The aetiologic relation between disequilibrium and orthostatic intolerance in patients with myalgic encephalomyelitis (CFS), 2018, Miwa & Inoue

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The etiologic relation between disequilibrium and orthostatic intolerance in patients with myalgic encephalomyelitis (chronic fatigue syndrome)
Kunihisa Miwa, MD, FJCC
Email the author MD, FJCC Kunihisa Miwa,
Yukichi Inoue, MD
Published Online: March 26, 2018
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DOI: https://doi.org/10.1016/j.jjcc.2018.02.010

Publication stage: In Press Corrected Proof

Highlights
  • Disequilibrium should be recognized as the important cause for orthostatic intolerance (OI).

  • Most patients with disequilibrium report sitting intolerance as well as OI.

  • Disequilibrium appears to be more influential cause for OI than postural orthostatic tachycardia.

Background
Orthostatic intolerance (OI) causes a marked reduction in the activities of daily living in patients with myalgic encephalomyelitis (ME) or chronic fatigue syndrome. Most symptoms of OI are thought to be related to cerebral hypo-perfusion and sympathetic activation. Because postural stability is an essential element of orthostatic tolerance, disequilibrium may be involved in the etiology of OI.

Methods and results
The study comprised 44 patients with ME (men, 11 and women, 33; mean age, 37 ± 9 years), who underwent neurological examinations and 10-min standing and sitting tests. Symptoms of OI were detected in 40 (91%) patients and those of sitting intolerance were detected in 30 (68%). Among the 40 patients with OI, disequilibrium with instability on standing with their feet together and eyes shut, was detected in 13 (32.5%) patients and hemodynamic dysfunction during the standing test was detected in 19 (47.5%); both of these were detected in 7 (17.5%) patients. Compared with 31 patients without disequilibrium, 13 (30%) patients with disequilibrium more prevalently reported symptoms during both standing (100% vs. 87%, p = 0.43) and sitting (92% vs. 58%, p = 0.06) tests. Several (46% vs. 3%, p < 0.01) patients failed to complete the 10-min standing test, and some (15% vs. 0%, p = 0.15) failed to complete the 10-min sitting test. Among the seven patients with both hemodynamic dysfunction during the standing test and disequilibrium, three (43%) failed to complete the standing test. Among the 6 patients with disequilibrium only, 3 (50%) failed while among the 12 patients with hemodynamic dysfunction only, including 8 patients with postural orthostatic tachycardia, none (0%, p = 0.02) failed.

Conclusions
Patients with ME and disequilibrium reported not only OI but also sitting intolerance. Disequilibrium should be recognized as an important cause of OI and appears to be a more influential cause for OI than postural orthostatic tachycardia in patients with ME.
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http://www.journal-of-cardiology.com/article/S0914-5087(18)30058-3/fulltext#.WrzVHiFZs-E.twitter
 
What's interesting is that it reaffirms that the OI in ME is something different to POTS. Obviously, some people might have POTS as a co-morbidity, but the OI looks like it's something else.

They don't appear to have come to conclusions about hypoperfusion definitely being the cause, although state it as a possible mechanism (I think--without seeing the full paper it's hard to know their conclusion on this).
 
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