MEDICAL UPDATE Summer 1999

Gupta S et al. Increased production of interleukin-6 by adherent and non-adherent mononuclear cells during 'natural fatigue' but not following 'experimental fatigue' in patients with chronic fatigue syndrome. International Journal of Molecular Medicine, 1999, 3, 2, 209-213.

Blood samples were taken from patients with CFS (CDC criteria '88) to assess the effect of natural and laboratory-induced ('experimental') fatigue on the levels of interleukin-6 (IL-6). IL-6 is a cytokine, produced as part of the immune system's response to infection.

Artificial substances were added to the blood samples to determine the likely response to infection. The samples obtained when the patients felt fatigued showed a significant increase in levels of IL-6. However, no such changes in IL-6 production were observed in blood taken during rest and 'experimental fatigue'.

These findings indicate that laboratory-induced fatigue may not have the same effect on the immune system as illness-related fatigue. The researchers therefore recommend that scientists obtain their data on several occasions during the natural course of the disease.

Jason, LA et al. Chronic fatigue syndrome: assessing symptoms and activity level. Journal of Clinical Psychology, 1999, 55, 4, 411-424.

This article discusses the drawbacks of the existing diagnostic criteria for CFS. For instance, none of them provide information on either the severity of symptoms or the fluctuations in symptoms and activity levels that occur over time. As a result, they do not reflect the complexity of CFS. The authors focus in particular on the latest criteria and summarise several studies which show they don't just select patients with CFS. Indeed, one (by Dr. Lucy Dechene and colleagues) found that 15% of 179 healthy adults also met the CDC criteria ('94).

The present study compared two patients with CFS (CDC criteria '94) with a healthy control on several measures. As expected, there were notable differences between the patients and control. To improve diagnosis, researchers recommend that symptom severity should be assessed on two occasions (at testing and for 'worst period').

Lovell, DM. Chronic fatigue syndrome among overseas development workers: a qualitative study. Journal of Travel Medicine, 1999, 6, 16-23.

This Oxford psychologist interviewed 12 individuals who had developed CFS (Oxford criteria) while working overseas with development organisations, or shortly after visiting development projects. The results were compared with those of 129 returned overseas workers who did not develop CFS. Two patients were taking antidepressants and 3 had recovered by the time of testing. The mean duration of illness was 25 months.

Most of the participants considered themselves to have been extremely healthy before they developed CFS. There was no indication that the illness had been caused by depression and there was no difference in depression scores between the two groups at the time of testing.

The patients themselves attributed the CFS to multiple causes, the principal ones being overwork, stress and infections. However, many mentioned that although busy, they enjoyed the work and felt happy. Among the consequences of CFS reported to be the most difficult were having to leave the development project prematurely, pain, powerlessness, loss of independence, and the unpredictability of CFS. Factors which had helped respondents cope with these difficulties included religious beliefs, comparisons with people who were worse off than they were, thinking about positive consequences of the condition, and talking with supportive people. Also helpful were: adequate rest, an activity schedule with realistic goals, dietary guidelines, sunshine and alternative therapies (massage, yoga etc.).

There was no support for the view that the symptoms represented an attempt to escape from responsibilities and the rat race (cf. Surawy et al). Moreover, there was no evidence of avoidance and the author suggests that the latter may be a strategy associated with depression (which was not a factor in this group).

These findings clearly conflict with the CBT model. Indeed, it seems that the patients described by Drs Wessely, Sharpe and their colleagues, are no more than a small subset of the total CFS population (max. 24% according to Bazelmans et al, Boston conference 1998).

Gibson, SLM and Gibson, RG. A multidimensional treatment plan for chronic fatigue syndrome. Journal of Nutritional & Environmental Medicine, 1999, 9, 47-54.

This pilot study involved 81 patients with CFS (Oxford criteria), who had not benefited from conventional treatments.

At the start of the trial, all patients were placed on a wheat-free diet plus supplements including Co-enzyme Q₁₀, oil of evening primrose and Magnesium OK. During the following months, inhalant allergies were treated (homoeopathically), other homeopathic remedies were added where required (third month), and psychotherapeutic techniques were introduced to improve self-image (months 4-6).

In all, 70% of those who completed the trial (n=64) reported a clinical improvement. The wheat-free diet and supplements appeared to be the most useful components of the regime, but from month 4 onwards, there was little change. Allergies and viral triggers made no significant difference to the outcome.

Although the findings seem to show that many patients may benefit from nutritional changes and homeopathy, one has to remember that this was a mixed group. This means that the results may not be relevant to subgroups like ME.

Farmer, A et al. Is disabling fatigue in childhood influenced by genes? Psychological Medicine, 1999, 29, 279-282. Plus paper by Hickie et al (ibid 259-268).

Farmer et al's research on 670 twins (aged 5-17) and Hickie et al's study of 1004 twins (aged 50 plus) suggest that genetics may play an important role in short-term fatigue.

This is an interesting finding, but until it's replicated in a patient group, we can not draw any conclusions about it's relevance in relation to CFS.

Copyright EM. Goudsmit 1999. ©
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