Myalgic encephalomyelitis: Enigma at the medicine's crossroads

Abstract

Myalgic encephalomyelitis is a complex, multisystem disease with chronic course significantly affecting patients' quality of life. Physical and mental exertion intolerability, muscle pain, and sleep problems are the main features accompanied often with cognitive inefficacy and vegetative symptoms. Prevalence is 7-3000 per 100,000 adults. It is estimated that 90% of the patients are misdiagnosed. Pathogenesis is still only speculative but current research points to disturbances in the immunological system, inflammatory pathways, autonomic and central nervous system, muscle and mitochondria, as well as alterations of gut microbiota and gut permeability. The onset is typically acute, following an infectious disease. Exertional intolerance lasting for more than six months is an important diagnostic factor. The core features must be moderate to severe and present at least 50% of the time. Diagnostic criteria should be fulfilled and differential diagnosis should be made to exclude other potential pathological conditions or to diagnose comorbidities. Brain magnetic resonance imaging morphometry has shown gray matter atrophy in occipital lobes bilaterally, right angular gyrus, and the posterior division of the left parahippocampal gyrus, consistent with memory problems and potentially with impairment of visual processing. Treatment is still symptomatic and of partial benefit. Symptomatic treatment can include medications for controlling pain and sleep problems, graded exercise and cognitive behavioral therapy. Larger controlled trials are needed to shed more light on this challenging condition.

Mijalgični encefalomijelitis je složeno, multisistemsko oboljenje sa hroničnim tokom koje značajno utiče na kvalitet života bolesnika. Slaba tolerancija na fizički i mentalni napor, bolovi u mišićima i problemi sa spavanjem glavne su odlike i često su praćene kognitivnom neefikasnošću i vegetativnim simptomima. Prevalencija je 7-3000 na 100.000 odraslih. Procenjuje se da je 90% ovih bolesnika pogrešno dijagnostikovano. Patogeneza je i dalje samo spekulativna, ali trenutna istraživanja ukazuju na poremećaje u imunološkom sistemu, inflamatornom odgovoru, autonomnom i centralnom nervnom sistemu, mišićima i mitohondrijama, kao i promene mikrobiote i propustljivosti creva. Početak bolesti je tipično akutan i prati infektivnu bolest. Netolerancija napora koja traje duže od šest meseci važan je dijagnostički kriterijum. Osnovne karakteristike moraju biti umerene do teške i prisutne najmanje 50% vremena. Isključivanje drugih mogućih patoloških stanja ili komorbiditetnih dijagnoza zahteva zadovoljavanje dijagnostičkih kriterijuma i diferencijalno dijagnostičko sagledavanje. Morfometrijska snimanja mozga magnetnom rezonancom pokazala su atrofiju sive mase u okcipitalnim režnjevima bilateralno, desnom angularnom girusu i posteriornom levom parahipokampalnom girusu, što može dovesti do problema sa pamćenjem i oštećenja vizuelne obrade informacija. Lečenje je i dalje simptomatsko i samo delimično uspešno. Simptomatski tretman može da uključuje lekove za kontrolu bola i problema sa spavanjem, doziranu fizičku aktivnost i kognitivno-bihevioralnu terapiju. Potrebne su veće studije da bi se razjasnilo ovo medicinsko stanje.