FW: ME/CFS plus unusual neurological symptoms and signs - is it always ME/CFS?

[Guest guest]

ME/CFS plus unusual neurological symptoms and signs - is it

always ME/CFS?

MAY BE REPOSTED

The 2002 Chief Medical Officer's Report into ME/CFS officially

recognised that a number of serious and unusual neurological symptoms

and signs do sometimes occur in more severely affected people with

ME/CFS. These can include double vision, blackouts, atypical

convulsions/fits, loss of speech, and loss of swallowing

(ref: www.doh.gov.uk/cmo/cfsmereport/ Section 4.2.1.2 ).

When these sort of neurological symptoms and/or signs occur, it is

always important to exclude the possibility of the cause being another

neurological disorder. On such condition is Hashimoto's

encephalopathy - the diagnosis of one particular case I referred to last

year on the message boards. This very interesting case involved a

14-year-old girl whose initial (mis)diagnosis had been severe CFS, along

with neurological features (including hand tremor, jerking leg movements

and blurred vision) and a number of thyroid function test anomalies

consistent with an autoimmune thyroiditis (as occur in Hashimoto's

encephalopathy).

Dr Abhijit Chaudhuri and Professor Behan (University of Glasgow)

have now published a definitive paper on this not uncommon autoimmune

central nervous system disorder affecting both children and adults which

always appears to include a significant degree of central fatigue. The

paper describes the principle clinical features in 18 such patients:

- central fatigue in 100%

- migraine-type headaches in 90%

- seizures (focal/general/myoclonic) in 67%

- stupor in the acute presentation in 67%

- focal neurological deficit in 67%

- psychosis, delusions or hallucinations in 50%

- cognitive impairment in 33%

- alternating hemiparesis (ie loss of use on one side of the body)

in 16%

- cerebellar ataxia (ie severe disturbance with balance/co-ordination)

in 15%

Dr Chaudhuri and Professor Behan conclude that the range of laboratory

investigation abnormalities found in these 18 patients (which include

brain biopsies) indicate that this is an autoimmune disease of the

central nervous system and so encephalomyelitis is a much more

appropriate descriptive term than encephalopathy.

Furthermore, with a prompt diagnosis and appropriate therapy, the

prognosis for complete recovery from Hashimoto's encephalomyelitis is

often excellent.

Reference:

The clinical spectrum, diagnosis, pathogenesis and treatment of

Hashimoto's encephalopathy (recurrent acute disseminated

encephalomyelitis). Current Medicinal Chemistry, 2003, 10, 1945 - 1953.

Dr Shepherd

Medical Adviser, MEA

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