Number 1 |
1st March 2007 |
NEUROLOGY
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Sherlin, L., Budzynski, T., Kogan Budzynski, H., Congedo, M., Fischer, ME and Buchwald, D. Low-resolution electromagnetic brain tomography (LORETA) of monozygotic twins discordant for chronic fatigue syndrome. Neuroimage, 2006 Dec 12; [Epub ahead of print] doi:10.1016/j.neuroimage.2006.11.007
Previous work using quantified EEG has suggested that brain activity in individuals with CFS and normal persons differs. Our objective was to investigate if specific frequency band-pass regions and spatial locations are associated with CFS using low-resolution electromagnetic brain tomography (LORETA).
We conducted a co-twin control study of 17 pairs of monozygotic twins where 1 twin met the CDC ’94 criteria for CFS and the co-twin was healthy. Twins underwent an extensive battery of tests including a structured psychiatric interview and a quantified EEG. Eyes closed EEG frequency-domain analysis was computed and the entire brain volume was compared of the CFS and healthy twins using a multiple comparison procedure.
Compared with their healthy co-twins, twins with CFS differed in current source density. The CFS twins had higher delta in the left uncus and parahippocampal gyrus and higher theta in the cingulate gyrus and right superior frontal gyrus.
These findings suggest that neurophysiological activity in specific areas of the brain may differentiate individuals with CFS from those in good health... The study also supports the neurobiological model that the right forebrain is associated with sympathetic activity and the left forebrain with the effective management of energy. These preliminary findings await replication.
Natelson, BH., Intriligator, R., Cherniack, NS., Chandler, HK and Stewart, JM. Hypocapnia is a biological marker for orthostatic intolerance in some patients with chronic fatigue syndrome. Dynamic Medicine, 2007 Jan 30, 6:2 [Epub ahead of print] doi:10.1186/1476-5918-6-2
Patients with CFS and those with orthostatic intolerance share many symptoms, yet questions exist as to whether CFS patients have physiological evidence of orthostatic intolerance. The objective was to determine if some CFS patients have increased rates of orthostatic hypotension, hypertension, tachycardia, or hypocapnia relative to age-matched controls. The following were assessed: blood pressure, heart rate, respiratory rate, end tidal CO2 and visual analog scales for orthostatic symptoms when supine and when standing for 8 minutes without moving legs.
The sample comprised 60 women and 15 men with CFS (CDC criteria ’94) and 36 women and 4 men serving as age matched controls with analyses confined to 62 patients and 35 controls showing either normal orthostatic testing or a physiological abnormal test. Outcome measures included orthostatic tachycardia; orthostatic hypotension; orthostatic hypertension; orthostatic hypocapnia or combinations thereof.
CFS patients had higher rates of abnormal tests than controls (53% vs 20%, p<.002), but rates of orthostatic tachycardia, orthostatic hypotension, and orthostatic hypertension did not differ significantly between patients and controls (11.3% vs 5.7%, 6.5% vs 2.9%, 19.4% vs 11.4%, respectively). In contrast, rates of orthostatic hypocapnia were significantly higher in CFS than in controls (20.6% vs 2.9%, p<.02). This CFS group reported significantly more feelings of illness and shortness of breath than either controls or CFS patients with normal physiological tests.
A substantial number of CFS patients have orthostatic intolerance in the form of orthostatic hypocapnia. This allows subgrouping of patients with CFS and thus reduces patient pool heterogeneity engendered by use of a clinical case definition.
http://www.dynamic-med.com/content/pdf/1476-5918-6-2.pdf
Richards, RS., Wang, L and Jelinek, H. Erythrocyte oxidative damage in chronic fatigue syndrome. Archives of Medical Research, 2007, 38, 1, 94-98.
It has been hypothesized that a link exists between erythrocyte metabolism (particularly redox metabolism) and erythrocyte shape and that both are related to erythrocyte deformability. The aim of this research is to confirm the results of earlier studies and to investigate a correlation between erythrocyte morphology and erythrocyte oxidative damage in CFS.
