Category: Pediatric ME/CFS

Chronic fatigue syndrome in children. Journal was wrong to criticise study in schoolchildren

Comment on: Managing chronic fatigue syndrome in children. [BMJ. 1997]

Editor—In his editorial on managing the chronic fatigue syndrome in children Harvey Marcovitch implies that a 37% response rate to our questionnaire about long term sickness absence in schools was poor and insufficiently explained, and he states that we overinterpreted the resulting data.1 2

You can read the full comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2127623/pdf/9361553.pdf

 

Source: Dowsett EG, Colby J. Chronic fatigue syndrome in children. Journal was wrong to criticise study in schoolchildren. BMJ. 1997 Oct 11;315(7113):949. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2127623/

 

Graded exercise in chronic fatigue syndrome. Including patients who rated themselves as a little better would have altered results

Comment on:

Randomised controlled trial of graded exercise in patients with the chronic fatigue syndrome. [BMJ. 1997]

Managing chronic fatigue syndrome in children. [BMJ. 1997]

 

Editor—“Editor’s choice” in the issue of 7 June states, “we agree that myalgic encephalomyelitis (or chronic fatigue syndrome) is a serious condition” and “all conditions have a mental and physical component.” This is the stance of the patient organisations supporting patients with this condition. Unfortunately, some doctors have trivialised this illness; ridiculed patients and their supporters; and subjected a few of them, including children, to oppressive, perhaps even abusive, forms of treatment. Hopefully, this is now a thing of the past. We need, as Harvey Marcovitch says, to explore what might be done to help them.

You can read the rest of this comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2127632/pdf/9361550.pdf

 

Source: Franklin AJ. Graded exercise in chronic fatigue syndrome. Including patients who rated themselves as a little better would have altered results. BMJ. 1997 Oct 11;315(7113):947; author reply 948. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2127632/

 

Chronic fatigue syndrome in young persons

Abstract:

The prevalence of chronic fatigue syndrome (CFS) in teenagers is 10-20 per 100,000 inhabitants in the Netherlands. The natural course of the disorder is not favourable according to the literature.

Proposed criteria for the diagnosis ‘CFS’ in adolescence are: absence of a physical explanation for the complaints, a disabling fatigue for at least six months and prolonged school absenteeism or severe motor and social disabilities. Exclusion criterion should be a psychiatric disorder.

Factors that attribute to the persistence of fatigue are somatic attributions, illness enhancing cognitions and behaviour of parents as well as physical inactivity. The role of the physician and the role of parents can enhance the problems.

The treatment should focus on decreasing the somatic attributions, on reinforcement by the parents of healthy adolescent behaviour, on the gradual increase of physical activity and on decreasing attention (including medical attention) for the somatic complaints.

 

Source: de Jong LW, Prins JB, Fiselier TJ, Weemaes CM, Meijer-van den Bergh EM, Bleijenberg G. Chronic fatigue syndrome in young persons. Ned Tijdschr Geneeskd. 1997 Aug 2;141(31):1513-6.[Article in Dutch] http://www.ncbi.nlm.nih.gov/pubmed/9543737

 

Managing chronic fatigue syndrome in children

Last month the British press made much of a study purporting to show that chronic fatigue syndrome was the single commonest cause of long term absence from school in Britain.1 The authors claimed to have calculated prevalence figures for both pupils (0.07%) and teachers (0.5%) similar to previously reported figures for the general population.2-4 Dowsett and Colby make much of “clusters” of cases, defined as three or more cases in a school. The press release distributed by one of the authors states that 39% of cases occurred in such clusters, saying that this “suggests that ME results from an infection.” It refers to one cluster extending over several schools in an area where there was “recreational water heavily polluted by sewage.” The published paper contains no reference to pollution by sewage or anything else, but only to several cases in “schools near two new towns in a rural environment alongside recreational water.”

You can read the full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2126833/pdf/9193280.pdf

Comment in:

Graded exercise in chronic fatigue syndrome. Including patients who rated themselves as a little better would have altered results. [BMJ. 1997]

Chronic fatigue syndrome in children. Journal was wrong to critizise study in schoolchildren. [BMJ. 1997]

Chronic fatigue syndrome in children. Patient organisations are denied a voice. [BMJ. 1997]

Comment on:

Randomised controlled trial of graded exercise in patients with the chronic fatigue syndrome. [BMJ. 1997]

 

Source: Marcovitch H. Managing chronic fatigue syndrome in children. BMJ. 1997 Jun 7;314(7095):1635-6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2126833/pdf/9193280.pdf (Full article)

 

Cognitive idiosyncrasies among children with the chronic fatigue syndrome: anomalies in self-reported activity levels

Abstract:

The possibility that children with the chronic fatigue syndrome (CFS) and their parents tend to display idiosyncratic cognitive processing concerning levels of activity was examined by means of subjective and objective measures of current activity, together with subjective and objective measures of desired and expected future activity.

