Maes en Twisk:

behandeling moet zich richten op organische oorzaken

(reaktie op van Houdenhove)








In het wetenschappelijke tijdschrift Patient Education and Counselling

leveren Maes en ondergetekende kritiek op een artikel van van Houdenhove (klik hier),

waarin laatstgenoemde stelt dat de omgaan-met-of-herstel-vraag irrelevant lijkt/is, en dat

patiënten op zoek moeten naar een nieuw evenwicht m.b.v. "een flexibele CGT-aanpak" (?).


Maes en Twisk daarentegen betogen dat de "behandeling" niet gericht moet zijn op "psychosociale barrières die de patiënt weerhouden van een nieuw evenwicht" en CGT(/GET),

maar op immunologische afwijkingen (inflammatie etc.), infekties en de gevolgen van (permanente) aktivering van het afweersysteem (nitrosatieve stress, channelopathie etc.)




Treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS),

a multisystem disease,

should target the pathophysiological aberrations

(inflammatory and oxidative and nitrosative stress pathways),

not the psychosocial "barriers" for a new equilibrium.

Patient Educ Couns. Available online 19 March 2010. doi: 10.1016/j.pec.2010.02.017.

Michael Maes, Frank N.M. Twisk.



Received 4 November 2009

published online 19 March 2010.





In a recent article published by B. van Houdenhove and P. Luyten

it is claimed that cognitive behavioral therapy and graded exercise therapy (CBT/GET)

are evidence based and are the most adequate treatments

to control symptoms and improve quality of life

of patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).


However, these authors do not disclose that

their own treatments at the Belgian CFS Reference Centers with CBT/GET

have proven to have no clinical effects.


The Belgian minister declared in the parliament that

CBT/GET at those centers are no curative therapies.


Even more, measured by objective standards

the CBT/GET approach has shown to be counterproductive.


van Houdenhove and Luyten neglect or deny all scientific findings on

the pathophysiology and possible medical treatments of ME/CFS.


However, there is now a consensus that

inflammatory and oxidative and nitrosative (IO&NS) pathways

underpin the pathophysiology of ME/CFS in humans and in animal models as well.


Human and animal data show that

treatments which target IO&NS pathways

are useful in treating ME/CFS.


van Houdenhove and Luyten also propose that

the time has come to shift treatment research in CFS

from efficacy studies to effectiveness studies in ‘real life’.


In our opinion, future research should use a high throughput screening,

made possible by the translational approach,

in order to

further examine the IO&NS pathways in detail;

further delineate novel drug-targets in the IO&NS pathways and

develop new drugs to treat this complex and serious medical disorder.





ME/CFS, Inflammation, Oxidative stress, CBT/GET, Cognitive behavioral therapy, Graded exercise therapy