Published: 2020-08-31 13:58 | Updated: 2020-08-31 14:25

Neck injuries and hypermobility are common among patients with ME/CFS

ME/CFS is a devastating disease with unknown genesis and no curative treatment. Some call the disease ME (Myalgic encephalomyelitis) and others CFS (Chronic fatigue syndrome), but the official name is ME/CFS. The disease has recently received increased worldwide attention after several cases of suicide among patients.

Afflicted patients suffer from a very low quality of life because of their aidless situation with a plethora of neurological symptoms, widespread pain, brain fog and severe fatigue exacerbated by even slight effort. There is no consensus on either causality or treatment for the disorder, and the prognosis is  poor.

It is estimated that more than 40 000 people in Sweden are suffering from ME/CFS, a number that may rise substantially in the future. Viral epidemics are well-known triggers for the onset of ME/CFS and the current COVID situation will most likely make the disease even more common. The connection between infections and onset of disease has led researchers to search for a unifying pathogenic explanation. Despite decades of research the search has been inconclusive, and the underlying mechanisms remain unclear.

A potential explanation behind the disease was recently proposed by a research team at the Karolinska Institute/Bragee Clinics (Stockholm). Clinical data from the Bragee ME-center indicated that hypermobility and strictures in the cervical spine were common in patients, of which the latter could be a sign of previous neck injury. To study this further, physicians at the clinic recruited 229 patients who were newly diagnosed with ME/CFS and consecutively invited to participate. The results were striking. Every second patient were hypermobile, and radiological examinations (MR) revealed that 80% had obstructions in the cervical spine and 83% displayed signs of elevated intracranial pressure. These numbers are far higher than what could be expected in the normal population and indicate that such abnormalities may be important in disease genesis, at least in some cases of ME/CFS.

These findings can explain many of the symptoms present in ME/CFS, says Björn Bragee, anesthesiologist and main author of the study. It is today rather clear that ME/CFS is a neurological disease, and interestingly, nearly all patients in the study experienced hyperalgesia and 3 out of 4 fulfilled the criteria for Fibromyalgia”.

We have a new project approved in which we seek to confirm these findings, by determining intracranial pressure more directly”.

The results are published in Frontiers of Neurology with open access.

Several projects are running attempting to verify these findings and evaluate treatment options, says Bo C Bertilson, MD and Research leader, affiliated to the Department of Neurobiology, Care Sciences and Society, Karolinska Institutet”.

Today’s research within the field are focused on neuroinflammation, which likely is of importance, but our data may very well complement and add to the field of neuroinflammation. There is an obvious need for clinical research in ME/CFS and patients and relatives at the Bragee ME-center contribute immensely to this.

Publication

Signs of Intracranial Hypertension,Hypermobility, and CraniocervicalObstructions in Patients With MyalgicEncephalomyelitis/Chronic FatigueSyndrome. Bragée B, Michos A, Drum B,Fahlgren M, Szulkin R andBertilson BC (2020) Front. Neurol. 11:828.doi: 10.3389/fneur.2020.  Published:28 August 2020

Contact

Björn Bragée, MD,  specialist in Anesthesiology and Pain Medicine, Bragée Clinics, Stockholm email bjorn.bragee@ki.se, phone +46708 993145

Bo Bertilsson, MD, PhD, NVS, spec. in General Medicine, Karolinska Institutet, email bo.bertilson@ki.se, phone +46707 32 02 32