Reduced glutathione (GSH), malondialdehyde (MDA), methemoglobin (metHb) and 2,3-diphosphoglyceric acid (2,3-DPG) were measured in 31 patients suffering from CFS (CDC criteria ’94) and 41 healthy control subjects. Scanning electron microscopic studies of the erythrocytes from both groups were also carried out.
There was evidence of oxidative damage in CFS with statistically significant increases in 2,3-DPG (p<0.05), metHb (p<0.005) and MDA (p<0.01). The CFS patients in this study also had significantly more stomatocytes in their blood than the normal subjects (p<0.005). There is a strong likelihood that the increase in erythrocyte antioxidant activity is associated with the presence of stomatocytes. The results of this study provide further evidence for the role of free radicals in the pathogenesis of CFS and a link between erythrocyte metabolism and erythrocyte shape.
Friedberg, F and Quick, Y. Alexithymia in chronic fatigue syndrome: associations with momentary, recall, and retrospective measures of somatic complaints and emotions. Psychosomatic Medicine, 2007, 69, 54-60.
The relationship between alexithymia and real-time momentary symptom assessments has not been reported. This cross-sectional study hypothesized that alexithymia would be a predictor of somatic symptoms using three different types of symptom measurement (momentary, recall, and retrospective) in the medically unexplained illness of CFS. In addition, it was hypothesized that negative affect would be a significant mediator of the relationship between alexithymia and somatic symptoms. Finally, the relation of alexithymia to physical illness attribution (a CFS illness predictor) was explored.
Participants were 111 adults with CFS (CDC criteria ’94). Alexithymia was assessed with the Toronto Alexithymia Scale. Momentary ratings of current symptoms and affect were recorded in electronic diaries carried for 3 weeks. Weekly recall of these momentary reports was also recorded. Retrospective measures included 6-month ratings of fatigue and pain, the Fatigue Severity Scale, the Brief Pain Inventory-Short Form, a CFS symptom measure, the Beck Depression Inventory-II, the Beck Anxiety Inventory, and an illness attribution rating.
Partial correlations, controlling for age and sex, yielded no significant associations between general or specific forms of alexithymia and momentary ratings of fatigue or pain. On the other hand, a significant association, partially mediated by anxiety scores, was found between a specific form of alexithymia and a retrospective pain measure. Finally, physical illness attribution was not significantly associated with alexithymia.
Based on assessments of real-time and retrospectively measured symptoms, these data provided only modest support for the alexithymia construct as a predictor of somatic symptoms in people with CFS.
Guise, J., Widdicombe, S and McKinlay, A. What is it like to have ME?’: the discursive construction of ME in computer-mediated communication and face-to-face interaction Health, 2007, 11, 1, 87-108.
ME (Myalgic Encephalomyelitis) or CFS is a debilitating illness for which no cause or medical tests have been identified. Debates over its nature have generated interest from qualitative researchers. However, participants are difficult to recruit because of the nature of their condition. Therefore, this study explores the utility of the internet as a means of eliciting accounts. We analyse data from focus groups and the internet in order to ascertain the extent to which previous research findings apply to the internet domain. Interviews were conducted among 49 members of internet groups (38 chatline, 11 personal) and 7 members of two face-to-face support groups. Discourse analysis of descriptions and accounts of ME or CFS revealed similar devices and interactional concerns in both internet and face-to-face communication. Participants constructed their condition as serious, enigmatic and not psychological. These functioned to deflect problematic assumptions about ME or CFS and to manage their accountability for the illness and its effects.
http://hea.sagepub.com/cgi/content/abstract/11/1/87
Sathyapalan, T., Campion, P., Beckett, S., Rigby, AS and Atkin, SL. High cocoa polyphenol rich chocolate improves the symptoms of chronic fatigue. Endocrine Abstracts, 2006, 12, P68
There are data suggesting neuroendocrine axis involvement in CFS including disturbance in hypothalamic-pituitary-adrenal (HPA) axis, growth hormone axis, opioidergic system and interactions with 5-hydroxy-tryptamine (5-HT) system. Studies with selective 5-HT-releasing agents, using prolactin or cortisol responses to stimulation, found evidence of enhanced serotonergic responses in patients with CFS. Cocoa is known to increase neurotransmitters like phenylethylamine, serotonin, and anandamide in the brain.
