Trial Report Repetitive Transcranial Magnetic Stimulation Ameliorates Symptoms in Patients with Myalgic Encephalomyelitis (Chronic Fatigue Syndrome), 2023, Miwa

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https://www.ibroneuroreports.org/article/S2667-2421(23)02277-7/fulltext

RESEARCH PAPER|ARTICLES IN PRESS
Repetitive Transcranial Magnetic Stimulation Ameliorates Symptoms in Patients with Myalgic Encephalomyelitis (Chronic Fatigue Syndrome)
Open Access
Published:October 30, 2023
DOI:https://doi.org/10.1016/j.ibneur.2023.10.008

Highlights
  • •
    Repetitive transcranial magnetic stimulation (rTMS) was applied to the brain in patients with myalgic encephalomyelitis.
  • •
    After therapy, the restriction of activity of daily living was ameliorated in most patients.
  • •
    rTMS alleviated various symptoms, especially orthostatic intolerance and disequilibrium.
Abstract
Background
Central nervous system dysfunction has been postulated to cause debilitating symptoms in patients with myalgic encephalomyelitis (ME) (originally called “chronic fatigue syndrome”). Repetitive transcranial magnetic stimulation (rTMS) is a newly developed neuromodulatory procedure and has been suggested to facilitate the cortical neural activity.

Methods
This study enrolled 30 patients with ME (7 men and 23 women) with a mean age of 39±12 years, who received rTMS treatment of both the left dorsolateral prefrontal cortex and the left primary motor area in the brain. The performance status score (0–9) for restricting activities of daily living, orthostatic intolerance (OI) during a 10-min standing test, neurologic disequilibrium diagnosed as unstable standing with their feet together and eyes closed, neuropathic pain or fibromyalgia, and muscle weakness were compared before and after treatment.

Results
After therapy, favorable effects were observed with a decrease in performance status score or index for restriction of activities of daily living of ≥2 points in 20 patients (67%). OI with the inability to complete the 10-min standing test was resolved in 10 (83%) out of 12 patients, and disequilibrium was resolved in 15 (88%) out of 17 patients. Neuropathic pain or fibromyalgia was attenuated in seven (70%) out of 10 patients. Muscle weakness with grip power of <10 kg was resolved in two (50%) out of four patients. No untoward effects were encountered in all the study patients.

Conclusion
The treatment with rTMS is effective in alleviating various symptoms, especially OI and disequilibrium, and in improving the activities of daily living in patients with ME.

Keywords
https://twitter.com/user/status/1720064128645997012
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I’m sorry to be harsh but it’s 2023 and we’re still dealing with joke open label studies with no control group. An impressive looking magnet is bound to bias the patients somewhat, eh Mr Researcher?
 
Sid said:
An impressive looking magnet is bound to bias the patients somewhat, eh Mr Researcher?
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Depends on the stickers on the equipment, and the motivational posters on the walls, and maybe the treats offered for after the treatment ... and before the questionnaire. "Mmmm, good cookies, I feel better."

Just think of how studies can be biased by having the pre-test questionnaire in one room (dark paint, depressing pictures) and the post-test one in another (bright paint, cheerful posters).
 
I love this:
Among the study 30 patients, 12 (40%) had OI demonstrated as the failure of completion of the 10-min standing test before therapy. Of the 12 patients, disequilibrium was positive in 11 (92%). After therapy, 10 (83%) of the 12 could complete the test (Fig. 1). All 10 patients had been classified as being with favorable therapeutic effects by rTMS evaluated by PS score changes, while 2 patients who failed to complete the 10-min standing still after treatment had been classified as being without favorable effects by PS score changes. Prevalence of postural orthostatic tachycardia or orthostatic hypotension appeared not to be different between the standing tests before and after treatment. Both heart rate and blood pressure at rest and at maximal heart rate, and also increase in heart rate, during the 10-min standing test, were not significantly different between the tests before and after treatment
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No change in the objective symptoms, but since the patients could now complete the test, they must be improved.
 
Have I got this right?
The patients had 10 treatments over 2 weeks during which time they stayed in hospital. The tests were done before and at the end of the 2 weeks. So surely any improvements could be a result of resting in hospital for 2 weeks.
 
Trish said:
Have I got this right?
The patients had 10 treatments over 2 weeks during which time they stayed in hospital. The tests were done before and at the end of the 2 weeks. So surely any improvements could be a result of resting in hospital for 2 weeks.
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We've seen that particular recipe for generating positive results in ME/CFS trials from Japan before. I can't recall it being picked up by researchers in other countries wanting to make probably ineffective treatments appear good. I imagine it's because most researchers and health systems don't have money to pay for people to have two weeks in residential care for a trial.
 
Hutan said:
We've seen that particular recipe for generating positive results in ME/CFS trials from Japan before. I can't recall it being picked up by researchers in other countries wanting to make probably ineffective treatments appear good. I imagine it's because most researchers and health systems don't have money to pay for people to have two weeks in residential care for a trial.
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@Trish is it not a thing of beauty --- BBPS researchers typically treat you with GET, CBT or whatever and get you to (subjectively i.e. questionnaires) evaluate the effect very soon after the "treatment" ends --- way to get positive results for ineffective treatments.
These folks distill it even further i.e. keep you in bed and get you to (subjectively) evaluate the outcome immediately --- not exactly real world though!
Watching Blue Planet repeat last night - this study methodology reminds me of the seal that has shortened it's [correction - "lactation"] period to 12 days i.e. due to polar bear predation!
 
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