Cerebral blood flow is reduced in ME/CFS during head-up tilt testing...(van Campen et al. 2020)

[Diwi9]

Cerebral blood flow is reduced in ME/CFS during head-up tilt testing even in the absence of hypotension or tachycardia: a quantitative, controlled study using Doppler echography
C. (Linda) M.C.van Campen Freek W.A.Verheugt Peter C.Rowe Frans C.Visser

Clinical Neurophysiology Practice
Available online 8 February 2020

https://www.sciencedirect.com/science/article/pii/S2467981X20300044

Abstract

Objective
The underlying hypothesis in orthostatic intolerance (OI) syndromes is that symptoms are associated with cerebral blood flow (CBF) reduction. Indirect CBF measurements (transcranial Doppler flow velocities), provide inconsistent support of this hypothesis. The aim of the study was to measure CBF during a 30 min head-up tilt test (HUT), using Doppler flow imaging of carotid and vertebral arteries, in individuals with chronic fatigue syndrome/myalgic encephalomyelitis (ME/CFS), a condition with a high prevalence of OI.

Methods
429 ME/CFS patients were studied: 247 had a normal heart rate (HR) and blood pressure (BP) response to HUT, 62 had delayed orthostatic hypotension (dOH), and 120 had postural orthostatic tachycardia syndrome (POTS). We also studied 44 healthy controls (HC). CBF measurements were made at mid-tilt and end-tilt. Before mid-tilt, we administered a verbal questionnaire to ascertain for 15 OI symptoms.

Results
End-tilt CBF reduction was 7% in HC versus 26% in the overall ME/CFS group, 24% in patients with a normal HR/BP response, 28% in those with dOH, and 29% in POTS patients (all P<.0005). Using a lower limit of normal of 2SD of CBF reduction in HC (13% reduction), 82% of patients with normal HR/BP response, 98% with dOH and 100% with POTS showed an abnormal CBF reduction. There was a linear correlation of summed OI symptoms with the degree of CBF reduction at mid-tilt (P<.0005).

Conclusions
During HUT, extracranial Doppler measurements demonstrate that CBF is reduced in ME/CFS patients with POTS, dOH, and even in those without HR/BP abnormalities.

Significance
This study shows that orthostatic intolerance symptoms are related to CBF reduction, and that the majority of ME/CFS patients (90%) show an abnormal cerebral flow reduction during orthostatic stress testing. This may have implications for the diagnosis and treatment of ME/CFS patients.

 

[EtherSpin]

Tell a fogged up guy with a virus going through the family right now ... This wouldn't mean any benefit from cerebral specific vasoconstrictor drugs ? When I was first getting seriously ill and didn't know what was up I took a supplement/over the counter thing called Vinpocetine which is actually a cerebral VasoDILATOR so that might have been silly ?

 

[pattismith]

"Conclusions
During HUT, extracranial Doppler measurements demonstrate that CBF is reduced in ME/CFS patients with POTS, dOH, and even in those without HR/BP abnormalities.

Significance
This study shows that orthostatic intolerance symptoms are related to CBF reduction, and that the majority of ME/CFS patients (90%) show an abnormal cerebral flow reduction during orthostatic stress testing. This may have implications for the diagnosis and treatment of ME/CFS patients."

amazing study, thank you Diwi9!

 

[Sushi]

"Conclusions
During HUT, extracranial Doppler measurements demonstrate that CBF is reduced in ME/CFS patients with POTS, dOH, and even in those without HR/BP abnormalities.

I wonder exactly how the reduced blood volume that has been shown to be typical plays into these findings? Perhaps it just magnified the CBF problem.

 

[xebex]

Tell a fogged up guy with a virus going through the family right now ... This wouldn't mean any benefit from cerebral specific vasoconstrictor drugs ? When I was first getting seriously ill and didn't know what was up I took a supplement/over the counter thing called Vinpocetine which is actually a cerebral VasoDILATOR so that might have been silly ?

i have had a lot of help from vasoconstricting drugs; pseudophedrine, ritalin, and anti-histamines, sadly they seem to be less effective after a couple of days so i have to cycle on and off them i get a few days a month of feeling better and more active.- am thinking of trying wellbutrin in the hope that it'll work more long term - but i'm scared of all the side effects that might come with it.