This was a double-blinded, randomised, placebo controlled fashion using high cocoa polyphenol rich chocolate in comparison to simulated iso-calorific chocolate dyed brown as placebo.
Ten patients were enrolled in the study of which 5 patients completed both arms. The Fatigue Scale score improved significantly after 8 weeks of the high cocoa polyphenol rich chocolate phase (32.6 vs. 22.0 p=0.012) and, interestingly, fell significantly when patients were given simulated iso-calorific chocolate (25.3 vs. 28.6 p=0.026). The residual function, as assessed by the London Handicap scale, also improved significantly after the active phase (0.485 vs. 0.628 p=0.018). The mean weight before and after the placebo arm were also unchanged (73.43 kg vs. 73.85 kg, respectively p=0.345). Anecdotally, two patients were able to return back to work after having had their symptoms for a 2 year period and continued on high cocoa poly-phenol rich chocolate.
High cocoa polyphenols rich chocolate 15 g three times daily improved fatigue and function in patients with CFS over a period of 8 weeks compared to simulated iso-calorific chocolate. Whether hormonal modulation by this high cocoa polyphenols rich chocolate also occurred needs clarification.
http://www.endocrine-abstracts.org/ea/0012/ea0012p68.htm
Taylor, RR., Thanawala, SG., Shiraishi, Y and Schoeny, ME. Long-term outcomes of an integrative rehabilitation program on quality of life: A follow-up study. Journal of Psychosomatic Research, 2006, 61, 6, 835-839.
The objective of this study was to assess the long-term effects of an integrative rehabilitation program on the overall quality of life of individuals with CFS. This study utilized a within-subjects, repeated measures cohort design. Twenty-three subjects diagnosed with CFS (CDC criteria ’94) attended eight sessions of an illness-management group followed by 7 months of goal-oriented, individualized counselling that occurred once weekly for 30 min per session. Quality of life was assessed at five time points (baseline, following the group phase, following the one-on-one phase, and 4 and 12 months following program completion).
A within-subjects repeated measures ANOVA revealed significant increases in overall quality of life for up to 1 year following program completion [F(4,21)=23.5, p<.001]. Definitive conclusions about program efficacy are limited by design issues. However, findings suggest that the program may have led to improvement in quality of life for up to 1 year following program completion.
[Ed. Note: Included in the programme were pacing, coping skills training, relaxation and meditation. Previous results reported in 2004 revealed moderate effect sizes immediately following the programme for symptom severity (Cohen’s d=.71) and overall quality of life (Cohen’s d=.66).]
Carpenter, J., Hutchings, A., Raine, R and Sanderson, C. An experimental study of the influence of individual participant characteristics on formal consensus development. International Journal of Technology in Assessment of Health Care, 2007, 23, 1, 108-115.
The aim of this study was to examine the influence of participants' characteristics on the results produced by formal consensus methods. The approach was an experimental study of 346 participants in 20 groups rating the appropriateness of four mental health interventions for the treatment of CFS, irritable bowel syndrome, and chronic back pain. There were four factors in the design: systematic literature review provided or not, decisions made under realistic or "ideal" resource assumptions, clinically mixed (general practitioners and mental health professionals) or homogenous group (general practitioners only), convened or mail-only group. A group's rating was defined as the median of participants' ratings. The influence of participants' characteristics (age, sex, and specialty) was examined using multilevel models.
The largest differences were between the GPs and mental health professionals, both in their initial ratings of the different interventions, and in how much they altered their ratings between rounds. There were smaller but statistically significant (p<.05) differences between specialty and age groups in initial ratings for the treatment (by whatever means) of different conditions, and for certain conditions women increased their ratings more than men. Women rated intervention more favourably when assuming "ideal" rather than realistic levels of resources, but men did not.
Our findings support the practice of treating professional specialty as an important determinant of the results in consensus panels.
