Journal of IiME Volume 3 Issue 1 www.investinme.org E EPPIIDDEEMMIICCSS ooff MMEE ((ccoonnttiinnuueedd)) mental deterioration before she died. The post-mortem revealed numerous small haemorrhages around blood vessels in the cerebral cortex extending into the midbrain, which were considered to be the cause of her death. These abnormalities may be found when patients die as the result of severe chronic alcoholism. This was not a factor in her case; she had had a febrile illness. Vasculitis involving the skin was recorded during outbreaks in Cumberland, Durham and North West London in 1955. A maculopapular rash may appear during the return of features of the initial illness such as flu-like symptoms and enlargement of lymph glands and liver. This skin overlying areas of localised muscle weakness may be affected at the time of these attacks. In conclusion, Iceland Disease and ME/NM is a muscle/brain disorder, which occurs as clusters of cases in families, in institutions such as hospitals or schools, in districts as far apart as the northern townships in Iceland and Adelaide in Australia or sporadically. It is an infectious disease with an incubation period of 5 to 8 days. Acheson in 1959 used the expression "in a greater or lesser degree" to describe "the symptoms and signs of damage to the brain and spinal cord" in this disease. This expression can also be applied to the febrile illness and muscle involvement. Many patients recover and return to normal activities in weeks or months, while others have relapses with reactivation of features of the initial illness and further damage to new areas of the brain or muscles. In extreme cases deterioration may lead to death. Muscle weakness has been measured in a few patients. After activity the recovery of muscle power is prolonged to an extent not recorded in any other disease. The association between these findings in muscle and vascular abnormalities in blood vessels and blood components needs exploring. For research purposes ME/NM patients with these physical signs should not be coupled with Invest in ME (Charity Nr. 1114035) patients whose main illness is chronic fatigue on exertion and who do not have these signs. References - Acheson ED. The clinical syndrome variously called Benign Myalgic Enchephalomyelitis, Iceland Disease and Epidemic Neuromyasthenia. Am J Med 1959; 26: 569-595. - Henderson DA, ShelokovA. Epidemic Neuromyasthenia – Clinical Syndrome. N Engl 1959; 260: 757-764, 814-818. - Leading Article A new clinical entity? Lancet 1956; 1: 789-790. Written by ED Acheson, introducing the term Benign Myalgic Encephalomyelitis. - Paul L, Wood L, Behan WMH, Maclaren WM. Demonstration of delayed recovery from fatiguing exercise in chronic fatigue syndrome. European J Neurol 1999; 6: 6369. - Pellew RA, Miles JA. Further investigations on a Disease resembling Poliomyelitis seen in Adelaide. Med J Aust 1955; 42: 480-482 - Ramsay AM. Encephalomyelitis in North West London. An endemic infection simulating poliomyelitis and hysteria. Lancet 1957; 2: 1196-1200. Description of 10 cases illustrating the association of behavioural disorders (neurasthenia) with brain disorders (cranial nerve palsies). - Shelokov A, Habel K, Verder E, Welsh W. Epidemic Neuromyasthenia. An outbreak of poliomyelitis-like illness in student nurses. N Engl J Med 1957; 257: 345-355. The Chestnut Lodge Epidemic, Washington, USA in 1953. - Sigurdsson B, Sigurjonsson J, Sigurdsson JHJ, Thorkelsson J, Gudmundsson KR. A disease epidemic in Iceland simulating Poliomyelitis. Am J Hyg 1950; 52: 222-238. - Wallis AL. An investigation into an unusual illness seen in Epidemic and Sporadic Form in a General Practice in Cumberland in 1955 and subsequent years. - White DN, Burtch RB. Iceland Disease – a new infection simulating Acute Anterior Poliomyelitis. Neurology 1954; 4: 506-516. Page 54/76
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