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. Co-Cure.org
metabolic myopathy: a postviral fatigue syndrome.
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
Lane RJ, Soteriou BA, Zhang H, Archard LC. Division of Clinical Neurosciences and Psychological Medicine, Imperial College, London SW7, UK. r.lane @ imperial.ac.uk
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