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BMJ Best Practice on Chronic Fatigue Syndrome (last updated: July 31, 2017)

RogerBlack

Senior Member
Messages
902
The best thing that could happen is that neurology develops into a more mature science that uses technologies that produce validated evidence leading to appropriate treatments based on sound evidence.

This is almost a 'you can't get there from here' problem.

In order to produce 'proper' results from neurology, you damn near need to get to complete brain/body simulations.

A hundred neurons (or even a million) is not going to get a meaningful result. It can say things like 'response to X artificial stimuli was 4% down under the measured conditions'.
It can't say things like 'X causes depression and anxiety'.

There are 1500000000000000 or so junctions between neurons in the human brain, and to go 'bottom up' - you nearly need to simulate the whole number.

FMRi is attempting to go 'top-down' - but has problems in that the signals are small, the resolution (both in time and volume) is terrible, with millions of neurons and many billion synapses in the sampled volume, and a thousand firings in the time resolution.

Electrodes are impractical in humans, and almost meaningless in other species, and only get at most a few hundred samples.
MEG is a magnetic technique to pick up large scale correlated activity in the brain, but it suffers from similar, though different problems as MRI, with the notable one that it only works at the brain surface.

And even if you got to brain/body simulations, then fun ethical problems arise.
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
This won't reverse deconditioning - high intensity/impact activity is needed to do that (and is not possible when you have ME or CFS).
This might be best for most people, but even establishing some activity will help. The issue here is more than with prescriptive exercise, and patients acknowledge that with pacing. Don't do too little, don't do too much, balance activity and rest. They seem to want to say we get worse with even minor activity, we should do a little, and we should have a set routine, all while holding to the exercise is good meme.

Just engaging in everyday life, which I think we typically do as much as we can, should be the goal in my view. For those of us who cannot do this we do need better answers, but prescriptive exercise is meaningless to very severe patients and problematic in all but subclinical cases, and even then I am doubtful if there is any aerobic component.

I suspect there is a range of interpretations on what deconditioning is, and without nailing that down with specific reference to ME there will be continuing confusion. In particular I do not want to see deconditioning conflated with unfit. We are not all athletes, not all fit, but I wonder how many mild patients are actually deconditioned?

Some of our experts do show that strength training can be of benefit, but patients have to persist with it at a very very slow pace, much slower than most trainers would agree with.
 

Deepwater

Senior Member
Messages
208
This seems almost revolutionary: "The lack of energy may be caused by autoimmune and metabolomic dysfunction that reduces mitochondrial ATP production." There is also a clear acknowledgement of PEM.

The rest seems still influenced by the CBT/GET school of thought but not as much as I would have expected in a British journal.

The proverbial committee and the camel, in other words.