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How I found the underlying cause of my CFS--anti NMDA antibodies

SK2018

SK
Messages
239
Location
Asia wide + UK
how many rounds of Rituximab to ppl typically do? I only have EBV - not CMV or HHV-6, so I am lucky in that regard b/c those infections seem to be much stronger than EBV from what I've read. thx.

Had Latent CMV and EBV for most of my life never once did they cause me any problems I was the picture of good health and my antibody control of them was impressive at a stable IGG 1:250 - 1:280 always plus potent T cells ,there is no way they would be able to cause me a sniff of trouble,but after getting a Neuro immune disease and requiring major immune suppression ?......that situation could change.

Rituximab at least here they generally do 2 infusions 500mg 2 weeks apart ,I think RTX is one of the safer immune suppressives as it only removes B cells which at least leaves you with all your T cells such as NK ,CD4 CD3 CD8 ect and it leaves you still With your existing pool
Of antibodies until almost the new round of B cells come out.

T cells (cell mediated immunity) is more important for viruses.

What makes you sure that EBV is making you have problems ?.
 

ebethc

Senior Member
Messages
1,901
Had Latent CMV and EBV for most of my life never once did they cause me any problems I was the picture of good health and my antibody control of them was impressive at a stable IGG 1:250 - 1:280 always plus potent T cells ,there is no way they would be able to cause me a sniff of trouble,but after getting a Neuro immune disease and requiring major immune suppression ?......that situation could change.

Rituximab at least here they generally do 2 infusions 500mg 2 weeks apart ,I think RTX is one of the safer immune suppressives as it only removes B cells which at least leaves you with all your T cells such as NK ,CD4 CD3 CD8 ect and it leaves you still With your existing pool
Of antibodies until almost the new round of B cells come out.

T cells (cell mediated immunity) is more important for viruses.

What makes you sure that EBV is making you have problems ?.

I have extremely high titers of EBV, and have had CFS for many years.. Made worse by a couple of bouts of mono that each made me progressively weaker... At best, I feel like I'm walking around w 30% of the flu, at worst, bedbound. I've been on a push-crash cycle for my adult life, and really can't take it anymore... I'm scheduled to see a CFS specialist in a couple of months (if I can afford it.. I keep having to push it off due to finances). He does rx Rituximab, and I don't know what he'll say - continue on the antivirals that I started last Spring - or bump it up a notch w something like Rituximab or whatever... In the mean time, I'm asking questions.

1 or 2 infusions does not seem terrible; from what I've read it can be a 12-18 month ordeal, costing $34k to $64k here in the u.s. (potential for reimbursement)... Is 500mg a high dose?

My concern w Rituximab is that I have extremely poor NK Cell function - 2 LU! So it seems counterintuitive to wipe out B cells when other immune factors are so poor. Was NK cell count or function a consideration in Rituximab therapy?

thx
 

SK2018

SK
Messages
239
Location
Asia wide + UK
I have extremely high titers of EBV, and have had CFS for many years.. Made worse by a couple of bouts of mono that each made me progressively weaker... At best, I feel like I'm walking around w 30% of the flu, at worst, bedbound. I've been on a push-crash cycle for my adult life, and really can't take it anymore... I'm scheduled to see a CFS specialist in a couple of months (if I can afford it.. I keep having to push it off due to finances). He does rx Rituximab, and I don't know what he'll say - continue on the antivirals that I started last Spring - or bump it up a notch w something like Rituximab or whatever... In the mean time, I'm asking questions.

1 or 2 infusions does not seem terrible; from what I've read it can be a 12-18 month ordeal, costing $34k to $64k here in the u.s. (potential for reimbursement)... Is 500mg a high dose?

My concern w Rituximab is that I have extremely poor NK Cell function - 2 LU! So it seems counterintuitive to wipe out B cells when other immune factors are so poor. Was NK cell count or function a consideration in Rituximab therapy?

thx

NK cell function which is a T cell ..It wasn't a problem for me as I have strong T cell function.

When you say you had very high EBV titres was it IGG or IGM? And what was the titre number ? Also did you have EBV DNA test to check for EBV viremia in the blood?ny CMV and EBV DNA was negative also .

