Importance of fatigue and its measurement in chronic liver disease - Gerber et al Jul 28 2019

Opinion Piece

Abstract

seemed well thought out... until the last bit
open access
https://www.wjgnet.com/1007-9327/full/v25/i28/3669.htm

 

"Central fatigue is characterized by a lack of self-motivation and can manifest both in physical and mental activities. Peripheral fatigue is classically manifested by neuromuscular dysfunction and muscle weakness. Therefore, the distinction is often seen as a difference between intention (central fatigue) versus ability (peripheral fatigue). "

That is interesting to know how they are thinking. It is another one of those things where they decide what we are thinking without ever asking. My self motivation has always been fine, it's just that I end up lying on the floor if I don't stop what I am doing. (A common occurrence when I had to do this for the kids)

 

As far as I'm aware, lack of self-motivation is characterized by lack of self-motivation and fatigue is characterized by fatigue. Those words already have a standard meaning. This is a definition that fundamentally differs from what is commonly understood by fatigue. Of course this redefinition is rather common but, still, words matter. I'm not sure it's worth reading further than that when the central topic being discussed is arbitrarily redefined.

The "central" part seems to try and do a lot of work, whatever is meant by that (likely CSS). Central heating does not suddenly about noise, plumbing or some entirely different definition of the word heating. Doublespeak has no place in medical research. Just say what you mean, deceit is dishonorable and unethical.

 

Just because some criteria exist for the first, this doesn't make it an exclusionary disease. I guess I'll never understand why there isn't a universal approach on fatigue and how to approach all potential co-diagnoses. This is how some people with non-viral liver and kidney diseases might end up in (post-viral) CFS studies and cause even greater bias and confusion. Is there any CFS patient who has been diagnosed for all potential co-diagnoses? I doubt it. The costs for this would be in the five digits and there are still doctors who consider it unethical to do biopsies given a manageable condition such as chronic fatigue.

This basically is one common explanation for why MG and CFS can not be the same. MG is peripheral while CFS is central. However, MG isn't always manifested completely peripheral. Smooth muscle tone is also involved sometimes, brain fog as well. Both can be attributed to ACh receptors.

CFS, on the other end, not always involves cognitive limitations and lack of motivation. What does remain in their definition, then? The failure to transmit motor impulses, which again is neuromuscular and could be attributed to MG as well. This doesn't mean that I believe that CFS is primarily neuromuscular. But I think CFS can manifest itself also peripheral, especially when cognition is fine but muscles are affected, in all possible regions of the human organism. Maybe it is immunologically mediated, maybe by impaired glycolysis, maybe both.

 

Yes, it shows they do not understand "central fatigue" at all.

The objective fatigue (as measured using electromyography) suffered by patients with muscular dystrophies and peripheral neuropathies is also "central fatigue".