 
Mobility Problems in ME
Dr. E.G. Dowsett
MB ChB. Dip.Bact.
Honorary Consultant Microbiologist
Permission
has kindly been given by the author for us to include this document on our
website
Basildon and Thurrock General Hospitals N H S Trust
28 February 2000
Re: MOBILITY PROBLEMS IN ME
INTRODUCTION
ME (Myalgic encephalomyelitis) is a common chronic
neurological disablement which affects between 300 and 500,000 individuals of
all ages in the UK, most of them in the most socially and economically active
population groups. The symptoms of this multi system disease are characterised
by post encephalitic damage to the brain stem (1) (which contains
major nerve centres controlling bodily homeostais) and through which many spinal
nerve tracts connect with higher centres in the brain. Some individuals have, in
addition, damage to skeletal and heart muscle.
SPECIFIC MOBILITY PROBLEMS INCLUDE THE FOLLOWING:
NEUROLOGICAL PROBLEMS.
-
Exhaustion, weakness and collapse following mental or
physical exertion beyond the patents’ capacity. This arises from
metabolic damage to the reticular activating system and to the hypothalamic
control of the pituitary-adrenal axis (2). Whereas in healthy
controls or in other illnesses (such as depression) there is an increased
metabolic response to exertion, in ME this is diminished, leading to sudden
collapse which requires several days or more for recovery. These
complications (following even trivial exercise) are not recognised in short
medical examinations for social benefits and no allowance is made for the
delayed effects of exertion.
Recent research indicates that these patients
(3.) have high resting energy requirements which
further diminish their resources.
Problems with balance are common in ME due to
involvement of spinal nerve tracts in the damaged brain stem.
MUSCULO-SKELETAL PROBLEMS
- Over 70% of ME patients suffer from significant bone and muscle pain
(due to disordered sensory perception – a further consequence of brain stem
damage which seriously affects their mobility).
Other patients have (in addition) metabolic damage to muscle fibres
resulting in abnormal early lactic acidosis as demonstrated by sub
anaerobic exercise tests.
30% of patients with abnormal exercise tests have evidence of
persistent infection in the muscle and of muscle infarcts (tender points
on pressure affecting mainly limb and trunk muscles) and of
jitter (due to incoordinated muscle fibre action) on slow leg
raising for example, following damage to the neuromuscular junction. A rapid
decline in thigh muscle tone can be demonstrated between 2 and 24 hours
after exercise (3.)
CARDIOVASCULAR PROBLEMS
Patients with ME suffer a variety of symptoms arising from
autonomic nervous system dysfunction (4.) including liability to
a dangerous drop in blood pressure on standing for more than a few minutes,
while some 20% have progressive and frequently undiagnosed degeneration of
cardiac muscle which has led, in several cases, to sudden death following
exercise.
TO SUMMARISE:
Mobility aids are an essential requirement for patients with ME if
they are to stabilise sufficiently to retain economic and physical independence.
I can think of nothing more detrimental to the prospect of stabilisation in this
illness than to remove any type of mobility support (including disabled parking
concession) which can ensure continued activity in the future and spare the
enormous potential cost of social and institutional care, associated with
deterioration and chronic disablement.
Dr E.G. Dowsett - Honorary Consultant Microbiologist
- Member of the Chief Medical Officer’s Working Party on ME
References:
(1.) SCHWARTZ RB. et al. SPECT
imaging of the brain: comparison of findings in patients with Chronic
Fatigue Syndrome, A1DS dementia complex and unipolar depression. American
Journal of Roentgenology. 1994; 162 : 943-951
(2.) DEMITRACK MA. et al.
Evidence for impaired activation of the Hypothalamic-Pituitary-Adrenal axis
in patients with Chronic Fatigue Syndrome. Journal of Endocrinology and
Metabolism. 1991; 73 : 1224-1234.
(3.) CHAUDHURI A, BEHAN WMH,
BEHAN PO. et al. Chronic Fatigue Syndrome. Proceedings of the Royal College
of Physicians, Edinburgh. 1998; 28 : 150-163
(4.)
STREETEN DHP, BELL DS. Circulating Blood Volume in Chronic Fatigue Syndrome.
Journal of Chronic Fatigue Syndrome. 1998; A91) : 3-11
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