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Kowal, K., Schacterele, RS., Schur, PH., Komaroff, AL and DuBuske LM. Prevalence of allergen-specific IgE among patients with chronic fatigue syndrome. Allergy and Asthma Proceedings, 2002, 23, 1, 35-39.
The prevalence of atopy among patients having CFS has been reported to be as high as 80% in published surveys. However, many of the reports relied on self-assessment for the presence of atopy or solely used total immunoglobulin E (IgE) levels to assess the likelihood of atopy.
To
more critically assess the presence of atopy among patients with CFS, testing
was done for total IgE and allergen-specific IgE using the Pharmacia CAP system
including 20 common allergens such as dust mites (Dermatophagoides pteronyssinus/Dermatophagoides
farinae), animal dander (cat/dog) and foods (egg white/milk/wheat/corn/peanut or
shrimp).
Testing
of 50 patients having documented CFS indicated that 78% had total IgE <100 IU/mL,
among whom 26% had a positive test for allergen specific IgE of class I or
greater for one or more allergens. Among the 22% of CFS patients having a total
IgE >100 IU/mL, 73% had a positive test for allergen-specific IgE for one or
more allergens. The most commonly positive allergens were dust mites (24-26%),
whereas molds (0-6%) and foods (0-4%) were rarely positive.
The overall frequency of positive results for the presence of allergen-specific IgE among CFS patients was 36%, not significantly different from the normal prevalence of these antibodies in the general population (20-35%). This assessment of the prevalence of allergen-specific IgE antibodies in patients with CFS fails to support a potential association between CFS and atopy.
Gaab,
J., Huster, D., Peisen, R., Engert, V., Schad, T., Schurmeyer, TH and Ehlert, U.
Low-dose dexamethasone suppression test in chronic fatigue syndrome and health. Psychosomatic
Medicine, 2002, 64, 2, 311-318.
OBJECTIVE:
The aim of this study was to examine the negative feedback regulations of the
hypothalamus-pituitary-adrenal (HPA) axis in CFS.
In
21 patients with CFS and 21 healthy control subjects, awakening and circadian
salivary free cortisol profiles were assessed over 2 consecutive days and
compared with awakening and circadian salivary free cortisol profiles after
administration of 0.5 mg of dexamethasone at 11:00 PM the previous day.
RESULTS:
Patients with CFS had normal salivary free cortisol profiles but showed enhanced
and prolonged suppression of salivary free cortisol after the administration of
0.5 mg of dexamethasone in comparison to the control subjects.
CONCLUSIONS:
Enhanced negative feedback of the HPA axis could be a plausible explanation for
the previously described alterations in HPA axis functioning in CFS. Because
similar changes have been described in stress-related disorders, a putative role
of stress in the pathogenesis of the enhanced feedback is possible.
Ax,
S., Gregg, VH and Jones, D. Caring for a relative with chronic fatigue
syndrome: difficulties, cognition and acceptance over time. Journal of the
Royal Society for the Promotion of Health, 2002,
122, 1, 35-42.
The present study explored the difficulties experienced by carers of CFS sufferers, their cognitions, and their efforts to accept the illness. Semi-structured interviews were conducted with 17 carers to study these issues, retrospectively, over three stages: before the diagnosis of CFS, shortly after the diagnosis, and at present. Surprisingly, the results suggested that carers, several of them absent from home during the day, felt that their lives were only minimally constrained by the illness. Nevertheless, all carers reported specific coping efforts to manage both the illness and their own distress, and indicated that they learned to accept the illness over time. However, acceptance appeared to be a form of resignation rather than a positive appreciation of the illness. In light of the uncertainties surrounding the origin of CFS and the carers' apparent confusion, the results obtained in the present study are significant in that they increase our understanding of CFS carers' quality of life, their efforts to cope with this illness, and the physical and emotional help they may provide to the sufferer. Such information can be usefully employed in the increasing development of counselling interventions and instrumental support networks that involve both sufferers and their carers.
Graffelman, AW., Knuistingh Neven, A., Nagelkerken, L., Petri, H., Springer, MP. Subjective sleep quality and depressive symptoms in patients with the chronic fatigue syndrome. Journal of Chronic Fatigue Syndrome, 2002, 10, 2, 19-28.
To evaluate subjective quality of sleep and depressive symptoms of patients with CFS.
Methods:
Adult patients with CFS (CDC criteria '94), were recruited by general
practitioners in the Leiden area, Holland. Age and sex-matched controls were
recruited. Questionnaires were handed out to 59 patients and 56 controls.
Results: CFS patients had a significant higher mean score than controls on the Groningen Sleep Quality Score (GSQS) and the Zung-index, i.e., worse sleep and depression scores.
