dorsal root ganglionitis

[Bluebottle]

Kay Gilderdale writes of her late, severely affected, daughter:

"When her body was examined by the pathologist who specialised in M.E., he discovered 'dorsal root ganglionitis' - infected nerve roots - and nodules of Nageotte, which are liitle tombs of dead cells, in her spinal cord. These would have caused her terrible pain and sensory nerve damage. They found similar cells in the body of Sophia Mirza, an M.E. sufferer who died in 2005 at the age of 32."

(I believe that Dr Shepherd arranged the autopsies)

Aren't such findings indicative of mass infection in the body?

Why are the severely affected with this neurological illness not being tested for infections, but are instead being virtually ignored with the exception of those who are (such as Sophia Mirza, who died as a result) being inappropriately sectioned?

Surely studying the severely affected should be a priority?

[Dr Charles Shepherd]

Post mortems that we have reported on so far:


Neuropathology of post-infectious chronic fatigue syndrome

Journal of the Neurological Sciences 2009 (S60-S61)

Cader S., O'Donovan D.G., Shepherd C., Chaudhuri A.

Abstract

Purpose: The pathogenesis of severe and relapsing chronic fatigue after
viral or bacterial infection is unknown. Many patients with post-infectious
chronic fatigue, which is classified as a neurological disease (G93.3,
ICD-10 classification), become disabled and do not recover fully despite
symptomatic and rehabilitative therapy.

Method: We report here the histopathological changes in the dorsal root
ganglia of three female patients with a diagnosis of chronic fatigue
syndrome. All three patients were seen by their local physicians and
specialists who had excluded alternative medical cause for their symptoms of
disabling fatigue and chronic pain. Due to the nature of death, a full
autopsy examination was carried out in each of these cases.

Results: The most remarkable and consistent abnormality was the presence of
active inflammation with T8 lymphocytic infiltration in the dorsal root
ganglion of one patient and evidence of past inflammation (nodules of
Nageotte) in two patients.

Conclusion: Dorsal root ganglion is the gateway for sensory information
reaching the central nervous system. Based on the histopathological changes
observed in three cases, we propose that inflammation of the dorsal root
ganglia may play a key role in the pathogenesis of post-infectious chronic
fatigue. Abnormal processing of sensory information secondary to dorsal root
ganglionitis could potentially contribute to fatigue due to higher perceived
effort and pain because of reduced sensory threshold. This may lead to new
treatment options in a group of patients that currently present a
significant challenge to neurologists.

[Dr Charles Shepherd]

This finding (ie dorsal root ganglionitis/DRG) is not indicative of a massive infection in the body

DRG is also found in Sjogren's Syndrome (not recognised as an infective condition) where it has been linked to what is called a peripheral neuropathy

And it could well be that this link is relevant to DRG in ME/CFS - because the dorsal root ganglion is a bundle of nerve cells lying outside the spinal cord (but connected to it) where information about sensation is collected, processed and then transmitted.

Inflammation in the DRG could therefore upset the way in which sensations (pain) are being dealt with leading to symptoms such as paraesthesiae (pins and needles, .loss of sensation, or painful sensations.

[Bluebottle]

Thank you for your extensive reply.

Is there a test for this on a living person please?

[Dr Charles Shepherd]

You can look at dorsal columns with MRI:

http://jnnp.bmj.com/content/71/4/488.full

but this has not been done in ME/CFS