Sunday Times: Feature Article expected soon

[Valentijn]

Sorry I don't understand PEM. Sleep disorders are extremely common and can cause symptoms that may be mistaken for ME, certainly by UK doctors. It's also possible that treating the sleep disorder allows healing in milder cases of ME. I know that when my sleep improved so did other symptoms. It didn't produce a dramatic improvement but a slow change that eventually allowed me to, for example, read these forums and find other things that might help.

Post-Exertional Malaise means getting very sick a day or so after exercise, usually lasting days or weeks. The International Consensus Criteria describes it as:

Characteristics are:
1. Marked, rapid physical and/or cognitive fatigability in response to exertion, which
may be minimal such as activities of daily living or simple mental tasks, can be
debilitating and cause a relapse.
2. Post-exertional symptom exacerbation: e.g. acute
flu-like symptoms, pain and worsening of other symptoms
3. Post-exertional exhaustion may occur immediately after activity or be delayed by
hours or days.
4. Recovery period is prolonged, usually taking 24 hours or longer. A
relapse can last days, weeks or longer.
5. Low threshold of physical and mental
fatigability (lack of stamina) results in a substantial reduction in pre-illness activity level.

The pain is quite a bit different from the localized muscle pain which normal people feel after exercise. If you do crunches with PEM, you'll probably end up with your full body hurting instead of just the abdominal muscles which were used, for example. It can be hard for people to initially pin down what is causing those sorts of symptoms - in many cases, it is blamed on viruses at first, or just being "fatigued".

If someone doesn't have that symptom, it's a lot more likely that they've been misdiagnosed.

 

[Valentijn]

Also, page 10 of the Canadian Consensus Criteria document at http://www.cfids-cab.org/MESA/me_overview.pdf shows a table with ME patients' abnormal reactions to exertion, compared to what happens with healthy people.

 

[MeSci]

How the heck can you tell someone had depression from a brain scan? And a deceased brain at that?! Not heard of that being possible before. Blimey. The wonders of technology. The mind boggles

Sorry - I wasn't clear there. The 'Alzheimer's' before-and-after scans were performed on living patients before and after they took the drug manufactured by the study authors. Yes - different brain disorders do show distinctly-different patterns in scans. Here is a link to images of scans of a normal and Alzheimer's brain (normal Brain Image on the left side/Alzheimer's Brain image on the right side):

http://www.petisllc.com/images/alz.jpg

and here are images from a depressed and non-depressed person:

http://www.riversideonline.com/source/images/image_popup/c7_pet_depression.jpg

They've used slightly different colour schemes; the key thing is that the darker areas indicate reduced activity.

So maybe those of who are definitely not depressed, but whose doctors refuse to believe it, should demand brain scans!

 

[barbc56]

There are limitations to brain scans. Unless there is specific pathology such as lesions for MS,and sometimes even then it's difficult to you just look at a brain scan and say, yes this is definitely depression, as there are so many overlapping functions of different parts of the brain. I was absolutely fascinated by Dr. Amen's work when it first came out, but it didn't really pan out to be as accurate as hoped for. Again the same problem. It should be interesting to see what develops in the future.

One of the main limitations of neuroimaging is that conclusions based on studies of groups of people might not apply to individuals. This limitation becomes especially important when use moves beyond the realm of scientific generalities to the domain of individual health care decisions. The apparent power of neuroimaging can be overwhelming to the parent searching for an explanation for her child’s disruptive behavior, or to a child seeking answers about his parent’s memory loss. However, many proposed applications—particularly those relating to the diagnosis or treatment of psychiatric disorders—simply are not supported by evidence from research.

Despite this progress, neuroimaging leaves several questions unanswered. First, it is impossible to say whether increased or decreased activity in a particular brain region is “better” or “abnormal.” For example, some studies found that schizophrenia patients had increased activity in specific brain areas (such as the prefrontal cortex) compared with healthy individuals, while other studies found that patients had decreased activity in the same brain areas. These conflicting findings suggest that group differences may be specific to the tasks on which the groups were tested, and they cannot be broadly interpreted as reflecting “better” or “worse” function in the patients

http://www.dana.org/news/cerebrum/detail.aspx?id=22220

A lot has been learned about the brain in the last several years. It's an exciting area of research. I've often said that the "new frontier" isn't just outer space but also the brain.

Barb

 

[MeSci]

There are limitations to brain scans. Unless there is specific pathology such as lesions for MS,and sometimes even then it's difficult to you just look at a brain scan and say, yes this is definitely depression, as there are so many overlapping functions of different parts of the brain. I was absolutely fascinated by Dr. Amen's work when it first came out, but it didn't really pan out to be as accurate as hoped for. Again the same problem. It should be interesting to see what develops in the future.



http://www.dana.org/news/cerebrum/detail.aspx?id=22220

A lot has been learned about the brain in the last several years. It's an exciting area of research. I've often said that the "new frontier" isn't just outer space but also the brain.

Barb

Yes, there are definitely limitations. But Alzheimer's patients have reduced activity in specific brain regions (and the reductions commonly occur in a specific order as the illness progresses), whereas depressed people have a more general reduction.

The article you link to is long and interesting from a quickish look. It refers mainly to MRI scans, which show slightly-different things from PET scans, which is why it can be useful to do both in some instances. fMRI and PET look not so much for lesions as variations in activity shown by blood flow, glucose uptake, etc.

Re the schizophrenia studies, without reading the papers in question I don't know whether the patients were in the same stages of the illness, whether they were taking medication, etc., so can't comment. It's a controversial diagnosis anyway, with a lot of disagreement between scientists.

It's true that imaging on its own will usually not be sufficient for a diagnosis to be made, but it can be very useful for assessing the efficacy of a treatment.

I agree that it is a fascinating area. I focused a lot on imaging and dementia, and also studied addiction, in my Master's studies as I find it so interesting.