ME and MS show remarkable levels of similarity in phenomenology and neuroimmune characteristics

adambeyoncelowe

adambeyoncelowe

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Myalgic encephalomyelitis/chronic fatigue syndrome and encephalomyelitis disseminata/multiple sclerosis show remarkable levels of similarity in phenomenology and neuroimmune characteristics
BMC Medicine201311:205
https://doi.org/10.1186/1741-7015-11-205

© Morris and Maes; licensee BioMed Central Ltd. 2013

Received: 16 June 2013

Accepted: 15 August 2013

Published: 17 September 2013

Abstract
Background
‘Encephalomyelitis disseminata’ (multiple sclerosis) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are both classified as diseases of the central nervous system by the World Health Organization. This review aims to compare the phenomenological and neuroimmune characteristics of MS with those of ME/CFS.

Discussion
There are remarkable phenomenological and neuroimmune overlaps between both disorders. Patients with ME/CFS and MS both experience severe levels of disabling fatigue and a worsening of symptoms following exercise and resort to energy conservation strategies in an attempt to meet the energy demands of day-to-day living. Debilitating autonomic symptoms, diminished cardiac responses to exercise, orthostatic intolerance and postural hypotension are experienced by patients with both illnesses. Both disorders show a relapsing-remitting or progressive course, while infections and psychosocial stress play a large part in worsening of fatigue symptoms. Activated immunoinflammatory, oxidative and nitrosative (O+NS) pathways and autoimmunity occur in both illnesses. The consequences of O+NS damage to self-epitopes is evidenced by the almost bewildering and almost identical array of autoantibodies formed against damaged epitopes seen in both illnesses. Mitochondrial dysfunctions, including lowered levels of ATP, decreased phosphocreatine synthesis and impaired oxidative phosphorylation, are heavily involved in the pathophysiology of both MS and ME/CFS. The findings produced by neuroimaging techniques are quite similar in both illnesses and show decreased cerebral blood flow, atrophy, gray matter reduction, white matter hyperintensities, increased cerebral lactate and choline signaling and lowered acetyl-aspartate levels.

Summary
This review shows that there are neuroimmune similarities between MS and ME/CFS. This further substantiates the view that ME/CFS is a neuroimmune illness and that patients with MS are immunologically primed to develop symptoms of ME/CFS.
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This is a few years old, but really highlights the similarities between these two illnesses (and thus makes the difference in treatments more stark).

Does anybody with any understanding of the specifics here have any comments? What do we think: is ME like MS? Certainly, the early literature compares them. Are there any glaring errors or assumptions here? Does another model (rather than the neuroimmune one) fit better?
 
Yes, I know, I've seen the comparisons. I wasn't saying ME is identical to MS, I'm just wondering whether other people agree that they're essentially the same type of illness. Byron Hyde, for instance, puts ME, MS and post-polio syndrome together. The 'functional' crew put ME, FM and IBS together. Those are the most stark examples of how different people understand the illness differently.
 
@adambeyoncelowe I'm sure there are similarities (relapsing-remitting) with MS and post polio syndrome. But whatever is causing PEM in ME is not happening with MS. Exercise improves cognitive and physical function in MS.

I don't have pain, IBS or improved symptoms with exercise.
 
MS also has bladder and GI issues, too, of course, so there is overlap. It's more about the modelling of aetiology and pathology.

My partner's mother has MS, and our symptoms are so similar. One big difference is that her remission periods are very clear and distinct, whereas we with ME seem to have a baseline of illness every day, even when we're not crashing. That may be due to treatment, though.
 
Also, yes, a poll might help, but I'm pretty sure most people will prefer a neuroimmune categorisation than a 'functional' one.

I do wonder if many of the more severe ME patients instead get an atypical MS diagnosis, since neurologists don't usually expect to see CNS damage in ME (despite some evidence of this).
 
I remember people being concerned that this paper rather over-stated the case on some of the issues with ME/CFS. I've had some interactions with Gerwyn Morris that left me less than impressed in the past.
 
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adambeyoncelowe said:
I do wonder if many of the more severe ME patients instead get an atypical MS diagnosis, since neurologists don't usually expect to see CNS damage in ME (despite some evidence of this).
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The M.E specialist I saw 26 years ago suspected MS because of the relapsing nature of my illness. I was referred to a neurologist who eventually r/o MS. I was diagnosed with atypical M.E. I'm not sure that I have CNS damage.
 
adambeyoncelowe said:
Does anybody with any understanding of the specifics here have any comments?
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Yes, I understand the specifics @adambeyoncelowe. This review is just plain wrong. As I understand it Morris is a patient with some science experience who teamed up with Maes whose immunology is based on very old and muddled themes without any convincing evidence. This is a bit like an undergraduate student publishing an essay based on a few hours in the library. I hate being so negative all the time but there is a lot to the old saying 'empty vessels make most noise'. The real scientist in the ME field do not publish much because they want to have something substantive before they do.

This review gets quoted by all sorts of people dipping in to the ME field. I am afraid it is a good index that the dippers don't have much grasp of immunology. There are no significant similarities between ME and MS as far as I can see other than that the symptoms may seem similar if you do not take a careful medical history.

One thing that is interesting is that the second peak age of onset for ME is the same as the peak for MS. That might mean that there is some neurodevelopment factor that is relevant to both illnesses. I don't think it has anything to do with oxidative stress or mitochondrial dysfunction or anything else we currently know about.
 
Jonathan Edwards said:
Yes, I understand the specifics @adambeyoncelowe. This review is just plain wrong. As I understand it Morris is a patient with some science experience who teamed up with Maes whose immunology is based on very old and muddled themes without any convincing evidence. This is a bit like an undergraduate student publishing an essay based on a few hours in the library. I hate being so negative all the time but there is a lot to the old saying 'empty vessels make most noise'. The real scientist in the ME field do not publish much because they want to have something substantive before they do.

This review gets quoted by all sorts of people dipping in to the ME field. I am afraid it is a good index that the dippers don't have much grasp of immunology. There are no significant similarities between ME and MS as far as I can see other than that the symptoms may seem similar if you do not take a careful medical history.

One thing that is interesting is that the second peak age of onset for ME is the same as the peak for MS. That might mean that there is some neurodevelopment factor that is relevant to both illnesses. I don't think it has anything to do with oxidative stress or mitochondrial dysfunction or anything else we currently know about.
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That's good to know at least. Obviously, presented as it has been, the comparisons look stronger than they are.
 
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