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==Comparison of Multiple Sclerosis and ME/CFS== Multiple sclerosis patients or samples are sometimes used for comparison with in [[ME/CFS]] in research studies, for instance at the [[CureME|UK ME/CFS biobank]], and both are [[female predominant diseases]] of the [[central nervous system]].<ref name="Lacerda2017">{{Cite journal | last = Lacerda | first = Eliana M. | authorlink = Eliana Lacerda | last2 = Bowman | first2 = Erinna W. | author-link2 = Erinna Bowman | last3 = Cliff | first3 = Jacqueline M. | authorlink3 = Jacqueline Cliff | last4 = Kingdon | first4 = Caroline C. | authorlink4 = Caroline Kingdon | last5 = King | first5 = Elizabeth C. | authorlink5 = Elizabeth King | last6 = Lee | first6 = Ji-Sook | last7 = Clark | first7 = Taane G. | last8 = Dockrell | first8 = Hazel M. | last9 = Riley | first9 = Eleanor M. | date = 2017 | title=The UK ME/CFS Biobank for biomedical research on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Multiple Sclerosis|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5482226/|journal=Open journal of bioresources|volume=4|issue=|pages=|doi=10.5334/ojb.28|issn=2056-5542|pmc=5482226|pmid=28649428|quote=|via=|access-date= | authorlink6 = | authorlink7 = Taane Clark | authorlink8 = Hazel Dockrell | authorlink9 = Eleanor Riley}}</ref><ref name="Morris2013">{{Cite journal | last = Morris | first = Gerwyn | authorlink = Gerwyn Morris | last2 = Maes | first2 = Michael | authorlink2 = Michael Maes | date = Dec 2013 | title = Myalgic encephalomyelitis/chronic fatigue syndrome and encephalomyelitis disseminata/multiple sclerosis show remarkable levels of similarity in phenomenology and neuroimmune characteristics|url=http://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-11-205|journal=BMC Medicine|language=en|volume=11|issue=1|pages=205|doi=10.1186/1741-7015-11-205|issn=1741-7015|pmc=3847236|pmid=24229326|quote=|via=}}</ref><ref name="White2012">{{Cite journal | last = White | first = Andrea T. | authorlink = Andrea White | last2 = Light | first2 = Alan R. | author-link2 = Alan Light | last3 = Hughen | first3 = Ronald W. | authorlink3 = Ronald Hughen | last4 = VanHaitsma | first4 = Timothy A. | authorlink4 = Timothy VanHaitsma | last5 = Light | first5 = Kathleen C. | authorlink5 = Kathleen Light | date = Jan 2012 | title = Differences in metabolite-detecting, adrenergic, and immune gene expression following moderate exercise in chronic fatigue syndrome, multiple sclerosis and healthy controls|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3256093/|journal=Psychosomatic Medicine|volume=74|issue=1 | pages = 46β54|doi=10.1097/PSY.0b013e31824152ed|issn=0033-3174|pmc=PMC3256093|pmid=22210239|quote=|via=}}</ref> There are many similar features in multiple sclerosis and [[ME/CFS|myalgic encephalomyelitis/chronic fatigue syndrome]] (ME/CFS), including: severe disabling [[fatigue]] that worsens after exercise; debilitating [[Autonomic nervous system|autonomic]] symptoms, including [[orthostatic intolerance]]; illness course may be relapsing-remitting or progressive; infections and psychosocial stress causing exacerbation; autoimmunity and [[auto-inflammatory]] processes; [[mitochondria dysfunction]]; and decreased cerebral blood flow, atrophy of some brain structures.<ref name="Morris2013" /> In the [[United States]], the prevalence rate of [[chronic fatigue syndrome]] (CFS) is 0.42% of the population versus MS which has a rate of 0.09%.