Poster presentations

Each year dozens of prospective papers are submitted to the scientific review committee for consideration. Typically the best papers are presented to the entire assembly, and less solid studies are relegated to "posters" in a side room or along the walls of the auditorium. This year the quality of papers was so good that several poster authors were asked to give a brief summary of their findings to the assembly.

C. Lennartsson of the Karolinska Institute (Sweden) confirmed previous reports that low level interval training is well tolerated in CFS/ME. She was followed by Mark Van Ness (University of the Pacific) whose exercise physiology group measured metabolic and immune responses to exercise. They confirmed that maximum aerobic capacity (VO₂ peak) was reduced in PWCs compared to sedentary controls (24.3 ml/min/kg compared to 31.4), and the oxygen capacity at the Anaerobic Threshold was also reduced. They introduced a new measure, VO₂ / workload that is also much lower in PWCs than controls (7.7 in CFS/ME compared to 8.9 in controls, where

Pat Fennell (CEO of Albany Health Management) described a paradigm shift that she is seeing in the patient population, namely a shift from acute care to chronic care needs. She briefly discussed her Four Phase Model and the Wagner model of chronic illness management. She urged providers to focus on whether the patient is responding to therapy; whether psychological support is needed; whether disability was inevitable; and whether interventions were appropriately matched to the phase of illness.

Garth Nicholson hypothesized that mitochondrial function is reduced in CFS/ME, and that replacement of essential mitochondrial lipids could improve mitochondrial function and reduce reactive oxygen species in the patient. In two studies, patients treated with glycophospholipids and "good" bacteria (NTFactor ^TM) reportedly achieved up to a 43% reduction in fatigue.

Daniel Blockmans (Leuven, Belgium) reported a randomized placebo-controlled crossover study of methylphenidate (Ritalin^TM), 20mg daily, in 60 PWCs. Subjects received either stimulant or placebo for 4 weeks, then treatment was crossed for another 4 weeks. Using the SF-36, the Hospital Depression and Anxiety Scale, and visual analog scales for pain, cognition, fatigue and other symptoms, Blockmans showed that stimulant medication improved fatigue and concentration significantly in 17% of cases. F. Garcia-Fructosa (Clínica CIMA, Barcelona) also provided a poster on the effect of modafanil (Provigil^TM, another type of stimulant) in PWCs. Modafanil was able to reduce daytime sleepiness by an average of 25% in 31 PWCs. However, 65% of patients reported some adverse effects (mostly anxiety, panic, irritability or palpitations), and 5 had to withdraw from the study. The drug did not interfere with sleep, however.

Comment: We have also noted that PWCs with hypersomnolence and/or excessive daytime sleepiness respond very well to stimulant medications. Some report improvement in concentration and focus as well. In our experience adverse effects are usually mild if patients start with a low dose and build up slowly.

Staci Stevens (Workwell, University of the Pacific) used the SF-36 survey to monitor post-exertional malaise after 10 minutes of exercise on a bicycle ergometer. Although patients and controls had similar results before exercise and 7 days afterward, it took controls only 1 day to recover, while no PWCs had recovered in 2 days and 50% required 5-6 days to recover.

Kenny DeMeirleir (Vrije Universeteit Brussels, Belgium) reported that 20-25% of Belgians typically suffer with lactose and fructose intolerance, respectively, whereas 71% of PWCs have intolerance to fructose (fruit sugars, beans, cauliflower, cabbage, and yes, brussel sprouts). Lactose intolerance was similar (20%) in PWCs and the general population.

Jonathan Kerr (St. George's University, London) has done extensive genomic and proteomic studies in PWCs. This time he reports on miRNA—short non-coding RNA sequences that are produced in the nucleus, migrate to the cytoplasm, and regulate translation (cellular protein production). Studying 15 PWCs and 30 controls, Kerr found 4 unique miRNAs in PWCs.

Paul Cheney reported that PWCs demonstrate evidence of diastolic dysfunction by tilt-echocardiography. This seems to confirm his previous finding of diastolic dysfunction on impedence cardiography, and is consistent with known deficiencies of mitochondrial or cellular energy in patients with CFS/ME and FM.

Comment: Our office has obtained impedance cardiograms on at least 8 PWCs, and have seen only trivial diastolic dysfunction, a condition that is reported in even healthy individuals. Confirmatory echocardiography in several subjects (but not tilt-echocardiography) has demonstrated NO significant abnormalities.