All these threads on the same thing are confusing. I'm not sure where to answer.
Reading through the paper, I find I have several disagreements with many of his assumptions, based on other things I've read as well as my own experiences. I don't doubt that a few people may have whatever disease he's talking about, but do not find it describes what I have and others I know. And, he says:
"As a caveat and for clarification we want to add an important qualifier. It is unknown if ME/CFS can be legitimately conceptualized as manifestation of a single, underlying pathophysiological process. Indeed, many ME/CFS researchers question a universal pathological matrix especially across the
different etiotypes of the disease. This may be seen as a discouragement or even fatal blow to the approach presented in this working paper."
There are patients with mycotoxins, Epstein Barr, Cocksackie B, CCI, arsenic toxicity, thiamine or B12 or iron or tyrosine or citrulline deficiency, adrenal insufficiency, lipopolysaccharides, oxidative and nitrosative stress and many other etiologies and drivers of their disease.
Furthermore, not all of us experience PEM has he describes it, not do our physical symptoms equate with our mood. I don't doubt that glial cells play a role, but I'm not convinced that his assumptions and then the conclusions he derives from those somewhat questionable assumptions neatly explain our problems across the board.