Schlömer, Ella, Stein, Elisa, Kedor, Claudia et al. · Frontiers in neuroscience · 2025 · DOI
This small study tested whether a medication called pyridostigmine could help ME/CFS patients recover hand grip strength after exertion. Twenty patients with ME/CFS showed significant muscle weakness and fatigue. When given pyridostigmine, their hand strength improved by about 2.6 kg after one hour, compared to a loss of 4.65 kg without the medication. The medication also appeared to help with blood pressure responses when standing up.
ME/CFS patients commonly experience disabling muscle weakness and exertional intolerance with limited treatment options. This study provides mechanistic evidence that acetylcholinesterase inhibition may rapidly improve neuromuscular function and orthostatic regulation, offering a potential therapeutic target for symptoms that significantly impact daily functioning. These findings support further investigation of pyridostigmine as a therapeutic option for ME/CFS.
This study does not prove that pyridostigmine is an effective long-term treatment—it only demonstrates acute effects in a single dose. The small sample size (n=20), lack of randomization and placebo control, and absence of follow-up data limit generalizability. The study cannot establish whether benefits persist with repeated dosing or translate to meaningful improvements in patients' daily activities and quality of life.
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
Schlömer, Ella, Stein, Elisa, Kedor, Claudia, Rust, Rebekka, Brock, Anna, Wittke, Kirsten, et al. (2025). Pyridostigmine improves hand grip strength in patients with myalgic encephalomyelitis/chronic fatigue syndrome.. Frontiers in neuroscience. https://doi.org/10.3389/fnins.2025.1637838
BibTeX
@article{mecfsatlas-schlmer-2025-pyridostigmine-improves,
author = {Schlömer, Ella and Stein, Elisa and Kedor, Claudia and Rust, Rebekka and Brock, Anna and Wittke, Kirsten and Scheibenbogen, Carmen and Kim, Laura},
title = {Pyridostigmine improves hand grip strength in patients with myalgic encephalomyelitis/chronic fatigue syndrome.},
journal = {Frontiers in neuroscience},
year = {2025},
doi = {10.3389/fnins.2025.1637838},
note = {PubMed: 40970182},
url = {https://www.mecfsatlas.com/evidence/schlmer-2025-pyridostigmine-improves},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/schlmer-2025-pyridostigmine-improves
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