Conclusions: In our study, CFS patients report more subjective sleep impairment and depressive symptoms than controls but these factors appear to be independent. The fact that only a minority of the CFS patients have depressive symptoms suggests it is unlikely that depression is the cause of CFS.
Van
Der Werf, SP., de Vree, B., van Der Meer JW and Bleijenberg G. The relations
among body consciousness, somatic symptom report, and information processing
speed in chronic fatigue syndrome. Neuropsychiatry, Neuropsychology and
Behavioral Neurology, 2002 15, 1, 2-9.
The
aim of this study was to assess the potential influence of body consciousness
and levels of somatic symptom report upon information processing speed in
patients with CFS.
BACKGROUND:
According to a model of a fixed information processing capacity, it was
predicted that in a group of patients with CFS, high body consciousness in
combination with a high report of somatic symptoms would affect
information-processing speed negatively.
METHODS:
Information- and motor-processing speed were simultaneously measured with a
simple- and a choice-reaction time task, whereas cognitive complaints were rated
with two questionnaires. The hypothesized influence of private body
consciousness and somatic symptom report upon information-processing speed was
tested in a model. A symptom-validity test was used to screen for possible
illness behavior.
RESULTS:
Private body consciousness was directly related to information-processing speed
and somatic symptom report. Somatic symptom report was related to both test
performance and memory and concentration complaints.
CONCLUSIONS:
Levels of private body consciousness directly affected somatic symptom report
and information-processing speed. This finding supports the role of attentive
processes in CFS, and offers, besides possible cerebral dysfunction, an
alternative explanation for slowing of information processing in CFS.
[Ed. Note: It is not clear which 'somatic' symptoms were assessed. The validity of some questionnaires deserves attention.]
De Becker, P., McGregor, N and De Meirleir, K. Possible triggers and mode of onset of chronic fatigue syndrome. Journal of Chronic Fatigue Syndrome, 2002, 10, 2, 3-18.
To identify the possible triggering events of CFS, we collected data on 1546 CFS patients and 309 excluded fatigued patients. Using extensive present and past medical history and lab reports as close as possible to the date of onset, an attempt was made to identify the agents that could play a role in the disease process.
Significant differences were found between the events at onset, between the Fukuda (1994) or Holmes (1988) definitions and a sudden as distinct from a gradual onset. We further found a series of subgroups of events that occurred at onset of CFS. Each of these onset event clusters was associated with an infectious event, blood transfusion or hepatitis B vaccination. In a large percentage of our study group an infectious event was combined with a non-infectious event. In summary, we can conclude that a number of different stressors and consequent immunological and neuroendocrinological changes can contribute to the onset of CFS.
Forty per cent met the 1988 criteria and 100% met the 1994 criteria. The former included more people with URTIs, and fewer with stress at onset. Bacterial infections were more common in the group as a whole compared with those meeting the 1988 criteria.
[Ed. Note: The inclusion of people with hepatitis, insect bites and post partum exhaustion challenges the accuracy of diagnosis of CFS in this sample.]
Jason,
LA., Taylor, RR., Plioplys, S., Stepanek, Z and Shlaes, J. Evaluating
attributions for an illness based upon the name: chronic fatigue syndrome,
myalgic encephalopathy and Florence Nightingale disease. American Journal of
Community Psychology, 2002, 30, 1, 133-148.
Reported
before. Findings indicated that the name, CFS may be regarded less seriously
than the Myalgic Encephalopathy name with respect to some important aspects of
the illness.
Sabath, DE., Barcy, S., Koelle, DM., Zeh, J., Ashton S and Buchwald D. Cellular immunity in monozygotic twins discordant for chronic fatigue syndrome. Journal of Infectious Diseases, 2002, 185, 6, 828-832.
The
objective of this study was to assess the nature and extent of abnormalities in
lymphocyte cell surface markers and NK cell activity in patients with CFS while
controlling for genetic factors. A co-twin control study of immune system
parameters was conducted for 22 pairs of monozygotic twins discordant for CFS
and 9 healthy pairs of twins. The CFS twins had greater numbers of CD62L(+) T
cells in several T cell subsets, although these differences did not achieve
statistical significance. Significantly greater variability was noted in twins
discordant for CFS than in the concordant healthy twins for 20 of 48 variables
examined.
Taylor,
RR., Jason, LA and Curie, CJ. Prognosis of chronic fatigue in a community-based
sample. Psychosomatic Medicine, 2002, 64, 2, 319-327.
This
study examined predictors of fatigue severity and predictors of continued
chronic fatigue status at wave 2 follow-up within a random, community-based
sample of individuals previously evaluated in a wave 1 prevalence study of
chronic fatigue and CFS which originally took place between 1995 and 1997.
