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Muscle fatigability
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'''Muscle fatigability''' in ME is a symptom in which [[Muscle|muscles]] become [[Paresis|weaker]] after minor [[exertion]] and a long period (3-5 days or longer) may elapse before full muscle power is restored. According to [[Melvin Ramsay]], it is the defining feature of [[myalgic encephalomyelitis]], without which a diagnosis of ME should not be made,<ref>{{Cite web|url=http://www.cfids-me.org/ramsay86.html | title = Ramsay's Definition of M.E., 1986 | website = cfids-me.org|access-date=2019-08-28}}</ref> though this symptom is noted to improve during remission. Similar muscle effects are known to occur in other neurological diseases such as [[multiple sclerosis]]<ref>[http://mssociety.ca/en/information/symptoms_mng_fatigue.htm Managing MS Symptoms - Fatigue and Fatigability]</ref> and [[post-polio syndrome|post-polio syndrome.]]<ref>{{Cite web|url=http://www.post-polio.org/edu/lep.html | title = The Late Effects of Polio: An Overview | website = post-polio.org|access-date=2019-08-28}}</ref> ==Prevalence== *In a 2001 Belgian study, 84.3% of patients meeting the [[Fukuda criteria]] and 88.3% of patients meeting the [[Holmes criteria]], in a cohort of 2073 [[Chronic fatigue syndrome|CFS]] patients, reported [[Paresis|muscle weakness]].<ref>{{Cite journal | last = De Becker | first = Pascale | authorlink = Pascale De Becker | last2 = McGregor | first2 = Neil | authorlink2 = Neil McGregor | last3 = De Meirleir | first3 = Kenny | author-link3 = Kenny De Meirleir | date = December 2001 | title = A definition‐based analysis of symptoms in a large cohort of patients with chronic fatigue syndrome|url=https://onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2796.2001.00890.x?sid=nlm%3Apubmed|journal=Journal of Internal Medicine|volume=250|issue=3|pages=234–240|doi=10.1046/j.1365-2796.2001.00890.x|quote=|via=}}</ref> *[[Katrina Berne]], PhD, reports a prevalence of 85-95% for [[Paresis|muscle weakness]].<ref>{{Cite book | last = Berne | first = Katrina | authorlink = Katrina Berne | date = Dec 1, 1995 | title = Running on Empty: The Complete Guide to Chronic Fatigue Syndrome (CFIDS)|edition= 2nd |url= https://www.amazon.co.uk/Running-Empty-Complete-Chronic-Syndrome/dp/0897931912/ |publisher= Hunter House | page = 59 |isbn= 978-0897931915}}</ref> ==Symptom recognition== *In the [[Holmes criteria]], unexplained generalized muscle weakness is an optional criteria for diagnosis, under the section ''Minor Symptom Criteria''.<ref>{{Cite web|url=http://www.cfids-me.org/holmes1988.html | title = Holmes Definition of Chronic Fatigue Syndrome, U.S. CDC 1988 | website = cfids-me.org|access-date=2019-08-28}}</ref> ==Notable studies== == Possible causes== * Muscle biopsies have shown evidence of mitochondrial degeneration,<ref>{{Cite journal | last = Behan | first = W.M.H. | authorlink = | last2 = More | first2 = I.A.R. | authorlink2 = | last3 = Behan | first3 = P.O. | author-link3 =Peter Behan | date = Dec 1991 | title = Mitochondrial abnormalities in the postviral fatigue syndrome|url=http://link.springer.com/10.1007/BF00294431|journal=Acta Neuropathologica|language=en|volume=83|issue=1 | pages = 61–65|doi=10.1007/BF00294431|issn=0001-6322|pmc=|pmid=|access-date=|quote=|via=}}</ref> deletions of [[mitochondrial DNA]],<ref>{{Cite journal | last = Vecchiet | first = L. | last2 = Montanari | first2 = G. | last3 = Pizzigallo | first3 = E. | last4 = Iezzi | first4 = S. | last5 = de Bigontina | first5 = P. | last6 = Dragani | first6 = L. | last7 = Vecchiet | first7 = J. | last8 = Giamberardino | first8 = M.A. | date = 1996-04-19 | title = Sensory characterization of somatic parietal tissues in humans with chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/8859904|journal=Neuroscience Letters|volume=208|issue=2|pages=117–120|doi=10.1016/0304-3940(96)12559-3|issn=0304-3940|pmid=8859904}}</ref><ref>{{Cite journal | last = Zhang | first = C. | authorlink = | last2 = Baumer | first2 = A. | authorlink2 = | last3 = Mackay | first3 = I.R. | authorlink3 = | last4 = Linnane | first4 = A.W. | authorlink4 = | last5 = Nagley | first5 = P. | authorlink5 = | date = Apr 1995 | title = Unusual pattern of mitochondrial DNA deletions in skeletal muscle of an adult human with chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/7633428|journal=Human Molecular Genetics|volume=4|issue=4 | pages = 751–754|doi=10.1093/hmg/4.4.751|issn=0964-6906|pmc=|pmid=7633428|access-date=|quote=|via=}}</ref> and the reduction of mitochondrial activity.