31P-mr spectroscopy of peripheral skeletal musculature under load: demonstration of normal energy metabolites compared with metabolic muscle diseases

Abstract:

PURPOSE: 31P-MR spectroscopy of skeletal muscle under exercise was used to obtain the range of normal variation and comparison was made for different neuromuscular diseases.

METHODS: 41 examinations of 24 volunteers and 41 investigations in 35 patients were performed on 1.5 T MR systems (Gyroscan 515 und S15/ACSII, Philips). Localised 31P-MR spectra of the calf muscle were obtained in time series with a resolution of 12 s.

RESULTS: Two types of muscle energy metabolism were identified from the pattern of spectroscopic time course in volunteers: While the first group was characterised by a remarkable decline to lower pH values during exercise, the second group showed only small pH shifts (minimum pH: 6.48 +/- 0.13 vs 6.87 +/- 0.07, p < 10(-6)) although comparable workload conditions were maintained. The pH-values correlated well with blood lactate analysis. Patients with metabolic disorders and chronic fatigue syndrome (CFS) showed decreased resting values of PCr/(PCr + Pi) and increased pH levels during exercise. PCr recovery was significantly delayed (0.31 vs 0.65 min-1, p < 0.00005) in metabolic muscle disorders but was normal in CFS patients.

CONCLUSION: Findings in volunteers indicate utilisation of different metabolic pathways which seems to be related to the fibre type composition of muscle. Reduced resting levels for PCr/(PCr + Pi), altered pH time courses, and decreased PCr recovery seem to be helpful indicators for diagnosis of metabolic muscle disorders.

Source: Block W, Träber F, Kuhl CK, Keller E, Lamerichs R, Karitzky J, Rink H, Schild HH. 31P-mr spectroscopy of peripheral skeletal musculature under load: demonstration of normal energy metabolites compared with metabolic muscle diseases. Rofo. 1998 Mar;168(3):250-7. [Article in German] http://www.ncbi.nlm.nih.gov/pubmed/9551111

Putting the rest cure to rest—again

Go home and rest” is still the advice given to many patients who complain of chronic fatigue. The refrain is echoed in self help books and magazines and adopted by many patients. What are the origins of rest as a treatment, does it work, and what evidence is there on which to base our advice to patients?

Victorian physicians diagnosed them as neurasthenia and routinely prescribed rest. This approach was typified by Silas Weir Mitchell’s “rest cure,” which was so popular as to be described as “the greatest advance of which practical medicine can boast in the last quarter of the century.” Despite such accolades, the popularity of the rest cure was short lived. By the turn of the century the same private clinics that once provided it were changing to more active treatments and to the newer psychotherapies. The years that followed saw the end of the rest cure; Karl Menninger poured scorn on the lack of psychological sophistication shown by its proponents, while Richard Asher drew attention to the “the dangers of going to bed.”

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1112768/

Comment in:

Treating chronic fatigue with exercise. Exercise improves mood and sleep. [BMJ. 1998]

Treating chronic fatigue with exercise. Exercise, and rest, should be tailored to individual needs. [BMJ. 1998]

Treating chronic fatigue with exercise. Results are contradictory for patients meeting different diagnostic criteria. [BMJ. 1998]

 

Source: Sharpe M, Wessely S. Putting the rest cure to rest—again. BMJ. 1998 Mar 14;316(7134):796. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1112768/ (Full article)

 

Lack of seasonal variation of symptoms in patients with chronic fatigue syndrome

Abstract:

Several of the symptoms involved in chronic fatigue syndrome (CFS) such as fatigue, hypersomnia, hyperphagia, weight gain, and mood show seasonal variations in the general population. The aim of this study was to investigate whether patients with CFS experience seasonal fluctuations in these symptoms as well.

Seasonal variation of symptoms was assessed in a group of 41 patients with CFS and 41 controls closely matched for age, gender, and city of residence. Participants were recruited across the US and were asked to complete the Seasonal Pattern Assessment Questionnaire (SPAQ) and the Profile of Mood States (POMS). CFS patients showed significantly lower scores on multiple SPAQ-derived measures as compared with controls. These included seasonal variation in energy, mood, appetite, weight, and sleep length.

Patients also reported a significantly reduced sensitivity toward sunny, dry, and long days than controls. No association was noted between intensity of seasonal changes and severity of depressive symptoms. Patients with CFS exhibit an abnormally reduced seasonal variation in mood and behavior and would not be expected to benefit from light therapy.