Wave 1 data were from a larger community-based prevalence study of CFS. In the present study, a second wave of data were collected in 1999 by randomly selecting a sample of participants from the wave 1 sample of 18,675 adults and readministering a telephone screening questionnaire designed to assess symptoms of CFS. The data relate to 51 (out of 67 selected) people with chronic fatigue and 78 (out of 156 selected) non-fatigued controls. Measures included the Chalder fatigue scale, the GHQ-12 and a CFS questionnaire similar to the one used before.
Wave
1 fatigue severity was a predictor of fatigue severity at wave 2 in the overall
sample of individuals with and without chronic fatigue (p<.05). A comparison
of 26 people with fatigue at follow-up and 25 people who were no longer
experiencing fatigue (the 'improved' group) revealed that the former felt
significantly worse for 24 hours
or more after exercising and they reported more CFS symptoms, joint pain,
and more unrefreshing sleep than the latter. In the sample of individuals with
chronic fatigue (n=51), wave 1 fatigue severity, worsening of fatigue with
physical exertion, and feeling worse for 24 hours or more after exercise
significantly predicted continued chronic fatigue status (vs. improvement) at
wave 2 follow-up (p<.05).
These findings underscore the prognostic validity of postexertional malaise in predicting long-term chronic fatigue and also highlight the importance of using population-based, representative random samples when attempting to identify long-term predictors of chronic fatigue at follow-up.
Hammond,
DC. Treatment of chronic fatigue with neurofeedback and self-hypnosis.
Neurorehabilitation, 2001, 16, 4, 295-300.
A
21 year old patient reported a relatively rapid onset of serious CFS, with her
worst symptoms being cognitive impairments. Congruent with research on rapid
onset CFS, she had no psychiatric history and specialized testing did not
suggest that somatization was likely. Neuroimaging and EEG research has
documented brain dysfunction in cases of CFS. Therefore, a quantitative EEG was
done comparing her to a normative data base. This revealed excessive left
frontal theta brainwave activity in an area previously implicated in SPECT
research. Therefore, a novel treatment approach was utilized consisting of a
combination of EEG neurofeedback and self-hypnosis training, both of which
seemed very beneficial. She experienced considerable improvement in fatigue,
vigor, and confusion as measured pre-post with the Profile of Mood States and
through collaborative interviews with both parents. Most of the changes were
maintained at 5, 7, and 9 month follow-up testing.
Harrison, S., Smith, A and Sykes, R. Residential rehabilitation courses in the self-directed management of chronic fatigue syndrome: a preliminary evaluation. Journal of chronic Fatigue Syndrome, 2002, 10, 2, 59-65.
Report on courses focusing on illness management, run by the charity Westcare. Outcome of 49 patients with CFS (not defined, no psychiatric disorder, mean duration = 5 years), show improvements at 12 months, particularly for fatigue and emotional distress. There was less improvement in somatic symptoms and cognitive function. The approach was based on counselling and directed towards teaching coping skills.
Antoni
M and Chalder, T. Symposium
synopsis: The effects and underlying mechanisms of cognitive behavioral
interventions in chronic fatigue syndrome. Psychosomatic Medicine, 2002,
64, 1, 89-90. Abstract 5.
Antoni,
MH and Weiss, D. Do stressors
and stress management intervention affect physical symptoms and physiological
functioning in chronic fatigue syndrome? Ibid p.90. Abstract 5A.
Prins,
J., Bazelmans, E., van der Werf, S., van der Meer, J and Bleijenberg, G.
Cognitive behaviour therapy for chronic fatigue syndrome: Predictors of
treatment outcome. Ibid, p.90. Abstract 5B.
Gaab, J., Engert, V., Schad, T., Schurmeyer, TH and Ehlert, U. Correlations between HPA axis dysregulations and patient characteristics in chronic fatigue syndrome: Implications for etiology and intervention. Ibid, p.90. Abstract 5C.
Van der Werf, SP., Prins, JB., van der Meer, JWM and Bleijenberg, G. Daily fatigue and daily activity in patients with chronic fatigue syndrome. Ibid, p.90. Abstract 5D.
Chalder,
T; Deale, A; Husain, K; Wessely, S. Cognitive behavioural treatment of
chronic fatigue syndrome: Review of the evidence and a five-year follow up. p.
90-91. Abstract 5E.
Jones,
JF., Nisenbaum, R., Solomon, L and Reeves, WC.
Chronic fatigue syndrome in adolescents: a population-based study. Pediatric
Research, 2002, 51, (4 PT 2 Suppl.) p. 4A.
Jou,
NT., Chia, KS., Louie, JS and Liebling, MR. Enterovirus in chronic fatigue
syndrome (CFS). Arthritis and Rheumatism, 2001, 44 (9 SUPPL) p. S351.