Goudsmit, EM. Chronic fatigue syndrome. Journal of the Royal Society of Medicine, 2007, 100, 7.
Letter noting factual errors and biased evaluation of the study by Goudsmit in the paper by Chambers et al. (ibid 2006, 99, 506-520).
Jerjes, WK., Taylor, NF., Wood, PJ and Cleare, AJ. Enhanced feedback sensitivity to prednisolone in chronic fatigue syndrome. Psychoneuroendocrinology, 2007 Feb 2; [Epub ahead of print] doi:10.1016/j.psyneuen.2006.12.005
Enhancement of negative feedback control of the HPA axis in patients with CFS has been reported using the low dose dexamethasone suppression test. We have developed the use of prednisolone (5mg) as a more physiologically appropriate alternative to dexamethasone in the investigation of mild degrees of glucocorticoid resistance or supersensitivity. The objective of the study was to use this test to look for alterations in negative feedback control of the HPA axis in CFS patients.
Fifteen patients with CFS (CDC criteria ’94, no comorbid psychiatric diagnosis) were recruited. They collected urine between 0900 and 1800h and saliva at 0900h pre-prednisolone. At midnight, they took prednisolone (5mg) orally and then collected urine and saliva at the same intervals the following day.
Salivary cortisol was lower in CFS subjects pre-prednisolone than controls. Urinary cortisol metabolites were lower in CFS subjects pre-prednisolone, but did not reach significance. Both measures were significantly lower in CFS subjects post-dose. Mean percentage suppression of both salivary cortisol and urinary cortisol metabolites was significantly higher in CFS compared to controls. There is enhanced sensitivity of the HPA axis to negative feedback in CFS as demonstrated using the prednisolone suppression test. This provides further evidence of alter-ations in the control of the HPA axis in patients with established CFS.
[Ed. Note: There was no measure of current stress levels, a known confounding factor.]
Maes, M., Mihaylova, I and Leunis, JC. Chronic fatigue syndrome is accompanied by an IgM-related immune response directed against neopitopes formed by oxidative or nitrosative damage to lipids and proteins. Neuroendocrinology Letters, 2006, 27, 5, 615-621.
There is now some evidence that CFS is accompanied by signs of oxidative stress and by a decreased antioxidant status. The aim of the present study was to examine whether CFS is accompanied by an immune response to neoepitopes of a variety of modified lipids and proteins indicating damage caused by oxidative and nitrosative stress.
Toward this end we examined serum antibodies to fatty acids (oleic, palmitic and myristic acid), by-products of lipid peroxidation, i.e. azelaic acid and malondialdehyde (MDA), acetylcholine, S-farnesyl-L-cysteine, and N-oxide modified amino-acids in 14 patients with CFS, 14 subjects with partial CFS and 11 normal controls.
We found that the prevalences and mean values for the serum IgM levels directed against oleic, palmitic and myristic acid, MDA, azelaic acid, S-farnesyl-L-cysteine, and the N-oxide derivates, nitro-tyrosine, nitro-phenylalanine, nitro-arginine, nitro-tryptophan, and nitro-cysteinyl were significantly greater in CFS patients than in normal controls, whereas patients with partial CFS took up an intermediate position. There were significant and positive correlations between the serum IgM levels directed against fatty acids, MDA and azelaic acid and the above N-oxide-derivates and the severity of illness (as measured by the FibroFatigue scale) and symptoms, such as aches and pain, muscular tension and fatigue.
The results show that CFS is characterized by an IgM-related immune response directed against disrupted lipid membrane components, by-products of lipid peroxidation, S-farnesyl-L-cysteine, and NO-modified amino-acids, which are normally not detected by the immune system but due to oxidative and nitrosative damage have become immunogenic.