<ref>{{Cite journal | last = Vecchiet | first = L. | last2 = Montanari | first2 = G. | last3 = Pizzigallo | first3 = E. | last4 = Iezzi | first4 = S. | last5 = de Bigontina | first5 = P. | last6 = Dragani | first6 = L. | last7 = Vecchiet | first7 = J. | last8 = Giamberardino | first8 = M.A. | date = 1996-04-19 | title = Sensory characterization of somatic parietal tissues in humans with chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/8859904|journal=Neuroscience Letters|volume=208|issue=2|pages=117–120|doi=10.1016/0304-3940(96)12559-3|issn=0304-3940|pmid=8859904}}</ref> * In addition, evidence of oxidative damage to muscles has been found in CFS.<ref>{{Cite journal | last = Fulle | first = S. | last2 = Mecocci | first2 = P. | last3 = Fanó | first3 = G. | last4 = Vecchiet | first4 = I. | last5 = Vecchini | first5 = A. | last6 = Racciotti | first6 = D. | last7 = Cherubini | first7 = A. | last8 = Pizzigallo | first8 = E. | last9 = Vecchiet | first9 = L. | date = 2000-12-15 | title = Specific oxidative alterations in vastus lateralis muscle of patients with the diagnosis of chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/11118815|journal=Free Radical Biology & Medicine|volume=29|issue=12|pages=1252–1259|doi=10.1016/s0891-5849(00)00419-6|issn=0891-5849|pmid=11118815}}</ref> * Studies have found reduced levels of serum [[carnitine]] which return to normal after recovery and correlate with symptom severity.<ref>{{Cite journal | last = Kuratsune | first = H. | authorlink = | last2 = Yamaguti | first2 = K. | authorlink2 = | last3 = Takahashi | first3 = M. | authorlink3 = | last4 = Misaki | first4 = H. | authorlink4 = | last5 = Tagawa | first5 = S. | authorlink5 = |last6 = Kitani | first6 = T. | authorlink6 = | date = Jan 1994 | title = Acylcarnitine deficiency in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/8148455|journal=Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America|volume=18 | issue = Suppl 1|pages=S62–67|doi=10.1093/clinids/18.supplement_1.s62|issn=1058-4838|pmc=|pmid=8148455|access-date=|quote=|via=}}</ref> * Exercise has also been found to induce both early and excessive [[lactic acid]] formation in the muscles<ref>{{Cite journal | last = Plioplys | first = A.V. | last2 = Plioplys | first2 = S. | date = 1995 | title=Serum levels of carnitine in chronic fatigue syndrome: clinical correlates|url=https://www.ncbi.nlm.nih.gov/pubmed/8544970|journal=Neuropsychobiology|volume=32|issue=3|pages=132–138|doi=10.1159/000119226|issn=0302-282X|pmid=8544970}}</ref> with a reduced intraceullar concentrations of [[ATP]] and acceleration of [[glycolysis]].<ref>{{Cite journal | last = McCully | first = K.K. | authorlink = | last2 = Natelson | first2 = B. H. | authorlink2 = Benjamin Natelson | last3 = Iotti | first3 = S. | authorlink3 = | last4 = Sisto | first4 = S. | authorlink4 = | last5 = Leigh | first5 = J.S. | authorlink5 = | date = May 1996 | title = Reduced oxidative muscle metabolism in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/8618560|journal=Muscle & Nerve|volume=19|issue=5 | pages = 621–625|doi=10.1002/(SICI)1097-4598(199605)19:53.0.CO;2-Q|issn=0148-639X|pmc=|pmid=8618560|access-date=|quote=|via=}}</ref> * Neurologist [[Peter Behan]] noted that ME patients were found to lack an important muscle enzyme called [[myoadenylate deaminase]]. A small peer-reviewed study found this present in only 5.5% of patients, and associated primarily with [[myalgia|muscle pain]] rather than fatigue.<ref name="Edwards1993">R.H. Edwards, H. Gibson, J.E. Clague, T. Helliwell [https://books.google.co.uk/books?id=uXISpTK0mHMC&pg=PA102&lpg=PA102&dq=Muscle+histopathology+and+physiology+in+chronic+fatigue+syndrome+CIBA&source=bl&sa=X#v=onepage&q&f=false Muscle histopathology and physiology in chronic fatigue syndrome]. CIBA Found. Symp., 173 (1993), pp. 102-117 (discussion 117–131)</ref> Myoadenylate deaminase has since been ruled out as the sole cause of ME/CFS.<ref name="Ch7">{{Citation | title = Muscle Histopathology and Physiology in Chronic Fatigue Syndrome | date = 2007-09-28|url=https://onlinelibrary.wiley.com/doi/10.1002/9780470514382.ch7|work=Ciba Foundation Symposium 173‐Chronic Fatigue Syndrome|pages=102–131 | last = Edwards | first = R. H.T. | authorlink = | last2 = Gibson | first2 = H. | authorlink2 = | last3 = Clague | first3 = J.E. | authorlink3 = | last4 = Helliwell | first4 = T. | authorlink4 = |isbn=978-0-470-51438-2|location=Chichester, UK|publisher=John Wiley & Sons, Ltd.|pmc=|pmid=|access-date=|quote=|via=}}</ref> ==Potential treatments== ==Learn more== *2016, [http://www.meassociation.org.uk/2016/07/two-newcastle-studies-into-muscle-dysfunction-and-immune-responses-read-the-lay-summaries-12-july-2016/ Two Newcastle studies into muscle dysfunction and immune responses | read the lay summaries] ==See also== *[[Exercise]] *[[Post-exertional malaise]] ==References== {{reflist}} [[Category:Signs and symptoms]] [[Category:Muscular signs and symptoms]]
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