Sotolongo,
A., Bradley, LA., Alarcon, GS., Cianfrini, LR., McKendree-Smith, NL., Kersh, BC
and Powell, T. Patients with fibromyalgia (FM) and chronic fatigue syndrome
(CFS) differ in pain coping strategy usage during exposure to acute pain. Arthritis
and Rheumatism, 2001, 44 (9 SUPPL), p. S382.
Craig,
T and Kakumanu, S. Chronic fatigue syndrome: evaluation and treatment. American
Family Physician, 2002, 65, 6, 1083-1090.
CFS
is characterized by debilitating fatigue with associated myalgias, tender lymph
nodes, arthralgias, chills, feverish feelings, and postexertional malaise.
Diagnosis of CFS is primarily by exclusion with no definitive laboratory test or
physical findings. Medical research continues to examine the many possible
etiologic agents for CFS (infectious, immunologic, neurologic, and psychiatric),
but the answer remains elusive. It is known that CFS is a heterogeneous disorder
possibly involving an interaction of biologic systems. Similarities with
fibromyalgia exist and concomitant illnesses include irritable bowel syndrome,
depression, and headaches. Therefore, treatment of CFS may be variable and
should be tailored to each patient. Therapy should include exercise, diet, good
sleep hygiene, antidepressants, and other medications, depending on the
patient's presentation.
Garralda, ME and Rangel, L. Annotation: Chronic fatigue syndrome in children and adolescents. Journal of Child Psychology and Psychiatry and Allied Disciplines, 2002, 43, 2, 169-176.
A review of publications on childhood CFS was undertaken and reference to work on adult CFS made. Most studies on childhood CFS have been on markedly affected children attending specialist pediatric clinics and very little is known about the condition as it presents in the community or to general medical services.
CFS
is commonly reported as being brought on by acute infections. Co-morbid
psychiatric (usually mood) disorders are present in at least a half. Personality
problems and health attitudes have been described as possible predisposing and
maintaining factors. Clinical reports indicate that family work focused on
engagement and on a rehabilitation programme (including graded increasing
activity and treatment of psychiatric co-morbidity) can help even the more
severely impaired children. Recovery may be expected in over two-thirds.
Conclusions:
CFS presents as a distinct, markedly impairing disorder of childhood... Research
into milder forms and into the efficacy of different treatment interventions is
specially needed.
Patarca-Montero,
R. Cytolytic cells and their function. Journal of Chronic Fatigue
Syndrome, 2002, 10, 2, 29-58.
Review discussing cytolytic cells in relation to CFS.
Alijotas,
J., Alegre, J., Fernandez-Sola, J., Cots, JM., Panisello, J., Peri, JM and Pujol,
R. Consensus report on the diagnosis and treatment of chronic fatigue
syndrome in Catalonia, Spain (Editorial, Spanish). Medicina Clinica,
2002, 118, 2, 73-76.
Brunet,
JL., Fatoohi, F., Liaudet, AP and Cozon, GJ. The role of
delayed pathology hypersensitivity in the syndrome of chronic fatigue:
value of the evaluation of lymphocyte activation by flow cytometry*.
Allergie et Immunology (Paris), 2002, 34, 2, 38-44.
This
article describes the detection of delayed-type hypersensitive responses to
certain common environmental antigens in almost fifty per cent of patients with
CFS. Such hypersensitivity can be detected by the intradermal administration of
antigens derived from commensal organisms like the yeast Candida albicans, and
then monitoring for a systemic reaction over the following six to forty-eight
hours. This approach can be consolidated by performing lymphocyte activation
tests in parallel and measuring in vitro T-cell activation by Candida albicans
antigens by three-colour flow cytometry based on CD3, CD4 and either CD69 or
CD25.
Another
useful parameter is the kinetics of neopterin excretion in the urine over the
course of the skin test. The results showed that the intensity of the DTH
response correlated with the number of T-cells activated in vitro.
Various
factors have been implicated in the fatigue of many patients, notably lack of
sleep. However, it remains difficult to establish causality in either one
direction or the other. This work is in the spirit of a multifactorial approach
to the group of conditions referred to as "chronic fatigue syndrome".
*
Source: Embase (article in French). 
De
Meirleir, K., Suhadolnik, RJ., Lebleu, B and Englebienne, P. Antiviral
pathway activation in chronic fatigue syndrome and acute infection. Clinical
Infectious Diseases, 2002, 34, 10, 1420-1421.
Letter
responding to the study by Gow et al (ibid, 2001, 33, 12, 2080) and challenging
their findings and interpretation of the results. With reply by Behan et al (p.
