Hypothesis COVID-19 and chronic fatigue syndrome: Is the worst yet to come?, Jan 2021, Wostyn

John Mac · Jan 4, 2021

COVID-19 and chronic fatigue syndrome: Is the worst yet to come?
Peter Wostyn

Abstract
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There has been concern about possible long-term sequelae resembling myalgic encephalomyelitis/chronic fatigue syndrome in COVID-19 patients.
Clarifying the mechanisms underlying such a “post-COVID-19 fatigue syndrome” is essential for the development of preventive and early treatment methods for this syndrome.
In the present paper, by integrating insights pertaining to the glymphatic system and the nasal cerebrospinal fluid outflow pathway with findings in patients with chronic fatigue syndrome, idiopathic intracranial hypertension, and COVID-19, I provide a coherent conceptual framework for understanding the pathophysiology of post-COVID-19 fatigue syndrome.
According to this hypothesis, this syndrome may result from damage to olfactory sensory neurons, causing reduced outflow of cerebrospinal fluid through the cribriform plate, and further leading to congestion of the glymphatic system with subsequent toxic build-up within the central nervous system.
I further postulate that patients with post-COVID-19 fatigue syndrome may benefit from cerebrospinal fluid drainage by restoring glymphatic transport and waste removal from the brain.
Obviously, further research is required to provide further evidence for the presence of this post-viral syndrome, and to provide additional insight regarding the relative contribution of the glymphatic-lymphatic system to it. Other mechanisms may also be involved.
If confirmed, the glymphatic-lymphatic system could represent a target in combating post-COVID-19 fatigue syndrome.
Moreover, further research in this area could also provide new insights into the understanding of chronic fatigue syndrome.
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https://www.sciencedirect.com/science/article/pii/S0306987720333600?dgcid=rss_sd_all

From the same author:
https://www.s4me.info/threads/the-p...hogenesis-and-therapy-2018-wostyn-et-al.5165/

Kalliope · Jan 4, 2021

John Mac said: ↑

COVID-19 and chronic fatigue syndrome: Is the worst yet to come?
Peter Wostyn

https://www.sciencedirect.com/science/article/pii/S0306987720333600?dgcid=rss_sd_all

From the same author:
https://www.s4me.info/threads/the-p...hogenesis-and-therapy-2018-wostyn-et-al.5165/

Click to expand...

Conflict of interest statement
Dr. Peter Wostyn is the inventor of pending patent applications pertaining to chronic fatigue syndrome treatment using cerebrospinal fluid diversion procedures.

rvallee · Jan 4, 2021

John Mac said: ↑

COVID-19 and chronic fatigue syndrome: Is the worst yet to come?
Peter Wostyn

https://www.sciencedirect.com/science/article/pii/S0306987720333600?dgcid=rss_sd_all

From the same author:
https://www.s4me.info/threads/the-p...hogenesis-and-therapy-2018-wostyn-et-al.5165/

Click to expand...

This seems prematurely over-specific.

Edit: Looks like the comment above this one captures the problem

forestglip · Jun 10, 2024

Merged thread

COVID-19 and chronic fatigue syndrome: Is the worst yet to come?

Author: Peter Wostyn

Abstract

I provide a coherent conceptual framework for understanding the pathophysiology of post-COVID-19 fatigue syndrome. According to this hypothesis, this syndrome may result from damage to olfactory sensory neurons, causing reduced outflow of cerebrospinal fluid through the cribriform plate, and further leading to congestion of the glymphatic system with subsequent toxic build-up within the central nervous system. I further postulate that patients with post-COVID-19 fatigue syndrome may benefit from cerebrospinal fluid drainage by restoring glymphatic transport and waste removal from the brain.
Click to expand...

Supportive evidence that a significant proportion of patients with CFS may represent a variant of IIH [idiopathic intracranial hypertension]

Based on CSF pressure readings in CFS patients, in whom headache was a prominent symptom, and their clinical response to CSF drainage, Higgins et al. [26], [27], [28] hypothesized that CFS and IIH may be related. Indeed, their study suggests that if headache is a prominent symptom in patients diagnosed with CFS, then a substantial proportion of patients with CFS may represent a variant of IIH without intracranial hypertension or papilledema, which responds to CSF withdrawal in the same way as IIH patients do. Higgins et al. [27] measured CSF pressure by lumbar puncture in 20 patients diagnosed with CFS, in whom headache was a prominent symptom. CSF pressure was found to be>20 cmH2O in five patients, four of whom fulfilled the criteria for IIH. These latter four patients were relabelled as IIH and treated accordingly. Mean CSF pressure was 19 cmH2O, which is towards the high end of normal [27]. Even more importantly, the authors also found that CSF withdrawal produced a symptomatic improvement in 17 patients (85%), that is in all five patients whose CSF pressures were>20 cmH2O and in 12 patients whose CSF pressures were between 12 and 20 cmH2O [27]. This improvement usually developed during, or soon after the procedure and lasted from a few minutes to several weeks. It generally took the form of reduced headache, a heightened alertness and a reduced sense of fatigue [27]. The authors suggested that incomplete forms of IIH, with average CSF pressures much lower than in the syndrome in full, may manifest as CFS [26], [27], [28].

The improvements noted following CSF drainage in these CFS patients at least suggest a neurological basis of some of their symptoms. However, a curious question remains as to why CFS patients with CSF pressures within the normal range should benefit from lowering of the CSF pressure. CSF withdrawal not only lowers CSF pressure, but also promotes the turnover of CSF, and I believe that CSF drainage may favorably affect the fluid dynamics of the glymphatic system, and that this could be an alternative explanation as to why CSF withdrawal may be beneficial in a subgroup of CFS patients [29]. As discussed below, this latter view [29] is now supported by very recent observations confirming that a significant proportion of CFS patients represent a variant of IIH [30] and that IIH may be considered as a manifestation of “glymphedema” of the brain [31].
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Implications for therapy of CFS

This may open the door to promising, future treatments of CFS by using CSF shunt devices.
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Implications for therapy of post-COVID-19 fatigue syndrome

Then glymphatic-lymphatic drainage therapies should be recommended as early treatment steps for post-COVID-19 fatigue syndrome. For instance, osteopathic manipulative medicine could be a practical option for promoting lymphatic drainage, as several studies have provided important proof of principle [38]. It has been argued that ME/CFS can be treated using the Perrin technique, based on traditional osteopathic concepts, to restore a healthier neuro-lymphatic flow. The Perrin technique is a system of manual diagnosis and treatment that is based on the hypothesis that ME/CFS is a disorder of the lymphatic drainage of the CNS, which leads to five physical signs [39]. I further postulate that patients with post-COVID-19 fatigue syndrome may also benefit from CSF drainage in the same way as CFS patients do [26], [27], [28].
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I barely understand what he's talking about, and the paper has much more detail on his mechanism theory than these quotes - I wasn't really sure what the important parts to copy were.

oldtimer · Jun 8, 2024

FCS (Fairly Confusing Stuff)

Wonko · Jun 9, 2024

Anyone got any leeches to deal with an excess of the humors?

Second thing medicine seems to think of, too much stuff inside so lets get it out. Granted the technology involved to do so may, or may not be, higher tech than leeches, but the idea, the concept, hasn't changed much since the stone age.

First thing/concept is usually to stop the red/brown/grey stuff from coming out, will someone plug the hole(s) it's coming from before it ruins the carpet.

Sooner or later, in a few thousand millenia, they'll come up with a third great concept.

forestglip · Jun 9, 2024

Thread about the referenced study of CSF drainage improving symptoms.

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