Category: Overview

Chronic fatigue syndrome does exist. Changes of biological parameters are measurable

Abstract:

Chronic fatigue syndrome is a debilitating condition characterised by neurocognitive and somatic symptoms. Although many patients report an infectious onset, there is no unequivocal evidence to support this. The immune system is activated, and the hypothalamic-pituitary-adrenal axis is involved. The aetiology is complex, and its understanding may require modification of our views on ill-health and disease.

 

Source: Evengård B, Komaroff AL. Chronic fatigue syndrome does exist. Changes of biological parameters are measurable. Lakartidningen. 1999 Jun 30;96(26-27):3166-9. [Article in Swedish] http://www.ncbi.nlm.nih.gov/pubmed/10423976

 

Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome

Abstract:

Fibromyalgia was almost completely absent from an urban affluent population compared with poor urban and rural communities. Seventeen percent of Gulf War veterans with soft tissue syndromes had fibromyalgia, a much higher rate than was seen in previous studies of rheumatic disease in the military population. A state of central hyperexcitability in the nociceptive system was reported in fibromyalgia. Altered functioning of the stress-response system has been further documented in fibromyalgia and chronic fatigue syndrome.

Administration of growth hormone to patients with fibromyalgia who have low levels of insulin-like growth factor 1 resulted in improvement in their symptoms and tenderness. An association between chronic fatigue syndrome and initial infections was demonstrated. A correlation between particular immunologic abnormalities and measures of disease severity was documented in chronic fatigue syndrome. Concomitant fibromyalgia in other rheumatic diseases was a major contributor to poor quality of life. A favorable outcome of fibromyalgia in children was reported; the majority of patients improved over 2 to 3 years of follow-up. Treatment of patients with fibromyalgia continues to be of limited success.

 

Source: Buskila D. Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome. Curr Opin Rheumatol. 1999 Mar;11(2):119-26. http://www.ncbi.nlm.nih.gov/pubmed/10319215

 

Stress-associated immune modulation: relevance to viral infections and chronic fatigue syndrome

Abstract:

The frequent association of an active viral infection with the symptoms of CFS led researchers to hypothesize that chronic fatigue syndrome (CFS) is induced by a virus. Results of these studies indicated that despite clinical support for this hypothesis, there were no clear data linking viruses to CFS. In this overview, we will explore the interrelation of the immune, endocrine, and central nervous systems, and the possibility that stress and/or the reactivation/replication of a latent virus (such as Epstein Barr virus) could modulate the immune system to induce CFS. Relevant research conducted in the developing field of psychoneuroimmunology will be reviewed, with a particular focus on cytokine synthesis, natural killer (NK) cell activity, and T-lymphocyte function, as they relate to CFS.

 

Source: Glaser R, Kiecolt-Glaser JK. Stress-associated immune modulation: relevance to viral infections and chronic fatigue syndrome. Am J Med. 1998 Sep 28;105(3A):35S-42S. http://www.ncbi.nlm.nih.gov/pubmed/9790480

 

Chronic fatigue syndrome or just plain tired?

The complaint of unremitting fatigue has been around for centuries. Over the years, people with fatigue have been said to suffer from myalgic encephalomyelitis, Icelandic disease, neurasthenia, nervous exhaustion, febricula and Yuppie flu.1,2 Interest in the illness known today as chronic fatigue syndrome (CFS) grew when a cluster of patients in Nevada were found to have a chronic mononucleosis-like syndrome associated with persistently high titres of antibodies to Epstein–Barr virus (EBV) in the late 1980s.2 Today, the role of EBV and other potential viral and immunologic triggers of CFS remains unclear, and even in the wake of a recent flurry of research, the pathophysiology of CFS is poorly understood and no single diagnostic test can confirm its presence.

While CFS support groups lobby for disability coverage for individuals with CFS and insurance companies fight the claims, neither the public nor the medical community unanimously agrees on the existence of CFS as a real clinical entity. Some believe it is merely a presentation of depression or other psychosomatic illness; others argue that individuals claiming to have CFS have seized upon a convenient diagnosis to explain the effects of overwork or “normal” fatigue.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1229654/pdf/cmaj_159_5_519.pdf

Comment in:

What causes chronic fatigue? [CMAJ. 1999]

What causes chronic fatigue? [CMAJ. 1999]

 

Source: Caplan C. Chronic fatigue syndrome or just plain tired? CMAJ. 1998 Sep 8;159(5):519-20. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1229654/

 

Reviewing the reviews: the example of chronic fatigue syndrome

Abstract:

OBJECTIVE: To test the hypothesis that the selection of literature in review articles is unsystematic and is influenced by the authors’ discipline and country of residence.

DATA SOURCES: Reviews in English published between 1980 and March 1996 in MEDLINE, EMBASE (BIDS), PSYCHLIT, and Current Contents were searched.

STUDY SELECTION: Reviews of chronic fatigue syndrome (CFS) were selected. Articles explicitly concerned with a specialty aspect of CFS and unattributed, unreferenced, or insufficiently referenced articles were discarded.

DATA EXTRACTION: Record of data sources in each review was noted as was the departmental specialty of the first author and his or her country of residence. The references cited in each index paper were tabulated by assigning them to 6 specialty categories, by article title, and by assigning them to 8 categories, by country of journal publication.

