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Myalgic Encephalomyelitis or Chronic Fatigue Syndrome

Last update: 23/05/2022, Dr. Miguel B. Royo Salvador, Medical Board number 10389. Neurosurgeon and Neurologist.



Chronic Fatigue Syndrome (CFS), or Myalgic Encephalomyelitis (ME), is a serious condition, a complex disorder of long duration that can affect many of the organism’s systems. Characteristic is extreme fatigue that does not improve with rest and entails difficulties to carry out normal activities, sometimes it even stops the patient from leaving the bed. It is also defined as “Systemic Exertion Intolerance Disease”.

The concept of Central sensitivity syndromes was introduced starting 1984 as the pathological concept embodying different processes with shared features, amongst them ME/CFS and Fibromyalgia.



The typical ME/CFS clinical picture can include some of the following: severe tiredness or extreme exhaustion lasting more than 24 hours after physical exertion, malaise or fatigue after physical exertion with worsening of the symptoms, joint or muscle pain without apparent cause, headaches, concentration and attention problems, memory loss, insomnia, nonrestorative sleep, dizziness, sore throat, mildly enlarged or pain in lymph nodes.


To date, this was diagnosed by exclusion; a wide range of tests was conducted to rule out other conditions with similar symptoms before confirming the diagnosis. To reach a diagnosis by exclusion, the fatigue must have been present for the last six months and be associated with at least four of the mentioned symptoms.

There are various criteria to take into account when considering the existence of a ME/CSF: the 1994 Fukuda criteria, the 2003 Canadian Consensus Criteria (CCC) and the 2011 Myalgic Encephalomyelitis-International Consensus Criteria (ME-ICC).
According to Nakatomi Y. (2018), positron emission tomography (PET scans) has shown the existence of a very extended neuro-inflammation in the brain areas of patients affected by ME/CSF, which is associated with the severity of their neuropsychological symptoms.

The Filum System® method, referring to the scientific findings on Fibromyalgia – a condition that belongs to the same disease group as ME/CSF – and based on the observation of several cases with the Filum Disease as a co-diagnosis, recommends MRI scans of the brain and spine.

Through MRIs, the probable presence of signs for an abnormal traction of the spinal cord can be checked, as a possible correlated and visible alteration on the neuro-imaging level. Furthermore, a brain positron emission tomography (PET) is recommended.


The specific causes for ME/CSF are currently unknown.

In terms of research on ME/CSF, specialists consider that a congenital predisposition to the disorder could be triggered later by a combination of factors. Recognised as possible causal factors to be investigated are especially:

  • Viral infections: several cases of the syndrome’s emergence following a viral infection have been detected.
  • Problems or changes in the immune system: it has been observed the ME/CSF patients’ immune systems seem to be affected.
  • Hormonal imbalances

– SAccording to the Filum System® health method:

As a result of the most recent findings on Fibromyalgia and its possible predisposition – caused by the abnormal spinal cord traction, provoked, in turn, by an excessively short or tense Filum terminale – we also recommend to take into account the possible presence of an abnormal traction in ME/CSF, as it is part of the same group of conditions as Fibromyalgia.

Risk factors

Among the risk factor playing a part in ME/CSF, the main ones to be recognized are:

  • Age: The syndrome can affect adult patients of all ages, but it can be observed that the incidence increases especially between the ages of 40 and 50 years.
  • Female gender: Women tend to receive the diagnosis with a higher frequency than men, however, given that the condition has been classified only recently, it has not been determined whether this could due to a greater tendency of the female sex to report symptoms.
  • Stress: It has been noted that physical or mental stress can be a trigger factor for ME/CSF.
  • Genetic factors/Family history: sometimes members of the same family have the syndrome, it is therefore being investigated whether genetics could be playing a role in this.

The Filum System® also takes into consideration the possible correlation of ME/CSF and caudal traction – produced by an excessively tense Filum Terminale –that we call Filum Disease and that consists of a congenital condition that can be inherited among family members.


The main complications observed in ME/CSF cases are the following:

  • Depression: the extreme exhaustion and overall tiredness, together with the rest of symptoms, especially the chronic pain affecting patients, can partake in the appearance of depression.
  • Social isolation: as a consequence of the difficulties of upholding normal activity, to the discomfort and limitations that the chronic fatigue can bring to the patients’ lives, they often end up isolating themselves socially.
  • Decline of the quality of life: a loss of prior level of the patients’ quality of life can be observed with the advance of the condition.


There is no treatment known to cure ME/CSF. To date, the most effective care focuses on symptom treatment and relief:

  • Cognitive training
  • Gradual exercises
  • Strategies using regular routines, relaxation, and techniques to sleep better and more.
  • Sleep treatments
  • Pain treatments
  • Balanced diet

Concerning our specialty, neurosurgery, and based on a study published by Dr Mantia and colleagues in 2015 and the application of the Filum System® in patients, it has been shown that the surgical approach prior to physiotherapy can benefit the patient in some cases of Fibromyalgia, always given that the existence of Filum Disease signs is confirmed previously.

It is still unclear whether this is attributable to a subgroup of central sensitivity syndromes or erroneous diagnostic interpretations, but also in several cases co-diagnosed with ME/CSF, the abnormal caudal traction of the nervous system has been observed. This phenomenon is being investigated and we recommend checking for Filum Disease signs in those patients, to be able to apply the neurosurgical treatment before the symptomatic one.