Meeus, M and Nijs, J. Central sensitization: a biopsychosocial explanation for chronic widespread pain in patients with fibromyalgia and chronic fatigue syndrome. Clinical Rheumatology, 2006, Nov 18; [Epub ahead of print] 10.1007/s10067-006-0433-9
In addition to the debilitating fatigue, the majority of patients with CFS experience chronic widespread pain. These pain complaints show the greatest overlap between CFS and fibromyalgia (FM). Although the literature provides evidence for central sensitization as a cause for the musculoskeletal pain in FM, in CFS this evidence is currently lacking, despite the observed similarities in both diseases. The knowledge concerning the physiological mechanism of central sensitization, the pathophysiology and the pain processing in FM, and the knowledge on the pathophysiology of CFS lead to the hypothesis that central sensitization is also responsible for the sustaining pain complaints in CFS.
This hypothesis is based on the hyperalgesia and allodynia reported in CFS, on the elevated concentrations of nitric oxide presented in the blood of CFS patients, on the typical personality styles seen in CFS and on the brain abnormalities shown on brain images. To examine the present hypothesis more research is required. Further investigations could use similar protocols to those already used in studies on pain in FM like, for example, studies on temporal summation, spatial summation, the role of psychosocial aspects in chronic pain, etc.
Reeves, WC., Heim, C., Maloney, EM., Solomon Youngblood, L., Unger, ER., Decker, MJ., Jones, JF and Rye, DB. Sleep characteristics of persons with chronic fatigue syndrome and non-fatigued controls: results from a population-based study. BMC Neurology, 2006, Nov 16, 6:41. doi:10.1186/1471-2377-6-41
The etiology and pathophysiology of CFS remain inchoate. Attempts to elucidate the pathophysiology must consider sleep physiology, as unrefreshing sleep is the most commonly reported of the 8 case-defining symptoms of CFS. Although published studies have consistently reported inefficient sleep and documented a variable occurrence of previously undiagnosed primary sleep disorders, they have not identified characteristic disturbances in sleep architecture or a distinctive pattern of polysomnographic abnormalities associated with CFS. This study recruited 35 CFS cases (CDC criteria ’94) and 40 non-fatigued controls from a population based study of CFS in Wichita, Kansas. Participants spent two nights in the research unit of a local hospital and underwent overnight polysomnographic and daytime multiple sleep latency testing in order to characterize sleep architecture.
Approximately 18% of persons with CFS and 7% of asymptomatic controls were diagnosed with severe primary sleep disorders and were excluded from further analysis. These rates were not significantly different. Persons with CFS had a significantly higher mean frequency of obstructive apnea per hour (p=.003); however, the difference was not clinically meaningful. Other characteristics of sleep architecture did not differ between persons with CFS and controls.
Although disordered breathing during sleep may be associated with CFS, this study generally did not provide evidence that altered sleep architecture is a critical factor in CFS. Future studies should further scrutinize the relationship between subjective sleep quality relative to objective polysomnographic measures.
http://www.biomedcentral.com/content/pdf/1471-2377-6-41.pdf
Smith, WR., White, PD and Buchwald, D. A case control study of premorbid and currently reported physical activity levels in chronic fatigue syndrome. BMC Psychiatry, 2006, 6:53. doi:10.1186/1471-244X-6-53
Patients with CFS typically report high levels of physical activity before becoming ill. Few studies have examined pre-morbid and current activity levels in chronically fatigued patients. In a case-control study, 33 patients with chronic, unexplained, disabling fatigue attending a university-based clinic specializing in fatigue, including 25 (76%) who fulfilled the 1994 CDC criteria for CFS, were compared to 33 healthy, age- and sex-matched controls. Patients rated their activity levels before their illness (around two years earlier) and currently, using scales designed for this purpose. Controls reported their level of activity of 2 years previously and currently. Chi-square analyses, Students t tests, and Wilcoxon signed rank tests were used in pair matched analyses.
Compared to healthy controls, patients with chronic, unexplained fatigue rated themselves as more active before their illness (p<0.01) and less active currently (p<0.001. The patients also reported that they currently stood or walked less than the controls (p<0.001), and spent more time reclining (p<0.001). These differences remained significant for the subset of patients who met strict criteria for CFS or FM alone.