DATA SYNTHESIS: Of 89 reviews, 3 (3.4%) reported on literature search and described search method. Authors from laboratory-based disciplines preferentially cited laboratory references, while psychiatry-based disciplines preferentially cited psychiatric literature (P = .01). A total of 71.6% of references cited by US authors were from US journals, while 54.9% of references cited by United Kingdom authors were published in United Kingdom journals (P = .001).

CONCLUSION: Citation of the literature is influenced by review authors’ discipline and nationality.

 

Source: Joyce J, Rabe-Hesketh S, Wessely S. Reviewing the reviews: the example of chronic fatigue syndrome. JAMA. 1998 Jul 15;280(3):264-6. http://www.ncbi.nlm.nih.gov/pubmed/9676676

 

Chronic fatigue syndrome: a review for clinicians

Abstract:

Syndromes characterized by persistent fatigue, musculoskeletal pain, sleep disturbance, and subjective cognitive impairment have been common problems in clinical practice for decades. The chronic fatigue syndrome case definition was created to standardize the patient population in research studies and to foster a systematic and comprehensive approach to the attempt to define the etiology and pathophysiology of these syndromes. The pathogenesis of chronic fatigue syndrome remains unknown, though it does appear to be associated with subtle neuroendocrine and immunologic abnormalities. Treatment of chronic fatigue syndrome is empirical. Significant palliation is often possible, though treatment success requires skillful practice of the art of medicine.

 

Source: Goshorn RK. Chronic fatigue syndrome: a review for clinicians. Semin Neurol. 1998;18(2):237-42. http://www.ncbi.nlm.nih.gov/pubmed/9608620

 

Chronic fatigue syndrome: a literature review from a physiatric perspective

Abstract:

To examine the literature on chronic fatigue syndrome (CFS), especially as it relates to cognitive deficits and exercise, more than 200 articles related to CFS were selected from computer-based research as well as pertinent articles noted in the references of individual articles. All were relevant articles on CFS, although articles in a foreign language were excluded. CFS is a controversial diagnosis of exclusion, but certain subgroups do appear to exist. It may represent multiple diseases or multiple stages of the same disease. Although cognitive deficits are commonly reported, the measured impairments are relatively subtle and are in the area of complex information processing speed, or efficiency.

Magnetic resonance imaging, single-photon emission computer tomography, and neuroendocrine studies present preliminary evidence suggestive of the cerebral involvement primarily in the white matter. The weakness and fatigue may be the result of alterations in the central nervous system, not in the peripheral muscles. However, it is hard to separate the documented weakness and endurance deficits from deconditioning.

Autonomic symptoms such as orthostatic intolerance and a predisposition to neurally mediated syncope may be explained by cardiovascular deconditioning, a postviral idiopathic autonomic neuropathy, or both. The review points out the need for more carefully designed studies of CFS that focus on the relationship between neuropathology, psychopathology and neuropsychologic functioning. The role of exercise as a stimulus for exacerbation or in treatment needs to be further studied using clear diagnostic criteria as well as control groups that carefully match the activity level.

 

Source: Jain SS, DeLisa JA. Chronic fatigue syndrome: a literature review from a physiatric perspective. Am J Phys Med Rehabil. 1998 Mar-Apr;77(2):160-7. http://www.ncbi.nlm.nih.gov/pubmed/9558019

 

Chronic fatigue syndrome: an update

Abstract:

Among the many patients who seek medical care for the complaint of fatigue, a small number suffer from chronic fatigue syndrome (CFS). CFS is a poorly understood condition characterized by debilitating fatigue and associated symptoms lasting at least six months. Studies indicate that the illness is not simply a manifestation of an underlying psychiatric disorder, but rather is an illness characterized by activation of the immune system, various abnormalities of several hypothalamic-pituitary axes, and reactivation of certain infectious agents.

 

Source: Komaroff AL, Buchwald DS. Chronic fatigue syndrome: an update. Annu Rev Med. 1998;49:1-13. http://www.ncbi.nlm.nih.gov/pubmed/9509246

 

Chronic fatigue syndrome

Abstract:

Chronic fatigue syndrome is a controversial disease entity. Opinions range from non-disease via psychiatric disorder to a somatic disturbance. Somatic pathogenetic hypotheses include persisting infections, intoxications, metabolic or immunologic disturbances, nervous system diseases and endocrine pathology. None of these hypotheses has been substantiated as yet. Psychological factors are important in the course of the disorder and can be used in the therapeutic approach of patients with chronic fatigue syndrome.

 

Source: van der Meer JW. Chronic fatigue syndrome. Ned Tijdschr Geneeskd. 1997 Aug 2;141(31):1507-9. [Article in Dutch] http://www.ncbi.nlm.nih.gov/pubmed/9543735

 

Chronic fatigue syndrome and occupational health

Abstract:

Chronic fatigue syndrome (CFS) is a controversial condition that many occupational physicians find difficult to advise on. In this article we review the nature and definition of CFS, the principal aetiologic hypotheses and the evidence concerning prognosis. We also outline a practical approach to patient assessment, diagnosis and management. The conclusions of this review are then applied to the disability discrimination field. The implications of the new UK occupational health legislation are also examined. Despite continuing controversy about the status, aetiology and optimum management of CFS, we argue that much can be done to improve the outcome for patients with this condition. The most urgent needs are for improved education and rehabilitation, especially in regard to employment. Occupational physicians are well placed to play an important and unique role in meeting these needs.

 

Source: Mounstephen A, Sharpe M. Chronic fatigue syndrome and occupational health. Occup Med (Lond). 1997 May;47(4):217-27. http://occmed.oxfordjournals.org/content/47/4/217.long (Full article)