1421), suggesting that the presence of the 37-kDa RNase L product found in some
patients with CFS is "a normal product of monocytes" and of no value
as a diagnostic marker.
Devulder,
J., Duprez, D., De Buyzere, M., Simoens, J., Michielsen, W., Van Duyse, A.,
Mariman, A., Mortier, E and Loge, D. Identifying subgroups in the chronic
fatigue syndrome. Pain Clinic, 2001, 13, 2, 145-152.
We
evaluated in 40 patients with CFS (32 women, 8 men; mean age 43.0. By
considering Holmes' 1988 (H) criteria for CFS and fibromyalgia (F) criteria, we
subdivided the population into 4 subgroups: (F+ H+, F+ H-, F- H+, F- H-).
Fibromyalgia patients not fulfilling Holmes' criteria (F+ H-) were statistically
different for pain pressure threshold (p = 0.03) from the other patients.
Moreover, this first group showed a normal infrared thermographic emission
considering pain, where the other patients showed a rather abnormal vasomotor
reaction.
Jason, LA., Taylor, RR., Kennedy, CL., Jordan, K., Huang, C-F., Torres‑Harding, S., Song, S and Johnson, D. A factor analysis of chronic fatigue symptoms in a community-based sample. Social Psychiatry and Psychiatric Epidemiology, 2002, 37, 4, 183-189.
Background: This study examined characteristics of fatigue in individuals with chronic fatigue from a community-based study. Most studies of chronic fatigue have been based on patients recruited from primary or tertiary care settings. Samples such as these might not be representative of patients within the general population. The purpose of this study was to determine the factor structure of participants' symptoms in a random community sample of individuals with chronic fatigue.
Method: A random sample of 18,675 respondents in Chicago received a brief telephone questionnaire designed to identify individuals with chronic fatigue. A group of 780 (4.2 %) with chronic fatigue received further interview via telephone questionnaire involving characteristics of their fatigue. The analyses for this study were based on those people identified with having chronic fatigue. A factor analysis was conducted on responses to questionnaire items, and a four-factor solution emerged. Mean factor scores were derived and analyzed in relation to sociodemographic characteristics and sample subgroups.
Results:
The four factors were labelled: Lack of Energy, Physical Exertion, Cognitive
Functioning, and Fatigue and Rest.
Conclusions: Results indicated that individuals with chronic fatigue have symptoms that can be differentiated into theoretically distinct factors.
Krueger,
GR., Koch, B., Hoffmann, A., Rojo, J., Brandt, ME., Wang, G and Buja LM.
Dynamics of chronic active herpesvirus-6 infection in patients with chronic
fatigue syndrome: data acquisition for computer modeling. In Vivo, 2001,
15, 6, 461-465.
Ten
adult patients with persistent active HHV-6 variant A infection and clinical CFS
were studied over a period of 24 months after initial clinical diagnosis. CFS
was diagnosed according to IIIP-revised CDC-criteria as defined by the CFS
Expert Advisory Group to the German Federal Ministry of Health in 1994.
Changes
in HHV-6 antibody titer, viral DNA load, peripheral blood T lymphocytes and
subpopulations, as well as CD4/CD8 cell ratio and cell death (apoptosis) were
monitored. Data were collected for comparison with respective changes in acute
HHV-6 infection and as a basis for future computer simulation studies.
The
results showed variable but slightly elevated numbers of HHV-6 DNA copies in the
blood of patients with CFS, while PBL (peripheral blood lymphocyte) apoptosis
rates were clearly increased. CD4/CD8 cell ratios varied from below 1 up to
values as seen in autoimmune disorders.
Contrary
to acute HHV-6 infection, T lymphocytes do not exhibit the usual response to
HHV-6, that is elevation of mature and immature populations suggesting a certain
degree of unresponsiveness.
The
data suggest that persistent low-dose stimulation by HHV-6 may favor imbalanced
immune response rather than overt immune deficiency. This hypothesis requires
confirmation through additional functional studies.
Lacour,
M., Zunder, T., Dettenkofer, M., Schonbeck, S., Ludtke, R and Scheidt, C. An
interdisciplinary therapeutic approach for dealing with patients attributing
chronic fatigue and functional memory disorders to environmental poisoning - a
pilot study. International Journal of Hygiene and Environmental Health,
2002, 204, 5-6, 339-346.
Nonspecific
symptoms and a general feeling of ill health that is difficult to objectify are
the commonest health problems with which patients present to an Environmental
Medicine Outpatient Department (OPD). Of this group, a great proportion meets
the classification criteria for CFS or Functional Memory Disorders in
association with Idiopathic Chronic Fatigue (FMD-ICF). This is a longitudinal
study of the OPD of Environmental Medicine, Freiburg University Hospital,
Germany, to determine the feasibility and impact of an interdisciplinary
therapeutic approach (self-help program, acupuncture, psychosomatic support by
group interventions) in 8 patients With CFS, FMD-ICF, or CFS in association
with self-reported Multiple Chemical Sensitivities (sr-MCS). The
intervention took into consideration the patients' need for treatment of
physical aspects of their disease.