<ref name="Jason2010">{{Cite journal | title = Frequency and content analysis of chronic fatigue syndrome in medical text books | date = 2010 | url=https://pubmed.ncbi.nlm.nih.gov/21128580/|journal=Australian Journal of Primary Health|volume=16|issue=2|pages=174β178 | last= Jason | first = Leonard A. | authorlink = Leonard Jason | last2 = Paavola | first2 = Erin | authorlink2 = | last3 = Porter | first3 = Nicole | authorlink3 = | last4 = Morello | first4 = Morgan L. | authorlink4 = |doi=10.1071/py09023|pmc=3691015|pmid=21128580|access-date=|issn=1448-7527|quote=|via=}}</ref> Approximately 14% of MS patients meet the [[Fukuda criteria]] for CFS.<ref name="Gaber2014">{{Cite journal | title = Multiple Sclerosis/Chronic Fatigue Syndrome overlap: When two common disorders collide | date = 2014 |url=https://pubmed.ncbi.nlm.nih.gov/25238862/|journal=NeuroRehabilitation|volume=35|issue=3 | pages = 529β534 | last = Gaber | first = Tarek A.-Z.K. | last2 = Oo | first2 = Wah Wah | last3 = Ringrose | first3 = Hollie|doi=10.3233/NRE-141146|pmid=25238862|issn=1878-6448}}</ref> In 2017, a study examined whether network analysis of cytokine production differed between patients with CFS, multiple sclerosis, and healthy controls. The study's model, using a select [[cytokine]] profile, showed that immunologic activation in CFS was significantly different from that found in the control and multiple sclerosis groups.<ref name="Sorenson, 2017" /> A 2015 study found a markedly disturbed immune signature in the [[cerebrospinal fluid]] that is consistent with immune activation in the [[central nervous system]] (CNS), and autoimmunity. The MS and ME/CFS groups had markedly different immune signatures, and the ME/CFS group had a greater degree of CNS [[immune activation]] than the MS group.<ref name="Hornig2016" /> In December 2016, [[Diana Ohanian|Ohanian]], et al, published a study identifying two key immune symptoms that physicians could use to differentiate [[myalgic encephalomyelitis]] (ME) and [[Chronic fatigue syndrome|CFS]] from MS: [[flu-like symptoms]] and [[Swollen lymph nodes|tender lymph nodes]]. Subjects included 106 people with MS and 354 people with [[myalgic encephalomyelitis|ME]] or CFS who completed the [[DePaul Symptom Questionnaire]]. The data was analyzed using data mining techniques and machine learning that resulted in correctly categorizing MS and ME or CFS 81.2% of the time. The authors conclude that "because ME or CFS and MS have similar presentations recognizing the importance of immune dysfunction for ME or CFS might be important for healthcare providers."<ref name="Ohanian, 2016">{{Cite journal | last1 = Ohanian | first1 = Diana | authorlink1 = Diana Ohanian | last2 = Brown | first2 = Abigail | authorlink2 = Abigail Brown | last3 = Sunnquist | first3 = Madison | authorlink3 = Madison Sunnquist | last4 = Furst | first4 = Jacob | authorlink4 = Jacob Furst | last5 = Nicholson | first5 = Laura | authorlink5 = Laura Nicholson | last6 = Klebek | first6 = Lauren | authorlink6 = Lauren Klebek | last7 = Jason | first7 = Leonard | authorlink7 = Leonard Jason | title = Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis | journal = EC Neurology | volume = 4.1 | issue = 2 | pages = 41-45 | date = 2016 | pmid = 28066845 | pmc = PMC5214344 | doi = | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5214344/}}</ref> === Differences in symptoms between multiple sclerosis and ME/CFS === Ohanian et al. (2016) found that the following five symptoms were significantly more common in patients with ME/CFS compared to patients with multiple sclerosis, with mean scores reported as: # [[Flu-like symptoms]]: reported in 51 in ME/CFS patients, and 17 inMS patients # [[Swollen lymph nodes|Tender lymph nodes]]: 37 in ME/CFS patients, 8% in MS patients # [[Alcohol intolerance]]: 38 in ME/CFS patients, 9 in MS patients # [[orthostatic intolerance|Inability to tolerate upright position]] (orthostatic intolerance): 51 in ME/CFS patients, 16 in MS patients # [[post-exertional symptom exacerbation]] e.g., next-day soreness after non-strenuous activities: 75 in ME/CFS patients, 46 in MS patients The presence of just two immune-related symptoms ([[tender lymph nodes]] and [[flu-like symptoms]]), which are optional symptoms in [[ME/CFS]], was found to correctly classify around 80% of patients with [[ME/CFS]], who did not have MS.