Neuromodulation in ME/CFS

The lecture by Dr. Stingl summarized his clinical experience in the drug treatment of ME/CFS patients. To date, there have been no comprehensive clinical studies and little scientific evidence on off-label medication in ME/CFS. Therefore, when administering drugs, it is always necessary to weigh up what effect can be achieved and how well the medication is tolerated. If it is unclear whether a drug improves symptoms, it should be discontinued or the dose reduced. Dr. Stingl presented different groups of drugs that can be used as off-label medication in ME/CFS. Low-dose benzodiazepines may help PEM, sensory overload, and mast cell activation in the short term, but the risk of addiction is high with long-term use. Anticonvulsants (medication for epilepsy) can be used to reduce nerve pain and possibly neuroinflammation. Antidepressants can treat ME/CFS-related depression and may also have anti-inflammatory effects. Naltrexone (opioid antagonist) may also have an anti-inflammatory effect and improve cognitive symptoms. Pyridostigmine inhibits acetylcholinesterase and may reduce postural tachycardia syndrome (POTS) and increase exercise capacity. In general, these drugs should be used in very low doses and with caution in ME/CFS.