The degree to which subjective reports of current activity level reflect objectively measured activity level was examined in a group of children with CFS and a healthy control group. All subjects were assessed over a 3-day period by means of ambulatory activity monitoring, and self-reports and parent-reports of current activity level were collected by means of visual analog scales.

Analysis of variance revealed a significant interaction between the method of measurement (objective versus subjective) and the participant group (CFS versus Healthy) with the CFS children and their parents underestimating actual level of activity relative to the healthy group. Desired and expected levels of future activity were also assessed by means of subjective report. Child and parent expected levels of future activity were compared with their desired levels.

Although expected levels of future activity were similar in the two groups, the divergence between expected levels and corresponding desired levels was significantly greater in the CFS group. These results are discussed in terms of idiosyncratic cognitive processes, which are hypothesized to be associated with CFS and which may play a role in the maintenance of the disorder.

 

Source: Fry AM, Martin M. Cognitive idiosyncrasies among children with the chronic fatigue syndrome: anomalies in self-reported activity levels. J Psychosom Res. 1996 Sep;41(3):213-23. http://www.ncbi.nlm.nih.gov/pubmed/8910244

 

Differential diagnosis of chronic fatigue in children: behavioral and emotional dimensions

Abstract:

A battery of self-report questionnaires and structured diagnostic interviews was administered to 20 children and adolescents who presented to a pediatric specialty clinic with chronic fatigue. Matched groups of healthy and depressed control subjects (aged 8 to 19 years) were also studied. Criteria were established to identify those items in the assessment battery that reliably differentiated among the three groups.

Analysis of item content suggested several clusters of characteristics that discriminated among the subject groups, including life changes, cognitive difficulties, negative self-attributions, social relationship disruption, and somatic symptom presentation.

The results suggest that certain psychological factors can discriminate chronic fatigue from depressive symptomatology, as well as normal functioning. Items discriminating among groups are presented in an organized questionnaire format to assist with the understanding and assessment of pediatric chronic fatigue cases.

 

Source: Carter BD, Kronenberger WG, Edwards JF, Michalczyk L, Marshall GS. Differential diagnosis of chronic fatigue in children: behavioral and emotional dimensions. J Dev Behav Pediatr. 1996 Feb;17(1):16-21. http://www.ncbi.nlm.nih.gov/pubmed/8675709

 

Psychosocial correlates of chronic fatigue syndrome in adolescent girls

Abstract:

Behavior problems and family functioning were investigated in a sample of 10 adolescent girls with chronic fatigue syndrome (CFS), 10 matched healthy adolescent girls, and 10 adolescents with childhood cancer in remission.

Based on the adolescent girls’ reports, the CFS group had significantly higher scores than the cancer and healthy comparison adolescent girls on somatic complaints and also significantly higher scores than the cancer controls on internalizing symptoms and depression. Parent reports resulted in significantly higher scores in the CFS group than the adolescent girls from the healthy comparison groups on internalizing scores and somatic complaints. There were no significant differences on any family variables.

 

Source: Pelcovitz D, Septimus A, Friedman SB, Krilov LR, Mandel F, Kaplan S. Psychosocial correlates of chronic fatigue syndrome in adolescent girls. J Dev Behav Pediatr. 1995 Oct;16(5):333-8. http://www.ncbi.nlm.nih.gov/pubmed/8557833

 

Is neurally mediated hypotension an unrecognised cause of chronic fatigue?

Abstract:

Neurally mediated hypotension is now recognised as a common cause of otherwise unexplained recurrent syncope, but has not been reported in association with chronic fatigue. We describe seven consecutive non-syncopal adolescents with chronic post-exertional fatigue, four of whom satisfied strict criteria for chronic fatigue syndrome. Upright tilt-table testing induced significant hypotension in all seven (median systolic blood pressure 65 mm Hg, range 37-75), consistent with the physiology of neurally mediated hypotension. Four had prompt improvement in their chronic fatigue when treated with atenolol or disopyramide. These observations suggest an overlap in the symptoms of chronic fatigue syndrome and neurally mediated hypotension.

