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Last updated January 1, 2014

Comment On New Research Findings in Muscles Reported in Journal of Neurology, Neurosurgery & Psychiatry

Enterovirus-related metabolic myopathy: a postviral fatigue syndrome

Charles Shepard, MD.

Enterovirus related metabolic myopathy: a postviral fatigue syndrome.
J Neurol Neurosurg Psychiatry. 2003, 74, 1382 - 1386

This is an important new UK study which deserves wider publicity because it:

(a) drives another nail into the coffin of the highly simplistic and flawed theory that graded exercise treatment works for everyone with ME/CFS because their muscle fatigue/weakness is solely due to deconditioning and inactivity,>>

(b) again demonstrates the equally flawed thinking on the possible role of muscle pathology and the role of exercise rehabilitation in the MRC research strategy document.

Having been involved with Professor George Radda's neuroimaging team at Oxford in the publication of the first paper to describe abnormal muscle energy metabolism in ME/CFS (Lancet, 1994, 1, 1367 - 1369), it's encouraging to know that there are other researchers like neurologist Dr Russel Lane (Charing Cross Hospital) and Professor Len Archard (Imperial College) who are also prepared to investigate the way in which viral infections may be causing a disturbance at a cellular level within skeletal muscle.

Lane, Archard et al have already published a number of papers examining this intriguing relationship and demonstrated abnormalities in muscle energy production which are more consistent with a myopathy (ie disorder of muscle) rather than simple deconditioning. And in this study they used the polymerase chain reaction (PCR) technique to look for the presence of genetic material (ie RNA) from enteroviruses (eg Coxsackie) in muscle biopsies. They then looked to see if there was any difference between patients with or without enteroviral RNA in the muscle when it came to an abnormal (ie increased) production of lactic acid during exercise. The results led them to the conclusion that there is an association between abnormal lactate responses to exercise (which reflects an impaired muscle energy metabolism) and the presence of enteroviral sequences in muscle - in at least a sub-group of their ME/CFS patients.

So it may be that a more appropriate term for at least a sub-group of people with ME/CFS is a post-viral metabolic myopathy. And there's no way that this description could end up being classified under a mental health category in WHO ICD-11.

J Neurol Neurosurg Psychiatry. 2003 Oct;74(10):1382-6
Enterovirus related metabolic myopathy: a postviral fatigue syndrome.

Lane RJ, Soteriou BA, Zhang H, Archard LC. Division of Clinical Neurosciences and Psychological Medicine, Imperial College, London SW7, UK. r.lane @

To detect and characterise enterovirus RNA in skeletal muscle from patients with chronic fatigue syndrome (CFS) and to compare efficiency of muscle energy metabolism in enterovirus positive and negative CFS patients.

Quadriceps muscle biopsy samples from 48 patients with CFS were processed to detect enterovirus RNA by two stage, reverse transcription, nested polymerase chain reaction (RT-NPCR), using enterovirus group specific primer sets. Direct nucleotide sequencing of PCR products was used to characterise the enterovirus. Controls were 29 subjects with normal muscles. On the day of biopsy, each CFS patient undertook a subanaerobic threshold exercise test (SATET). Venous plasma lactate was measured immediately before and after exercise, and 30 minutes after testing. An abnormal lactate response to exercise (SATET+) was defined as an exercise test in which plasma lactate exceeded the upper 99% confidence limits for normal sedentary controls at two or more time points.

Muscle biopsy samples from 20.8% of the CFS patients were positive for enterovirus sequences by RT-NPCR, while all the 29 control samples were negative; 58.3% of the CFS patients had a SATET+ response. Nine of the 10 enterovirus positive cases were among the 28 SATET+ patients (32.1%), compared with only one (5%) of the 20 SATET- patients. PCR products were most closely related to coxsackie B virus.

There is an association between abnormal lactate response to exercise, reflecting impaired muscle energy metabolism, and the presence of enterovirus sequences in muscle in a proportion of CFS patients.




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