Cerebral Blood Flow Is Reduced in Severe ME/CFS during a 20 degrees head up tilt test (Van Campen et al 2020)

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Cerebral Blood Flow Is Reduced in Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients During Mild Orthostatic Stress Testing: An Exploratory Study at 20 Degrees of Head-Up Tilt Testing

C Linda M C van Campen 1 , Peter C Rowe 2 , Frans C Visser 1



Abstract

Introduction: In a study of 429 adults with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), we demonstrated that 86% had symptoms of orthostatic intolerance in daily life. Using extracranial Doppler measurements of the internal carotid and vertebral arteries during a 30-min head-up tilt to 70 degrees, 90% had an abnormal reduction in cerebral blood flow (CBF). A standard head-up tilt test of this duration might not be tolerated by the most severely affected bed-ridden ME/CFS patients. This study examined whether a shorter 15-min test at a lower 20 degree tilt angle would be sufficient to provoke reductions in cerebral blood flow in severe ME/CFS patients.

Methods and results: Nineteen severe ME/CFS patients with orthostatic intolerance complaints in daily life were studied: 18 females. The mean (SD) age was 35(14) years, body surface area (BSA) was 1.8(0.2) m2 and BMI was 24.0(5.4) kg/m2. The median disease duration was 14 (IQR 5-18) years. Heart rate increased, and stroke volume index and end-tidal CO2 decreased significantly during the test (p ranging from <0.001 to <0.0001). The cardiac index decreased by 26(7)%: p < 0.0001. CBF decreased from 617(72) to 452(63) mL/min, a 27(5)% decline. All 19 severely affected ME/CFS patients met the criteria for an abnormal CBF reduction.

Conclusions: Using a less demanding 20 degree tilt test for 15 min in severe ME/CFS patients resulted in a mean CBF decline of 27%. This is comparable to the mean 26% decline previously noted in less severely affected patients studied during a 30-min 70 degree head-up tilt. These observations have implications for the evaluation and treatment of severely affected individuals with ME/CFS.

Keywords: 20 degree tilt table testing; cardiac index; cerebral blood flow; chronic fatigue syndrome; myalgic encephalomyelitis; orthostatic intolerance; postural orthostatic tachycardia syndrome; stroke volume index.
 

Booble

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Have not been tested but I'm 99.9% sure I'd only need 10-minute and 10 degree tilt to lose cerebral blood flow!
I don't even like the dentist chair when the hygienist has me slightly further back than flat.
 
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This is why people with me/cfs lie down!
I consistently feel weird pressure in the back of the skull, head and. neck....when I lay down on my back for any length of time. My voice is more hoarse when I lie down that way; throat more off, my sinus inflames more...A weird kind of pressure head ache often happens.

So when I lie down, mostly I lie on my stomach. I sleep on my side. So I seem to avoid this laying back position.

Does this happen to anyone else? I have some of this POTS/OI stuff but maybe not as much as some people.
 

Booble

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I consistently feel weird pressure in the back of the skull, head and. neck....when I lay down on my back for any length of time. My voice is more hoarse when I lie down that way; throat more off, my sinus inflames more...A weird kind of pressure head ache often happens.

So when I lie down, mostly I lie on my stomach. I sleep on my side. So I seem to avoid this laying back position.

Does this happen to anyone else? I have some of this POTS/OI stuff but maybe not as much as some people.
Yep. When I was younger I liked being on my stomach. Now I don't have good range of motion in my neck so it's hard to be on my stomach with my head to the side. I can be on my back for reading and whatnot as long as my head is pretty far upright. Side sleeper.
 

Booble

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I'm trying to work on better neck range of motion. I think problems in that area and posture related contribute to some of my issues, especially the ocular migraines -- those awful 20-minute "scintillating scotoma" auras.
 

Hopeful2021

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I'm trying to work on better neck range of motion. I think problems in that area and posture related contribute to some of my issues, especially the ocular migraines -- those awful 20-minute "scintillating scotoma" auras.
I've been working lots on my neck too. To my toes and fingers too. So many connections and leverage points. I like PRP shots but not deep like traditional prp injections. And I do a number of neuroplasticity devices on my neck and fascia patterns. I'm able to take longer and true walking strides because of all this work. (A severe episode threw my instability into overdrive.)
 
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When you get close to severe its really obvious thats a large part of what is going on, with the brain at least, not sure about legs.

Could it be part of the bodies antiviral strategy ? if the virus must go into the cell and then replicates the explodes the cell and then it travels into the blood and then it goes to another part of the body and thats part of how it grows and spreads, then slowing down blood flow at the fine end of the scale it could slow the spread of the virus and give the antibodies or T cells or what not more of a chance to latch onto the virus particles ? just a guess it could be unrealistic.
 

