Figure 3.

A second model that explains the high incidence of characteristic symptoms of myalgic encephalomyelitis/chronic fatigue syndrome (MS/CFS) in multiple sclerosis (MS). This model shows that MS patients are neuroimmunologically primed towards a higher expression of ME/CFS symptoms. Thus, the activation of immunoinflammatory, oxidative and nitrosative (O+NS), autoimmune and mitochondrial pathways, and brain dysfunctions may prime MS patients for an increased prevalence of ME/CFS symptoms. CMI = cell-mediated immunity; PICs = proinflammatory cytokines.