Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Comprehensive Review Aug 2019 Rivera, Mastronardi, Silva-Aldana,Arcos-Burgos,Lidbury

Review article MDPI Diagnostics

Received: 22 May 2019; Accepted: 15 July 2019; Published: 7 August 2019

full text here
https://www.mdpi.com/2075-4418/9/3/91/htm

(not familiar with any of the authors)

 

Lidbury has received funding from ME Research UK previously. Also, he's an author on https://www.s4me.info/threads/rethi...ng-symptom-severity-2019-lidbury-et-al.10426/

 

I'm really skeptical about onset data. I don't remember filling any questionnaires where onset was asked, only year of official diagnosis. Given that it is known that delays vary from several months to several decades between onset and diagnosis we simply don't have enough reliable data to be so declarative.

From my personal (flawed) memory of people mentioning their approximate onset age it indicates much lower age than is commonly used, an average around early 20's if not earlier because of how underrepresented children are. Late onset seems to be mostly the result of abysmally long delays in diagnosis.

I just think it shouldn't be this prominently mentioned as onset. There are particular problems related to age in this disease, from it being long-referred to as a disease of the bored middle-aged or that children don't contract it.

Otherwise this seems rather fine work at first glance.

 

Thorough, grown-up! Not able to follow the all the medical detail, but generally it seems a sound attempt to cover all the complexities, and give considered and sensible suggestions. One error...it suggested that the International Consensus was followed by the Canadian Consensus, but it was the other way round. So other unintended inaccuracies should be checked for. But it seems to be informative rather than partisan. Might be useful to show a doctor who thinks no research has been done!

 

The history of ME/CFS is rather well described. However, the article is very speculative and I am especially concerned with the claims that are made about the involvement of stress in ME/CFS (paragraphs 5.5.3, 5.5.5 & discussion). For example:

Their argument about the involvement of the HPA axis is based off of studies of hypocortisolism in CFS, and seems to have been inspired at least in part (according to Table 1) by a poor review by Tomas et al. (ref. 14, from Julia Newton's group) that discusses:

- hypocortisolism, from a meta-analysis of cortisol levels in functional somatic disorders which fails to account for many confounding factors -- especially sleep disturbance in ME/CFS -- and does not reach statistical significance when some are (medication, physical activity levels, depression)
- speculation on childhood trauma based on studies in rodents...
- the positive upregulation of mineralocorticoid & glucocorticoids receptors, but Newton et al. contradict this hypothesis:

Newton et al. are also aware of the confounding factors:

The main review they cite for HPA axis dysfunction in ME/CFS is that of Maes' group (2017) which, similarly, contains conflicting findings from CFS studies, where the assessment of PEM is uncertain.

Strangely, Cortes et al. also contradict themselves. First quote from paragraph 5.5.5, second one from the discussion:

None of the references here -- 224, 130, 223 and also 222 earlier -- are about ME/CFS, so they are cited on a speculative basis, and in a vague way: it is unclear how they support the authors' claims. For example:

There also are some typos throughout the paper (repeated occurrences of "ME/CSF"). Brett Lidbury is both a co-author of the paper and the guest editor of the special issue it was published in, so this double role makes me question the extent to which he was involved in peer reviewing & editing it (review reports are unavailable).

Given the emphasis that Cortes et al. give to the neuroendocrine system (including emotional distress, stress as factors in the pathophysiology of ME/CFS) despite the issues with the quality of the evidence they present, I would not recommend this review to someone who is trying to get an overview of biomedical research on ME/CFS. Komaroff's short article in JAMA (2019) is probably a better resource.