Journal of IiME Volume 3 Issue 1 www.investinme.org Epidemics of ME EPIDEMICS of ME Epidemics are associated with ME. A Review of The Clinical Syndrome Variously Called Benign Myalgic Encephalomyelitis, Iceland Disease and Epidemic Neuromyasthenia by E D Acheson (American Journal of Medicine, 1959) by Dr J Gordon Parish Many of the findings described in the landmark Acheson 1959 paper are very much relevant to our understanding of ME today. The disease was initially thought to resemble poliomyelitis until distinguishing features occurred; no patient developed the paralysis and muscle wasting seen in poliomyelitis which is a disease of the spinal cord. Naldrett White, a Canadian neurologist, and Robert Burtch, an American family physician, described an epidemic in 1950 in Upper New York State in the USA in an area close to the Canadian border. They thought that muscles were directly involved during the initial infection. Accompanying a mildly elevated temperature to 99–100 ºF (37.2–37.8 ºC) in nearly every patient, there was pain and tenderness in various muscles sometimes with increased skin sensitivity over the affected areas making contact with clothes or bedding very unpleasant. In contrast to hypersensitivity, difficulty in moving limbs and numbness with diminished skin sensation on clinical testing suggested peripheral nerve involvement. Where there was weakness on using a hand and sensory symptoms, examination revealed an ulnar nerve disorder. Nerve roots were sometimes involved in the legs and were tender to pressure. This was associated with dragging of the legs on walking or foot drop. Another feature was lymphadenopathy in some patients. Enlarged tender anterior neck or axillary lymph glands are mentioned. Examination of the blood and cerebrospinal fluid showed only minor abnormalities in two patients. White and Burtch thought that they might be dealing with an infection affecting Invest in ME (Charity Nr. 1114035) From the Incline village episode to the Royal Free. Yet little is discussed about these. In the 4th International ME/CFS Conference Professor Harald Nyland will discuss the recent epidemic associated with Giardia in Norway. Yet this isn’t new. It seems relevant to recall this review by Dr Gordon Parrish of an article by E D Acheson in the American Journal of Medicine muscle. The standard test for muscle damage at that time was 24 hour urinary creatine excretion, and this was found to be raised in the 13 patients who were tested with a tendency for the urinary creatine to fall to normal levels as the patients recovered. The creatine phosphokinase enzyme test for muscle damage was not available at that time. Subsequently, it was found to be normal or only slightly elevated in ME suggesting that the disturbance is different from that found in other muscle diseases. The illness had a striking resemblance to the disease described by Sigurdsson and others in Iceland during the winter of 1948–1949, and hence the name Iceland Disease was suggested for the illness. In a leading article published anonymously in the Lancet in May 1956, Acheson reviewed eight similar outbreaks and suggested a title Benign Myalgic Encephalomyelitis for the new clinical entity based on the presumed underlying pathology. He considered the disease to be "benign" compared with other epidemic infections of the nervous system seen in various types of encephalitis and in poliomyelitis due to the absence of patients dying. However, "benign" was later deleted from the title, leading to the abbreviation to ME, because in some cases the severity and duration of the disability resulting from the disease was far from being benign. He mentioned that hepatitis and Page 52/76
53 Publizr Home