BREAKTHROUGH FOR ME

by Geraint Jones

For years, ME has been treated with suspicion by doctors. Many believe that for every genuine sufferer there is another who simply believes himself to be ill. Experts cannot agree on whether the condition is a physical illness or a psychological disorder which exists only in the victim's mind. One reason for this scepticism is that, as yet, no one has been able to provide an accurate diagnosis for ME, or myalgic encephalomyelitis, which is known to affect 150,000 people in Britain. There is no known cure and treatment is often based on antidepressant drugs like Prozae, with limited success.

All this may be about to change. Dr Ian James, consultant and reader in clinical pharmacology at London's Royal Free Hospital School of Medicine, believes that he has found a way of diagnosing the chronic fatigue syndrome and hopes to use it to develop a treatment programme. The breakthrough came after months of research spearheaded by Dr James and Professor John Barbur of London's City University. It centres round the discovery that the eyes of ME sufferers respond to light and motion stimuli in an unusual way.

"Several doctors treating ME patients noticed that they showed an abnormal pupil response", says Dr James. "When the pupil is subjected to changes in light, or is required to alter focus from a close object to one further away, it does so by constricting and dilating. ME patients' eyes do this as well but there is an initial period of instability when the pupil fluctuates in size".

Using a computerised "pupilometer", which precisely measures eye responses, Dr James embarked on a detailed study of this phenomenon on ME patients, using non-sufferers as a control. A variety of shapes were flashed on to a screen and moved across it, while a computer precisely measured pupil reflex to each of the 40 tests. Results confirmed that the pupil fluctuation was peculiar to those participants who suffered from ME.

Dr James concluded that the abnormal pupil response is a result of some kind of interference in the transfer of impulses from the brain to the eye. He believes that ME is the result of a deficiency of a neuro-transmitter called 5HT, whose job it is to pass impulses through nerves to cells. The eyes of ME sufferers treated with 5HT behave normally. "I do not yet know how the ME virus causes abnormalities in 5HT transmission but it does inhibit its function", says Dr James.

By administering drugs to stimulate levels of 5HT, together with treatment aimed at fighting post-viral disease, Dr James believes that ME sufferers can be cured. "I believe that ME is a problem of the brain, a neuro-pharmacological disorder. The people I see are very motivated towards getting better. The ME can mean they are bed-ridden for years, yet they look quite well, so people have no sympathy. I believe that there is a physical cause for chronic fatigue, but there undoubtedly is a strong link between ME and the psychological make-up of a sufferer. Many sufferers are perfectionists who take on a mammoth work-load. They cannot switch off. If they are laid low by a virus, they do not recover from it properly, and that is where their problems start. It may be that their psychological make-up renders them vulnerable to the ME. But it is not the cause".

Dr James believes that there may be several different fatigue syndromes hiding under the ME umbrella. Some patients suffer depression, others do not. Some are permanently tired, others tire occasionally. Some recover after a few months, others take years.

"There is no evidence of structural damage to the brain, so everyone is capable of recovery from ME", he says. He stresses that there is much work still to be done and needs more ME sufferers to volunteer to take part in his research. Anyone interested should contact the Persistent Virus Disease Research Foundation, 01494 674769.