Successfully reported this slideshow.
Your SlideShare is downloading. ×

Julia Newton Presentation

Loading in …3
×

Check these out next

1 of 44 Ad
1 of 44 Ad
Advertisement

More Related Content

Viewers also liked (20)

Advertisement
Advertisement

Julia Newton Presentation

  1. 1. Standing up for Fatigue Julia L Newton MBBS, FRCP, PhD Professor of Ageing and Medicine Newcastle University
  2. 2. Outline •  Previous research
  3. 3. Outline •  Previous research •  Clinical service
  4. 4. Outline •  Previous research •  Clinical service •  Current research
  5. 5. Outline •  Previous research •  Clinical service •  Current research •  What I would do if I was running Scotland and had the opportunity to change the management of CFS/ME patients …
  6. 6. Research themes •  Autonomic nervous system function in health and disease •  Chronic diseases •  CFS/ME
  7. 7. CFS/ME Chronic Disease Dysautonomia-Associated Fatigue (DAF) Non-Fatigued Fatigued DAF Fatigue Non-DAF Fatigue Newton QJM 2007
  8. 8. Primary Biliary Cirrhosis (PBC)
  9. 9. In PBC Fatigue is NOT benign
  10. 10. Perceived fatigue is comparable across chronic disease groups
  11. 11. So what do we see in my clinical service ? Dizziness Falls Syncope Ward & Kenny, Am J Med 1993
  12. 12. So what do we see in my clinical service ? Dysautonomia Dizziness Falls Syncope Ward & Kenny, Am J Med 1993
  13. 13. So what do we see in my clinical service ? Dysautonomia Dizziness Falls Syncope Fatigue Ward & Kenny, Am J Med 1993
  14. 14. Fatigue is more severe in those with low blood pressure Fatigue severity Fatigue severity Legge et al., Europace 2008
  15. 15. Parasympathetic
  16. 16. Sympathetic
  17. 17. Symptoms on standing occur in 89% of those with CFS/ME
  18. 18. Actual blood pressure abnormalities Newton Psychosomatic Research in press
  19. 19. What happens if you tilt CFS patients ? •  Symptoms during tilt ~ 48%
  20. 20. 52% have orthostatic hypotension
  21. 21. 27 % have Positional Orthostatic Tachycardia Syndrome (POTS) a) b) 0 2 4 6 8 10 12 min 0 2 4 6 8 min Ewan et al., Europace 2008 Hoad et al., QJM 2008
  22. 22. Technological Developments
  23. 23. Parameters •  Haemodynamic – HR & BP •  Autonomic – Heart rate variability & Baroreflex sensitivity •  Cardiovascular – Impedance Cardiography
  24. 24. Newcastle Magnetic Resonance Centre MRI studies School of Biology GABA Gln NAA Gln NAA Asp
  25. 25. Muscle MRI
  26. 26. Muscle MRI
  27. 27. Cardiac MRI
  28. 28. Cardiac MRI
  29. 29. Brain MRI
  30. 30. Brain MRI
  31. 31. Brain MRI
  32. 32. Opportunities ..
  33. 33. Your options ? •  Identify and investigate those who present to CFS/ME Clinical services who also describe syncope or pre-syncope. •  Identify and investigate those who present to CFS/ME Clinical services who describe symptoms on standing
  34. 34. Your options ? •  Haemodynamic assessment of everyone presenting to a CFS/ME Clinical Service – treatment of abnormalities when they are found •  Treatment of everyone with CFS/ME with an autonomic phenotype •  Treatment of everyone with CFS/ME with interventions to address dysautonomia
  35. 35. Interventions ? •  Home orthostatic training •  Midodrine
  36. 36. Current work •  ME Research UK project – establishing a prospective cohort. –  Brain –  Muscle –  Liver MRC PBC study Research for patient benefit
  37. 37. Fatigue Work is Supported by Liver North Northern CFS/ME Clinical Network JRRG
  38. 38. Questions ?
  39. 39. •  Cross-border collaboration - Is there relevant experience of 'cross- border' collaboration in any aspect of this research, and could such collaboration be further developed to the advantage of both Newcastle University (and NHS North East) & NHS Scotland (or any of its regions)? •  International collaboration - Is there any experience of international collaboration relevant to this research, or how that could affect service provision? •  Ownership of research results - Where collaboration might take place, could shared ownership of results, (and any treatment processes developed from them), cause problems for development of NHS service provision?

×