500mg is considered a normal dose.

The price in the US seems ridiculous a true rip off ,in Shanghai it's 18000 RMB for 500mg dose which is USD 2800
 

ebethc

Senior Member
Messages
1,901
NK cell function which is a T cell ..It wasn't a problem for me as I have strong T cell function.

When you say you had very high EBV titres was it IGG or IGM? And what was the titre number ? Also did you have EBV DNA test to check for EBV viremia in the blood?ny CMV and EBV DNA was negative also .

500mg is considered a normal dose.

The price in the US seems ridiculous a true rip off ,in Shanghai it's 18000 RMB for 500mg dose which is USD 2800

how many rounds is typical for RTX? Over what period of time? Does it make you even sicker? even at $2800 a pop, that adds up!

I have never heard of the EBV DNA test or viremia ... why is it important?

My EBV titers are measured quite the way you describe, ie, x:xx EBV titers:
EA-IgG = 2.98 HIGH
  • < or = 0.9 is negative"
EBNA-IgG = > 5.00 HIGH (not measured above this number)
  • < or = 0.9 is negative
  • Epstein Barr Nuclear Antigen
VCA-IgG = > 5.00 HIGH (not measured above this number)
  • < or = 0.9 is negative
  • “Viral Capsid Antigen"
VCA-IgM = < or = 0.9 NORMAL
  • < or = 0.9 is negative
 

ebethc

Senior Member
Messages
1,901
John Hopkins : reset and reversed MS by rebooting a patients immune system via cycophlasphamide Some apparent permanent disability was reversed.


is this considered in the same family as RTX, or next gen, or something else?
 

SK2018

SK
Messages
239
Location
Asia wide + UK
how many rounds is typical for RTX? Over what period of time? Does it make you even sicker? even at $2800 a pop, that adds up!

I have never heard of the EBV DNA test or viremia ... why is it important?

My EBV titers are measured quite the way you describe, ie, x:xx EBV titers:
EA-IgG = 2.98 HIGH
  • < or = 0.9 is negative"
EBNA-IgG = > 5.00 HIGH (not measured above this number)

  • < or = 0.9 is negative
  • Epstein Barr Nuclear Antigen
VCA-IgG = > 5.00 HIGH (not measured above this number)

  • < or = 0.9 is negative
  • “Viral Capsid Antigen"
VCA-IgM = < or = 0.9 NORMAL
  • < or = 0.9 is negative


DNA tests are important as it can detect actual virus in the blood,from your above tests I don't see any indication to worry about EBV.

First your IGM is negative which means there is no reactivation, your IGG is not high and everybody who was exposed to EBV before will develop protective circulating antibodies, my IGG for EBV has been 1:250 roughly for most of my life and most of that time I was a picture of health,yours are not high at all and frankly you should feel safer than you have a strong protective antibody response to this virus.

If your worried get a EBV DNA test if it comes back negative stop
Taking the antivirals as no point causing side effects from antivirals without good reason,if all viruses come back negative you may have an autoimmune form of the disease.
 
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ebethc

Senior Member
Messages
1,901
DNA tests are important as it can detect actual virus in the blood,from your above tests I don't see any indication to worry about EBV.

First your IGM is negative which means there is no reactivation, your IGG is not high and everybody who was exposed to EBV before will develop protective circulating antibodies, my IGG for EBV has been 1:250 roughly for most of my life and most of that time I was a picture of health,yours are not high at all and frankly you should feel safer than you have a strong protective antibody response to this virus.

If your worried get a EBV DNA test if it comes back negative stop
Taking the antivirals as no point causing side effects from antivirals without good reason,if all viruses come back negative you may have an autoimmune form of the disease.