This
is an important step to motivate patients into required psychosomatic support.
Although none of the patients was willing to accept psychosomatic support or
psychotherapy at study outset, acceptance of psychosomatic group interventions
was high during the study course. Additionally five patients started with
personal counselling at the Psychosomatic Clinic, and, without feeling
stigmatized, 4 patients started with specific psychotherapy. The patients'
quality of life showed no increase after four months, but, as shown by the
Sum-Score of SF-36, it had improved significantly at the end of the study, which
covered eight months' treatment (p=0.015). Two follow-up investigations showed
that this improvement probably persisted in part (mainly in the dimensions
mental health, social function, physical role function, and vitality). In
conclusion our interdisciplinary therapeutic approach indicates successful
treatment of patients attributing CFS, CFS/ sr-MCS, and FMD-ICF to environmental
poisoning. We now plan to conduct a randomized controlled trial in the future.
Linder,
R., Dinser, R., Wagner, M., Krueger, GRF and Hoffmann, A. Generation of
classification criteria for chronic fatigue syndrome using an artificial neural
network and traditional criteria set. In Vivo, 2002, 16, 1, 37-43.
Objective: The definition of CFS is still disputed and no validated classification criteria have been published. Artificial neural networks (ANN) are computer-based models that can help to evaluate complex correlations. We examined the utility of ANN and other conventional methods in generating classification criteria for CFS compared to other diseases with prominent fatigue, systemic lupus erythematosus (SLE) and fibromyalgia syndrome (FM).
Patients and Methods: Ninety-nine case patients with CFS, 41 patients with SLE and 58 with FM were recruited from a generalist outpatient population. Clinical symptoms were documented with help of a predefined questionnaire. The patients were randomly divided into two groups. One group (n=158) served to derive classification criteria sets by two fold cross-validation, using a) unweighted application of criteria, b) regression coefficients, c) regression tree analysis, and d) artificial neural networks in parallel. These criteria were validated with the second group (n=40).
Results: Classification criteria developed by ANN were found to have a sensitivity of 95% and a specificity of 85%. ANN achieved a higher accuracy than any of the other methods.
Conclusion:
...The most accurate criteria were derived with the help of ANN. We therefore
recommend the use of ANN for the classification of syndromes with complex
interrelated symptoms like CFS.
Setness,
PA and Mettner, J.
Chronic fatigue syndrome. Postgraduate Medicine, 2002, 111, 4,
137-138.
Soto,
NE and Straus, SE.
Chronic fatigue syndrome and herpes-viruses: the fading evidence. Herpes,
2000, 7, 2, 46-50
Herpesviruses,
in particular Epstein-Barr virus (EBV), cytomegalovirus (CMV) and human
herpesvirus 6 (HHV-6), have, for the past two decades, come under considerable
scrutiny as aetiological agents of CFS. However, virological findings of
herpesviruses in CFS have not been consistent between different studies, and the
unusual patterns of serological responses to EBV, CMV and HHV-6 have not been
specific for CFS, being observed also in asymptomatic individuals.
Studies
have also shown that the presumable elevation of antibody titres to EBV, CMV or
HHV-6 in CFS are not observed only with these viruses, but also with other
organisms such as herpes simplex virus and measles.
Tan
EM, Sugiura K, Gupta S.
The case definition of chronic fatigue syndrome. Journal of Clinical
Immunology, 2002, 22, 1, 8-12.
The
1994 case definition of chronic fatigue syndrome is widely used not only for
diagnosis but also for clinical and laboratory-based observations of this
clinical entity. The criteria for the 1994 case definition are based primarily
on symptoms and not on physical signs or chemical or immunological tests. This
situation has resulted in conflicting clinical and laboratory observations that
in all likelihood is due to different populations of patients being studied in
different centers. Based on some of the recent publications, there appears to be
an emerging picture of this disease entity that we propose could be used to
subgroup CFS into four different subclasses.
These
subclasses would consist of chronic fatigue with primarily nervous system
disorders such as impaired memory or concentration and headache, chronic fatigue
with primarily endocrine system disorders such as unrefreshing sleep and
postexertional malaise, chronic fatigue with musculoskeletal system disorders
such as muscle pain and joint pain, and chronic fatigue with immune
system-infectious disorders such as sore throat and tender lymph nodes.
It
is suggested that if clinical and laboratory-based studies on CFS were
conducted on more homogeneous subgroups of patients, the data from one center to
the other might not be as conflicting and more insights can be shed on the
nature of this clinical condition.
