Home orthostatic training in chronic fatigue syndrome–a randomized, placebo-controlled feasibility study

Abstract:

BACKGROUND: Orthostatic (Tilt)-training is an effective treatment for neurally mediated hypotension (NMH). NMH is a frequent finding in chronic fatigue syndrome (CFS). We evaluated home orthostatic training (HOT) in CFS in a randomized placebo-controlled feasibility study.

METHODS: Thirty-eight patients with CFS (Fukuda Criteria) were randomly allocated to daily tilt training (n = 19) or sham training (n = 19) for 6 months. Haemodynamic responses to standing were performed in all subjects using continuous technology (Taskforce) at enrolment, week 1, 4 and 24. Symptom response and compliance were assessed using diaries.

RESULTS: Two patients (one from each arm) withdrew from the study. Fourteen patients in each group complied completely or partially, and patients found the training manageable and achievable. Compared to the sham group, blood pressure while standing dropped to 8.0 mmHg less in the HOT group at 4 weeks (95% CI: 1.0 to 15.0, P = 0.03). At 4 weeks, the HOT group had higher total peripheral resistance compared to the sham group; mean difference 70.2, 95% CI: -371.4 to 511.8. Changes were maintained at 6 months. There was no significant difference in fatigue between groups at 4 weeks (mean difference 1.4, 95% CI: -13.5 to 16.2), but there was a trend towards improvement in fatigue at 6 months. Compliers had lower fatigue compared to non-compliers.

CONCLUSIONS: A placebo-controlled study of HOT in CFS is feasible. HOT is well tolerated and generally complied with. A likely physiological rationale for HOT in CFS is related to reductions in orthostatic intolerance. An adequately powered study including strategies to enhance compliance is warranted.

 

Source: Sutcliffe K, Gray J, Tan MP, Pairman J, Wilton K, Parry SW, Newton JL. Home orthostatic training in chronic fatigue syndrome–a randomized, placebo-controlled feasibility study. Eur J Clin Invest. 2010 Jan;40(1):18-24. doi: 10.1111/j.1365-2362.2009.02225.x. Epub 2009 Nov 12. https://www.ncbi.nlm.nih.gov/pubmed/19912315

 

Plasma cytokines in women with chronic fatigue syndrome

Abstract:

BACKGROUND: Chronic Fatigue Syndrome (CFS) studies from our laboratory and others have described cytokine abnormalities. Other studies reported no difference between CFS and controls. However, methodologies varied widely and few studies measured more than 4 or 5 cytokines. Multiplex technology permits the determination of cytokines for a large panel of cytokines simultaneously with high sensitivity and with only 30 ul of plasma per sample. No widely accepted laboratory test or marker is available for the diagnosis or prognosis of CFS. This study screened plasma factors to identify circulating biomarkers associated with CFS.

METHODS: Cytokines were measured in plasma from female CFS cases and female healthy controls. Multiplex technology provided profiles of 16 plasma factors including the pro -inflammatory cytokines: tumor necrosis factor alpha (TNFalpha), lymphotoxin alpha (LTalpha), interleukin (IL) – IL-Ialpha, IL-1beta, IL-6; TH1 cytokines: interferon gamma (IFNgamma), IL-12p70, IL-2, IL-15; TH2: IL-4, IL-5; TH17 cytokines, IL-17 and IL-23; anti-inflammatory cytokines IL-10, IL-13; the inflammatory mediator and neutrophil attracting chemokine IL-8 (CXCL8). Analysis by receiver operating characteristic (ROC) curve assessed the biomarker potential of each cytokine.

RESULTS: The following cytokines were elevated in CFS compared to controls: LTalpha, IL-1alpha, IL-1beta, IL-4, IL-5, IL-6 and IL-12. The following cytokines were decreased in CFS: IL-8, IL-13 and IL-15. The following cytokines were not different: TNFalpha, IFNgamma, IL-2, IL-10, IL-23 and IL-17. Applying (ROC) curve analyses, areas under the curves (AUC) for IL-5 (0. 84), LTalpha (0.77), IL-4 (0.77), IL-12 (0.76) indicated good biomarker potential. The AUC of IL-6 (0.73), IL-15 (0.73), IL-8 (0.69), IL-13 (0.68) IL-1alpha (0.62), IL-1beta (0.62) showed fair potential as biomarkers.

