Multimodal and Simultaneous Assessments of Brain and Spinal Fluid Abnormalities in CFS,... Effects of Psychiatric Comorbidity, 2017, Natelson et al

Discussion in 'ME/CFS research' started by Hutan, Mar 23, 2024.

  1. Hutan

    Hutan Moderator Staff Member

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    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5393352/

    Abstract
    The purpose of this study was to investigate whether CFS patients without comorbid psychiatric diagnoses differ from CFS patients with comorbid psychiatric diagnoses and healthy control subjects in neuropsychological performance, the proportion with elevated spinal fluid protein or white cell counts, cerebral blood flow (CBF), brain ventricular lactate and cortical glutathione (GSH).

    The results of the study did not show any differences in any of the outcome measures between CFS patients with and without psychiatric comorbidity, thus indicating that psychiatric status may not be an exacerbating factor in CFS. Importantly, significant differences were found between the pooled samples of CFS compared to controls. These included lower GSH and CBF and higher ventricular lactate and rates of spinal fluid abnormalities in CFS patients compared to healthy controls. Thirteen of 26 patients had abnormal values on two or more of these 4 brain-related variables.

    These findings, which replicate the results of several of our prior studies, support the presence of a number of neurobiological and spinal fluid abnormalities in CFS. These results will lead to further investigation into objective biomarkers of the disorder to advance the understanding of CFS.
     
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  2. Hutan

    Hutan Moderator Staff Member

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    Fukuda criteria

     
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  3. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

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    Not yet. Sadly the cited-bys are reviews and "may help withs".
     
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  4. Hutan

    Hutan Moderator Staff Member

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    Cognitive tests
    Spinal fluid
    Neuroimaging
    some overlap but interesting

    underwhelming result, given these three regions were the most different out of 39 regions.
     
  5. Joan Crawford

    Joan Crawford Senior Member (Voting Rights)

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    This is the neuropsychological testing used:

    "All subjects underwent a battery of neuropsychological tests, which included the b Adult Reading Test, a measure used to estimate overall intellectual ability prior to illness onset7; the Gordon Vigilance and Distractibility Test, computer administered measures to evaluate sustained and focused attention as well as processing speed8; the WAIS IV Digit Span forward and backward, assessments of simple attention and working memory9; and the Rey-Osterrieth complex figure test, a measure of visuo-constructional ability and visual memory10."

    I've not seen the Gordon testing being used before in pwME. Seems an odd choice to use something new. It is used for ADHD assessment mainly. Digit Span is commonly OK ish in pwME. And the R-O doesn't necessarily get at the cognitive issues pwME face. Far better tests exist (for example PASAT - auditory information processing, working memory, time pressure etc) and it's a mystery why they were not used here.....
     
  6. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

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    Except the patients were scanned supine. The result might be quite different and stronger if they were in an upright MRI. This is one of the things we've been missing up until now -> #alltestsarenormal.

    [15] is Increased ventricular lactate in chronic fatigue syndrome. III. Relationships to cortical glutathione and clinical symptoms implicate oxidative stress in disorder pathophysiology (2012, NMR in Biomedicine) —

     
  7. Eddie

    Eddie Senior Member (Voting Rights)

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    Jarred Younger presented some preliminary unpublished lactate data during the ME/CFS Research Roadmap series. It seemed to have a similar distribution to what they found in this paper; that there is overlap between HC and ME/CFS but a higher average and some patients with very clearly abnormal levels. This could reflect some patients being in PEM, as I'm pretty sure PEM was not specifically induced for either study. Not sure when it is planned to be published though.
     
  8. rvallee

    rvallee Senior Member (Voting Rights)

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    All of those are routinely handed out to pwME, sometimes in alternative to, sometimes in addition to. So it's hard to say whether there is any validity to any of those. And the standard questionnaires for this mostly have overlapping questions so even if it's not just someone's opinion, there is no way to validate either way since the instrument is basically no better than a dowsing rod.

    The DSM is often presented as a step forward, but frankly it has been a huge step backward for medicine because it sometimes works explicitly by taking the mere suspicion of something as a fact, when the medical standard is solid verifiable evidence most of the time. It's like twice-removed hearsay from an unverifiable source who commented anonymously counterbalancing anything but verified timestamped video. This is not the way to do things.
     
  9. Sean

    Sean Moderator Staff Member

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    All of which could easily be explained as the (secondary and contingent, i.e. unnecessary) consequences of having your life destroyed by a nasty disease, and even nastier neglect and mistreatment by the medical profession and society.

    How often do you see those psychosocial factors being even mentioned by the psychosocial advocates, let alone robustly assessed and taken into account?

    What is most interesting about those figures (and I would add in suicide rates) is that they are not a lot higher, given the extraordinary primary physical and secondary psychosocial (including economic) burden patients are having to endure.

    What these figures really tell us is just how psychologically resilient patients are, under such extreme assaults.

    There are psychosocial pathologies in play in this situation alright. But being unhappy about mistreatment and suffering, and speaking out about it and demanding it be fixed, is not one of them. What is indisputably a profound psychosocial and moral pathology is the abuse of power to prevent that situation being revealed and rectified.
     
  10. Eddie

    Eddie Senior Member (Voting Rights)

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    The study itself showed that these psychiatric diagnosis had no impact on the measured parameters. What is more interesting to me are the differences between the ME and control patients.

     
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  11. Joan Crawford

    Joan Crawford Senior Member (Voting Rights)

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    Absolutely this.
     
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  12. rvallee

    rvallee Senior Member (Voting Rights)

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    Hey we are Type A personalities after all! Well, some are. Not really statistically different than the whole population. And it doesn't affect outcomes. But it could! Imagine a world where it could. It would obviously explain why we all just give in to the "sick role". Well, we mostly don't, and those contradict one another, but it could be the case. Add an engine and some wings and you got a fully functioning airplane, you just have to meet a few conditions that aren't met and it's a perfect model of reality. It all makes sense if you don't think about it.
     
  13. Sean

    Sean Moderator Staff Member

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    Extreme, and sustained.
     

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