 

[EtherSpin]

i have had a lot of help from vasoconstricting drugs; pseudophedrine, ritalin, and anti-histamines, sadly they seem to be less effective after a couple of days so i have to cycle on and off them i get a few days a month of feeling better and more active.- am thinking of trying wellbutrin in the hope that it'll work more long term - but i'm scared of all the side effects that might come with it.

thanks for your input. I have been on wellbutrin about 5 years and the only thing I had was insomnia from the slow release tablet at first and was doing a super bodgy solution of cutting a notch into it so it could release faster but ultimately settled on cutting in half and using that. no side effects now but also not sure how many benefits - one of those things i got prescribed during a rare crisis where my main fear is that it IS helping and I'd only find out by big problems when i cease it !
all the best especially at this time

 

[xebex]

@EtherSpin i tried wellbutrin, i think it would have been great for me, i felt great on it right from the start but it gave me pretty bad tinnitus which hasn't gone away though taurine seems to be helping considering trying a more consistent trial of concerta using some supplements that should help mitigate side effects this might be of some help to you?

https://getrecoop.com/

I am currenlty just making my own out of supps i already have, just gotta add curcumin and vit C

 

[Mary]

Tell a fogged up guy with a virus going through the family right now ... This wouldn't mean any benefit from cerebral specific vasoconstrictor drugs ? When I was first getting seriously ill and didn't know what was up I took a supplement/over the counter thing called Vinpocetine which is actually a cerebral VasoDILATOR so that might have been silly ?

i have had a lot of help from vasoconstricting drugs; pseudophedrine, ritalin, and anti-histamines, sadly they seem to be less effective after a couple of days so i have to cycle on and off them i get a few days a month of feeling better and more active.- am thinking of trying wellbutrin in the hope that it'll work more long term - but i'm scared of all the side effects that might come with it.

@EtherSpin , @xebex - I'm confused. Wouldn't vasodilators help increase blood flow? It seems vasoconstrictors would reduce blood flow. What am I not understanding here?

 

[xebex]

@EtherSpin , @xebex - I'm confused. Wouldn't vasodilators help increase blood flow? It seems vasoconstrictors would reduce blood flow. What am I not understanding here?

i think it depends, if your blood vessels are already dilated possibly due to histamine issues, or maybe collagen issues, thus causing low blood pressure, you need constrictors to increase the pressure and get them squeezing the blood around, its a bit like using compression stockings. If you had normal blood vessels, constriction would lead to high blood pressure and reduced blood flow which is not good.

If you had already constricted vessels you would also have restricted blood flow essentially causing similar symptoms but from the opposite end, then you would need dilators. I've heard of someone on here doing great on dilators. It's about figuring our what the vessels are doing and taking a med to counteract that.

Ultimately, if you have high blood pressure, a vasoconstrictor is prob not going to help.

 

[Mary]

Thank you @xebex - that makes sense!

 

[barabara]

So the majority of people with ME/CFS in this study have a normal table tilt test, yet orthostatic intolerance.

Does anyone know if this test is available in any hospital? Hospitals don't list tests from what I've seen, and it doesn't seem like anyone besides a doctor can answer inquiries about it either.

Since 90% of people with ME/CFS show abnormally low CBF during the tilt test, such a test would prove invaluable to document disability in people with ME/CFS. This number is very impressive considering the heterogeneity of the population.

 

[kushami]

You can get this testing (transcranial or carotid Doppler ultrasound combined with tilt table test) at a small number of autonomic labs. There are posts on the DINET forum, or you could email Dysautonomia International.

An alternative approach is to find a hospital that offers Doppler ultrasound for other purposes (e.g. stroke, aneurysm) and get your specialist to ask them to combine it with a NASA lean test.

If you live in the Netherlands, you could go to the clinic where this study was done, Stichting Cardio Zorg.