Patients with chronic, unexplained, disabling fatigue reported being more physically active before becoming ill than healthy controls. This finding could be explained by greater premorbid activity levels that could predispose to illness, or by an overestimation of previous activity. Either possibility could influence patients perceptions of their current activity levels and their judgments of recovery. Perceived activity should be addressed as part of the management of the illness.
[Ed. Note: On the basis of the patients’ estimates of activity levels several years earlier, the authors speculate about possible misperception, which they link to the illness and which they suggest may be helped with CBT. There is little discussion of the possibility that the estimates might be reliable although they do mention biologically-based oversensitivity as another influence on perception.]
http://www.biomedcentral.com/content/pdf/1471-244x-6-53.pdf
Teitelbaum, JE., Johnson, C and Cyr, JS. The use of D-Ribose in chronic fatigue syndrome and fibromyalgia: a pilot study. Journal of Alternative and Complementary Medicine, 2006, 12, 9, 857-862.
Fibromyalgia (FM) and CFS are debilitating syndromes that are often associated with impaired cellular energy metabolism. As D-ribose has been shown to increase cellular energy synthesis in heart and skeletal muscle, this open-label uncontrolled pilot study was done to evaluate if D-ribose could improve symptoms in FM and/or CFS patients.
Forty-one patients with a diagnosis of FM and/or CFS (CDC criteria) were given D-ribose, a naturally occurring pentose carbohydrate, at a dose of 5 g t.i.d. for a total of 280 g. All patients completed questionnaires containing discrete visual analogue scales and a global assessment pre- and post-D-ribose administration.
D-ribose, which was well-tolerated, resulted in a significant improvement in all five visual analog scale (VAS) categories: energy; sleep; mental clarity; pain intensity; and well-being, as well as an improvement in patients' global assessment. Approximately 66% of patients experienced significant improvement while on D-ribose, with an average increase in energy on the VAS of 45% and an average improvement in overall well-being of 30% (p<0.0001).
D-ribose significantly reduced clinical symptoms in patients suffering from FM and CFS.
[Ed. Note: Global assessment measures also revealed that 14.4% felt “much better” but that 8.6% noted “no change” or judged themselves as “somewhat worse”.]
Wearden, AJ and Chew-Graham, C. Managing chronic fatigue syndrome in UK primary care: challenges and opportunities. Chronic Illness, 2006, 2, 143-153.
[Ed. Note: Uncritical discussion paper on management written from the perspective of the CBT school.]
Jason, LA., Bell, DS., Row, K., Van Hoof, ELS., Jordan, K., Lapp, C., Gurwitt, A., Miike, T., Torres-Harding, S and De Meirleir, K. A pediatric case definition for myalgic encephalomyelitis and chronic fatigue syndrome. Journal of Chronic Fatigue Syndrome, 2006, 13, 2/3, 1-44.
A significant problem in the literature is the lack of both a pediatric definition of ME/CFS and a reliable instrument to assess it. These deficiencies can lead to criterion variance problems resulting in studies labelling children with a wide variety of symptoms as having ME/CFS. Subsequently, comparisons between articles become more difficult, decreasing the possibility of conducting a meta-analysis. This article presents recommendations developed by the International Association of Chronic Fatigue Syndrome Pediatric Case Definition Working group for a ME/CFS pediatric case definition. It is hoped that this pediatric case definition will lead to more appropriate identification of children and adolescents with ME/CFS.
http://www.cfids-cab.org/MESA/Jason-1a.pdf
http://www.name-us.org/DefintionsPages/DefPediatric.htm
Van Hoof, E., De Becker, P and De Meirleir, K. Pediatric chronic fatigue syndrome and Munchausen-by-proxy: a case study. Journal of Chronic Fatigue Syndrome, 2006, 13, 2/3, 45-53.
Pediatric CFS posits even more challenges for professional caregivers in comparison with adult CFS samples. Most children with CFS display a decrease in school attendance and a decrease in social activities. As several conditions such as school phobia, primary psychiatric disorders or family disturbance present the same characteristics, the diagnostic process appears more complex. Family disturbance, moreover, is often specified as child abuse, neglect or even Munchausen-by-proxy. As skepticism is frequently associated with a diagnosis of CFS, patients and parents must fend for themselves, fighting allegations of child abuse and neglect. This case study illustrates what happens when such allegations are put forward.
