"Cerebral blood flow is reduced in ME/CFS during head-up tilt testing even in the absence of hypotension or tachycardia... van Campen et al, 2020

Full title:
Cerebral blood flow is reduced in ME/CFS during head-up tilt testing even in the absence of hypotension or tachycardia: a quantitative, controlled study using Doppler echography

https://www.sciencedirect.com/science/article/pii/S2467981X20300044

Patients were classified as having CFS, chronic fatigue, or no chronic fatigue as defined by Fukuda and colleagues(Fukuda et al. , 1994) and as having ME or no ME as defined by Carruthers and colleagues(Carruthers et al. , 2011).


Hmmmm..... It may be that the definition and diagnosis of orthostatic intolerance needs to be revised.

 

To facilitate sharing:
https://twitter.com/user/status/1226945192445562889

 

Just a heads up - this is a preprint so the final product may have some changes (though this has been reviewed, edited etc already).

 

Very nice. Just the other day I was thinking that maybe the best treatment approach that we have at the moment would be to try and get blood flow working better. Other treatment directions are very speculative, but this one not as much.

I also suspect some genes related to orthostatic intolerance are going to show up on the GWAS study.

 

An important paper. It is interesting that the experiments were performed in the Netherlands. I hope this will provide a paradigm change over there and all around the world.

 

Yes, that could be interesting – it seems to run in our family.

I've had it since childhood, and getting ME at 17 didn't make it any worse, but of course it's possible I might otherwise have grown out of it. My mum struggled with it all her life, but her sister (who would actually pass out if she had to queue) was better once she got into her 20s.

 

Impressive N.

Interesting to note the direction of symptoms between patients and controls. For controls they almost all disappear by the 10-minute mark, whereas nearly half increase for patients. The questions asked are very pertinent, love to see people who ask the right questions. The image is poor quality, sadly:



Maybe random observation but: we are observing changes in PRBCs deformity, making oxygenation harder, especially in capilaries. Somehow the neurovascular system must compensate for that in order to keep oxygenation in good order, perhaps by constricting capilaries less than is needed, which has a cascading effect of having less blood pressure (which was observed here) and depriving some systems or organs of oxygen so as to keep the brain as best oxygenated in the circumstances? Which isn't even enough as it still leads to significant reduction of both flow and pressure.

 

Bolding mine.

 

Something else is that maybe the anecdotal positive effect of magnesium is related to improved brain blood flow.

 

It would be interesting to look at people with other conditions causing stiff PRBCs, to see if they have the same response to it.... (Thinking ahead too quickly, as always – obviously the first priority would be bigger studies in ME!)

 

@rvallee - This is a pre-print version. Is it possible the image quality will improve in the final publication version?

 

I was able to download the PDF from the science direct web page. The download link is at the top of the screen.

It's a pre-print copy but the images are better than the one you posted.

 

Sadly they are often considered quacks by many mainstream docs. It's slowly changing though.

 

@Milo, thank you for pointing out the 90% number for pwME with CBF reduction. I believe a similar number has been noted in other studies for OI by Dr. Rowe, one of the authors in this study.

 

@DokaGirl - I think you are correct that other studies by Rowe have shown a high %age of OI but if I remember correctly those were (mostly?) in pediatric patients who often had pronounced OI symptoms. This study seems to indicate that when symptoms don't show up on a HITT practitioners might need to be more open to treating for OI and/or checking CBF.

 

I found it a readable paper for the layperson. The validity of the measurement techniques they used is way beyond me, but this statement struck me:

They do not speculate on causation...

 

link to larger image: https://ars.els-cdn.com/content/image/1-s2.0-S2467981X20300044-gr5_lrg.jpg

 

What I found most interesting in this study (assuming I've understood this) is that the reduction in cerebral blood flow (CBF) was correlated with symptoms *and* the CBF reduction was found even in ME/CFS patients who had normal heart rate and blood pressure on the tilt table test.

Even if these percentages end up being lower in any repeat studies in the future, the fact that patients had reduced CBF, even when they had apparently normal tilt table tests, is quite interesting. It would explain several of the folks here on this forum who had symptoms during a tilt test (and who get symptoms while standing in line, taking a shower, etc) but still had "normal" results on the tilt test.

This assumes that this measurement is reliable (I know nothing about measuring CBF).

(edited to clarify one sentence)

 

I would be curious to know
-whether this happens with astronauts coming back from Space Station, and if yes, for how long
-then whether this happens for a healthy control who has been paid to spend 1-2 months horizontal.
-does this happen with other diseases, such as congestive heart failure, multiple sclerosis, Parkinson’s, and diabetes, just to name a few? How about post-concussion, both acute and long term?
-could it be considered a biomarker?