Is the efficacy of repetitive transcranial magnetic stimulation influenced by baseline severity of fatigue symptom in patients with [ME], 2019, Yang

[Andy]

ABSTRACT
Objectives: Recently, repetitive transcranial magnetic stimulation (rTMS) has been therapeutically applied for patients with myalgic encephalomyelitis (ME). However, it is still unclear which clinical factors could influence the efficacy of rTMS for ME patients. The purpose of this study is to clarify whether baseline severity of fatigue symptom would influence the efficacy of rTMS applied for ME patients.

Methods: Twenty-two patients with ME were studied. Each patient was hospitalized to receive 6-8 sessions of rTMS. In this study, high-frequency rTMS of 10 hertz was applied over prefrontal cortex. To evaluate the severity of fatigue symptom, Brief Fatigue Inventory (BFI) score and Visual Analogue Scale (VAS) rate were applied before and after rTMS application. Based on the BFI score before rTMS, the patients were divided into 2 groups, “severe group” (n = 9) and “mild group” (n = 13). We compared the extent of the improvements of fatigue symptom between 2 groups.

Results: In severe group, compared to before rTMS, VAS rate was significantly lower not only at discharge but also 2 weeks after discharge. Similarly, mild group also showed significant decrease in VAS rate at the same timepoints. However, the extent of VAS rate change didn’t differ between 2 groups. In addition, no significant correlation between baseline score of BFI and the changes in VAS rate was indicated.

Conclusions: It can be concluded that rTMS can improve fatigue symptom in ME patients regardless of baseline severity of fatigue symptom. It is expected that rTMS can be a novel therapeutic intervention for ME patients.

Paywall, https://www.tandfonline.com/doi/abs/10.1080/00207454.2019.1663189
Sci hub, https://sci-hub.se/10.1080/00207454.2019.1663189

 

[Snow Leopard]

*cough* unrandomised.

 

[Jonathan Edwards]

Not sure how you can randomise if there aren't even any controls?!

 

[Trish]

The patients were hospitalised for 3 or 4 days for the treatments. Surely the effect of improvement in fatigue could be from resting more while in hospital.
They really needed to have a randomised control group having exactly the same hospital care and sham treatment, then compare results between groups.

 

[Hutan]

Same point as Trish, just more words. But I've written them, so will post anyway.

Oh, good grief. A treatment desperately in search of an illness.

Each patient was hospitalized for three or four days to receive 6-8 sessions of high-frequency rTMS. The two 18-minute treatment sessions were provided daily (the session was started at 9:00 am after breakfast and 1:00 pm after lunch).

The Brief Fatigue Inventory asks you to rate your fatigue (i.e. weariness and tiredness) now and for the last 24 hours on a scale of 1 to 10. If you took any group of people and had them prepare for a 3 or 4 day stay at the hospital, they would probably turn up a bit weary. Packing, making arrangements for the care of the children or the dog, getting to the hospital...

Then have them sit around for three or four days, with meals provided and no obligations. Give them any treatment you care to dream up that involves reclining for 18 minutes at a time. Ask them to rate their fatigue again at the end of the three or four days. And, like magic, there's a response to the treatment!

To be fair, on average, gains were maintained over the two weeks following discharge, but there's a whole host of expectation and researcher pleasing potentially at work there. Out of the 21, after two weeks 6 got worse or essentially stayed the same with respect to baseline BFI and 3 were lost to followup.

 

[Mithriel]

The patients were hospitalised for 3 or 4 days for the treatments. Surely the effect of improvement in fatigue could be from resting more while in hospital.
They really needed to have a randomised control group having exactly the same hospital care and sham treatment, then compare results between groups.

I was in hospital for a fortnight being traumatised by neurologists but no one paid any attention to the fact I felt much better being fed 3 times a day without effort and spending the rest of the time lying in bed reading.

 

[rvallee]

This doesn't appear to be of any value. There are too many flaws to conclude anything.

 

[Hoopoe]

The authors could join Science For ME to learn how to actually produce reliable evidence. Or maybe read a textbook which they have apparently never done.