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Maintenance tDCS: A Case of Full and Durable Recovery from Myalgic Encephalomyelitis/Chronic Fatigue

Discussion in 'Alternative Therapies' started by Jesse2233, Jul 13, 2017.

  1. Jesse2233

    Jesse2233 Senior Member

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    Link
     
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  2. ljimbo423

    ljimbo423 Senior Member

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    It sounds like decreasing the neuro-inflammation, greatly improved his cfs. I think neuro-inflammation, caused by immune system dysfunction, is a huge cause of symptoms and I am becoming more and more convinced of it all the time. It's always nice to hear success stories!
     
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  3. Mary

    Mary Senior Member

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    @Jesse2233 - this looks potentially very interesting. I have a lot of questions - are they sure the man had ME/CFS? It's not the same thing as extreme fatigue, though he might have had ME/CFS. I'm very surprised that psychiatrists actually came up with something useful! I have such a low opinion of them and generally run the other way at the first whiff of them. Although, maybe they're right - it has been all in our heads all this time, neuroinflammation-wise. :rolleyes:

    I wish the paper was open access. Have they tried this with other patients? Has anyone else done this? I know you don't have these answers. And I'm wondering if they would be willing to share their protocol with other researchers. I guess there's one way to find out ---

    Thanks for posting --
     
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  4. Sushi

    Sushi Senior Member Albuquerque

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    Interesting, but they don't say enough to be convincing on their diagnosis. He was working, he slept normally, no mention of PEM, and he had a childhood history of neurological illness. We need more information to even attempt to evaluate this.
     
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  5. Woolie

    Woolie Senior Member

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    Its good that they collected some objective measures of improvement. Otherwise, with this being an open label study, the patient-reported improvements would be pretty uninterpretable.

    But tDCS is a worry. Its involves placing electrodes at different points on the skull, and passing a very small current across them. Its super small. You can place the two electrodes at different points to sort of "target" the electrical potential to different parts of the brain. In a loose kind of way.

    I have worked with tDCS in my research, and have not been able to obtain any reliable behavioural effects using it. Lots of other researchers I've spoken to have had the same experience. tDCS was really hyped for a while, but now we're all starting to question whether it really does anything, short or long term. Could just be a huge placebo pill.

    One also wonders why this is a single case study. Case studies have a place in science, but to be useful, we need to know something about the reasons the case was selected for report. Was it because he's the only person they've seen with such intractable CFS? If so, they don't get about much. Or is it - as seems more likely - that he was the only person to respond? If so, it could be a random effect - the paper notes that this patient's condition is relapsing-remitting, so its entirely possible that one of his remissions just coincided with the treatment.

    I hate to put a downer on everyone by being so sceptical. But I do worry that false claims about "neuro" type treatments could be heading us in the wrong direction. The claim that ME is all in the brain isn't very different from the claim that it is all in the mind, especially in the minds of some of the numpties working in our area. And we've already seen where things like "central sensitization syndrome" lead us, and its not good.

    And besides, a neuro explanation just doesn't seem to meet the minimum requirements for me. There isn't a plausible brain mechanism that can explain all the ins and outs of MECFS. But there are plausible immune mechanisms that fit the whole picture. So that seems to me a much better place to look for answers.
     
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  6. Woolie

    Woolie Senior Member

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    PS I'm pretty sure this guy had MECFS. His viral history is a really strong indicator, I reckon.
     
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  7. lnester7

    lnester7 Seven

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    Stimulant! Not such a good idea for some.
     
  8. ljimbo423

    ljimbo423 Senior Member

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    I don't think it has to be either or, neuro or immune. Why can't it be both?:) Immune system dysfunction can cause glial cell (immune cells in the brain) activation, and neuro-inflammtion.

    Immune system dysfunction can also cause mito. dysfunction by increasing oxidative stress.
     
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  9. Woolie

    Woolie Senior Member

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    It could be. Or it could just be that the brain, being part of the body, is affected by MECFS too. I find it odd that people are surprised when a systemic illness affects the brain. Of course it does, the brain is a body part. And probably the most vulnerable of them all.

    But if you're looking for a causal explanation, good explanations start simple - with one primary cause - and you only add on complexity if you need it. The brain isn't the place to start, I don't think.
     
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  10. ljimbo423

    ljimbo423 Senior Member

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    I agree that the brain isn't the place to start. I think it's the immune system and whatever it is reacting to, that is causing the problems, everything else is down stream of those 2 events, including neuro-inflammation.
     
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  11. Hip

    Hip Senior Member

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    I tried a home-made version transcranial direct current stimulation (tDCS) myself, by passing a battery-powered low voltage current through my bathwater while I was in the bath (this is called a galvanic bath, although galvanic baths usually pass current through the body rather than the head).

    This bath approach has the advantage of not needing any electrodes, since the water itself evenly delivers the current to your skin, and therefore avoids the creation of hotspots and skin irritation where the electrodes are attached. Although you don't have the ability to target specific areas of the brain without using electrodes.

    I did these galvanic baths daily for one week, but did not notice much, except that I found on the days I did these baths, I did not need my usual midday 45 minute nap, possibly as a result of the mild stimulating effect that the electric current produced.

    In my galvanic baths, I used electric currents of comparable strength to those used in tDCS (Wikipedia says for tDCS, up to 60 min and up to 4 mA daily is safe, so I based my galvanic bath current on that).


