Category: Overlapping Illnesses

Multiple chemical sensitivity disorder in patients with neurotoxic illnesses

Abstract:

The data of 466 subjects suffering from neurologic disorders which are suggested to be caused by neurotoxic agents in their environment retrospectively was evaluated and documented. Among these cases there were 151 subjects with symptoms of Multiple Chemical Sensitivity Disorder (MCSD). The relationship between the neurological health impairments and neurotoxic agents in the environment of these patients was characterised using five different categories (probable = A, possible = B, uncertain = C, unclarified = D, not probable = E). From the 466 patients 320 subjects (69%) could be assigned to the categories A and B, respectively.

Within theses 320 cases with chronic neurotoxic health impairments 136 subjects (79 females and 57 males) showed signs of MCSD. Age and gender of cases as well as duration and character of exposure to neurotoxic substances retrospectively were assessed from the explicit files of the patients, which had been made anonymous for this purpose. Frequency of characteristic symptoms of neurotoxicity were analysed. Results are given for patients with neurotoxic health impairments with MCSD (n = 136) and without MCSD (n = 184).

Neurotoxic substances which were used as indoor wood preservatives (mainly Pentachlorophenol and/or Lindane) were found to be the causative agents in 63% of the cases with neurotoxic health impairments and MCSD. Other important neurotoxic substances to which the patients were mainly exposed were organic solvents (25%), formaldehyde (15%), dental materials (15%), pyrethroides (13%), and other biocides (19%) (multiple exposures were possible). The time of exposure was calculated as being > or = 10 years for 55% of the patients with MCSD and for 50% of the group with neurotoxic health impairments but without MCSD.

Out of the 184 cases with neurotoxic health impairments but without MCSD there were 22%, and out of the 136 cases with MCSD there were 39% who showed all symptoms of chronic fatigue syndrome. 53% of the cases with MCSD had an allergic disposition compared to only 20% of the cases without MCSD.

This work is not a controlled epidemiological study but a retrospective documentation and evaluation of data related to environmental medicine. With the present documentation in this purely descriptive manner the proof of a causal relationship was not possible or intended. But because corresponding epidemiological studies are lacking, this documentation can give important information on characteristic features of Multiple Chemical Sensitivity Disorder and chronic neurotoxic health impairments. Such information is essential for planning and carrying out epidemiological studies urgently needed in this field.

Comment in:

Comment on K. Lohmann, Anke Pröhl, E. Schwarz. Multiple chemical sensitivity in patients with neurotoxic illnesses. Gesundheitswesen. 1997 [Article in German]

 

Source: Lohmann K, Pröhl A, Schwarz E. Multiple chemical sensitivity disorder in patients with neurotoxic illnesses. Gesundheitswesen. 1996 Jun;58(6):322-31. [Article in German] http://www.ncbi.nlm.nih.gov/pubmed/8766847

 

Fibromyalgia and chronic fatigue syndrome: similarities and differences

Abstract:

CFS and FM are clinical conditions characterized by a variety of nonspecific symptoms including prominent fatigue, myalgia, and sleep disturbances. There are no diagnostic studies or widely accepted, pathogenic, explanatory models for either illness. Despite remarkably different diagnostic criteria, CFS and FM have many demographic and clinical similarities. More specifically, few differences exist in the domains of symptoms, examination findings, laboratory tests, functional status, psychosocial features, and psychiatric disorders. FM appears to represent an additional burden of suffering among those with CFS, however, underscoring the importance of recognizing concurrent CFS and FM. Further clarification of the similarities (and differences) between CFS and FM may be useful in studies of prognosis and help define subsets of patients who may benefit from specific therapeutic interventions.

 

Source: Buchwald D. Fibromyalgia and chronic fatigue syndrome: similarities and differences. Rheum Dis Clin North Am. 1996 May;22(2):219-43. http://www.ncbi.nlm.nih.gov/pubmed/9157484

 

A controlled comparison of multiple chemical sensitivities and chronic fatigue syndrome

Abstract:

The present study had two objectives: 1) to determine the characteristics that differentiated subjects with multiple chemical sensitivities (MCS), chemical sensitivities (CS), and chronic fatigue syndrome (CFS); and 2) to evaluate the psychiatric and neuropsychological complaints of these groups relative to normal controls.