The IgG vs IgM in EBV is often disputed....I thought the same as you, but after all the reading (... and then some more reading..) I have decided that it depends on the immune picture, i.e., coupled w biomarkers like bad NK function, I think that it does indicate viral re-activation.. See Teitelbaum's explanation (which I've seen agreement on in other places)... Antivirals were a breakthrough for me, and I've tried so many drugs/supplements that I don't believe it's psychosomatic... I had a terrible bout w mono in 2001 and the ENT said 'You tested negative, but I've seen enough cases of mono to know that you have mono' and he put me on prednisone, etc. My throat was swollen closed


"It's true that IgG elevation reflects old infection, and most healthy people test IgG positive for EBV, CMV, HHV 6 and HSV1. Because of the immune dysfunction in fibromyalgia and CFS, viral reactivation is usually detected. This will not result in the standard IgM test for acute infection being positive, but has been shown to be associated with very high IgG titres in combination with a clinical picture that is suggestive. Though there is no set cutoff for the IgG to confirm viral reactivation, I consider titres of 4 (or 1:640) or higher to raise a suspicion for HHV 6, CMV, and perhaps HSV 1 reactivation.

http://www.healthrising.org/forums/...hronic-fatigue-syndrome-and-fibromyalgia.397/


 

SK2018

SK
Messages
239
Location
Asia wide + UK
The IgG vs IgM in EBV is often disputed....I thought the same as you, but after all the reading (... and then some more reading..) I have decided that it depends on the immune picture, i.e., coupled w biomarkers like bad NK function, I think that it does indicate viral re-activation.. See Teitelbaum's explanation (which I've seen agreement on in other places)... Antivirals were a breakthrough for me, and I've tried so many drugs/supplements that I don't believe it's psychosomatic... I had a terrible bout w mono in 2001 and the ENT said 'You tested negative, but I've seen enough cases of mono to know that you have mono' and he put me on prednisone, etc. My throat was swollen closed


"It's true that IgG elevation reflects old infection, and most healthy people test IgG positive for EBV, CMV, HHV 6 and HSV1. Because of the immune dysfunction in fibromyalgia and CFS, viral reactivation is usually detected. This will not result in the standard IgM test for acute infection being positive, but has been shown to be associated with very high IgG titres in combination with a clinical picture that is suggestive. Though there is no set cutoff for the IgG to confirm viral reactivation, I consider titres of 4 (or 1:640) or higher to raise a suspicion for HHV 6, CMV, and perhaps HSV 1 reactivation.

http://www.healthrising.org/forums/...hronic-fatigue-syndrome-and-fibromyalgia.397/

Ok if that is the case then how come I had 1:250 1:300 high titres all my life and was healthy as can be and a negative DNA test,don't you think it would be prudent to get a PCR DNA test for EBV,?if there are no viral copies detected in the blood then it's not the virus directly troubling you ,unless you have a faulty B cell response which can be triggered by its initial infection and latency ,like for me HSV 2 caused my illness but 1: it is latent not active and not the virus directly 2: it's becuase of an incorrect B cell response.

Btw what are your main symptoms ?
 

Research 1st

Severe ME, POTS & MCAS.
Messages
768
How I found the underlying cause of my CFS--anti NMDA antibodies

7 pages an no one has realised the obvious.

If a person has evidence of significantly raised (pathalogical) anti NMDA receptor antibodies and any history of psychotic or psychiatric events ( these not being a feature of CFS), they don't have CFS and were misdiagnosed.

CFS diagnostic criteria is defined by unexplained, chronic fatigue. This means at the time of diagnosis, even something as simple as Anemia or a Vitamin D deficiency would prevent a diagnosis,never mind having high levels of CNS autoimmunity known to induce psychiatric, autonomic and ensuing CF.

So If you have any explained reason for CF, by very definition, you cannot have CFS and were misdiagnosed with CFS.

For the record I have very severe ME + POTS and have had every single autoantibody known to man, including NMDA receptor encephalitis tested. They are all negative (at cut off levels for disease diagniosis), except those found in experiential POTS + ME research - what a surprise.

ME is ME, and NMDA receptor autoimmune disease affecting neurology, is precisely that, not because I want it to be, but because these are the rules that the CDC in America set up (Fukuda criteria CFS). In addition all other criteria I know of (except F48.0 Psych criteria CFS from UK used in PACE trial) also forbids anyone with psychiatric symptoms, that explain CF to also be diagnosed with CFS or ME-ICC.

