The link between idiopathic intracranial hypertension, fibromyalgia, and CFS: exploration of a shared pathophysiology (2018) Hulens et al.

[Milo]

The link between idiopathic intracranial hypertension, fibromyalgia, and chronic fatigue syndrome: exploration of a shared pathophysiology

(This is a hypothesis paper)

https://www.dovepress.com/the-link-...on-fibromyalgia-and-peer-reviewed-article-JPR

Abstract:

Purpose:

Idiopathic intracranial hypertension (IICH) is a condition characterized by raised intracranial pressure (ICP), and its diagnosis is established when the opening pressure measured during a lumbar puncture is elevated >20 cm H2O in nonobese patients or >25 cm H2O in obese patients.

Papilledema is caused by forced filling of the optic nerve sheath with cerebrospinal fluid (CSF). Other common but underappreciated symptoms of IICH are neck pain, back pain, and radicular pain in the arms and legs resulting from associated increased spinal pressure and forced filling of the spinal nerves with CSF.

Widespread pain and also several other characteristics of IICH share notable similarities with characteristics of fibromyalgia (FM) and chronic fatigue syndrome (CFS), two overlapping chronic pain conditions.

The aim of this review was to compare literature data regarding the characteristics of IICH, FM, and CFS and to link the shared data to an apparent underlying physiopathology, that is, increased ICP.

Methods:

Data in the literature regarding these three conditions were compared and linked to the hypothesis of the shared underlying physiopathology of increased cerebrospinal pressure.

Results:

The shared characteristics of IICH, FM, and CFS that can be caused by increased ICP include headaches, fatigue, cognitive impairment, loss of gray matter, involvement of cranial nerves, and overload of the lymphatic olfactory pathway.

Increased pressure in the spinal canal and in peripheral nerve root sheaths causes widespread pain, weakness in the arms and legs, walking difficulties (ataxia), and bladder, bowel, and sphincter symptoms.

Additionally, IICH, FM, and CFS are frequently associated with sympathetic overactivity symptoms and obesity. These conditions share a strong female predominance and are frequently associated with Ehlers-Danlos syndrome.

Conclusion:

IICH, FM, and CFS share a large variety of symptoms that might all be explained by the same pathophysiology of increased cerebrospinal pressure

 

[MeSci]

Additionally, IICH, FM, and CFS are frequently associated with sympathetic overactivity symptoms and obesity.(my emphasis)

Is that true?

I put on a lot of weight in the early 2000s - became almost obese - but put it down to anxiety/eating too much, or possibly/likely eating the wrong things. The last conclusion was due to the fact that when I cut out gluten the excess weight just fell away. (I'm also a long-term vegan.)

 

[Andy]

Here are the sections in the paper that mention obesity.

Obesity

IICH is mostly diagnosed in obese female patients. Obesity increases intra-abdominal pressure and therefore also increases ICP.101 This hypothesis might explain why obese women have an increased risk of developing FM or CFS.26,70

Depression/anxiety/poor quality of life

It is well known that FM and CFS patients suffer from depression, anxiety, and poor quality of life.20,47

IICH is also characterized by poor quality of life and headaches or obesity alone cannot account for this result.54

Disability

Additionally, as in patients with FM and those with CFS, patients with IICH have a high rate of disability, as reflected by objective measures such as unemployment.32,65 Patients with IICH also have a high hospital admission rate (38% in 2007), which is only partly due to the higher rate of concomitant obesity.34

And here are the references used to support the obesity claims.

70.
Norris T, Hawton K, Hamilton-Shield J, Crawley E. Obesity in adolescents with chronic fatigue syndrome: an observational study. Arch Dis Child. 2017;102(1):35–39.

Abstract
Objective Identify the prevalence of obesity in patients with chronic fatigue syndrome (CFS) compared with healthy adolescents, and those identified with CFS in a population cohort.

Design Cross-sectional analysis of multiple imputed data.

Setting Data from UK paediatric CFS/myalgic encephalomyelitis (CFS/ME) services compared with data collected at two time points in the Avon Longitudinal Study of Parents and Children (ALSPAC).

Patients 1685 adolescents who attended a CFS/ME specialist service between 2004 and 2014 and 13 978 adolescents aged approximately 13 years and 16 years participating in the ALSPAC study.

Main outcome measures Body mass index (BMI) (kg/m2), sex-specific and age-specific BMI Z-scores (relative to the International Obesity Task Force cut-offs) and prevalence of obesity (%).

Results Adolescents who had attended specialist CFS/ME services had a higher prevalence of obesity (age 13 years: 9.28%; age 16 years: 16.43%) compared with both adolescents classified as CFS/ME in ALSPAC (age 13 years: 3.72%; age 16 years: 5.46%) and those non-CFS in ALSPAC (age 13 years: 4.18%; age 16 years: 4.46%). The increased odds of obesity in those who attended specialist services (relative to non-CFS in ALSPAC) was apparent at both 13 years (OR: 2.31 (1.54 to 3.48)) and 16 years, with a greater likelihood observed at 16 years (OR: 4.07 (2.04 to 8.11)).

Conclusions We observed an increased prevalence of obesity in adolescents who were affected severely enough to be referred to a specialist CFS/ME service. Further longitudinal research is required in order to identify the temporal relationship between the two conditions.

Link, https://adc.bmj.com/content/102/1/35

26.
Dias DNG, Marques MAA, Bettini SC, Paiva EDS. Prevalence of fibromyalgia in patients treated at the bariatric surgery outpatient clinic of Hospital de Clínicas do Paraná - Curitiba. Rev Bras Reumatol Engl Ed. 2017;57(5):425–430.

Abstract
INTRODUCTION:
Fibromyalgia (FM) is a chronic pain syndrome characterized by generalized pain. It is known that obese patients have more skeletal muscle pain and physical dysfunction than normal weight patients. Therefore, it is important that the early diagnosis of FM be attained in obese patients.

OBJECTIVE:
To determine the prevalence of FM in a group of obese patients with indication of bariatric surgery.

MATERIALS AND METHODS:
The patients were recruited from the Bariatric Surgery outpatient clinic of Hospital de Clínicas of UFPR (HC-UFPR) before being submitted to surgery. Patient assessment consisted in verifying the presence or absence of FM using the 1990 and 2011 ACR criteria, as well as the presence of comorbidities.

RESULTS:
98 patients were evaluated, of which 84 were females. The mean age was 42.07 years and the BMI was 45.39. The prevalence of FM was 34% (n=29) according to the 1990 criteria and 45% (n=38) according to the 2011 criteria. There was no difference in age, BMI, Epworth score and prevalence of other diseases among patients who met or not the 1990 criteria. Only depression was more common in patients with FM. (24.14% vs. 5.45%). The same findings were seen in patients that met the 2011 criteria.

CONCLUSIONS:
The prevalence of FM in patients with morbid obesity is extremely high. However, BMI does not differ in patients with or without FM. The presence of depression may be a risk factor for the development of FM in these patients.

Link, https://www.sciencedirect.com/science/article/pii/S2255502117300147?via=ihub

 

[LadyBirb]

This one may be interesting.
I have IIH that was diagnosed recently and have had ME/CFS for 3+ years. I’ll start a thread elsewhere though.

I’ll watch and wait, I’m interested to see where they go because I do feel like some people with the conditions names may need checked for IIH based on varying tidbits I’ve seen described around the web. Hope if the research continues that this hypothesis acknowledges severe ME/cfs and PEM or at least addresses it. Another paper I read on this comparison lacked a lot of understanding of ME (I think it was by different people).