Pyrrhus

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When you get close to severe its really obvious thats a large part of what is going on, with the brain at least, not sure about legs.

Could it be part of the bodies antiviral strategy ? if the virus must go into the cell and then replicates the explodes the cell and then it travels into the blood and then it goes to another part of the body and thats part of how it grows and spreads, then slowing down blood flow at the fine end of the scale it could slow the spread of the virus and give the antibodies or T cells or what not more of a chance to latch onto the virus particles ? just a guess it could be unrealistic.
In serious limb infections, there may be an automatic response similar to what you describe, intended to confine the infection.

In this particular case, however, we are simply talking about the shifting of blood out of the head due to the force of gravity when raising the head. Normally, the autonomic system pushes back against gravity, ensuring an uninterrupted flow of blood to the brain. But in dysautonomia, there is insufficient push back against gravity when raising the head, and as a result there is a drop in blood flow to the brain.

Hope this helps.
 

Pyrrhus

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A new publication by the same authors, that suggests that head-up tilt testing can itself provoke PEM:

Numeric Rating Scales Show Prolonged Post-exertional Symptoms After Orthostatic Testing of Adults With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
https://www.frontiersin.org/articles/10.3389/fmed.2020.602894/full
Excerpt:
van Campen et al 2021 said:
Introduction:
Muscle pain, fatigue, and concentration problems are common among individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). These symptoms are commonly increased as part of the phenomenon of postexertional malaise (PEM). An increase in the severity of these symptoms is described following physical or mental exercise in ME/CFS patients. Another important symptom of ME/CFS is orthostatic intolerance, which can be detected by head-up tilt testing (HUT). The effect of HUT on PEM has not been studied extensively. For this purpose, we assessed numeric rating scales (NRS) for pain, fatigue, and concentration pre- and post-HUT. As pain is a core symptom in fibromyalgia (FM), we subgrouped ME/CFS patients by the presence or absence of FM.

Methods and Results:
In eligible ME/CFS patients who underwent HUT, NRS of pain, fatigue, and concentration were obtained pre-HUT, immediately after HUT, at 24 and 48 h, and at 7 days posttest. We studied 174 ME/CFS patients with FM, 104 without FM, and 30 healthy controls (HC). Values for all symptoms were unchanged for HC pre- and post-HUT. Compared with pre-HUT, the three NRS post-HUT were significantly elevated in both ME/CFS patient groups even after 7 days. NRS pain was significantly higher at all time points measured in the ME/CFS patients with FM compared with those without FM. In ME/CFS patients, the maximum fatigue and concentration scores occurred directly post-HUT, whereas pain perception reached the maximum 24 h post-HUT.

Conclusion:
NRS scores of pain, fatigue, and concentration were significantly increased even at 7 days post-HUT compared with pre-HUT in ME/CFS patients with and without FM, suggesting that orthostatic stress is an important determinant of PEM.
 

Booble

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I feel like any one of us with POTS would say, "Duh, I could have told you that, Dr. Researcher!"
some science is just so- proving the obvious.

Somebody I know got a masters degree, regarding some wild plant, and they proved that if you thin out adjacent seedlings, your plant nearby grows larger.

We've been growing lettuce for a while now, you thin out seedlings ...keep weeds down. End up with. a head of lettuce.
 

Booble

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some science is just so- proving the obvious.

Somebody I know got a masters degree, regarding some wild plant, and they proved that if you thin out adjacent seedlings, your plant nearby grows larger.

We've been growing lettuce for a while now, you thin out seedlings ...keep weeds down. End up with. a head of lettuce.
Fair enough!
 

lenora

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I have an adjustable bed and this certainly helps explain the headaches I constantly have.

As most of you know, I'm a 74 yr. old female, who probably had POTS in my early years, long before it was even known, let alone a problem. During those years, I always had extremely low blood pressure, and no matter how many times it was taken, the results were the same.

Fast forward past ACM Surgery and an early menopause at age 42. Since then, I've had the opposite - high blood pressure, really, really high yet small veins and arteries. I am the owner of 6 stents and yet I believe there is something about sitting up vertically for long periods of time that is not good for us. I can almost convince anyone of that matter...scientific or not.

Little by little my bed goes lower as I hope to escape the headache and watch the TV show or, later in the evening, read a book. When I'm flat most symptoms disappear. I do have high cholesterol in addition to my other problems (which are many) and my father died of heart disease at age 40. Of nine of us, me being the oldest, we all had/have familial high cholesterol and BP. Seven of my siblings are now dead, and not one died as a result of heart disease.

I'm way past worrying about the cause of my death...it's coming as anyone in our age range (hubby is 77 this year), can attest. Like CFS/ME and our other problems, we realize it and make our peace with what's coming. This new research will be especially for those of you who are young...and yes, I'm glad. Yours, Lenora.