Torres-Harding, SR., Jordan, K., Jason, LA and Arias, R. Psychosocial and physical impact of chronic fatigue in a community-based sample. Journal of Chronic Fatigue Syndrome, 2006, 13, 2/3, 55-74.
Few studies have examined the problem of chronic fatigue in children and adolescents and its potential impact on functioning. Chronic fatigue may have a negative impact on school functioning, family activities, psychological well-being, physical functioning, and severity of medical symptomatology. This study compared psychosocial, family, and physical functioning between a randomly selected community based sample of 36 children and adolescents with chronic fatigue and a group of 21 children and adolescents without fatigue. Children and parents completed a comprehensive medical history questionnaire and questionnaires assessing psychological functioning, family functioning, and school attendance.
Results indicated that children with chronic fatigue tended to have more difficulties in overall physical and psychological functioning, as measured by the Child Health Questionnaire and the Child Behavior Checklist. In addition, children in the chronic fatigue group experienced disruptions in a range of activities and reported more severe physical symptomatology when compared to children without fatigue. Findings suggest that children and adolescents with chronic fatigue may have a range of associated difficulties, including limitations in physical and psychosocial functioning and a negative impact on the ability to engage in normative activities.
Jordan, KM., Jason, LA., Mears, CJ., Katz, BZ., Rademaker, A., Huang, CF., Richman, J., McCready, W., Ayers, PM and Taylor, KK. Prevalence of pediatric chronic fatigue syndrome in a community-based sample. Journal of Chronic Fatigue Syndrome, 2006, 13, 2/3, 75-78.
This study evaluated the prevalence of CFS among children and adolescents (ages 5 to 17) in an ethnically and socio-economically diverse community population. This investigation attempted to address limitations of previous studies by using a community-based sample and thoroughly evaluating each participant (i.e., using medical and psychological evaluations) to determine a proper diagnosis of CFS. A community-based sample of children and adolescents aged 5 to 17 were screened for symptoms of CFS by telephone. Those reported to suffer from CFS-like symptoms were given medical and psychological evaluations to allow a determination of the CFS diagnosis.
The overall prevalence rate for the sample was 60 per 100,000 or .06%. The prevalence for the adolescents (aged 13 to 17) was 181 per 100,000 or .181%. The current prevalence estimate for CFS in adolescents is higher than previous estimates. CFS was more common in adolescents than pre-pubescent children.
Bell, DS and Van Hoof, E. Guidelines for the diagnosis of pediatric chronic fatigue syndrome: things parents need to know. Journal of Chronic Fatigue Syndrome, 2006, 13, 2/3, 79-88.
In this volume, CFS in children and adolescents is specifically addressed. It is a topic long overdue. It is my sincere hope that the criteria presented here will begin a process of rigorous clinical testing and refinement so that pediatricians and other medical providers will come to have a reliable and accepted way of making the diagnosis of ME/CFS in a person under 18 years of age. This short review is meant for parents and other caregivers as a brief summary of the guidelines that may be of value. The primary role of these guidelines is to present a strict and rigorous definition that can be tried and tested. This summary is to make the process of diagnosis somewhat easier for parents and caregivers alike until the testing process is completed. Therefore, for more detailed symptom description and exclusionary illness description, I would refer the reader to the primary article. Professional caregivers and clinicians may make this article available to inform parents with a child/adolescent suffering from CFS
Lapp, CW. Recognizing pediatric CFS in the primary care practice: a practicing clinician's approach. Journal of Chronic Fatigue Syndrome, 2006, 13, 2/3, 89-96.
Pediatricians and primary care physicians may be uncomfortable diagnosing CFS in children because a good diagnostic tool has not been available. Deferring a diagnosis, however, may lead to apprehension, over-utilization of medical resources in a search for validity, a delay in treatment, and possibly inappropriate coping techniques. This case-based article discusses symptoms and signs seen in adolescent patients with CFS, evaluation of suspect cases, and both current and future diagnostic case definitions.
