Category: Case Study

Efficacy of a half dose of oral pyridostigmine in the treatment of chronic fatigue syndrome: three case reports

Abstract:

Chronic fatigue syndrome (CFS) is characterized by persistent mental and physical fatigue for at least 6 months. Its pathophysiology is unknown and there is no proven effective treatment. We describe three cases who fulfill the criteria of CFS, in whom a defect of neuromuscular transmission and dysautonomia are present and who respond to acetylcholine-esterase inhibition.

Case 1: 18-year-old female with a 3-year history of CFS. Response of compound-muscle-action potential, recorded using surface recording electrode, over left abductor pollicis brevis muscle, to repetitive nerve stimulation (RNS) at a rate of 10 Hz showed a 42% incremental response. Composite autonomic scoring system (CASS) showed mild cholinergic impairment (cardiovagal score: 1; sudomotor score: 2). Serological tests for Epstein-Barr virus (EBV) revealed positive antiviral capsid antigens (anti-VCA) immunoglobulins G (IgG). Oral pyridostigmine therapy (30 mg) resulted in marked improvement in symptoms.

Case 2: 28-year-old female with 10-year history of CFS. RNS, using identical protocol, showed a 60% incremental response over the same muscle. CASS showed mild cholinergic impairment (cardiovagal score: 1; sudomotor score: 2) and this patient was also positive for EBV. This patient responded dramatically to 10-mg pyridostigmine.

Case 3: 29-year-old female with a history of CFS for longer than 15 years. Repetitive stimulation, using identical paradigm to left abductor pollicis brevis muscle, showed a 42% incremental response. CASS showed mildly cholinergic impairment (cardiovagal score: 2; sudomotor score: 1). EBV antibody titers were positive. Patient responded to 30-mg pyridostigmine with an improvement in her fatigue.

These three cases generate the hypothesis that the fatigue in some patients with clinical CFS might be due to a combination of mild neuromuscular transmission defect combined with cholinergic dysautonomia. Support for this thesis derives from the improvement with cholinesterase inhibition.

 

Source: Kawamura Y, Kihara M, Nishimoto K, Taki M. Efficacy of a half dose of oral pyridostigmine in the treatment of chronic fatigue syndrome: three case reports. Pathophysiology. 2003 May;9(3):189-194. http://www.ncbi.nlm.nih.gov/pubmed/14567934

 

Does graded activity increase activity? A case study of chronic fatigue syndrome

Abstract:

The reliance on self-report outcome measures in clinical trials of graded activity-oriented cognitive-behavior therapy in chronic fatigue syndrome (CFS) makes it difficult to draw definitive conclusions about actual behavioral change.

The participant in this case study was a 52-year-old married male with CFS who was working full-time. Outcome measures included a step counter to objectively measure physical activity as well as a daily diary measure of exercise activity and in vivo ratings of perceived energy, fatigue, and affect. The following psychometric instruments were also used: the CFS Symptom Inventory, the SF-36, the Beck Depression Inventory, and the Beck Anxiety Inventory. The 26-session graded activity intervention involved gradual increases in physical activity.

From baseline to treatment termination, the patient’s self-reported increase in walk time from 0 to 155 min a week contrasted with a surprising 10.6% decrease in mean weekly step counts. The final follow-up assessment revealed a “much improved” global rating, substantial increases in patient-recorded walk time and weight lifting intensity, yet a relatively modest increment in weekly step counts. It appeared that improvement was associated with mood-enhancing, stress-reducing activities that were substituted for stress-exacerbating activities.

Copyright 2003 Elsevier Science Ltd.

 

Source: Friedberg F. Does graded activity increase activity? A case study of chronic fatigue syndrome.  J Behav Ther Exp Psychiatry. 2002 Sep-Dec;33(3-4):203-15. http://www.ncbi.nlm.nih.gov/pubmed/12628637

 

Symptom or illness? The exhausting life of an adolescent with chronic fatigue syndrome

Abstract:

This case report presents the assessment of a 16-year old boy with chronic fatigue syndrome (CFS). Questions on the etiology, dynamics, diagnostics and treatment of this complex condition are briefly discussed.