<ref name="Ohanian, 2016" /> ===Notable studies comparing ME/CFS and multiple sclerosis=== *2012, Differences in metabolite-detecting, adrenergic, and immune gene expression after moderate exercise in patients with chronic fatigue syndrome, patients with multiple sclerosis, and healthy controls.<ref name="White2012" /> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3256093/ (Full Text)] *2013, Myalgic encephalomyelitis/chronic fatigue syndrome and encephalomyelitis disseminata/multiple sclerosis show remarkable levels of similarity in phenomenology and neuroimmune characteristics<ref name="Morris2013" /> - [https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-11-205 (Full Text)] *2015, A Preliminary Comparative Assessment of the Role of CD8+ [[T cell|T Cell]]s in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis and Multiple Sclerosis<ref name="Brenu2016">{{Cite journal | last1 = Brenu | first1 = EW | authorlink1 = Ekua Brenu | last2 = Broadley | first2 = S | authorlink2 = Simon Broadley | last3 = Nguyen | first3 = T | authorlink3 = Thao Nguyen | last4 = Johnston | first4 = S | authorlink4 = Samantha Johnston | last5 = Ramos | first5 = S | authorlink5 = Sandra Ramos | last6 = Staines | first6 = D | authorlink6 = Donald Staines | last7 = Marshall-Gradisnik | first7 = S | authorlink7 = Sonya Marshall-Gradisnik | title = A Preliminary Comparative Assessment of the Role of CD8+ T Cells in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis and Multiple Sclerosis | journal = Journal of Immunology Research | volume = | pages = | date = 2016 | doi = 10.1155/2016/9064529 | url = https://pdfs.semanticscholar.org/bf21/36527480dcd18592aa0e60970c5f5b2400fb.pdf }}</ref> - [https://pdfs.semanticscholar.org/bf21/36527480dcd18592aa0e60970c5f5b2400fb.pdf (Full Text)] *2015, A Comparison of Cytokine Profiles of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis and Multiple Sclerosis Patients<ref name="Wong, 2015">{{Cite journal | last1 = Wong | first1 = Naomi | authorlink1 = Naomi Wong | last2 = Nguyen | first2 = Thao | authorlink2 = Thao Nguyen | last3 = Brenu | first3 = Ekua Weba | authorlink3 = Ekua Brenu | last4 = Broadley | first4 = Simon | authorlink4 = Simon Broadley | last5 = Staines | first5 = Donald | authorlink5 = Donald Staines | last6 = Marshall-Gradisnik | first6 = Sonya | authorlink6 = Sonya Marshall-Gradisnik | title = A Comparison of Cytokine Profiles of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis and Multiple Sclerosis Patients | journal = International Journal of Clinical Medicine | volume = 6 | issue = 10 | pages = 769-783 | date = 2015 | url = https://doi.org/10.4236%2Fijcm.2015.610103 | pmid = | doi = 10.4236/ijcm.2015.610103 }}</ref> - [http://file.scirp.org/Html/10-2101204_60764.htm (Full Text)] *2016, Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis<ref name="Ohanian, 2016" /> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5214344/ (Full Text)] *2016, Pilot Study of [[Natural killer cell|Natural Killer Cell]]s in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis and Multiple Sclerosis<ref name="HuthTK2016">{{Cite journal | last1 = Huth | first1 = TK | authorlink1 = Teilah Huth | last2 = Brenu | first2 = EW | authorlink2 = Ekua Brenu | last3 = Ramos | first3 = S | authorlink3 = Sandra Ramos | last4 = Nguyen | first4 = T | authorlink4 = | last5 = Broadley | first5 = S | authorlink5 = | last6 = Staines | first6 = D | authorlink6 = Donald Staines | last7 = Marshall-Gradisnik | first7 = S | authorlink7 = Sonya Marshall-Gradisnik | title = Pilot Study of Natural Killer Cells in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis and Multiple Sclerosis | journal = Scand J Immunol | date = Jan 2016 | volume = 83 | issue = 1 | pages = 44-51 | pmid = 26381393 | doi = 10.1111/sji.12388 | url = https://www.ncbi.nlm.nih.gov/pubmed/26381393 }}</ref> - [https://www.ncbi.nlm.nih.gov/pubmed/26381393 (Abstract)] *2016, [[Regulatory T cell|Regulatory T]], natural killer T and Ξ³Ξ΄ T cells in multiple sclerosis and chronic fatigue syndrome/myalgic encephalomyelitis: a comparison<ref name="Ramos, 2016">{{Cite journal | last1 = Ramos | first1 = S | authorlink1 = Sandra Ramos | last2 = Brenu | first2 = E | authorlink2 = Ekua Brenu | last3 = Broadley | first3 = S | authorlink3 = | last4 = Kwiatek | first4 = R | authorlink4 = Richard Kwiatek | last5 = Ng | first5 = J | authorlink5 = | last6 =Nguyen | first6 = T | authorlink6 = | last7 = Freeman | first7 = S | authorlink7 = | last8 = Staines | first8 = D | authorlink8 = Donald Staines | last9 =Marshall-Gradisnik | first9 = S | authorlink9 = Sonya Marshall-Gradisnik | title = Regulatory T, natural killer T and Ξ³Ξ΄ T cells in multiple sclerosis and chronic fatigue syndrome/myalgic encephalomyelitis: a comparison | journal = Asian Pac J Allergy Immunol | volume = | issue = 34 | pages = 300-305 | date = March 20, 2016 | doi = 10.12932/AP0733 | url = http://apjai-journal.org/wp-content/uploads/2016/12/8RegulatoryTnaturalkillerAPJAIVol34No4December2016P300.pdf}}</ref> - [http://apjai-journal.org/wp-content/uploads/2016/12/8RegulatoryTnaturalkillerAPJAIVol34No4December2016P300.pdf (Full Text)] *2016, [[Cytokine]] network analysis of cerebrospinal fluid in myalgic encephalomyelitis/chronic fatigue syndrome<ref name="Hornig2016">{{Cite journal | last1 = Hornig | first1 = M | authorlink1 = Mady Hornig | last2 = Gottschalk | first2 = CG | authorlink2 = Gunnar Gottschalk | last3 = Peterson | first3 = DL | authorlink3 = Daniel Peterson | last4 = Knox | first4 = KK | authorlink4 = | last5 = Schultz | first5 = AF | authorlink5 = | last6 =Eddy | first6 = ML | authorlink6 = | last7 = Che | first7 = X | authorlink7 = | last8 = Lipkin | first8 = WI | authorlink8 = Ian Lipkin | title = Cytokine network analysis of cerebrospinal fluid in myalgic encephalomyelitis/chronic fatigue syndrome | journal = Molecular Psychiatry | issn = 1359-4184 | volume = 21 | issue = 2| pages = 261β269 | date = Feb 2016 | doi = 10.1038/mp.2015.29 | url = http://www.nature.com/doifinder/10.1038/mp.2015.29}}</ref> - [https://www.nature.com/articles/mp201529 (Abstract)] *2017, Differentiating Multiple Sclerosis from Myalgic Encephalomyelitis and Chronic Fatigue Syndrome<ref name="Jason, Ohanian, 2017">{{Cite journal | last1 = Jason | first1 = LA | authorlink1 = Leonard Jason | last2 = Ohanian | first2 = D | authorlink2 = Diana Ohanian | last3 = Brown | first3 = A | authorlink3 = Abigail Brown | last4 = Sunnquist | first4 = M | authorlink4 = Madison Sunnquist | last5 = McManimen | first5 = S | authorlink5 = Stephanie McManimen | last6 = Klebek | first6 = L | authorlink6 = | last7 = Fox | first7 = P | authorlink7 = Pamela Fox | last8 = Sorenson | first8 = M | authorlink8 = Matthew Sorenson | title = Differentiating Multiple Sclerosis from Myalgic