Comment in:

Is neurally mediated hypotension an unrecognised cause of chronic fatigue? [Lancet. 1995]

Is neurally mediated hypotension an unrecognised cause of chronic fatigue? [Lancet. 1995]

Is neurally mediated hypotension an unrecognised cause of chronic fatigue? [Lancet. 1995]

 

Source: Rowe PC, Bou-Holaigah I, Kan JS, Calkins H. Is neurally mediated hypotension an unrecognised cause of chronic fatigue? Lancet. 1995 Mar 11;345(8950):623-4. http://www.ncbi.nlm.nih.gov/pubmed/7898182

 

Case control study of chronic fatigue in pediatric patients

Abstract:

OBJECTIVE: To determine the demographic characteristics, medical features, psychological profile, and natural history of children with chronic fatigue.

DESIGN: Case control study.

SETTING: Pediatric Infectious Diseases Clinic of Kosair Children’s Hospital, 1990 to 1992.

PARTICIPANTS: Forty-four patients referred for persistent fatigue were evaluated. Twenty patients participated in a psychological study; 20 healthy controls of similar age and gender were recruited from community pediatric practices and 20 matched depressed controls were recruited from university psychiatry services (subjects were treated as groups in the analyses).

MEASURES: Demographic data were obtained for all referred patients. Those with fatigue for at least 2 months and no alternative diagnosis received a detailed history, physical, and battery of laboratory tests (complete blood count, sedimentation rate, chemistry panel, chest X-ray thyroid stimulating hormone, thyroxine, anti-nuclear antibodies, urinalysis, immunoglobulins, and Epstein-Barr virus (EBV), toxoplasma, and cytomegalovirus serologies). Psychological study participants completed the following: background structured interview; Kaufman Brief Intelligence Test; Children’s Depression Inventory; Child Behavior Checklist; Youth Self Report; Diagnostic Interview for Children and Adolescents-Revised; mail-in follow-up survey.

RESULTS: The median age of fatigue patients was 14.3 years; 60% were female, 96% white, and 87% from the mid/upper socioeconomic status (SES). Fatigue patients were demographically similar to 21 patients referred for infectious mononucleosis (IM) but were older than other clinic patients (P < .0001). White race (P = .0568) and mid/upper SES (P = .0403) were over-represented among fatigue patients compared to patients referred for other diagnoses. Of 36 patients meeting criteria for further study, 5 had an IM-like illness including evidence of recent EBV infection. For the remaining 31 patients, clinical and laboratory evaluations were unrevealing. Psychological study subjects reported marked declines in quality-of-life and scored high on measures of internalizing, withdrawal, and social isolation. Nine met diagnostic criteria for depression, although depressive symptoms were not as prominent as those reported by depressed controls. Fatigue subjects scored higher on somatization than both control groups. The follow-up survey indicated symptomatic improvement in most patients.

CONCLUSIONS: Chronic fatigue was a common reason for referral, with over-representation of white children from mid/upper SES. After exclusion of EBV-associated IM, screening laboratory tests were not helpful in establishing specific organic diagnoses. Whereas the natural history was favorable, chronic fatigue resulted in major quality-of-life changes and was associated with significant levels of psychosocial distress.

IMPLICATIONS: Psychological evaluation is warranted in these patients, as some may have treatable psychological conditions. Given the absence of proved medical therapies, psychosocial interventions to improve quality-of-life should be studied.

 

Source: Carter BD, Edwards JF, Kronenberger WG, Michalczyk L, Marshall GS. Case control study of chronic fatigue in pediatric patients. Pediatrics. 1995 Feb;95(2):179-86. http://www.ncbi.nlm.nih.gov/pubmed/7838632

 

Primary juvenile fibromyalgia syndrome and chronic fatigue syndrome in adolescents

Abstract:

Chronic fatigue syndrome (CFS) and primary juvenile fibromyalgia syndrome (PJFS) are illnesses with a similar pattern of symptoms of unknown etiology. Twenty-seven children for whom CFS was diagnosed were evaluated for fibromyalgia by the presence of widespread pain and multiple tender points.

Eight children (29.6%) fulfilled criteria for fibromyalgia. Those children who met fibromyalgia criteria had a statistically greater degree of subjective muscle pain, sleep disturbance, and neurological symptoms than did those who did not meet the fibromyalgia criteria. There was no statistical difference between groups in degree of fatigue, headache, sore throat, abdominal pain, depression, lymph node pain, concentration difficulty, eye pain, and joint pain.

CFS in children and PJFS appear to be overlapping clinical entities and may be indistinguishable by current diagnostic criteria.

 

Source: Bell DS, Bell KM, Cheney PR. Primary juvenile fibromyalgia syndrome and chronic fatigue syndrome in adolescents. Clin Infect Dis. 1994 Jan;18 Suppl 1:S21-3. http://www.ncbi.nlm.nih.gov/pubmed/8148447