McAlpine, Lindsay, Zubair, Adeel S, Joseph, Phillip et al. · Neurology(R) neuroimmunology & neuroinflammation · 2024 · DOI
This study looked at 16 patients who developed nerve damage in their small nerves after COVID-19. The researchers found that 92% of these patients also had symptoms of ME/CFS, including post-exertional malaise (feeling much worse after activity). When 9 patients were treated with IVIG (an immune therapy), all of them improved significantly, while only 3 out of 7 untreated patients improved.
This study provides objective evidence linking COVID-19 to measurable nerve damage (SFN) in patients with ME/CFS-like symptoms, suggesting a potential biological mechanism for post-COVID ME/CFS. The finding that IVIG may effectively treat these symptoms offers hope for a treatable subset of long COVID patients. Understanding these connections helps validate ME/CFS as a real physiological condition and identifies potential therapeutic approaches.
This study does not prove that all ME/CFS cases result from small fiber neuropathy, nor does it establish that IVIG is effective for ME/CFS broadly—only for the specific subgroup with biopsy-confirmed SFN. The small sample size and retrospective design mean results may not apply to larger populations, and selection bias may have influenced which patients received treatment. Correlation between SFN and dysautonomia does not prove causation.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
McAlpine, Lindsay, Zubair, Adeel S, Joseph, Phillip, & Spudich, Serena (2024). Case-Control Study of Individuals With Small Fiber Neuropathy After COVID-19.. Neurology(R) neuroimmunology & neuroinflammation. https://doi.org/10.1212/NXI.0000000000200244
BibTeX
@article{mecfsatlas-mcalpine-2024-case-control,
author = {McAlpine, Lindsay and Zubair, Adeel S and Joseph, Phillip and Spudich, Serena},
title = {Case-Control Study of Individuals With Small Fiber Neuropathy After COVID-19.},
journal = {Neurology(R) neuroimmunology & neuroinflammation},
year = {2024},
doi = {10.1212/NXI.0000000000200244},
note = {PubMed: 38630952},
url = {https://www.mecfsatlas.com/evidence/mcalpine-2024-case-control},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/mcalpine-2024-case-control
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