A cross-sectional comparison was made of the following groups matched for age, sex, and education: 1) patients whose sensitivities to multiple low level chemical exposures began with a defined exposure (MCS; N = 23); 2) patients with sensitivities to multiple chemicals without a clear date of onset (CS; N = 13); 3) patients meeting CDC criteria for Chronic Fatigue Syndrome (CFS; N = 18); and 4) normal controls (N = 18).

Subjects with sensitivities to chemicals (MCS and CS) reported significantly more lifestyle changes due to chemical sensitivities and significantly more chemical substances that made them ill compared with chronic fatigue and normal controls. MCS, CS, and CFS patients had significantly higher rates of current psychiatric disorders than normal controls and reported significantly more physical symptoms with no medical explanation.

Seventy-four percent of MCS and 61% of CFS did not qualify for any current Axis I psychiatric diagnosis. Chemically sensitive subjects without a defined date of onset (CS) had the highest rate of Axis I psychiatric disorders (69%). On the MMPI-2, 44% of MCS, 42% of CS, 53% of CFS, and none of the controls achieved clinically significant elevations on scales associated with somatoform disorders.

With the exception of one complex test of visual memory, no significant differences were noted among the groups on tests of neuropsychological function. Standardized measures of psychiatric and neuropsychological function did not differentiate subjects with sensitivities to chemicals from those with chronic fatigue. Subjects with sensitivities to chemicals and no clear date of onset had the highest rate of psychiatric morbidity. Standardized neuropsychological tests did not substantiate the cognitive impairment reported symptomatically. Cognitive deficits may become apparent under controlled exposure conditions.

 

Source: Fiedler N, Kipen HM, DeLuca J, Kelly-McNeil K, Natelson B. A controlled comparison of multiple chemical sensitivities and chronic fatigue syndrome. Psychosom Med. 1996 Jan-Feb;58(1):38-49. http://www.ncbi.nlm.nih.gov/pubmed/8677287

 

Silicone breast implant–associated musculoskeletal manifestations

Abstract:

Three hundred consecutive women with silicone breast implants (SBI), referred to the arthritis clinic with a variety of musculoskeletal complaints, were evaluated for the presence of underlying connective tissue disease. A complete history and physical examination were performed, as well as laboratory testing for C-reactive protein, rheumatoid factor; and autoantibody determination by indirect immunofluorescence and immunodiffusion.

The group mean age was 44.4 years (range 25-69), the mean time from initial implant surgery to appearance of symptoms was 6.8 years (range: 6m-19y) and 83.3% of women studied had clinical manifestations highly suggestive of an underlying connective tissue disorder. Fifty-four percent met criteria for fibromyalgia and/or chronic fatigue syndrome, distinct connective tissue diseases was detected in 11%, undifferentiated connective tissue disease or human adjuvant disease was found in 10.6%, and a variety of disorders such as angioneurotic oedema, frozen shoulder, multiple sclerosis-like syndrome were present.

Several other miscellaneous conditions including recurrent unexplained low grade fever, hair loss, skin rash, sicca symptoms, Raynaud’s phenomenon, carpal tunnel syndrome, memory loss, headaches, chest pain, and shortness of breath were also seen accompanying specific and non-specific conditions. Seventy percent of patients who underwent explanation of the implants reported improvement of their systemic symptomatology.

A significant proportion of SBI patients referred for rheumatic evaluation have clinical manifestations highly suggestive of an underlying connective tissue disease. Furthermore, improvement of their symptomatology follows explanation of the implants in over half of the patients.