    In the study on tDCS for ME/CFS, they used 2 mA for 20 minutes, placing the anode (+) electrode pad on the left dorsolateral prefrontal cortex, and the cathode (-) electrode pad on the right dorsolateral prefrontal cortex. The location of the dorsolateral prefrontal cortexes is shown in this blog article.



    But looking at the full paper here on Sci Hub, it says:
    So it looks like the full benefits of this treatment only appear after a few months. Thus I may have stopped my tDCS experiments too soon, as I stopped after one week. After reading this, though, I am tempted to try it again for longer.


    It's interesting how the study measured various physiological parameters both before treatment, when the patient had ME/CFS, and after treatment, when he was in remission:
    The authors note that:

    The study says that:
    So if I understood this correctly, it appears that he requires daily tDCS to keep his ME/CFS at bay; thus in this case tDCS is not a cure, but keeps his ME/CFS in remission.


    Sounds like this man had mild ME/CFS though, as he was still able to work in teaching (those with moderate or severe ME/CFS are not able to work):
    Also, his ME/CFS was a little unusual in that he seemed to have intermittent fatigue, rather than the more continual fatigue symptoms that most of us here are used to:
     
    Last edited: Jul 15, 2017
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  12. Alvin2

    Alvin2 If humans were rational...

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    This has more holes in it then Swiss cheese

    We know nothing about him and can't confirm he had ME/CFS at all. If he slept normally and had no PEM then it sounds likely he had something else.
    Modafinil keeps you awake, its not a wonder drug that cures inflammation, fixes pyruvate dehydrogenase, modulates the immune system/microbiome/whatever is causing ME/CFS and kills viruses. If it did all these things we would not only all be better, it would be in the product label, these uses would greatly expand their market and they would be happy to extend the patent.

    It would be nice if this was a universal ME/CFS fix it drug, but its more likely he spontaneously recovered or didn't have ME/CFS at all. If they want to run a double blind placebo controlled crossover study they can add more evidence to their results but i would be very unsurprised if the study did not pan out the way they expect.
     
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  13. barbc56

    barbc56 Senior Member

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    You have to be kidding! Water and electricity do not mix. If you do any little thing wrong you might as well take a bath with your plugged in hair dryer while eating your swiss cheese.

    It's a tragedy waiting to happen!

    Plus what @Alvin2 said.
     
    Last edited: Jul 16, 2017
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  14. lansbergen

    lansbergen Senior Member

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    Yep
     
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  15. Hip

    Hip Senior Member

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    That sounds like the sort of comment an over-anxious auntie might make. It's completely safe if you use low battery voltages. Although I wouldn't suggest anyone without a scientific or technical background attempt it, ie, those who don't understand basic equations such as Ohm's law.



    The progress he made is very common in ME/CFS patients: on the scale of severe, moderate, mild and remission, he merely moved up one level on the scale, from mild to remission. We see these types of improvements in ME/CFS patients all the time, from various therapies, eg LDN or oxymatrine. Why do you find it so hard to believe that this combined therapy of tDCS and modafinil moved him up the relatively small jump from mild to remission?
     
    Last edited: Jul 16, 2017
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  16. Alvin2

    Alvin2 If humans were rational...

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    Because its likely it was spontaneous remission and i know a great deal about Modafinil, its an atypical wakefulness promoting agent, used in people deficient in Orexin or to prevent sleep.

    If ME/CFS was another name for narcolepsy then Modafinil (or better yet Armodafinil) would be the first line therapy.

    I'm glad to hear this person got better but i am not at all convinced Modafinil is an ME/CFS treatment of choice, especially given its been tried elsewhere to rather poor effect. However if all those observations were wrong then Dr Davis should be made aware of it and after Rituximab Modafinil can be the subject of a double blind placebo controlled study
     
    Last edited: Jul 16, 2017
  17. Hip

    Hip Senior Member

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    I don't know where you got this assumption that a drug must boost mitochondria in order to be helpful for ME/CFS. There are dozens of drugs that are helpful for ME/CFS, but whose mechanism is nothing to do with mitochondrial function.

    Several ME/CFS doctors find modafinil helpful for some ME/CFS patient's fatigue and brain fog: see this article.

    But improvement of this guy in the study is more attributable to the tDCS, because if you read the paper, you will notice that he was already taking modafinil even before he started using tDCS. In fact after starting tDCS, he actually lowered his modafinil dose.


    But I'd be more interested in reports of other ME/CFS patients who try tDCS, and post their results.
     
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  18. Alvin2

    Alvin2 If humans were rational...

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    Fair enough that it does not have to boost mitochondria. However i don't have the energy to argue this, so if you wish to try Modafinil then go ahead, and if it does not work i won't be at all surprised.
    Its safety profile is quite good so thats a bonus
     
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  19. Hip

    Hip Senior Member

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    I don't do well on stimulants myself: they work for me, but I tend to feel quite mentally depleted the next day, almost like a hangover. So I personally don't have much interest in modafinil.

    But I am interested in the tDCS, and whether this might have benefits for ME/CFS.

    This study of 41 fibromyalgia patients found that tDCS was useful for reducing pain after 10 daily sessions. Interestingly, the patients who had tDCS applied the to left primary motor cortex got longer lasting results (lasting for two months) than those who had tDCS applied to the dorsolateral prefrontal cortex.
     
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  20. Alvin2

    Alvin2 If humans were rational...

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    Electrocute your brain to treat something that may be caused by a lack of pyruvate dehydrogenase activity.
    Understood.
     
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