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Orthostatic challenge, cerebral blood flow and neurocognition in CFS

Discussion in 'Latest ME/CFS Research' started by Marco, Oct 5, 2014.

  1. Marco

    Marco Grrrrrrr!

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    Near Cognac, France
    Abstract of a small study that proposes beneficial effects of phenylephrine (alpha adrenergic receptor agonist used for hypotension) on orthostatic challenge induced reduced cerebral blood flow and impaired cognition :

    Phenylephrine Alteration of Cerebral Blood Flow During Orthostasis; Effect on N-Back Performance in Chronic Fatigue Syndrome


    http://jap.physiology.org/content/early/2014/09/30/japplphysiol.00527.2014
     
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  2. Dolphin

    Dolphin Senior Member

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    This figure shows evidence that the thinking of people with ME/CFS slows down when they are upright.

    The researchers looked at the effect of a 60 degree tilt compared to the result when the individuals were supine (flat). HUT=Head Up Tilt.

    They looked at 5 different cognitive tests. The tests are more demanding as n increases (from left to right). They looked at how long it took to give an answer.

    If you look at the healthy people in the top graph, there is no difference whether the individual was flat or upright.

    However, if you look at the CFS patients (bottom graph), when they were upright their results were statistically worse (notice the stars) for n=2, n=3 and n=4 (and the gap increased as the task became more difficult).


    Medow 2014.png
     
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  3. Kati

    Kati Patient in training

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    @Dolphin what does 'n' represent? (I'm a bit slow and reclining...)
     
  4. Valentijn

    Valentijn Senior Member

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    Cognitive tests, with each higher number being a more difficult one.
     
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  5. Marky90

    Marky90 Science breeds knowledge, opinion breeds ignorance

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    ahimsa likes this.
  6. SDSue

    SDSue Southeast

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    I thought this looked exciting, too, but it seems to me phenylephrine is just like Midodrine (which is commonly used for POTS) - another alpha 1-adrenergic agonist.

    Did I miss something? I sure hope so! :)
     
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  7. Gingergrrl

    Gingergrrl Senior Member

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    Is phenylephrine a new prescription med or something in trials? How does it differ from Midodrine and Droxidopa? Just to make sure, is it different from Ephedrine based things that actually cause tachycardia?!!!
     
  8. ahimsa

    ahimsa Senior Member

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    @Marky90, thanks for posting the link to that article!

    I have not yet read the article about the research but I think any new research on OI in ME/CFS is a good thing. And this was done by a well known doctor, Dr. Julian Stewart.

    @Gingergrrl, I'm pretty sure phenylephrine is an over the counter drug, not a prescription. It's a decongestent but it is not the same as pseudoephedrine (generic Sudafed). Someone please correct me if this is wrong.
     
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  9. meeKO

    meeKO

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    My wife just started taking phenylephrine but it hasn't had much impact on her OI or POTS or NMH. She'll keep on it for abit but this week we're re-trying to find something that makes a difference.
     
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  10. SDSue

    SDSue Southeast

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    I can't find the reference, but if memory serves they used IV phenylephrine in this trial because oral had no effect. Does anyone know for sure?

    @meeKO @ahimsa
     
  11. ahimsa

    ahimsa Senior Member

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    Hi @SDSue,

    I don't have access to the full article. I did read the abstract (tried to!) and it did not say--unless I missed it, which is entirely possible. :rolleyes:

    My earlier post on this thread was just the result of googling the drug name. I thought I recognized that drug (I generally buy generic, not brand name) but I wanted to make sure it was the one I was thinking about.

    Sorry, but that's all I got! :) I have no actual expertise! :D
     
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  12. Forbin

    Forbin Senior Member

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    This kind of failure to respond correctly to variations in CO2 levels is also at the heart of central sleep apnea (as opposed to obstructive sleep apnea). I'm not sure how common central sleep apnea is among ME patients, but it seems consistent with a general pattern of faulty system regulation..
     
  13. meeKO

    meeKO

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    I haven't done any reading I'm afraid but I could believe it as the over the counter Sudafed PE doesn't seem to be helping even combined with Deralin (Propranolol hydrochloride)...
     
  14. valentinelynx

    valentinelynx Senior Member

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    Phenylephrine is mostly ineffective when taken orally. The marketing of it as a substitute for pseudoephedrine is pretty much a scam. We use in the anesthesia to raise blood pressure all the time (very old drug). Problem is it only lasts about 5-10 minutes. So I doubt it would be useful as a treatment for OI. Therefore, this study would be useful only as demonstrating a principle not as a discovery of a new treatment drug.
     
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