 

Source: Cuellar ML, Gluck O, Molina JF, Gutierrez S, Garcia C, Espinoza R. Silicone breast implant–associated musculoskeletal manifestations. Clin Rheumatol. 1995 Nov;14(6):667-72. http://www.ncbi.nlm.nih.gov/pubmed/8608686

 

Patients with a self diagnosis of myalgic encephalomyelitis

Comment in: Patients with a self diagnosis of myalgic encephalomyelitis. [BMJ. 1995]

 

EDITOR,-Myalgic encephalomyelitis is most commonly related to an underlying psychological or psychiatric disturbance.’2 Shonagh Scott and colleagues report that when general practitioners deal with symptoms consistent with those of myalgic encephalomyelitis their attitude is likely to be influenced by the patient’s perception, expectations, and social class.’ It is not uncommon for patients to diagnose myalgic encephalomyelitis themselves before they seek a consultation; this can lead to disruption of the doctor-patient relationship, unsatisfactory consultations, and possibly failure to diagnose any underlying pathological process. We report on a patient with a self diagnosis of myalgic encephalomyelitis in whom hypopituitarism was diagnosed only after a protracted period

You can read the full comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2550388/pdf/bmj00603-0061a.pdf

Comment on:

Population based study of fatigue and psychological distress. [BMJ. 1994]

Professional and popular views of chronic fatigue syndrome. [BMJ. 1994]

 

Source: Hurel SJ, Abuiasha B, Baylis PH, Harris PE. Patients with a self diagnosis of myalgic encephalomyelitis. BMJ. 1995 Jul 29;311(7000):329. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2550388/pdf/bmj00603-0061a.pdf (Full comment)

 

Sleep disturbances and fatigue in women with fibromyalgia and chronic fatigue syndrome

Abstract:

OBJECTIVE: To determine the relationship between sleep disturbances and fatigue in women with fibromyalgia (FM) and those with chronic fatigue syndrome (CFS) and to assess whether any differences existed between the two groups.

DESIGN: Descriptive comparative.

SETTING: Community program on chronic fatigue syndrome and related disorders.

PARTICIPANTS: Sixty-three women who attended the program; 13 had CFS, and 50 had FM.

MAIN OUTCOME MEASURES: A moderately strong relationship between fatigue and sleepiness was found (r = .63, p < .01). Trouble staying asleep was the highest rated sleep disturbance, and fatigue was the most common subjective feeling reported. Women with CFS reported significantly more trouble staying asleep than women with FM, t(61) = 1.81, p < .03.

CONCLUSIONS: Data from this study support that women with FM and CFS encounter problems sleeping. Clinicians are encouraged to assess women with FM and CFS for their quality of sleep rather than amount of sleep. Researchers are encouraged to continue study of sleep disturbances in women with FM and CFS to improve understanding of the disturbances and to test the effectiveness of sleep interventions.

 

Source: Schaefer KM. Sleep disturbances and fatigue in women with fibromyalgia and chronic fatigue syndrome. J Obstet Gynecol Neonatal Nurs. 1995 Mar-Apr;24(3):229-33. http://www.ncbi.nlm.nih.gov/pubmed/7782955

 

Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome

Abstract:

Two important studies in which nuclear magnetic resonance spectroscopy was used convincingly demonstrated that muscle is not the primary pathologic factor in fibromyalgia. There were further studies reporting that fibromyalgia-chronic fatigue syndrome may follow well treated Lyme disease or mimic Lyme disease. The longest therapeutic trial to date in fibromyalgia demonstrated an initial modest effect of tricyclic medications, but at 6 months that efficacy was no longer evident. Investigation in both fibromyalgia and chronic fatigue syndrome now focuses on the central nervous system. The use of new technology, eg, neurohormonal assays and imaging such as single-photon emission computed tomography scan, may be important in understanding these elusive conditions.

 

Source: Goldenberg DL. Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome. Curr Opin Rheumatol. 1995 Mar;7(2):127-35. http://www.ncbi.nlm.nih.gov/pubmed/7766493

 

Post-hepatitis syndrome revisited

Abstract:

To examine the role of acute hepatitis A and B infection in the aetiology of chronic fatigue syndrome and psychiatric morbidity we studied 40 patients with acute viral hepatitis A or B consecutively admitted to an infectious diseases unit and studied at least 6 months after recovery.

Liver function tests (LFT) had returned to normal in each case. Forty-seven patients with other infectious diseases, of which 12 were presumed viral, admitted immediately after each hepatitis patient during the same period acted as controls. The main outcome measures were scores on a fatigue and muscle pain questionnaire, general health questionnaire (GHQ-12) and supplementary questions.

