by SARS-CoV-2 virus a vast number of individuals complain about continuing breathlessness and fatigue even months after the onset of the disease. This overwhelming phenomenon has not been well defined and has been called “post-COVID syndrome” or “long-COVID” [1]. There are striking similarities to myalgic encephalomyelitis also called chronic fatigue syndrome linked to a viral and autoimmune pathogenesis. In both disorders neurotransmitter receptor antibodies against ß-adrenergic and muscarinic receptors may play a key role. We found similar elevation of these autoantibodies in both patient groups.

Extracorporeal apheresis using a special filter seems to be effective in reducing these antibodies in a significant way clearly improving the debilitating symptoms of patients with chronic fatigue syndrome. Therefore, such a form of neuropheresis may provide a promising therapeutic option for patients with post-COVID-19 syndrome. This method will also be effective when other hitherto unknown antibodies and inflammatory mediators are involved.

Source: Bornstein SR, Voit-Bak K, Donate T, Rodionov RN, Gainetdinov RR, Tselmin S, Kanczkowski W, Müller GM, Achleitner M, Wang J, Licinio J, Bauer M, Young AH, Thuret S, Bechmann N, Straube R. Chronic post-COVID-19 syndrome and chronic fatigue syndrome: Is there a role for extracorporeal apheresis? Mol Psychiatry. 2021 Jun 17. doi: 10.1038/s41380-021-01148-4. Epub ahead of print. PMID: 34140635. https://pubmed.ncbi.nlm.nih.gov/34140635/

Central Sensitivity and Fibromyalgia

Abstract:

Fibromyalgia presents with symptoms of widespread pain, fatigue, sleeping and cognitive disturbances as well as other somatic symptoms. It often overlaps with other conditions termed ‘central sensitivity syndromes’ such as irritable bowel syndrome, chronic fatigue syndrome and temporomandibular disorder. Central sensitisation, mediated by amplified processing in the central nervous system, has been identified as the key pathogenic mechanism in these disorders. The term ‘central sensitivity’ can be used to collectively describe the clinical presentation of these disorders.

Fibromyalgia is highly prevalent in most rheumatic diseases as well as non-rheumatic chronic diseases and if unrecognised results in high morbidity. It is diagnosed clinically after excluding important differential diagnoses. Diagnostic criteria have been developed as tools to help identify and diagnose fibromyalgia. Such tools can fulfill an important need when managing patients with rheumatic disease and other chronic diseases as a way to identify fibromyalgia and improve patient outcomes. Treatment involves an integrated approach including education, exercise, stress reduction and pharmacological therapies targeting the central nervous system. This approach is suitable for all presentations of central sensitivity and some central sensitivity syndromes have additional treatment options specific to the clinical presentation.

Source: Mezhov V, Guymer E, Littlejohn G. Central Sensitivity and Fibromyalgia. Intern Med J. 2021 Jun 17. doi: 10.1111/imj.15430. Epub ahead of print. PMID: 34139045. https://pubmed.ncbi.nlm.nih.gov/34139045/

Chronic fatigue and post-exertional malaise in people living with long COVID

Abstract:

Purpose People living with long COVID describe a high symptom burden, and a more detailed assessment of chronic fatigue and post-exertional malaise (PEM) may inform the development of rehabilitation recommendations. The aims of this study were to use validated questionnaires to measure the severity of fatigue and compare this with normative data and thresholds for clinical relevance in other diseases; measure and describe the impact of PEM; and describe symptoms of dysfunctional breathing, self-reported physical activity/sitting time, and health-related quality of life.

Methods This was an observational study involving an online survey for adults living with long COVID (data collection from February-April, 2021) following a confirmed or suspected SARS-CoV-2 infection. Questionnaires included the Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-F) and DePaul Symptom Questionnaire-Post-Exertional Malaise.

Results After data cleaning, n=213 participants were included in the analysis. Participants primarily identified as women (85.5%), aged 40-59 (78.4%), who had been experiencing long COVID symptoms for ≥6 months (72.3%). The total FACIT-F score was 18±10 (where the score can range from 0-52, and a lower score indicates more severe fatigue), and 71.4% were experiencing chronic fatigue. Post-exertional symptom exacerbation affected most participants, and 58.7% met the scoring thresholds used in people living with myalgic encephalomyelitis/chronic fatigue syndrome. PEM occurred alongside a reduced capacity to work, be physically active, and function both physically and socially.

Conclusion Long COVID is characterized by chronic fatigue that is clinically relevant and is at least as severe as fatigue in several other clinical conditions, including cancer. PEM appears to be a common and significant challenge for the majority of this patient group. Patients, researchers, and allied health professionals are seeking information on safe rehabilitation for people living with long COVID, particularly regarding exercise. Fatigue and post-exertional symptom exacerbation must be monitored and reported in studies involving interventions for people with long COVID.

Source: Rosie Twomey, Jessica DeMars, Kelli Franklin, S. Nicole Culos-Reed, Jason Weatherald, James G. Wrightson. Chronic fatigue and post-exertional malaise in people living with long COVID. medRxiv 2021.06.11.21258564; doi: https://doi.org/10.1101/2021.06.11.21258564 https://www.medrxiv.org/content/10.1101/2021.06.11.21258564v1

Epistemic in/justice in patient participation. A discourse analysis of the Dutch ME/CFS Health Council advisory process

Abstract:

In healthcare settings, patient participation is increasingly adopted as a possible remedy to ill people suffering from ‘epistemic injustices’ – that is to their unfair harming as knowers. In exploring and interpreting patient participation discourses within the 2013-2018 Dutch Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS) Health Council advisory process, this paper assesses the epistemological emancipatory value of this participatory practice. It reveals that in the analysed case, patient representatives predominantly offer biomedical knowledge about ME/CFS. They frame this condition as primarily somatic, and accordingly, perceive appropriate diagnostic criteria, research avenues and treatment options as quantifiable, objectifiable and explicitly non-psychogenic.

This paper argues that such a dominant biomedical patient participatory practice is ambiguous in terms of its ability to correct epistemic injustices towards ill people. Biomedicalized patient participation may enhance people’s credibility and their ability to make sense of their illness, but it may also undermine their valid position within participatory practices as well as lead to (sustaining) biased and reductive ideas about who ill people are and what kind of knowledge they hold. The final section of this paper offers a brief reflection on how to navigate such biomedicalized participatory practices in order to attain more emancipatory ones.

Source: de Boer ML. Epistemic in/justice in patient participation. A discourse analysis of the Dutch ME/CFS Health Council advisory process. Sociol Health Illn. 2021 Jun 17. doi: 10.1111/1467-9566.13301. Epub ahead of print. PMID: 34137042. https://pubmed.ncbi.nlm.nih.gov/34137042/