So in conclusion, the unfortunate OP was misdiagnosed with CFS, when all along they had a neuropsychiatric autoimmune illness. We have seen thus countless of times regarding other diagnosese. Most commonly, POTS, Thyroid/Coeliac disease, Pituitary (GH deficiency) and Cancers.

This is the fault of the CDC, not the patient. The patient is told ''you have CFS'' and then that's that. No more work up. If extensive and expensive work up had been performed, these autoantibodies could have been found in the first place.

That's the tragedy of it all, the patients suffer.
 
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SK2018

SK
Messages
239
Location
Asia wide + UK
7 pages an no one has realised the obvious.

If a person has evidence of significantly raised (pathalogical) anti NMDA receptor antibodies and any history of psychotic or psychiatric events ( these not being a feature of CFS), they don't have CFS and were misdiagnosed.

CFS diagnostic criteria is defined by unexplained, chronic fatigue. This means at the time of diagnosis, even something as simple as Anemia or a Vitamin D deficiency would prevent a diagnosis,never mind having high levels of CNS autoimmunity known to induce psychiatric, autonomic and ensuing CF.

So If you have any explained reason for CF, by very definition, you cannot have CFS and were misdiagnosed with CFS.

For the record I have very severe ME + POTS and have had every single autoantibody known to man, including NMDA receptor encephalitis tested. They are all negative (at cut off levels for disease diagniosis), except those found in experiential POTS + ME research - what a surprise.

ME is ME, and NMDA receptor autoimmune disease affecting neurology, is precisely that, not because I want it to be, but because these are the rules that the CDC in America set up (Fukuda criteria CFS). In addition all other criteria I know of (except F48.0 Psych criteria CFS from UK used in PACE trial) also forbids anyone with psychiatric symptoms, that explain CF to also be diagnosed with CFS or ME-ICC.
Correct I was misdiagnosed as were probably a lot of people on this forum that might have other different reasons for their similar set of symptoms.

My NMDA was low level not so abrupt and not many pysch symptoms except panic attacks,and the B cell dysfunction which caused 2 sections of my immune system to chronically battle each other ie T cells vs rogue B cells explained systemic symptoms. My list of symptoms were as follows. DP and DR , anxiety attacks ,autonomic dysfunctions ,regular flu like
Symptoms esp after physical exertion ,swollen lymph nodes,twitches tingling night sweats,overly vivid dreams and physical and mental fatigued ,sleep
Disturbance.

I think your reply raises a very good point and many members here have a similar list of symptoms that may be triggered by different causes,also bare in mind there are a huge number of auto antibodies yet to be discovered.

Classic ME is a Neuro immune illness ,I have a form of one ,many people do here also,what the underlying cause is for our similar yet also differing syndromes will most likely remain unclear for many until more better diagnostic tools are available.Until then , people are going to search for all possibilities for symptom markers and causative evidence,be it auto antibodies,Viruses ,chronic bacterial infections ,toxins or indeed even viral titres.If I did not dig deep and persist I would not have found out the truth and thus would not be eligible for immuno modulation treatment on the NHS.
I am firmly with Jonathan Edwards view that ME is a B cell mediated Neuro immune disease.As the lack of infective markers ,fluctuating course and mostly normal blood testing results all points towards immune mediation of illness.
 

ebethc

Senior Member
Messages
1,901
Ok if that is the case then how come I had 1:250 1:300 high titres all my life and was healthy as can be and a negative DNA test, don't you think it would be prudent to get a PCR DNA test for EBV?

I don't know. btw - I still don't understand the "x:xxx" results... My test results are not shown in that format.

Yes, but it's really up to Dr Kaufman @ OMI when I see him early next year.. AV's have been good for me, although they were way to hard on my stomach so after 3 mos I switched to high quality olive leaf extract, which has AV properties.. https://www.ncbi.nlm.nih.gov/pubmed/12878215

bottom line: there isn't a lot of consensus on EBV testing and active vs non-active
http://simmaronresearch.com/2014/03/1591/

...unless you have a faulty B cell response which can be triggered by its initial infection and latency

Btw what are your main symptoms ?