 

Source: Di Gallo A. Symptom or illness? The exhausting life of an adolescent with chronic fatigue syndrome.  Z Kinder Jugendpsychiatr Psychother. 2002 May;30(2):135-40. [Article in German] http://www.ncbi.nlm.nih.gov/pubmed/12053877

 

Peripheral vestibular dysfunction in chronic fatigue syndrome

Abstract:

OBJECTIVE: To report left-sided peripheral vestibular failure as the cause of dizziness in a 12-year-old boy diagnosed as having chronic fatigue syndrome (CFS).

DESIGN: Retrospective case report with review of literature and discussion.

SETTING: Tertiary children’s hospital.

CONCLUSION: We recommend proper vestibular assessment for CFS patients presenting with dizziness, as effective treatment for peripheral vestibular disorder exists in the form of balance rehabilitation exercises.

 

Source: Palaniappan R, Sirimanna T. Peripheral vestibular dysfunction in chronic fatigue syndrome. Int J Pediatr Otorhinolaryngol. 2002 May 31;64(1):69-72. http://www.ncbi.nlm.nih.gov/pubmed/12020917

 

Cognitive behavioral therapy and fasting therapy for a patient with chronic fatigue syndrome

Abstract:

Cognitive behavioral therapy temporarily alleviated symptoms of a chronic fatigue syndrome patient but the anxiety about rehabilitation into work became stronger and his symptoms worsened. This patient was successfully rehabilitated by fasting therapy. Natural killer cell activity and serum acylcarnitine levels recovered after fasting therapy. Though fasting therapy transiently increased physical and mental subjective symptoms, the patient gained self-confidence by overcoming difficulties after fasting therapy. A combination of cognitive behavioral therapy and fasting therapy is promising as a treatment for chronic fatigue syndrome.

 

Source: Masuda A, Nakayama T, Yamanaka T, Hatsutanmaru K, Tei C. Cognitive behavioral therapy and fasting therapy for a patient with chronic fatigue syndrome. Intern Med. 2001 Nov;40(11):1158-61. https://www.jstage.jst.go.jp/article/internalmedicine1992/40/11/40_11_1158/_article (Full article)

 

Chronic fatigue syndrome (CFS) associated with Staphylococcus spp. bacteremia, responsive to potassium arsenite 0.5% in a veterinary surgeon and his coworking wife, handling with CFS animal cases

Abstract:

Chronic fatigue syndrome (CFS) in human patients remain a controversial and perplexing condition with emerging zoonotic aspects. Recent advances in human medicine seem to indicate a bacterial etiology and the condition has already been described in horses, dogs, cats and birds of prey in association with micrococci-like organisms in the blood.

To evaluate the possibility of a chronic bacteremia, a veterinary surgeon (the author) and his coworking wife, both diagnosed with CFS and meeting the CDC working case definition, were submitted to rapid blood cultures and fresh blood smears investigations.

Blood cultures proved Staph-positive and micrococci-like organisms in the blood were repeatedly observed in the 3-year period preceding the arsenical therapy, during which several medicaments, including antibiotics, proved unsuccessful. Following treatment with a low dosage arsenical drug (potassium arsenite 0.5%, im., 1 ml/12 h, for 10 days) both patients experienced complete remission. At the post-treatment control made 1 month later, micrococci had disappeared from the blood, and the CD4/CD8 ratio was raising.

