Multiple Sclerosis/Chronic Fatigue Syndrome overlap: When two common disorders collide

Abstract

INTRODUCTION: Fatigue is a major cause of disability and handicap in Multiple Sclerosis (MS) patients. The management of this common problem is often difficult. Chronic Fatigue Syndrome (CFS/ME) is another common cause of fatigue which is prevalent in the same population of middle aged females commonly affected by MS. AIM: This report aims at examining the potential coexistence of MS and CFS/ME in the same patients. METHOD: This is a retrospective study examining a cohort of MS patients referred for rehabilitation. The subjects were screened for CFS/ME symptoms. RESULTS: Sixty-four MS patients (43 females) were screened for CFS/ME. Nine patients (14%) with a mean age 52 (SD 9.7) who were all females fulfilled the Fukuda criteria for diagnosis of CFS/ME. Their symptoms, including muscular and joint pain, malaise and recurrent headaches, were not explained by the pattern of their MS. DISCUSSION: MS and CFS/ME are two common conditions with increased prevalence in middle aged females. As the diagnosis of CFS/ME is clinical with no positive clinical signs or investigations; it can be made with difficulty in the presence of another clear explanation for the disabling fatigue. Our results suggest that the two conditions may co-exist. Considering CFS/ME as a potential co-morbidity may lead to more focused and appropriate management.

More Stamina, a Gamified mHealth Solution for Persons with Multiple Sclerosis: Research Through Design

“…Fatigue is a nonspecific symptom that can be caused by many conditions and syndromes such as the chronic fatigue syndrome, anemia, hypothyroidism, or sleep apnea [ 74 ]. It is possible that our More Stamina solution could be of use in other conditions that require fatigue management, but this would need to be explored separately.…”

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome as a Hyper-Regulated Immune System Driven by an Interplay Between Regulatory T Cells and Chronic Human Herpesvirus Infections

“…Given this basic immunological theory based on the cross-regulation model, it is reasonable to question where patients suffering from ME/CFS are placed in the distribution of the regulation cutoff. On the one hand, patients of this disease often show clinical symptoms similar to the ones presented by patients with autoimmune diseases, such as rheumatoid arthritis and multiple sclerosis (39, 40). On the other hand, patients suffering from ME/CFS do not develop the disease spontaneously as expected from a pathology with a strong genetic component.…”

“…Since the responding clone has a high autoimmune potential, an immune response mounted solely by Teffs is not regulated and, therefore, it can be interpreted as the hallmark of an autoimmune disease resulting from an infection. If HHV6 is able to reach the brain and express a protein similar to the myelin basic protein (Table 1), then this mode of infection might initiate multiple sclerosis, an autoimmune disease whose clinical symptoms greatly overlap with the ones reported by many patients with ME/CFS (39). In this line of thought, the density of Tregs is expected to be affected by different viral capacities of the infecting HHV6, which may contribute to differences in pathogenesis and subsequent case definitions between multiple sclerosis and ME/CFS.…”

Immune network analysis of cerebrospinal fluid in myalgic encephalomyelitis/chronic fatigue syndrome with atypical and classical presentations

“…3, 4 In prior work defining CSF immune signatures in ME/CFS patients with classical presentations we found evidence of disrupted interleukin (IL)-1 signaling in CNS as compared with subjects with multiple sclerosis and no-disease controls. 5 A proportion of patients who meet diagnostic criteria for ME/CFS at the onset of their illness have either a remote history of relatively uncommon exposures (viral encephalitis, illness after foreign travel or blood transfusion, Gulf War Illness) or develop comorbid immune-mediated 6, 7 or neurological 8, 9 disorders years later. Here we report discrete immunological profiles in the CSF of subjects with ME/CFS who vary in clinical presentation and comorbidity.…”