Category: Pediatric ME/CFS

Chronic fatigue syndrome in adolescents: a follow-up study

Abstract:

OBJECTIVES: To compare the frequency of persistent symptoms up to 8 years after illness onset in adolescents diagnosed as having chronic fatigue syndrome, idiopathic chronic fatigue, and unexplained fatigue for less than 6 months, and to determine if hospital admission is associated with outcome.

DESIGN: A cohort study using questionnaire follow-up.

SETTING: A tertiary referral hospital.

PATIENTS: Consecutive adolescents referred for assessment of persistent fatigue were identified and retrospectively divided into 3 groups according to the diagnostic criteria for chronic fatigue syndrome and idiopathic chronic fatigue.

INTERVENTION: A questionnaire was designed and administered by telephone at a mean of 4.57 years after the initial examination.

MAIN OUTCOME MEASURE: The persistence of self-reported symptoms was compared with respect to patient group and admission.

RESULTS: Outcome data were obtained for 34 (69%) of the 49 eligible subjects. Twenty-five percent of the chronic fatigue syndrome group showed near to complete improvement, 31% showed partial improvement, and 44% showed no improvement. The idiopathic chronic fatigue group had near to complete recovery in 50%, partial in 10%, and no improvement in 40%. Those with unexplained fatigue for less than 6 months had all recovered. There was no difference between the outcome of the subjects admitted to the hospital and those managed as outpatients.

CONCLUSIONS: Adolescents with less than 6 months of fatigue have a good outcome. Unexplained fatigue lasting more than 6 months has a similar outcome regardless of the presence of minor criteria for chronic fatigue syndrome.

Comment in: Adolescent chronic fatigue syndrome. [Arch Pediatr Adolesc Med. 2004]

 

Source: Gill AC, Dosen A, Ziegler JB. Chronic fatigue syndrome in adolescents: a follow-up study. Arch Pediatr Adolesc Med. 2004 Mar;158(3):225-9. http://www.ncbi.nlm.nih.gov/pubmed/14993080

 

Chronic fatigue syndrome in children: a cross sectional survey

Abstract:

BACKGROUND: Chronic fatigue syndrome (CFS) in children is a controversial diagnosis with unclear aetiology, ill defined but likely increasing incidence, and debatable clinical management options. However these children experience real and considerable suffering. Appropriate research in this clinical population is sparse and usually occurs in tertiary referral units.

METHODS: Cross sectional survey of 36 children attending a GP specialist interest clinic in southeast England.

RESULTS: Patient sociodemographics and clinical morbidity were largely comparable to the literature from tertiary referral research centres. Some prognostic indicators for adults did not readily transfer to this younger age group, although several children had a positive family psychiatric history. Receiving treatment was associated with increased school attendance, but one third of subjects obtained no qualifications. Return to normal health or significant overall improvement was reported by 29/36 subjects.

CONCLUSIONS: The outcomes in this setting are favourable and comparable to those seen in a controlled setting; this study supports the concept that the prognosis for CFS in children and adolescents is generally good. However, the impact of the illness is significant and this is perhaps most evident in terms of education. Current methods of reporting educational outcomes in the literature are varied and merit development of standardised tools.

 

Source: Patel MX, Smith DG, Chalder T, Wessely S. Chronic fatigue syndrome in children: a cross sectional survey. Arch Dis Child. 2003 Oct;88(10):894-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1719321/ (Full article)

 

Epidemiology of chronic fatigue syndrome and self reported myalgic encephalomyelitis in 5-15 year olds: cross sectional study

Chronic fatigue syndrome is characterised by severe physical and mental fatigue associated with disability, which by definition markedly affects people’s lives. At one end of the spectrum, newspaper headlines imply that chronic fatigue syndrome or myalgic encephalomyelitis in children is of epidemic proportions, whereas at the other end the existence of the disorder is refuted. Attempts have been made to assess the size of the problem in the community, general practice, schools, and secondary care.w1-w5 Methodological problems, however, such as selection biases and poor response rates make it difficult to draw conclusions from these studies. We are unaware of any population studies in the United Kingdom that examine the prevalence of and factors associated with chronic fatigue syndrome in children. We determined the prevalence of chronic fatigue, chronic fatigue syndrome, and reported myalgic encephalomyelitis in 5-15 year olds and examined demographic and psychiatric associations.

