By Brent L. Handel Q.C.
Patients with Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS, or CFS) are accustomed to disappointment. The cause of the disorder remains unknown; it can be difficult to diagnose, and treatment options are few, and proof in a court of law is even more difficult.
Those are the words of Dr. Jose Montoya, M.D., professor of Infectious Diseases and Geographic Medicine at Stanford University School of Medicine. Recent cutting-edge research at Stanford University School of Medicine have discovered that the brains of patients with chronic fatigue syndrome have diminished white matter and white matter abnormalities in the right hemisphere. The radiology researchers using a trio of sophisticated imaging methodologies, found that chronic fatigue syndrome patients’ brains diverge from those of healthy subjects in at least three distinct ways. Chronic fatigue syndrome affects between 100,000 and 400,000 individuals in Canada and millions more worldwide. The combination of symptoms can devastate a patient’s life for 10, 20 or even 30 years, said Dr. Montoya, who has been following 200 CFS patients for several years in an effort to identify the syndromes’ underlying mechanisms.
What is exciting about this breakthrough at Stanford is that it potentially provides a CFS-specific diagnostic biomarker that researchers have been desperately seeking for decades. A biomarker would make a significant change in how civil litigation on disability claims and personal injury claims from motor vehicle collisions in Red Deer are conducted.
These findings hold the promise of identifying the area or areas of the brain where the disease has hijacked the central nervous system. Many CFS patients complain of brain or central nervous system abnormalities that cannot be explained.
The three key findings are as follows: (1) first, an MRI showed that overall white-matter content of CFS patients’ brains, compared with that of healthy subjects’ brains, was reduced. The researcher said this finding wasn’t entirely unexpected as it has been theorized that CFS involves chronic inflammation, quite possibly as a protracted immunological response to an as-yet unspecified viral infection. Inflammation is known to take a particular toll on white matter.
However, a second finding was entirely unexpected. Using an advanced imaging technique, the researchers identified a consistent abnormality in a particular part of a nerve tract in the right hemisphere of CFS patients’ brains. This area is called the right arcuate fasciculus. There was a strong correlation between the degree of abnormality in this area and the severity of the patient’s condition.
The third finding involved a thickening of the gray matter at the two areas of the brain connected by the right arcuate fasciculus in CFS patients, compared with controls. Dr. Zeineh, one of the lead radiologist researchers, said this correspondence with the observed abnormality in the white matter joining them makes it unlikely that the two were chance findings.
This breakthrough in CFS research has recently been reported in the New York Times as a ground-breaking study, as well the New York Times article mentioned a Japanese study published in March 2014 which also found cerebral inflammation in patients who suffer from CFS, or, as it is called, myalgic encephalomyelitis/CFS. The combination of the two independent studies is ground-breaking and of extreme importance in this area. It is being used for a condition that’s often misdiagnosed – patients are sometimes forced to visit numerous doctors and battle disability insurance companies – all while fighting the debilitating symptoms – before securing a diagnosis.
The culmination of the two studies, one by Stanford and another independently by a Japanese research team, strengthens significantly the argument that can be made in a court of law that the CFS sufferers have a serious physiological dysfunction at the root of the condition.
For many CFS patients, the primary symptom is not just fatigue but more specifically post-exertional malaise, the total depletion of energy after even minimal amounts of activity, which often does not show up for 24 to 48 hours later, making regulation of activity and monitoring of energy expenditure even more difficult for these patients. As well, the CFS patients suffer from sleep disorders, lapses in cognitive function, and muscle pain. Some patients are even virtually bedbound for long periods.
Many experts now believe that in people with CFS, a viral infection or some other physiological insult or exposure, or perhaps a combination of exposures, has kicked the immune system into permanent overdrive, leading to the cascade of symptoms. The new brain research done independently by two separate entities this year appears at a timely moment. In December 2014 a panel convened by the National Institutes of Health held a two-day workshop charged with “advancing the research” on the illness of the disorder. Furthermore the Institute of Medicine is conducting a separate, government-sponsored initiative to assess and evaluate the many sets of diagnostic criteria for ME/CFS, with the results expected next year.
Bottom line, for civil litigators is the area of chronic fatigue syndrome will change drastically over the next one to two years as this research filters its way into the medical journals and hopefully into the courtrooms. Hopefully the Alberta Court of Queen’s Bench will be more receptive to admitting research articles as evidence rather than just relying on the so-called experts before the court who may be 10 years behind the latest research. This is important because the sophisticated MRI technology cited in the new CFS research is available in Red Deer, Lethbridge, and Medicine Hat, but is not available in smaller cities so victims of violent car collisions may not obtain the proper diagnosis or will have to travel to other cities to have the appropriate sophisticated MRI performed to assist the personal injury lawyer in proving a case of chronic fatigue syndrome with this latest research.