CONCLUSION: Cytokine abnormalities are common in CFS. In this study, 10 of 16 cytokines examined showed good to fair promise as biomarkers. However, the cytokine changes observed are likely to more indicative of immune activation and inflammation, rather than specific for CFS. As such, they are targets for herapeutic strategies. Newer techniques allow evaluation of large panels of cytokines in a cost effective fashion.

 

Source: Fletcher MA, Zeng XR, Barnes Z, Levis S, Klimas NG. Plasma cytokines in women with chronic fatigue syndrome. J Transl Med. 2009 Nov 12;7:96. doi: 10.1186/1479-5876-7-96. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779802/ (Full article)

 

An in vivo proton neurospectroscopy study of cerebral oxidative stress in myalgic encephalomyelitis (chronic fatigue syndrome)

Abstract:

A particularly important family of antioxidant defence enzymes in the body are the glutathione peroxidases, which remove H(2)O(2) by coupling its reduction to H(2)O with oxidation of reduced glutathione (GSH) to oxidised glutathione (GSSG). There are suggestions that GSH in the peripheral blood may be reduced in myalgic encephalomyelitis, which is a highly disabling neurological disease of unknown aetiology.

Since many of the symptoms relate to cerebral functioning, it would seem probable that peripheral blood GSH findings would be reflected in lower cerebral GSH levels. The aim of this study was to carry out the first direct assessment of cerebral GSH levels in myalgic encephalomyelitis; the hypothesis being tested was that cerebral GSH levels would be reduced in myalgic encephalomyelitis.

Cerebral proton neurospectroscopy was carried out at a magnetic field strength of 3T in 26 subjects; spectra were obtained from 20x20x20mm(3) voxels using a point-resolved spectroscopy pulse sequence. The mean cerebral GSH level in the myalgic encephalomyelitis patients was 2.703 (SD 2.311) which did not differ significantly from that in age- and gender-matched normal controls who did not have any history of neurological or other major medical disorder (5.191, SD 8.984; NS). Therefore our study does not suggest that GSH is reduced in the brain in myalgic encephalomyelitis.

At the present time, based on the results of this study, there is no evidence to support the suggestion that, by taking glutathione supplements, an improvement in the brain-related symptomatology of myalgic encephalomyelitis may occur.

 

Source: Puri BK, Agour M, Gunatilake KD, Fernando KA, Gurusinghe AI, Treasaden IH. An in vivo proton neurospectroscopy study of cerebral oxidative stress in myalgic encephalomyelitis (chronic fatigue syndrome). Prostaglandins Leukot Essent Fatty Acids. 2009 Nov-Dec;81(5-6):303-5. doi: 10.1016/j.plefa.2009.10.002. Epub 2009 Nov 10.https://www.ncbi.nlm.nih.gov/pubmed/19906518

 

Provision of social support to individuals with chronic fatigue syndrome

Abstract:

The present study evaluated a buddy program designed to provide support for individuals with chronic fatigue syndrome (CFS). The intervention involved weekly visits by a student paraprofessional, who helped out with tasks that needed to be done in an effort to reduce some of the taxing demands and responsibilities that participants regularly encountered. This model of rehabilitation focused on avoiding overexertion in persons with CFS, aiming to avoid setbacks and relapses while increasing their tolerance for activity.

Participants with CFS were randomly assigned to either a 4-month buddy intervention or a control condition. Posttest results showed that individuals who received a student buddy intervention had significantly greater reductions in fatigue severity and increases in vitality than individuals in the control condition. There were no significant changes between groups for physical functioning and stress.

Buddy interventions that help patients with CFS reduce overexertion and possibly remain within their energy envelopes can be thought of as representing a different paradigm than nonpharmacologic interventions that focus only on increasing levels of activity through graded exercise.

Copyright 2009 Wiley Periodicals, Inc.

 

Source: Jason LA, Roesner N, Porter N, Parenti B, Mortensen J, Till L. Provision of social support to individuals with chronic fatigue syndrome. J Clin Psychol. 2010 Mar;66(3):249-58. doi: 10.1002/jclp.20648. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693568/ (Full article)

 

Family-focused cognitive behaviour therapy versus psycho-education for chronic fatigue syndrome in 11- to 18-year-olds: a randomized controlled treatment trial

Abstract:

BACKGROUND: Only one previous randomized controlled trial (RCT) has examined the efficacy of cognitive behaviour therapy (CBT) for chronic fatigue syndrome (CFS) in children. The aim of this study was to compare family-focused CBT with psycho-education for CFS in adolescents.