You can read the rest of this article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC196393/

 

Source: Chalder T, Goodman R, Wessely S, Hotopf M, Meltzer H. Epidemiology of chronic fatigue syndrome and self reported myalgic encephalomyelitis in 5-15 year olds: cross sectional study. BMJ. 2003 Sep 20;327(7416):654-5.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC196393/ (Full article)

Comparative study of anxiety, depression, somatization, functional disability, and illness attribution in adolescents with chronic fatigue or migraine

Abstract:

OBJECTIVE: To compare adolescents with migraine, unexplained profound chronic fatigue of >6 months duration, and normal school controls on measures of anxiety, depression, somatization, functional disability, and illness attribution.

METHODS: Adolescents referred to Children’s Hospital and Regional Medical Center for behavioral treatment of migraine (n = 179) or evaluation of chronic fatigue (n = 97) were compared with a group of healthy controls of similar age and sex from a middle school (n = 32). Subjects completed the Spielberger State-Trait Anxiety Inventory-Trait Form, the Children’s Depression Inventory, the Childhood Somatization Inventory, and estimated the number of school days missed in the past 6 months because of illness. Migraine and fatigued subjects completed an illness attribution questionnaire.

RESULTS: Subjects in the 3 groups were 56% to 70% female and ranged from 11 years old to 18 years old with a mean age of 14.0 +/- 2.0. Forty-six of the 97 chronically fatigued adolescents met 1994 Centers for Disease Control and Prevention (CDC) criteria for chronic fatigue syndrome (CDC-CFS), while 51 had idiopathic chronic fatigue syndrome (I-CFS) that did not meet full CDC criteria. Adolescents with migraine had significantly higher anxiety scores than those with I-CFS or controls and higher somatization scores than controls. Adolescents with CDC-CFS had significantly higher anxiety scores than those with I-CFS or controls, and higher depression and somatization scores than all other groups. There were significant differences between all groups for school days missed with CDC-CFS more than I-CFS more than migraine more than controls. Parents of adolescents with unexplained I-CFS had significantly lower attribution scores relating illness to possible psychological or stress factors than parents of adolescents with CDC-CFS or migraine.

CONCLUSIONS: Adolescents referred to an academic center for evaluation of unexplained chronic fatigue had greater rates of school absenteeism than adolescents with migraine or healthy controls. Those meeting CDC-CFS criteria had higher anxiety scores than controls and higher depression and somatization scores than migraineurs or controls. Parents of adolescents with I-CFS were less likely to endorse psychological factors as possibly contributing to their symptoms than parents of adolescents with CDC-CFS or migraine.

 

Source: Smith MS, Martin-Herz SP, Womack WM, Marsigan JL. Comparative study of anxiety, depression, somatization, functional disability, and illness attribution in adolescents with chronic fatigue or migraine. Pediatrics. 2003 Apr;111(4 Pt 1):e376-81. http://www.ncbi.nlm.nih.gov/pubmed/12671155

 

Asthenia in adolescents

Abstract:

Fatigue is defined as a subjective sensation of tiredness or weariness that occurs at rest. The perception of fatigue among 12-15 years-old Italian adolescents in a school survey was about 70%. Generally the symptoms are reported after a viral illness or an infection. In adolescents with persistent or severe fatigue a selected screening evaluation to look for an underlying organic disorder is warranted. A practical diagnostic approach is given and a brief description of chronic fatigue syndrome is reported according to CDC revised diagnostic criteria published in 1997.

 

Source: De Sanctis V, Mangiagli A, Campisi S, Raiola G. Asthenia in adolescents. Minerva Pediatr. 2002 Dec;54(6):631-7. [Article in Italian] http://www.ncbi.nlm.nih.gov/pubmed/12388954

 

Doctor accused of “interfering” in girl’s treatment is cleared by GMC

A consultant paediatrician who disagreed with the parents of a girl with chronic fatigue syndrome about her treatment and obtained her medical records without their consent has been cleared of serious professional misconduct by the General Medical Council. The case resumed last week, having been adjourned in June (29 June, p 1539).

Christopher Cheetham, consultant paediatrician at Wycombe General Hospital, continued to involve himself in the case of the 12 year old girl after her parents, named only as Mr and Mrs B, made it clear they no longer wanted him to do so.

Dr Harvey Marcovitch, editor of Archives of Disease in Childhood, said the case had caused concern among paediatricians about their child protection role. “A lot of paediatricians have been contacting the college [the Royal College of Paediatrics and Child Health], saying they have a terrible dilemma when families won’t cooperate with them in knowing how far they’re allowed to go in spreading information.”

