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When mitochondria fail, the body cannot generate enough energy to meet even basic metabolic demands, directly causing the severe physical exhaustion and post-exertional malaise (PEM) that leaves patients bedbound after minor exertion

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HT affects women 710 times more frequently than men, a difference largely attributed to the epigenetic mechanism of X-chromosome inactivation

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A combination of interrelated effectors such as glutamate excitotoxicity, mitochondria dysfunction, glial cell pathology, impaired axonal transport, protein aggregations, and neurotrophic factor deficits leads to progressive motor neuron degeneration and eventual death