Entirely possible... How do you know if you have a faulty B cell response? is there a test?

Lifelong joint pain, IBS, chronic sinus problems, fatigue, PEM, brain fog, sore throat and swollen lymph gland in neck (although this has greatly improved in the past year due to AV & OLE), sensitivity to light, noise, extreme sensitivity to shifting barometric pressure & pollution, frequent gut infections, viruses, colds... The only thing that I don't have is OI/POTS.

MCAS - high tryptase ... couldn't tolerate drugs, so I use quercetin
very poor NK cell function - 2 LU
Slightly Hypothyroid since severe throat infection in 2001... btw I tested "negative" for mono then, but the ENT said it was a false negative b/c he's seen a lot of mono and said I for sure had mono...tx w abx and prednisone, which gave me panic attacks.. Had something similar in college.. Breakdown of immune system SEVERE fatigue and unable to function ~3x in my life... Digging my way out of a crash now. I'm a 6 on the disability scale and want to get to 8 by the end of 2017.. Hopefully, I will be able to afford Dr Kaufman in 2017 to help achieve this goal... need to get work and health insurance first.. Since Trump & company will gut healthcare, I'm not bothering to go on obamacare as planned, but have to get an office job w good insurance.

ps I'm adopted and met my biological mother.. She and her daughter have the same symptoms as me, so I know it's genetic...
 

Cohen2

Senior Member
Messages
119
Location
New Zealand
Thanks for sharing the cause of your illness @Shawn Im glad you figured it out so quickly. Ive been following this thread. Id be keen to get the neuronal antibody testing but Im too unwell to travel to Shanghai. Unfortunately the health system here in New Zealand is similar to the NHS. Ive had nothing but pretty standard testing since I first got ill and have been treated poorly by most Drs. Ive had all the physical symptoms youve mentioned and more plus panic attacks since the onset of my illness and DP, DR on and off and a couple of periods of psychosis aswell. Before the onset I was very fit and mentally well.

@ebethc The research on lack of immune response to EBV in people with ME is interesting to me, as when I first had EBV (according to one Paul Bunell) I had no IgG or IgM EBV antibodies and this continued any time I got tested for at least six years after. I think that would suggest a lack of immune response, unless the Pual Bunell was a false positive. I dont know how common that is.

Do you know anything about what an IgG level for CMV would be for it to be considered active? As mine is always raised and wondered if that could be a partial cause for my ME
 

ebethc

Senior Member
Messages
1,901
@ebethc The research on lack of immune response to EBV in people with ME is interesting to me, as when I first had EBV (according to one Paul Bunell) I had no IgG or IgM EBV antibodies and this continued any time I got tested for at least six years after. I think that would suggest a lack of immune response, unless the Pual Bunell was a false positive. I dont know how common that is.

Do you know anything about what an IgG level for CMV would be for it to be considered active? As mine is always raised and wondered if that could be a partial cause for my ME

what do you mean by lack of immune response? I don't believe I'm familiar w this, unless it's called something else..

I don't know anything about CMV, but there are plenty of ppl here who do

good luck.
 

SK2018

SK
Messages
239
Location
Asia wide + UK
Thanks for sharing the cause of your illness @Shawn Im glad you figured it out so quickly. Ive been following this thread. Id be keen to get the neuronal antibody testing but Im too unwell to travel to Shanghai. Unfortunately the health system here in New Zealand is similar to the NHS. Ive had nothing but pretty standard testing since I first got ill and have been treated poorly by most Drs. Ive had all the physical symptoms youve mentioned and more plus panic attacks since the onset of my illness and DP, DR on and off and a couple of periods of psychosis aswell. Before the onset I was very fit and mentally well.

@ebethc The research on lack of immune response to EBV in people with ME is interesting to me, as when I first had EBV (according to one Paul Bunell) I had no IgG or IgM EBV antibodies and this continued any time I got tested for at least six years after. I think that would suggest a lack of immune response, unless the Pual Bunell was a false positive. I dont know how common that is.