He said the college’s president, Professor David Hall, was seeking a meeting with the GMC president, Professor Graeme Catto, to discuss the issue.

The girl, now 17, was confined to bed for two years. Social services convened two child protection case conferences but decided she was not at risk.

Dr Cheetham recommended an inpatient programme of psychotherapy and physiotherapy. Mr and Mrs B disagreed, believing her illness to be organic, and told him by letter that they no longer wanted him involved in their daughter’s care.

The family’s GP called in Dr Nigel Speight, a consultant paediatrician from Durham with a special interest in chronic fatigue syndrome. He agreed with Mr and Mrs B that their daughter should be treated at home under the care of her GP.

Dr Cheetham sought to involve social services and continued to insist, in letters to Dr Speight and others, that the girl was being deprived of proper treatment.

Dr Cheetham’s counsel argued that the Children Act 1989, which provides for intervention when a child is thought to be suffering or likely to suffer significant harm, justified Dr Cheetham’s actions.

Taking into account the circumstances of the girl’s condition and management as known to Dr Cheetham at the time and his “integrity, expertise, and reputation as a senior paediatrician,” the GMC’s professional conduct committee “could not feel sure” that he had no reasonable cause to suspect significant harm. He could not, therefore, be said to have no right to intervene.

The committee said the Bs were “intelligent, loving, and devoted parents” who were entitled to have the treatment of their choice for their child. But that did not nullify the right of a doctor with legitimate concerns for his former patient.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1124209/

 

Source: Dyer C. Doctor accused of “interfering” in girl’s treatment is cleared by GMC. BMJ. 2002 Sep 28;325(7366):673. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1124209/ (Full article)

 

Joint hypermobility is more common in children with chronic fatigue syndrome than in healthy controls

Abstract:

OBJECTIVE: To determine whether children with chronic fatigue syndrome (CFS) have a higher prevalence of joint hypermobility than gender-matched controls.

STUDY DESIGN: Matched case-control study comparing the Beighton joint hypermobility scores in 58 consecutive children with CFS (incident cases) with 58 otherwise healthy controls referred to a dermatology clinic for evaluation of common skin problems. A second group of 58 patients previously diagnosed with CFS (prevalent cases) was matched by gender to the incident cases to evaluate temporal changes in referral patterns.

RESULTS: Of the 58 patients in each group, 71% were female. The median Beighton scores were higher in incident CFS cases than in healthy controls (4 vs 1, P <.001). More incident CFS cases had Beighton scores >/=4 (consistent with joint hypermobility), 60% versus 24%, P <.0001. Incident and prevalent CFS cases had similar Beighton scores. The odds ratio for hypermobility in all patients with CFS versus healthy controls was 3.5 (P <.001; 95% CI, 1.6-7.5).

CONCLUSIONS: Joint hypermobility is more common in patients with CFS than in otherwise healthy children with common skin disorders. The etiologic significance of the observed association remains to be defined.

 

Source: Barron DF, Cohen BA, Geraghty MT, Violand R, Rowe PC. Joint hypermobility is more common in children with chronic fatigue syndrome than in healthy controls. J Pediatr. 2002 Sep;141(3):421-5. http://www.ncbi.nlm.nih.gov/pubmed/12219066

 

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

 

Chronic fatigue syndrome: successful outcome of an intensive inpatient programme

Abstract:

OBJECTIVE: To study the outcome of adolescents with chronic fatigue syndrome (CFS) following an intensive multi-disciplinary inpatient programme.

METHODS: A follow-up questionnaire was distributed to all 57 adolescents who had completed the CFS inpatient programme at the Austin and Repatriation Medical Centre.

RESULTS: Forty-two adolescents (74%) returned follow-up questionnaires. Immediately following the programme and up to five years after the programme, the majority of participants had returned to school and were functioning better in terms of physical activity and social interactions as compared with before the programme. Before the programme, 94% of adolescents were attending school half-time or less. Up to 5 years after the programme, 78% of adolescents were attending school full-time or with occasional absences only.

CONCLUSIONS: A multidisciplinary inpatient programme for CFS was successful in helping to rehabilitate this group of adolescents who were significantly incapacitated prior to entering the inpatient programme.

 

Source: Lim A, Lubitz L. Chronic fatigue syndrome: successful outcome of an intensive inpatient programme. J Paediatr Child Health. 2002 Jun;38(3):295-9. http://www.ncbi.nlm.nih.gov/pubmed/12047700

 

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