METHOD: Sixty-three 11- to 18-year-olds (43 girls, 20 boys) with CFS were randomly assigned to either family-focused CBT or psycho-education delivered over 6 months. School attendance was the main outcome, which was assessed at the end of treatment and at 3, 6 and 12 months follow-up.

RESULTS: At the main outcome point (the 6-month follow-up) both groups had improved similarly. However, although those who received family-focused CBT were attending school for longer than those who received psycho-education, at discharge from treatment and at 3 months follow-up, they improved less quickly across the follow-up period.

CONCLUSIONS: Adolescents with CFS get back to school more quickly after family-focused CBT. This is important as they are at a crucial stage of their development. However, the finding that psycho-education was as effective as family-focused CBT at 6 and 12 months follow-up has important implications for health service delivery.

 

Source: Chalder T, Deary V, Husain K, Walwyn R. Family-focused cognitive behaviour therapy versus psycho-education for chronic fatigue syndrome in 11- to 18-year-olds: a randomized controlled treatment trial. Psychol Med. 2010 Aug;40(8):1269-79. doi: 10.1017/S003329170999153X. Epub 2009 Nov 6. https://www.ncbi.nlm.nih.gov/pubmed/19891804

 

Somatic comorbidities in irritable bowel syndrome: fibromyalgia, chronic fatigue syndrome, and interstitial cystitis

Abstract:

Fibromyalgia, chronic fatigue syndrome, and interstitial cystitis frequently overlap with irritable bowel syndrome (IBS). There is a positive correlation between the incidence of these comorbidities and increased health care seeking, reduction in quality of life, and higher levels of mood disorders, which raises the question of a common underlying pathophysiology. A possible central hypersensitization disorder seems to be particularly involved in the dysfunction of bidirectional neural pathways and viscerovisceral cross-interactions within the CNS, thus explaining these many extraintestinal manifestations in IBS.

 

Source: Mathieu N.Somatic comorbidities in irritable bowel syndrome: fibromyalgia, chronic fatigue syndrome, and interstitial cystitis. Gastroenterol Clin Biol. 2009 Feb;33 Suppl 1:S17-25. doi: 10.1016/S0399-8320(09)71521-0. [Article in French] https://www.ncbi.nlm.nih.gov/pubmed/19303534

http://www.em-consulte.com/article/206075/alertePM (Full article)

Chronic fatigue syndrome: aetiology, diagnosis and treatment

Abstract:

Chronic fatigue syndrome is characterised by intense fatigue, with duration of over six months and associated to other related symptoms. The latter include asthenia and easily induced tiredness that is not recovered after a night’s sleep. The fatigue becomes so severe that it forces a 50% reduction in daily activities.

Given its unknown aetiology, different hypotheses have been considered to explain the origin of the condition (from immunological disorders to the presence of post-traumatic oxidative stress), although there are no conclusive diagnostic tests.

Diagnosis is established through the exclusion of other diseases causing fatigue. This syndrome is rare in childhood and adolescence, although the fatigue symptom per se is quite common in paediatric patients.

Currently, no curative treatment exists for patients with chronic fatigue syndrome. The therapeutic approach to this syndrome requires a combination of different therapeutic modalities. The specific characteristics of the symptomatology of patients with chronic fatigue require a rapid adaptation of the educational, healthcare and social systems to prevent the problems derived from current systems. Such patients require multidisciplinary management due to the multiple and different issues affecting them.

This document was realized by one of the Interdisciplinary Work Groups from the Institute for Rare Diseases, and its aim is to point out the main social and care needs for people affected with Chronic Fatigue Syndrome. For this, it includes not only the view of representatives for different scientific societies, but also the patient associations view, because they know the true history of their social and sanitary needs. In an interdisciplinary approach, this work also reviews the principal scientific, medical, socio-sanitary and psychological aspects of Chronic Fatigue Syndrome.

 

Source: Avellaneda Fernández A1, Pérez Martín A, Izquierdo Martínez M, Arruti Bustillo M, Barbado Hernández FJ, de la Cruz Labrado J, Díaz-Delgado Peñas R, Gutiérrez Rivas E, Palacín Delgado C, Rivera Redondo J, Ramón Giménez JR. Chronic fatigue syndrome: aetiology, diagnosis and treatment. BMC Psychiatry. 2009 Oct 23;9 Suppl 1:S1. doi: 10.1186/1471-244X-9-S1-S1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2766938/ (Full article)

 

Cardiovascular dysfunction with low cardiac output due to a small heart in patients with chronic fatigue syndrome

Abstract:

OBJECTIVE: Little attention has been paid to possible cardiovascular involvement in patients with chronic fatigue syndrome (CFS), although many of their symptoms and signs suggest cardiovascular dysfunction. Possible cardiovascular symptoms and cardiac function were investigated in CFS patients.