Oleske, JM., Friedman, KJ., Kaufman, KR., Palumbo, D., Sterling, J and Evans, TL. Chronic fatigue syndrome in children and adolescents. Journal of Chronic Fatigue Syndrome, 2006, 13, 2/3, 97-115.
An overview of the unique aspects of CFS in children and adolescents (CACFS) is herein provided for healthcare professionals who may be called upon to diagnose and/or treat this illness. Young age of onset, puberty, and interactions with peers and the educational system provide greater diagnostic and treatment challenges than found with adult onset CFS. A review of diagnostic procedures and treatment protocols found in the contemporary literature is coupled with the professional experiences of the authors in treating CACFS to delineate the roles and responsibilities of family, healthcare providers and educators in diagnosing, treating and supporting the CACFS patient. Areas discussed include: pathogenesis, patient evaluation, clinical evaluation, laboratory evaluation, treatment options, psychological issues, role of schools, and the roles of primary and tertiary care providers.
CACFS can be diagnosed and treated with varying levels of success if all the professionals involved in the treatment program have a clear understanding of their roles and responsibilities. Primary care physicians, pediatricians, other subspecialists, family members, social workers and educators, may all be called upon to participate in the treatment program of CACFS. While it is best to have one, compassionate physician in charge of care, the CACFS may benefit from the inclusion of specialized treatment options available from or through a tertiary care provider. To the extent possible, socialization, education and psychological support of the CACFS should be provided.
Kato, K., Sullivan, PF., Evengård, B and Pedersen, NL. Premorbid predictors of chronic fatigue. Archives of General Psychiatry, 2006, 63, 1267-1272.
CFS is a disabling problem characterized by persistent fatigue lasting at least 6 months with a number of ancillary symptoms. Although the etiology of chronic fatiguing illness is unknown, some evidence suggests that stress may confer increased risk for development of the disorder. Moreover, subjects with chronic fatiguing illness may have distinctive personality traits, although this finding could reflect confounding by other mechanisms.
The aim of this study was to assess the prospective association of premorbid self-reported stress and personality with chronic fatigue–like illness. This was a prospective nested case-control study in a population-based sample from the Swedish Twin Registry, 19192 twins born between January 1, 1935, and December 31, 1958. At the time of testing, 447 had chronic fatigue plus four additional CDC symptoms (CFS-like cases).
Information about current chronic fatiguing illnesses was obtained from computer-assisted telephone interviews conducted between 1998 and 2002. Self-reported stress (based on a single question) and personality scales (emotional instability, also known as neuroticism, and extraversion in the Eysenck Personality Inventory) were measured from 1972 to 1973 by a mailed questionnaire. Relative risks were estimated with case-control analyses (matched for age and sex) and co-twin control analyses (comparing discordant pairs).
Higher emotional instability and self-reported stress in the premorbid period were associated with higher risk for chronic fatigue–like illness in matched case-control analyses (odds ratios, 1.72 and 1.64, respectively). In co-twin control analyses, relative risk of emotional instability decreased to 1.02 whereas that of stress increased considerably to 5.81. There was no association between extraversion and fatigue.
Elevated premorbid stress is a significant risk factor for chronic fatigue–like illness, the effect of which may be buffered by genetic influences. Emotional instability assessed 25 years earlier is associated with chronic fatigue through genetic mechanisms contributing to both personality style and expression of the disorder. These findings suggest plausible mechanisms for chronic fatiguing illness.
http://archpsyc.ama-assn.org/cgi/content/abstract/63/11/1267
[Ed. Note: The EPI N scale includes many items asking about the presence of symptoms also common in CFS. This confounding may inflate scores. The question about stress was “Do you experience your daily existence as being very ‘stress filled’?” with the answers coded as ‘yes’ or ‘no’. They did not ask for a reason, so the response may have reflected an illness, such as CFS. The number of CFS-like cases formed a tiny percentage of the total sample]
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