 

Source: García-Borreguero D, Dale JK, Rosenthal NE, Chiara A, O’Fallon A, Bartko JJ, Straus SE. Lack of seasonal variation of symptoms in patients with chronic fatigue syndrome. Psychiatry Res. 1998 Feb 9;77(2):71-7. http://www.ncbi.nlm.nih.gov/pubmed/9541142

 

Muscle fibre characteristics and lactate responses to exercise in chronic fatigue syndrome

Abstract:

OBJECTIVES: To examine the proportions of type 1 and type 2 muscle fibres and the degree of muscle fibre atrophy and hypertrophy in patients with chronic fatigue syndrome in relation to lactate responses to exercise, and to determine to what extent any abnormalities found might be due to inactivity.

METHODS: Quadriceps needle muscle biopsies were obtained from 105 patients with chronic fatigue syndrome and the proportions of type 1 and 2 fibres and fibre atrophy and hypertrophy factors were determined from histochemical preparations, using a semiautomated image analysis system. Forty one randomly selected biopsies were also examined by electron microscopy. Lactate responses to exercise were measured in the subanaerobic threshold exercise test (SATET).

RESULTS: Inactivity would be expected to result in a shift to type 2 fibre predominance and fibre atrophy, but type 1 predominance (23%) was more common than type 2 predominance (3%), and fibre atrophy was found in only 10.4% of cases. Patients with increased lactate responses to exercise did have significantly fewer type 1 muscle fibres (p<0.043 males, p<0.0003 females), but there was no evidence that this group was less active than the patients with normal lactate responses. No significant ultrastructural abnormalities were found.

CONCLUSION: Muscle histometry in patients with chronic fatigue syndrome generally did not show the changes expected as a result of inactivity. However, patients with abnormal lactate responses to exercise had a significantly lower proportion of mitochondria rich type 1 muscle fibres.

 

Source: Lane RJ, Barrett MC, Woodrow D, Moss J, Fletcher R, Archard LC. Muscle fibre characteristics and lactate responses to exercise in chronic fatigue syndrome. J Neurol Neurosurg Psychiatry. 1998 Mar;64(3):362-7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2169994/ (Full article)

 

Magnesium deficit in a sample of the Belgian population presenting with chronic fatigue

Abstract:

97 patients (25 per cent males, ages ranging from 14 to 73 years, median 38 years) with complaints of chronic fatigue (chronic fatigue syndrome, fibromyalgia or/and spasmophilia) have been enrolled in a prospective study to evaluate the Mg status and the dietary intake of Mg. An IV loading test (performed following the Ryzen protocol) showed a Mg deficit in 44 patients.

After Mg supplementation in 24 patients, the loading test showed a significant decrease (p = 0.0018) in Mg retention. Mean values of serum Mg, red blood cell Mg and magnesuria showed no significant difference between patients with or without Mg deficiency.

No association was found between Mg deficiency, CFS or FM. However serum Mg level was significantly lower in the patients with spasmophilia than in the other patients.

 

Source: Moorkens G, Manuel y Keenoy B, Vertommen J, Meludu S, Noe M, De Leeuw I. Magnesium deficit in a sample of the Belgian population presenting with chronic fatigue. Magnes Res. 1997 Dec;10(4):329-37. http://www.ncbi.nlm.nih.gov/pubmed/9513929

 

 

 

 

Core body temperature is normal in chronic fatigue syndrome

Abstract:

BACKGROUND: Subjects with chronic fatigue syndrome (CFS) frequently report symptoms of subnormal body temperature and low-grade fever. We conducted a study to determine whether CFS subjects manifest any abnormality of core body temperature (CBT) that might help explain their fatigue.

METHODS: Continuous 24-hour recordings of CBT measured every 5 min were performed in 7 subjects meeting the Centers for Disease Control definition of CFS. Three additional groups were studied: normal controls, subjects with seasonal allergy, and subjects with major depression. Subjects (n = 7) in each group were age-, sex-, and weight-matched to the CFS group and had normal basal metabolic rates, thyroid function, and 24-hour urinary free cortisol excretions. CBT was measured with an ingestible radio frequency transmitter pill and a belt-worn receiver-logger. Each pill was factory-calibrated to +/- 0.1 degree C and field-calibrated with a water bath calibration prior to use.

RESULTS: The 24-hour mean calibration-adjusted CBTs of each group were not significantly different (control: 37.00 +/- 0.17 degrees C; CFS: 37.04 +/- 0.31 degrees C; allergy: 37.15 +/- 0.18 degrees C; depression: 37.16 +/- 0.18 degrees C). Similarly, the mean peak and trough circadian temperatures were not statistically different. The mean 24-hour profile of CBT for each group showed a similar circadian rhythm. In simultaneously collected blood samples, each group showed a similar circadian profile of serum cortisol with a peak occurring at 08:00.