The hepatitis cases scored significantly higher fatigue scores, GHQ-12 scores and muscle pain scores. Length of time since recovery from illness, age and sex were not confounding factors. Hepatitis cases were also less energetic, had greater weight change, had altered alcohol tolerance, had less exercise tolerance and felt less fit than the control group and compared with their premorbid state.

Hence fatigue is more common after recovery in patients hospitalized for hepatitis A and B up to 30 months post-infection compared with matched controls hospitalized for other infectious diseases. Hepatitis A and B infection is a risk factor for post-infection fatigue, intermittent fatigue, as well as for psychiatric morbidity.

 

Source: Berelowitz GJ, Burgess AP, Thanabalasingham T, Murray-Lyon IM, Wright DJ. Post-hepatitis syndrome revisited. J Viral Hepat. 1995;2(3):133-8. http://www.ncbi.nlm.nih.gov/pubmed/7493307

 

Fatigue secondary to chronic illness: postpolio syndrome, chronic fatigue syndrome, and multiple sclerosis

Abstract:

Estimates of the percentage of patients with postpolio syndrome, chronic fatigue syndrome, and multiple sclerosis who experience fatigue range from approximately 75% to 100%. In this study we describe the severity of fatigue and its impact on subjects with these three diagnoses.

The Fatigue Severity Scale, the Human Activity Profile, and the Nottingham Health Profile were used to measure fatigue, activity, and health status respectively of each diagnostic group as well as a control group. Using a Kruskal-Wallis one-way analysis of variance followed by a Bonferroni-adjusted Mann Whitney U test all diagnostic groups reported significantly higher levels (p = .0000 to p = .002) of fatigue and lower perceived health status than the control group.

Subjects with chronic fatigue and multiple sclerosis also had significantly reduced activity levels (p = .002 to p = .01) compared with the control group. Further attention should be directed toward understanding the relationship between fatigue and ability to engage in activities as well as strategies for remediation and/or compensation of the fatigue.

 

Source: Packer TL, Sauriol A, Brouwer B. Fatigue secondary to chronic illness: postpolio syndrome, chronic fatigue syndrome, and multiple sclerosis. Arch Phys Med Rehabil. 1994 Oct;75(10):1122-6. http://www.ncbi.nlm.nih.gov/pubmed/7944918

 

Comparison of patients with chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivities

Abstract:

BACKGROUND: Chronic fatigue syndrome (CFS), fibromyalgia (FM), and multiple chemical sensitivities (MCS) are conditions associated with fatigue and a variety of other symptoms that appear to share many clinical and demographic features. Our objectives were to describe the similarities and differences among patients with CFS, FM, and MCS. Additional objectives were to determine how frequently patients with MCS and FM met the criteria for CFS and if they differed in their health locus of control.

METHODS: Demographic, clinical, and psychosocial measures were prospectively collected in 90 patients, 30 each with CFS, FM, and MCS. Patients were recruited from a university-based referral clinic devoted to the evaluation and treatment of chronic fatigue and three private practices. Variables included demographic features, symptoms characteristic of each condition, psychological complaints, a measure of health locus of control, and information on health care use.

RESULTS: Overall, the three patient groups were remarkably similar in demographic characteristics and the presence of specific symptoms. Patients with CFS and FM frequently reported symptoms compatible with MCS. Likewise, 70% of patients with FM and 30% of those with MCS met the criteria for CFS. Health care use was substantial among patients with CFS, FM, and MCS, with an average of 22.1, 39.7, and 23.3 visits, respectively, to a medical provider during the prior year. Health locus of control did not differ among the three populations.

CONCLUSIONS: In general, demographic and clinical factors and health locus of control do not clearly distinguish patients with CFS, FM, and MCS. Symptoms typical of each disorder are prevalent in the other two conditions.

Comment in: Chronic fatigue, fibromyalgia, and chemical sensitivity: overlapping disorders. [Arch Intern Med. 1995]

 

Source: Buchwald D, Garrity D. Comparison of patients with chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivities. Arch Intern Med. 1994 Sep 26;154(18):2049-53. http://www.ncbi.nlm.nih.gov/pubmed/8092909