Since the publication in 1992 of Dr. Royo-Salvador’s doctoral thesis connecting the caudal traction of the whole nervous system by the filum terminale as the cause of several conditions included within the Filum Disease, a new treatment has been designed. The treatment is in this case etiological or concerned with the cause, given that surgically sectioning the filum terminale eliminates the caudal spinal cord traction force responsible for the disease mechanism.

Our technique for the Sectioning of the Filum terminale is minimally invasive and tends to be indicated for all cases of Filum Disease as soon as possible as the involved risks are minimal and the progression of the disease is halted.

The minimally invasive Filum System® Sectioning of the Filum terminale


1. Eliminates the traction of the spinal cord caused by the ligament when it is too short or tense.

2. The surgical time with ICSEB’s own minimally invasive technique is of 45 minutes. Few hours of hospitalisation. Local anaesthesia. Short post-operative period with no limitation. No need of admission in Intensive Care Unit. No blood transfusions.

3. Its application involves a mortality rate of 0%, with no sequelae.

4. Improves the symptoms and stops the evolution of the conditions related to the Filum Disease.


More than 1500 Filum Disease and Neuro-Cranio-Vertebral Syndrome patients have undergone surgery with the Filum System® method with excellent results and a high patient satisfaction rate. It has eliminated the cause and halted the progression of the condition as well as the mechanical conflict within the nervous system.

It has been noted that with Fibromyalgia patients who underwent the surgical sectioning of the filum terminale according to the Filum System®, and physiotherapy thereafter, the majority of patients experience a significant improvement in comparison to patients treated with physiotherapy only.

In several cases, the patients had also been co-diagnosed with ME/CSF with Filum Disease and/or Fibromyalgia.


  1. IACFS/ME: Primer for Clinical Practitioners . Members of the IACFS/ME Primer Writing Committee, Fred Friedberg, Ph.D., Chairperson Stony Brook, 2014, New York, USA.
  2. Yunus, M. B. (2007). Role of central sensitization in symptoms beyond muscle pain, and the evaluation of a patient with widespread pain. Best Practice & Research Clinical Rheumatology, 21(3), 481-497.
  3. Nakatomi Y, Mizuno K, Ishii A, Wada Y, Tanaka M, Tazawa S, Onoe K, Fukuda S, Kawabe J, Takahashi K, et al. J Neuroinflammation in Patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: An C-(R)-PK11195 PET Study. Nucl Med. 2014 Jun; 55(6): 945-50. Epub 2014 Mar 24.
  4. Dr. Miguel B. Royo Salvador (1996), Siringomielia, escoliosis y malformación de Arnold-Chiari idiopáticas, etiología común (PDF). REV NEUROL (Barc); 24 (132): 937-959.
  5. Dr. Miguel B. Royo Salvador (1996), Platibasia, impresión basilar, retroceso odontoideo y kinking del tronco cerebral, etiología común con la siringomielia, escoliosis y malformación de Arnold-Chiari idiopáticas (PDF). REV NEUROL (Barc); 24 (134): 1241-1250
  6. Dr. Miguel B. Royo Salvador (1997), Nuevo tratamiento quirúrgico para la siringomielia, la escoliosis, la malformación de Arnold-Chiari, el kinking del tronco cerebral, el retroceso odontoideo, la impresión basilar y la platibasia idiopáticas (PDF). REV NEUROL; 25 (140): 523-530
  7. M. B. Royo-Salvador, J. Solé-Llenas, J. M. Doménech, and R. González-Adrio, (2005) “Results of the section of the filum terminale in 20 patients with syringomyelia, scoliosis and Chiari malformation“.(PDF). Acta Neurochir (Wien) 147: 515–523.
  8. M. B. Royo-Salvador (1992), “Aportación a la etiología de la siringomielia“, Tesis doctoral (PDF). Universidad Autónoma de Barcelona.
  9. M. B. Royo-Salvador (2014), “Filum System® Bibliography” (PDF).
  10. M. B. Royo-Salvador (2014), “Filum System® Guía Breve”.

Filum Disease

Since Dr Royo-Salvador’s investigations of his doctoral thesis (1992), it has been shown that various conditions with unknown cause – such as the brainstem kinking, basilar impression, Arnold-Chiari Syndrome Type I, idiopathic syringomyelia, idiopathic scoliosis, platybasia and odontoid retroflexion – are part of the same group by sharing the same cause: the traction o the spinal cord and the entire nervous system hence establishing new disease concept: the Filum Disease (FD). It is called the Neuro-cranio-vertebral syndrome when the cause of the mechanical conflict is not congenital.

The mechanical conflict determining the tractive force of the whole nervous system in the Filum Disease occurs in all human embryos, so to a bigger or smaller extent, they all suffer its consequences and can manifest in very different forms and intensities.

By sharing, amongst others, the cause of the Filum Disease, also disk herniations, some cerebral vascular insufficiency syndromes, facet joint and Baastrup’s syndromes, fibromyalgia, chronic fatigue, nocturnal enuresis, urinary incontinence, and parapareses have an involvement in the Filum Disease.

A health method, the Filum System®, has been designed to define the diagnosis, give direction about the treatment and the follow up of the Filum Disease.

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