 

Source: Tarello W. Chronic fatigue syndrome (CFS) associated with Staphylococcus spp. bacteremia, responsive to potassium arsenite 0.5% in a veterinary surgeon and his coworking wife, handling with CFS animal cases. Comp Immunol Microbiol Infect Dis. 2001 Oct;24(4):233-46. http://www.ncbi.nlm.nih.gov/pubmed/11561958

 

Recovery from chronic fatigue syndrome associated with changes in neuroendocrine function

[This is a case study on graded exercise. You can read the full report here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1280066/pdf/11220065.pdf]

 

Source: Sharma A, Oyebode F, Kendall MJ, Jones DA. Recovery from chronic fatigue syndrome associated with changes in neuroendocrine function. J R Soc Med. 2001 Jan;94(1):26-7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1280066/ (Full article)

 

Cognitive behavior therapy for chronic fatigue syndrome: a case study

Abstract:

The case of a 26-year old woman with Chronic Fatigue Syndrome (CFS) is presented. Multidimensional assessment showing severe debilitating fatigue and considerable psychological, social and occupational impairment confirmed the diagnosis. Cognitive behavior therapy (CBT) was based on a tested causal model of CFS and individual behavioral analyses. Key elements in CBT were process variables from the CFS model, like sense of control, causal attributions, physical activity and focusing on bodily functions. Goals were recovery from fatigue, returning to work and relapse prevention. The course of therapy is described in detail to illustrate difficulties in treating CFS. Assessments were made five times, at baseline and at 8, 14, 21 and 33 months. Comparison of the pretest, post-test and follow-up scores of the outcome variables, fatigue and functional impairment and of the process variables showed clinically significant improvement from the range of CFS patients to the range of healthy controls.

 

Source: Prins JB, Bleijenberg G. Cognitive behavior therapy for chronic fatigue syndrome: a case study. J Behav Ther Exp Psychiatry. 1999 Dec;30(4):325-39. http://www.ncbi.nlm.nih.gov/pubmed/10759328

 

Chronic Chlamydia pneumoniae infection: a treatable cause of chronic fatigue syndrome

Chronic fatigue syndrome (CFS), an elusive and controversial illness, has been a difficult management problem for clinicians. A number of infectious agents have been implicated as the cause of CFS, although consistent and compelling evidence is still lacking [1]. Few well-documented infections could cause persistent in- flammatory reaction leading to the symptomatology of CFS [2, 3]. Chlamydia pneumoniae is a common cause of respiratory infection and has been demonstrated within plaques of the coronary arteries years after initial infection [4]. Recently demonstrated replication of C. pneumoniae within human macrophages and endothelial cells [5] and a potent inducer of proinflammatory cytokines, such as TNF-a and IL-1 [6], raised the possibility of chronic infection that leads to persistent inflammatory response. A previous study failed to demonstrate elevated titers of antibody to C. pneumoniae in 50 patients with CFS [7], although fatigue is a common symptom reported by patients for whom sp

Over the past 3 years, we encountered 10 of 171 patients with symptoms of chronic fatigue who had elevated titers of antibody to C. pneumoniae long after initial respiratory infection. Most patients had favorable clinical and serological responses to a 1- to 2-months course of azithromycin therapy, although relapse was common. The clinical symptoms of and titers of antibody to C. pneumoniae for our 10 patients over the course of treatment are summarized in table 1.

You can read the rest of this article here: http://cid.oxfordjournals.org/content/29/2/452.long

 

Source: Chia JK, Chia LY. Chronic Chlamydia pneumoniae infection: a treatable cause of chronic fatigue syndrome. Clin Infect Dis. 1999 Aug;29(2):452-3. http://cid.oxfordjournals.org/content/29/2/452.long (Full article)

 

Managing chronic fatigue syndrome: overview and case study

Abstract:

1. The basic principles of envelope theory are explained. By not overexerting themselves, people with CFS can avoid the setbacks and relapses that commonly occur in response to overexertion while increasing their tolerance to activity. 2. By collecting time series data on fluctuations in energy levels, important clinical observations can be made in respect to a client’s unique condition and experience with CFS.

 

Source: Jason LA, Melrose H, Lerman A, Burroughs V, Lewis K, King CP, Frankenberry EL. AAOHN J. 1999 Jan;47(1):17-21. http://www.ncbi.nlm.nih.gov/pubmed/10205371