Journal of IiME Volume 6 Issue 1 (June 2012) common in ME/CFS patients (23), and it has been suggested that hypotension associated with orthostatic stress may impair neurocognitive functioning in ME/CFS patients with postural tachycardia syndrome (24). Therefore, our results as well as those presented by Hameroff et al. (http://www.quantumconsciousness.org/docume nts/ATUS201101634A.pdf) may lead to interventional applications of transcranial sonography in the treatment of orthostatic intolerance, one of the major symptoms of ME/CFS. The observed increase in systolic blood pressure in the absence of a concomitant increase in heart rate or diastolic pressure, is of particular significance for ME/CFS, and it can be interpreted as if transcranial sonography was associated with increased cardiac output; in particular, as if it increased the stroke volume, an index that is frequently decreased in ME/CFS patients and is associated with the most common symptoms reported in ME/CFS, i.e. shortness of breath, dyspnea on effort, rapid heartbeat, chest pain, fainting, orthostatic dizziness and coldness of feet (23). The observed decrease in heart rate might also prove useful in those ME/CFS where tachycardia is a symptom associated with neurocognitive defects (25). In order to determine the anatomical correlate of the subjectively perceived increase in muscle strength, we measured by ultrasonography the thickness of the biceps brachii in relaxation and maximal contraction, before and after transcranial sonography (Fig. 4).Ten min before transcranial sonography, the thickness of the biceps increased from 24.9 mm (Fig. 4, panel A) to 38.3 mm during maximal contraction (Fig. 4, panel B). Ten min after the end of the procedure, the thickness of the biceps increased from 24.9 mm (Fig. 4, panel C) to 43.2 mm (Fig. 4, panel B). The increase in thickness was accompanied by a concomitant increase in the angle between the muscle fibres and the muscle aponeurosis. These results demonstrate that the subjectively perceived increase in muscle strength was indeed associated with a measurable increase in the capacity of the muscle to contract with significant increase in muscle fibre shortening. Discussion The results presented in this study raise the possibility of using transcranial sonography as a tool for the diagnosis, follow-up and treatment of ME/CFS patients. In recent years the cost of ultrasound imaging machines is significantly decreased and a good quality apparatus is now sold (in the year 2012) for about 20.000,00 Euros. In the hands of properly trained health care professionals the procedure of transcranial sonography described here can be used for the study of brain pulsations and/or rhythmic impulses and for the study of vascularisation of the meninges. Furthermore, considering that significant neuroanatomical changes occur in ME/CFS, and that these changes are consistent with impaired memory (26), transcranial sonography may prove a simple and inexpensive tool to assess these changes and monitor progression of the disease as well as improvements associated with treatments. The inherent safety of the technique as well as the absence of discomfort make this procedure quite acceptable by patients and this characteristics may prompt extensive studies on a significant number of patients. In addition to its use a tool contributing to diagnosis and follow-up, our results suggest that transcranial sonography may also prove useful in controlling some of the most disturbing symptoms of ME/CFS, i.e. chronic pain and mood alterations as demonstrated by Hameroff et al. ((http://www.quantumconsciousness.org/docume nts/ATUS201101634A.pdf), hypotension, tachycardia and muscle weakness. Figure legends Figure 1. The operator (M.R.) applying the probe to his right temporal region. Sitting in front of the ultrasound imaging machine, the operator is able Invest in ME (Charity Nr. 1114035) www.investinme.org Page 26 of 108
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