Cerebrospinal fluid opening pressure in relation to symptomatology and craniocervical anatomy in patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)
Caleb Jolley, Björn A Bragée, Lauri Sakari Soinne, Helena Huhmar, Hans Billing, Bo Christer Bertilson, Per Sjogren
Background
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a debilitating disease that affects millions worldwide. Its cause remains unknown; though many physiological mechanisms are impaired. Structural abnormalities in the craniocervical region seem to be more prevalent in patients with ME/CFS with a possible impact on intra-cranial pressure (ICP) and lumbar puncture (LP) measurements. This study seeks to quantify occurrence of elevated cerebrospinal fluid (CSF) opening pressure and a possible association with clinical symptoms and radiological variables in craniocervical segments in a cohort of patients with ME/CFS.
Methods
The study included 34 patients previously diagnosed with ME/CFS as part of larger case-control study, in whom LP was performed only in cases. Key measurements include age, sex, opening pressure from LP, symptomatic relief post-LP, and radiological variables with potential influence on CSF dynamics. Individuals were stratified into two groups according to opening pressure (OP) measurements using 20 cmH2O as cut point, with subsequent statistical comparisons.
Results
Altogether, most participants reported moderate disease severity (65%) and a concomitant self-reported low quality of life. The median CSF opening pressure was 18 (IQR 8) cmH2O, ranging from 11 to 29.5. Opening pressure stratification detected 21 of the 34 cases (62%) to have an OP measurement <20cmH2O (low-OP) and 13 (38%) with an OP measurement ≥20cmH2O (high-OP).
The two OP-groups did not differ significantly in baseline characteristics, including disease severity and quality-of-life. However, for certain radiological measurements the high-OP group presented with measures reflecting a wider spinal canal, with a significantly larger foramen magnum diameter (33.9 mm) as compared with the low-OP group (31.7 mm). Estimates of symptom relief 1-4 days post-LP were significantly higher among patients in the high-OP group (62%) compared to the 14% in the low-OP group.
Conclusions
This study suggests that a proportion of patients with ME/CFS have elevated CSF opening pressures and may experience symptom relief following CSF subtraction. Our data indicate that some anatomical structures in the craniocervical area may be related to CSF pressure, although interpretation is challenging and merits further investigation.
Web | DOI | Frontiers in Medicine | Abstract only ahead of publication
Caleb Jolley, Björn A Bragée, Lauri Sakari Soinne, Helena Huhmar, Hans Billing, Bo Christer Bertilson, Per Sjogren
Background
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a debilitating disease that affects millions worldwide. Its cause remains unknown; though many physiological mechanisms are impaired. Structural abnormalities in the craniocervical region seem to be more prevalent in patients with ME/CFS with a possible impact on intra-cranial pressure (ICP) and lumbar puncture (LP) measurements. This study seeks to quantify occurrence of elevated cerebrospinal fluid (CSF) opening pressure and a possible association with clinical symptoms and radiological variables in craniocervical segments in a cohort of patients with ME/CFS.
Methods
The study included 34 patients previously diagnosed with ME/CFS as part of larger case-control study, in whom LP was performed only in cases. Key measurements include age, sex, opening pressure from LP, symptomatic relief post-LP, and radiological variables with potential influence on CSF dynamics. Individuals were stratified into two groups according to opening pressure (OP) measurements using 20 cmH2O as cut point, with subsequent statistical comparisons.
Results
Altogether, most participants reported moderate disease severity (65%) and a concomitant self-reported low quality of life. The median CSF opening pressure was 18 (IQR 8) cmH2O, ranging from 11 to 29.5. Opening pressure stratification detected 21 of the 34 cases (62%) to have an OP measurement <20cmH2O (low-OP) and 13 (38%) with an OP measurement ≥20cmH2O (high-OP).
The two OP-groups did not differ significantly in baseline characteristics, including disease severity and quality-of-life. However, for certain radiological measurements the high-OP group presented with measures reflecting a wider spinal canal, with a significantly larger foramen magnum diameter (33.9 mm) as compared with the low-OP group (31.7 mm). Estimates of symptom relief 1-4 days post-LP were significantly higher among patients in the high-OP group (62%) compared to the 14% in the low-OP group.
Conclusions
This study suggests that a proportion of patients with ME/CFS have elevated CSF opening pressures and may experience symptom relief following CSF subtraction. Our data indicate that some anatomical structures in the craniocervical area may be related to CSF pressure, although interpretation is challenging and merits further investigation.
Web | DOI | Frontiers in Medicine | Abstract only ahead of publication