Encephalomyelitis and Chronic Fatigue Syndrome| journal = Insights in Biomedicine | volume = 2 | issue = 2 | pages = | date = 2017 | url = https://doi.org/10.21767%2F2572-5610.100011 | doi = 10.21767/2572-5610.100011 }}</ref> - [http://biomedicine.imedpub.com/differentiating-multiple-sclerosis-from-myalgic-encephalomyelitis-and-chronic-fatigue-syndrome.pdf (Full Text)] *2017, Dysregulation of cytokine pathways in chronic fatigue syndrome and multiple sclerosis<ref name="Sorenson, 2017">{{Cite journal | last1 = Sorenson | first1 = Matthew | authorlink1 = Matthew Sorenson | last2 = Furst | first2 = Jacob | authorlink2 = Jacob Furst | last3 = Mathews | first3 = Herbert | authorlink3 = Herbert Mathews | last4 = Jason | first4 = Leonard A. | authorlink4 = Leonard Jason | title = Dysregulation of cytokine pathways in chronic fatigue syndrome and multiple sclerosis | journal = Fatigue: Biomedicine, Health & Behavior | volume = 5 | issue = 3 | pages = 145-158 | date = 2017 | pmid = | doi = 10.1080/21641846.2017.1335237|url=https://doi.org/10.1080%2F21641846.2017.1335237|pmc=|quote=|access-date= | authorlink5 = |via=}}</ref> - [https://www.researchgate.net/publication/318094772_Dysregulation_of_cytokine_pathways_in_chronic_fatigue_syndrome_and_multiple_sclerosis_Dysregulation_of_cytokine_pathways_in_chronic_fatigue_syndrome_and_multiple_sclerosis (Abstract)] *2017, Endogenous Pain Facilitation Rather Than Inhibition Differs Between People with Chronic Fatigue Syndrome, Multiple Sclerosis, and Controls: An Observational Study<ref name="Polli, 2017">{{Cite journal | last1 = Polli | first1 = Andrea | authorlink1 = | last2 = Willekens | first2 = Barbara | authorlink2 = | last3 = Meeus | first3 = Mira| authorlink3 = Mira Meeus | last4 = Nijs | first4 = Jo | authorlink4 = Jo Nijs | last5 = Collin | first5 = Simon M. | authorlink5 = Simon Collin | last6 =Ickmans | first6 = Kelly | authorlink6 = Kelly Ickmans | title = Endogenous Pain Facilitation Rather Than Inhibition Differs Between People with Chronic Fatigue Syndrome, Multiple Sclerosis, and Controls: An Observational Study Observational Study | journal = Pain Physician | volume = 20 | issue = 4 | pages = E489-E497 | date = 2017 | pmid = 28535557 | url = http://www.painphysicianjournal.com/current/pdf?article=NDQxMQ%3D%3D&journal=105 }}</ref> - [http://www.painphysicianjournal.com/current/pdf?article=NDQxMQ%3D%3D&journal=105 (Full Text)] *2018, Functional Status and Well-Being in People with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Compared with People with Multiple Sclerosis and Healthy Controls<ref>{{Cite journal | last = Kingdon | first = Caroline C. | last2 = Bowman | first2 = Erinna W. | last3 = Curran | first3 = Hayley | last4 = Nacul | first4 = Luis | last5 = Lacerda | first5 = Eliana M. | date = 2018-12-01 | title = Functional Status and Well-Being in People with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Compared with People with Multiple Sclerosis and Healthy Controls|url=https://doi.org/10.1007/s41669-018-0071-6|journal=PharmacoEconomics - Open|language=en|volume=2|issue=4|pages=381β392|doi=10.1007/s41669-018-0071-6|issn=2509-4254|pmc=|pmid=29536371|quote= | author-link = Caroline Kingdon | authorlink2 = Erinna Bowman | authorlink3 = Hayley Curran | authorlink4 = Luis Nacul | authorlink5 = Eliana Lacerda | via=}}</ref> - [https://link.springer.com/article/10.1007%2Fs41669-018-0071-6 (Full Text)] ===Other studies=== *2015, HIV and lower risk of multiple sclerosis: beginning to unravel a mystery using a record-linked database study - [https://www.ncbi.nlm.nih.gov/pubmed/25091370 (Abstract)]
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