METHODS: Cardiovascular symptoms were intensively investigated and cardiac function was evaluated echocardiographically.

PATIENTS: Fifty-three patients (23 men and 30 women, mean age: 31+/-7 years) with CFS under 50 years were studied.

RESULTS: Slender build (body mass index <20 kg/m(2)) was common (47%). Possible cardiovascular symptoms including shortness of breath (32%), dyspnea on effort (28%), rapid heartbeat (38%), chest pain (43%), fainting (43%), orthostatic dizziness (45%) and coldness of feet (42%), were all frequent complaints. Hypotension (28%) was occasionally noted. Electrocardiograms frequently revealed right axis deviation (21%) and severe sinus arrhythmia (34%) suggesting accentuated parasympathetic nervous activity. Small heart shadow (cardiothoracic ratio <or=42%) was noted on the chest roentgenogram in 32 patients (60%). Echocardiographic examination demonstrated low cardiac indexes (<2 L/min/m(2)) with low stroke volume indexes (<30 mL/m(2)) due to a small left ventricular chamber in 19 (36%, p<0.05 vs. 8% in 36 controls). None had reduced left ventricular ejection fraction.

CONCLUSION: Cardiovascular symptoms are common in CFS patients. Cardiac dysfunction with low cardiac output due to small left ventricular chamber may contribute to the development of chronic fatigue as a constitutional factor in a considerable number of CFS patients.

 

Source: Miwa K, Fujita M. Cardiovascular dysfunction with low cardiac output due to a small heart in patients with chronic fatigue syndrome. Intern Med. 2009;48(21):1849-54. Epub 2009 Nov 2. https://www.ncbi.nlm.nih.gov/pubmed/19881233

 

Randomized controlled study on influence of acupuncture for life quality of patients with chronic fatigue syndrome

Abstract:

OBJECTIVE: To observe effects of acupuncture on quality of life of patients with chronic fatigue syndrome (CFS).

METHODS: Randomized, controlled and single-blinded study method was used, 70 cases were divided into an observation group and a control group, 35 cases in each group. The observation group was treated with acupuncture at Baihui (GV 20), Danzhong (CV 17), Zhongwan (CV 12), Qihai (CV 6), Guanyuan (CV 4), Hegu (LI 4), Zusanli (ST 36), etc.; the control group was treated with acupuncture at non-meridian points (2 cm to the acupoints), thrice a week. The treatment was given for 14 times. The World Health Organization Quality of Life (WHOQOL-BREF) scale was used to evaluate the patients’ quality of life before and after treatment.

RESULTS: The physiological field, individuals own perception of his health condition and total score were significantly improved after treatment in the observation group (all P<0.05); there were no obvious changes in the psychology, social relationships, environment and subjective feelings about the quality of life (all P>0.05). The score of the environmental field in the control group was significantly decreased compared to that before treatment (P<0.05), and there were no significant changes in the other scores. There were no adverse effects in patients.

CONCLUSION: Acupuncture can improve the quality of life of CFS patients, especially in physiological field and the individual perception to his well being. Acupuncture has high safety, and the acupoints has high specific degree than non-meridian points.

 

Source: Wang JJ, Song YJ, Wu ZC, Chu XO, Wang QM, Wei LN, Wang XJ, Meng H. Randomized controlled study on influence of acupuncture for life quality of patients with chronic fatigue syndrome. Zhongguo Zhen Jiu. 2009 Oct;29(10):780-4. [Article in Chinese] https://www.ncbi.nlm.nih.gov/pubmed/19873911

 

A case of chronic fatigue syndrome triggered by influenza H1N1 (swine influenza)

Abstract:

This case report describes an adolescent boy who was diagnosed as suffering from chronic fatigue syndrome 5 months after infection with H1N1 influenza.

 

Source: Vallings R. A case of chronic fatigue syndrome triggered by influenza H1N1 (swine influenza) .J Clin Pathol. 2010 Feb;63(2):184-5. doi: 10.1136/jcp.2009.071944. Epub 2009 Oct 26. https://www.ncbi.nlm.nih.gov/pubmed/19858526