Torres-Harding,
SR., Jason, LA and Taylor, RR.
Fatigue severity, attributions, medical utilization, and symptoms in persons
with chronic fatigue. Journal of Behavioral Medicine, 2002, 25, 2,
99-113.
This study examined the roles of ethnicity, gender, and socio-economic status (SES) in predicting fatigue severity, symptoms, medical utilization, and attributions among a sample of individuals with chronic fatigue. Using path analysis, a model was tested and revised. In the new model, gender predicted fatigue, ethnicity predicted attributions, fatigue predicted medical utilization and attributions, and attributions predicted medical utilization.
Women
reported more fatigue and were more likely to feel that stress and depression
were causing their fatigue. Higher-SES participants were more likely to
cite stress and over-work as causing their fatigue. Latinos reported more
physical symptoms than African Americans and Whites. The implications of these
results are discussed.
Whiting,
P.
Interventions for the treatment and management of chronic fatigue syndrome: A
systematic review (vol 386, pg 1360, 2001) (Correction, English). JAMA,
2002, 287, 11, p.1401.
Correction relating to letter responding to Goudsmit plus retraction of a statement relating to the London criteria.
Filippi,
M., Rocca, MA., Colombo, B., Falini, A., Codella, M., Scotti, G and Comi, G.
Functional magnetic resonance imaging correlates of fatigue in multiple
sclerosis. Neuroimage, 2002, 15, 3, 559-567.
Although fatigue is a common and troublesome symptom of multiple sclerosis (MS), its pathogenesis is poorly understood. In this study, we used functional magnetic resonance imaging (fMRI) to test whether a different pattern of movement-associated cortical and subcortical activations might contribute to the development of fatigue in patients with MS. We obtained fMRI during the execution of a simple motor task with completely normally functioning hands from 15 MS patients with fatigue (F), 14 MS patients without fatigue (NF), and 15 sex- and age-matched healthy volunteers. F and NF MS patients were also matched for major clinical and MRI variables. FMRI data were analyzed using statistical parametric mapping. In all patients, severity of fatigue was rated using the Fatigue Severity Scale (FSS).
Compared to healthy subjects, MS patients showed more significant activations of the contralateral primary somatomotor cortex, the contralateral ascending limb of the Sylvian fissure, the contralateral intraparietal sulcus (EPS), the contralateral supplementary motor area, and the ipsilateral and contralateral cingulate motor area (CMA). Compared to F MS patients, NF patients showed more significant activations of the ipsilateral cerebellar hemisphere, the ipsilateral rolandic operculum, the ipsilateral precuneus, the contralateral thalamus, and the contralateral middle frontal gyrus. In contrast, F MS patients had a more significant activation of the contralateral CMA. Significant inverse correlations were found between FSS scores and relative activations of the contralateral IPS (r=-0.63), ipsilateral rolandic operculum (r=-0.61), and thalamus (r=-0.62).
This study provides additional evidence that fatigue in MS is related to impaired interactions between functionally related cortical and subcortical areas. It also suggests that fMRI might be a valuable tool to monitor the efficacy of treatment aimed at reducing MS-related fatigue.
Lavidor, M., Weller, A and Babkoff, H. Multidimensional fatigue, somatic symptoms and depression. British Journal of Health Psychology, 2002, 7, 67-75.
Several
fatigue questionnaires, a mental health inventory and measure
of somatic complaints were administered to a randomly selected adult
sample of 278. Depression was positively correlated with all aspects of fatigue
except one (tiredness which responds to rest and sleep). Fatigue was more severe
where depression was present alongside somatization.
De Vries, M., Soetekouw, PMMB., Van Der Meer, JWM., Folgering, H and Bleijenberg, G. Physical activity and exercise performance in symptomatic Cambodia veterans. Quarterly Journal of Medicine, 2002, 95, 2, 99-105.
Dutch (ex-)servicemen who encounter health problems since return from the 1992-3 peace operation UNTAC, commonly complain of reduced activity levels, decreases in physical fitness and aggravation of symptoms after strenuous exercise.
Aim: To evaluate these symptoms.
Design: A prospective study of 26 symptomatic Cambodia veterans and 26 matched controls (healthy Cambodia veterans).
Methods: Using an actometer and diaries, both groups were followed for a 12-day baseline period prior to an incremental maximal exercise test on a bicycle ergometer, followed by 7 days of post-ergometer data.
