Journal of IiME Volume 3 Issue 1 www.investinme.org E EPPIIDDEEMMIICCSS ooff MMEE ((ccoonnttiinnuueedd)) enlargement of the spleen might occur in addition to lymph gland involvement indicating the reticuloendothelial system participated in the clinical picture in some of the epidemics. Alexis Shelokov and colleagues investigated an outbreak involving 50 student nurses and their tutors participating in residential courses at a psychiatric hospital near Washington DC, USA in 1953. Half the patients had muscle weakness and poliomyelitis was suspected then eliminated. No other cause for the muscle weakness was found. All patients had features of a generalised illness similar to that described in patients with Iceland Disease. After the initial illness there was a subacute phase lasting several months consisting of episodes of feeling unwell and further muscle weakness. Donald Henderson and Alexis Shelokov reviewed 23 similar epidemics in 1959. They found that the affected muscles were tender either diffusely or in focal discrete areas, which felt "oedematous, doughy or rubbery in consistence". They introduced the term Epidemic Neuromyasthenia, linking neurasthenia with myasthenia to describe the clinical picture. The term neurasthenia is unfortunate as it implies a disturbance of behaviour, which can follow an infection or be the result of stress, in the form of irritability and an inability to take exercise without excessive fatigue. Similar disturbances including crying spells without provocation are also seen during the convalescence of patients who have had strokes or head injuries. The association of similar behavioural disturbances with brain cell disorders such as cranial nerve palsies and hemiparesis with extensor plantar response is mentioned by Henderson and Shelokov (1959) as an occasional finding in some epidemics. The association is clearly illustrated by Melvin Ramsay in a serious of sporadic cases admitted to an infectious diseases department of a local hospital from the population of North West London in 1955 and 1956. Rather than labelling the illness neuromyasthenia a slight change to Invest in ME (Charity Nr. 1114035) neuronomyasthenia indicating a disease of nerve cells (or neurones) and muscle cells with muscle weakness might be more appropriate. Neurologists prefer to limit the term myasthenia to myasthenia gravis, a disorder of the neuromuscular junction which may present as a severe type of muscle weakness. In patients with Myalgic Encephalomyelitis/Neuronomyasthenia (ME/NM), "myasthenia mitis" has been used to describe a milder form of myasthenia in which muscle weakness develops during normal daily activities. Clinical tests were subsequently developed, which measure the declining muscle performance with activity and the slow recovery of muscle afterwards. In 1998 this delayed recovery of muscle function after a fatiguing isometric exercise test was confirmed in 1999 by Lorna Paul and colleagues. MERGE has funded research which has revealed abnormalities in the function of blood vessels and blood cells. Abnormalities of blood vessels have been described in these epidemics of ME/NM. Infectious material was transferred from patients to monkeys during an epidemic in Adelaide, Australia in 1949–1950. The monkeys became ill and post-mortem examinations were carried out a month later. The only abnormalities discovered by Pellew and Miles (1955) were minute red spots along the course of the sciatic nerves. Under the microscope the red spots contained localised collections of inflammatory cells, which had also infiltrated the area where the nerve roots come out of the spinal cord. The red colour of the spots was due to leakage of red blood cells. ME/NM is very rarely fatal so that a postmortem study showing similar haemorrhages in humans is unique. However, during the North of England epidemic in 1955 Andrew Wallis described the findings in a patient in her fifties, who developed the characteristic febrile illness leaving her debilitated and emotional. During the next fifteen months she continued to run a low grade fever with continued Page 53/76
54 Publizr Home