Do you know anything about what an IgG level for CMV would be for it to be considered active? As mine is always raised and wondered if that could be a partial cause for my ME

Unless I read wrong you said you had a poor immune response to EBV and despite having the virus were unable to get detectable IGG or IGM readings,this really made me take notice as this is EXACTLY what happened and is happening with my HSV 2 infection and what I found out was the reason for this was my body did not produce the Correct antibodies for HSV 2 and instead produced a cross reactive auto antibody that hits the virus and my own tissue as well thus making me sick,this sounds exactly what is happening with you ,my HSV type 2 continues to be negative despite Previously having the virus confirmed by a DNA lesion Swab,before at best I get an equivocal result but never positive,it's amazing how doctors in there cruel ignorance never take notice of these subtle yet extremely important markers.

I would focus on this finding if I was you.

believe me before I got this shit figured out I was abused and ridiculed by doctors ,it hurt me deeply and made me resent and hate anyone in a white coat despite my immense suffering I was cast away like an unwanted menace ,a once proud Photographer with a large following ,a respectful job beautiful girlfriend and a bottle full of dreams,I wiahed to have AIDS or cancer as sad as that sounds so that I could be treated with empathy and respect ,I found out what was wrong with me because I never gave up and went through literal hell and back to get to this point and I never once let the hurtful dismissals those narrow minded devils gave me to force me to lay down and accept an "existence" over a life.

Now about your raised CMV stuff this is also what I am experiencing ,no antibodies to HSV 2 for the reasons I mentioned previously yet elevated CMV and HSV 1 and EBV antibodies at 1:340 and 1:400 here is the theory the Neuro immune specialist here thinks that explains this.

Just say an average person has the common level of IGG titre for a latent virus of say 1:20 a titre of 1:380 would be a 18-19 fold increase (which many with CFS have ) now the cut off mark for auto and Normal antibodies to become clinically relevant is around 1:4 ect ,so let's say we had an autoantibody in our system that was below the clinical threshold marker at 1:1 after a triggering infection and humoral B cell dominant dysfunction this titre as with all the other titres would increase 18 fold also,which would bring it up to around 1:20 or in some 1:30 1:40 which is way past the threshold for auto antibodies to produce clinical symptoms,during times of infection and high stress these auto antibody titres could rise even more.So the auto antibodies which many people carry below positive testing thresholds were only able to produce clinical disease sue to a massive runaway up regulation of the humoral side of the immune system in short : uncontrolled antibody production and B cell dis regulation.

This theory is solid and is in fact commonly found in people with strange diseases like ours.

As for me ,I want my immune system reset and wiped out with cycophlasphamide ( I posted a John Hopkins video about this earlier in the thread) so it can re generate from scratch,this dysfunction won't fix itself without intervention and auto antibodies making us sick is just a marker sign of an underlining serious immune dysfunction.

My immune system is totally out of whack but insertingly I don't have over productions of antibodies for bacteria infections,I wonder if with you it's also this way? So it's the humoral viral side of my immune system that deals with viruses that has went AWOL.


Below I have attached a copy of my viral reports ect infectious stuff ,notice my HSV 2 is still not positive,this blood test was done after 3 plasmapheresis sessions before the PP my CMV titre was 1:340 and HSV 1 1:327 and EBV 1:352 now it's down to 1:30 which is still above most normal people's titre "despite" being after 3 PP sessions.Now I had quite high titres before my triggering infection (not this high though) so it could be a sign of a predisposition for an immune system which will easily go out of whack in future with the right trigger.Also take note of the "negative" viral DNA tests which means despite what many people on PR worry about its most likely bornthe virus causing such titres it's simply an out of whack humoral immune system which can make people very sick indeed.

It's a pity I can't tolerate Rituximab as my immune system ( most likely T cells) attack and consumes it as it is after all a foreign protein with murine elements included,I probably could have got away with suffering that kind of immune response before my immune cells for some reason moved into my brain because now any systemic reaction also causes an inflammatory reaction within my nervous systems which obviously includes the CNS and I don't need to explain just how much that could drop my baseline down.
Sad indeed...I'll have to go down the chemical route abeit carefully,I think RTX out of all immune modulators is the most safe as it leaves other elements of your system alone except B cells and it's not very toxic.
 

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