Results: During baseline, symptomatic Cambodia veterans reported more symptoms, had lower levels of physical activity and took longer periods of rest after high activity periods. Symptomatic veterans did not perceive the exercise test needing more exertion than healthy veterans did, although their physical fitness was decreased. Post-ergometer, daily observed symptoms did not aggravate in symptomatic veterans. Four days post-ergometer (a Sunday), actometer and daily observed activity scores were lowered in both groups. As compared to baseline, one day post-ergometer, levels of physical activity were changed in healthy veterans, but not in controls.
Complaints about reduced activity levels and decreases in physical fitness in symptomatic Cambodia veterans were confirmed. Post-exertion malaise was not found (so the illness is not ME, Ed).
Kerr, JR., Bracewell, J., Laing, I., Mattey, DL., Bernstein, RM., Bruce, IN and Tyrrell, DAJ. Chronic fatigue syndrome and arthralgia following Parvovirus B19 infection. Journal of Rheumatology, 2002, 29, 595-602.
To determine the incidence of arthralgia and fatigue complicating B19 infection, along with associated B19 markers and autoantibodies. We studied patients with acute B19 infection (n=51), patients followed from the time of acute B19 infection (mean 22.5 mo, n=39), and healthy controls (n=50). Clinical details were collected using a questionnaire and blood was tested for B19 markers and autoantibodies.
Results. Acute B19 arthralgia occurred in 31 patients and was associated with female sex (p=0.007) and age >20 years (p=0.02). Acute B19 fatigue occurred in 8 patients and was not significantly associated with any marker. At follow-up, symptoms consisted of arthralgia (n=5), arthralgia and fatigue (n=6), fatigue (n=7), lymphadenopathy (n=1), and purpura due to thrombocytopenia (n=2). Chronic B19 arthralgia was associated with persistent B19 viremia (p = 0.029). Comparison of the B19 follow-up group with the controls revealed a significantly increased prevalence of arthralgia (p=0.0002), fatigue (p<0.0001), and all other markers. Chronic B19 arthralgia was associated with both acute B19 arthralgia (p=0.0168) and positive ANA at acute infection (p=0.0043). Chronic B19 fatigue was associated with acute B19 fatigue (p=0.011). Five patients fulfilled the CDC criteria for a diagnosis of CFS and one of these was negative for serum anti-B19 IgG at follow-up by both Western blot and immunofluorescence. However, there was no characteristic pattern of B19 markers/autoantibodies in patients with B19 associated chronic fatigue.
Conclusion. CFS may follow acute parvovirus B19 infection; however, attribution of a case of CFS to B19 infection may be extremely difficult in the absence of serological confirmation of acute infection at fatigue onset.
Lydston,D., Lechner, S., LaPerriere, A., Antoni,M., Ishii, M., Devieux, J., Brondolo, E., Tobin, J., Schneiderman, N and Weiss, S. Decreases in viral load following a CBSM+ group intervention. Psychosomatic Medicine, 2002, 64, 1, Abstract no. 65.
The SMART/EST Women's Project randomized 451 low-income minority women with AIDS to a 10-week cognitive-behavioral stress management/expressive supportive therapy group or a time-matched individual psychoeducational condition. We examined whether changes in cognitive behavioral skills (CBS) from baseline to post intervention were associated with favorable outcomes on viral load, CD4 and CD8 count as a function of condition assignment. A subset of English speaking women (n=52) who completed baseline and post-intervention assessments for the biological variables pilot study were derived from the larger parent study sample. Change scores were computed for baseline/post-intervention and then dichotomized to separate those who reported an increased ability in CBS from those who experienced no change or a decreased ability in CBS. Viral load values were windsorized, and then log transformed. In 2x2x2 repeated measures ANOVAs, there were significant CBS (positive vs. negative CBS change) X Condition (group vs. individual) X Time (baseline vs. post-intervention) interactions for viral load [F(1,45)=8.82, p<.01] after change in anti-retroviral medication adherence, CD4 and CD8 count were controlled.
The participants who were assigned to the group condition and increased their utilization of CBS had a decrease in viral load [F (1,14)=6.90, p<.02], those who decreased their CBS usage had an increase in viral load [F (1,27)=3.72, p<.03]. No corresponding significant results were found for CD4 or CD8 count. This finding suggests that the benefit of CBS training in the group condition has a significant impact upon viral load. Potential mediators-moderators of this relationship will be discussed.
[Ed. Note: This shows the importance of using relevant variables to measure effect. Indeed, it's one of the first looking at the effect on virology].
Various.
Annals of the New York Academy of Science, 2002, 933.
Articles
on chemical sensitivity include:
Miller, CS (p. 1-23), Bell et al (p. 38-47) and Mullington JM et al, (p. 201-210). Bell et al review their findings, the neural sensitization model, and characteristics in patients (e.g. female gender, preference for high carbohydrate/sugar intake). Mullington et al focus in particular on the relationship between inflammation and sleep.
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