Multiple Sclerosis and ME/CFS - similarities, differences, misdiagnoses

Thanks for your reply, @Adrian.

This suggested evidence of demyelination in MRI brain scans for pwME, makes me wonder how many people with ME, first get a MS diagnosis or vice versa.

If I understand correctly, these punctuate lesions in the brains of pwME are the white spots dismissed several years ago as unimportant.

Maybe, just maybe they are significant.

 

Going back to maybe the 90s, at the time they found lesions in ME patients resembling AIDS dementia, but the lesions were not constant, they appeared and disappeared. I do not recall recent studies just now.

 

Here is a 1992 study that indicated brain lesions on MRI. There is a new study in the works looking at the brain, that was mentioned on this forum. More attention should be paid to this, instead of dismissing it.


1992 Jan 15;116(2):103-13.
doi: 10.7326/0003-4819-116-2-103.
A chronic illness characterized by fatigue, neurologic and immunologic disorders, and active human herpesvirus type 6 infection
Dedra Buchwald 1, Paul R Cheney, Daniel L Peterson, Berch Henry, Susan B Wormsley, Ann Geiger, Dharam V Ablashi, S Zaki Salahuddin, CArl Saxinger, Royce Biddle, Ron Kikinis, Ferenc A Jolesz, Thomas Folks, N Balachandran, James B Peter, Robert C Gallo, Anthony L Komaroff
Affiliations

• PMID: 1309285
  
• DOI: 10.7326/0003-4819-116-2-103

Abstract


Objective: To conduct neurologic, immunologic, and virologic studies in patients with a chronic debilitating illness of acute onset.

Design: Cohort study with comparison to matched, healthy control subjects.

Patients: We studied 259 patients who sought care in one medical practice; 29% of the patients were regularly bedridden or shut-in.

Main outcome measures: Detailed medical history, physical examination, conventional hematologic and chemistry testing, magnetic resonance imaging (MRI) studies, lymphocyte phenotyping studies, and assays for active infection of patients' lymphocytes with human herpesvirus type 6 (HHV-6).

Main results: Patients had a higher mean (+/- SD) CD4/CD8 T-cell ratio than matched healthy controls (3.16 +/- 1.5 compared with 2.3 +/- 1.0, respectively; P less than 0.003). Magnetic resonance scans of the brain showed punctate, subcortical areas of high signal intensity consistent with edema or demyelination in 78% of patients (95% CI, 72% to 86%) and in 21% of controls (CI, 11% to 36%) (P less than 10(-9)). Primary cell culture of lymphocytes showed active replication of HHV-6 in 79 of 113 patients (70%; CI, 61% to 78%) and in 8 of 40 controls (20%; CI, 9% to 36%) (P less than 10(-8], a finding confirmed by assays using monoclonal antibodies specific for HHV-6 proteins and by polymerase chain reaction assays specific for HHV-6 DNA.

Conclusions: Neurologic symptoms, MRI findings, and lymphocyte phenotyping studies suggest that the patients may have been experiencing a chronic, immunologically mediated inflammatory process of the central nervous system. The active replication of HHV-6 most likely represents reactivation of latent infection, perhaps due to immunologic dysfunction. Our study did not directly address whether HHV-6, a lymphotropic and gliotropic virus, plays a role in producing the symptoms or the immunologic and neurologic dysfunction seen in this illness. Whether the findings in our patients, who came from a relatively small geographic area, will be generalizable to other patients with a similar syndrome remains to be seen:
https://pubmed.ncbi.nlm.nih.gov/1309285/

(My bolding re "Magnetic resonance scans...")

 

I was able to find this
"There is at least the distinct appearance of overlap in some of the neurological signs and symptoms between ME/CFS and MS. A leading international expert in MS, Dr. Charles Poser, has also studied ME/CFS. In an article entitled "The Differential Diagnosis of CFS and MS" published in the CFIDS Research Review (CFIDS Association of America), Dr. Poser writes: "An alarming number of CFS patients are misdiagnosed with multiple sclerosis (MS). The severity and symptoms of CFS fluctuate and sometimes mimic the relapses and remission of MS...In a review of 366 patients referred to me who had been diagnosed with MS by a board-certified neurologist, only 236 patients (65%) had been correctly diagnosed. An astounding 28 (22%) actually had CFS.""
https://www.massmecfs.org/differential-diagnosis?start=2

I couldn't find the article referenced. I did find
Diagnostic criteria for multiple sclerosis, 2001, Poser and Brinar, paywalled, https://www.sciencedirect.com/science/article/abs/pii/S0303846700001256

Although it is paywalled it has previews of sections of the paper. One section preview is
"The chronic fatigue syndrome/myalgic encephalomyelitis
The list of clinical differential diagnoses of MS is long, but one condition, the very existence of which is still controversial, deserves special mention because it is so often confused with MS. Paraclinical tests, including MRI may be abnormal. The generally accepted criteria for chronic fatigue syndrome (CFS) [20], [21] are so broad that many patients suffering from a wide variety of functional or imaginary conditions may be included. More demanding requirements identify a group that truly..."

 

Thanks @Andy.

I seem to recall another article comparing ME and MS.
I will have a look for that.

 

The following study uses the Fukuda cfs criteria to ascertain whether "cfs" and MS coexist in some patients:

. 2014;35(3):529-34.
doi: 10.3233/NRE-141146.
Multiple Sclerosis/Chronic Fatigue Syndrome overlap: When two common disorders collide
Tarek A-Z K Gaber 1, Wah Wah Oo 2, Hollie Ringrose 3
Affiliations

• PMID: 25238862
  
• DOI: 10.3233/NRE-141146

Abstract


Introduction: Fatigue is a major cause of disability and handicap in Multiple Sclerosis (MS) patients. The management of this common problem is often difficult. Chronic Fatigue Syndrome (CFS/ME) is another common cause of fatigue which is prevalent in the same population of middle aged females commonly affected by MS.

Aim: This report aims at examining the potential coexistence of MS and CFS/ME in the same patients.

Method: This is a retrospective study examining a cohort of MS patients referred for rehabilitation. The subjects were screened for CFS/ME symptoms.

Results: Sixty-four MS patients (43 females) were screened for CFS/ME. Nine patients (14%) with a mean age 52 (SD 9.7) who were all females fulfilled the Fukuda criteria for diagnosis of CFS/ME. Their symptoms, including muscular and joint pain, malaise and recurrent headaches, were not explained by the pattern of their MS.

Discussion: MS and CFS/ME are two common conditions with increased prevalence in middle aged females. As the diagnosis of CFS/ME is clinical with no positive clinical signs or investigations; it can be made with difficulty in the presence of another clear explanation for the disabling fatigue. Our results suggest that the two conditions may co-exist. Considering CFS/ME as a potential co-morbidity may lead to more focused and appropriate management.

Keywords: Chronic Fatigue Syndrome; Multiple Sclerosis; fatigue; myalgic encephalitis.

https://pubmed.ncbi.nlm.nih.gov/25238862/