CONCLUSIONS: Subjects with CFS have normal CBT despite frequent self-reports of subnormal body temperature and low-grade fever.

 

Source: Hamilos DL, Nutter D, Gershtenson J, Redmond DP, Clementi JD, Schmaling KB, Make BJ, Jones JF. Core body temperature is normal in chronic fatigue syndrome. Biol Psychiatry. 1998 Feb 15;43(4):293-302. http://www.ncbi.nlm.nih.gov/pubmed/9513740

 

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

 

Increased illness experience preceding chronic fatigue syndrome: a case control study

Abstract:

BACKGROUND: Almost all published work on chronic fatigue syndrome (CFS) has involved retrospective surveys of cases, which may introduce recall bias. Only medical records collected before diagnosis of CFS can eliminate this.

METHODS: Using data collected several years prior to the development of the illness, we performed a case control study, comparing the reported illness records of all people who subsequently made an insurance claim as a result of CFS, with those of future multiple sclerosis (MS) claimants, and those of non-claimant controls (NC).

RESULTS: The study encompassed 133 CFS, 75 MS and 162 NC cases. CFS cases had recorded significantly more illnesses at time of proposal for insurance than the two control groups, and had significantly more claims between proposal and diagnosis of their disorder. Almost all disease categories were reported higher in future CFS sufferers, lethargy having the highest odds ratio after adjustment in a multivariate model.

INTERPRETATION: The results of this paper on CFS patients who claim permanent health insurance do not support a specific viral or immunological explanation for CFS. We conclude that abnormal illness behaviour is of greater importance than previously recognised.

Comment in:

Increased illness experience preceding chronic fatigue syndrome. [J R Coll Physicians Lond. 1998]

Increased illness experience preceding chronic fatigue syndrome. [J R Coll Physicians Lond. 1998]

 

Source: Hall GH, Hamilton WT, Round AP. Increased illness experience preceding chronic fatigue syndrome: a case control study. J R Coll Physicians Lond. 1998 Jan-Feb;32(1):44-8. http://www.ncbi.nlm.nih.gov/pubmed/9507441

Long- and short-term blood pressure and RR-interval variability and psychosomatic distress in chronic fatigue syndrome

Abstract:

1. Chronic low blood pressure has been associated with fatigue and low mood. However, in the chronic fatigue syndrome (CFS) the blood pressure (BP) and heart rate profile and their variabilities have not been characterized as yet.

2. We performed office and 24 h ambulatory BP recordings in 38 subjects (age, 34.8 +/- 8.0 years) who fulfilled the Holmes criteria for CFS and in 38 healthy control subjects (age 35.6 +/- 10.5 years), as well as short-term beat-to-beat BP and RR-interval recordings for 10 min in supine and standing position, and calculated spectral indices.

3. In CFS office (123 +/- 19/70 +/- 12 mmHg) as well as 24-h, day- and night-time blood pressure values (116 +/- 11.1/71 +/- 11.1, 121 +/- 9.2/77 +/- 8.0 and 110 +/- 10.5/65 +/- 9.2 mmHg respectively) were within reference limits.

4. Heart rate was consistently higher (P < 0.01) in CFS patients, based on both office (77 +/- 12 compared with 68 +/- 12 beats min-1) and 24 h ambulatory recordings (77 +/- 12 compared with 67 +/- 15 beats min-1).

5. In supine position, spectral indices of BP variability (total, low-frequency and high-frequency variances) were all significantly (P < 0.01) lower in CFS. In standing position the differences disappeared. Analysis of RR-interval variability could not detect major alterations in autonomic function in CFS.

Comment in: Long- and short-term blood pressure and RR-interval variability and psychosomatic distress in chronic fatigue syndrome. [Clin Sci (Lond). 1999]

 

Source: Duprez DA, De Buyzere ML, Drieghe B, Vanhaverbeke F, Taes Y, Michielsen W, Clement DL. Long- and short-term blood pressure and RR-interval variability and psychosomatic distress in chronic fatigue syndrome. Clin Sci (Lond). 1998 Jan;94(1):57-63. http://www.ncbi.nlm.nih.gov/pubmed/9505867

 

Hypnosis in chronic fatigue syndrome

Chronic fatigue syndrome (CFS) is characterized by medically unexplained chronic and disabling physical and mental fatigue. There is growing evidence of organic abnormalities 2 but the involvement of psychological factors in its aetiology and chronicity should also be recognized 3.

One approach to the complaint assumes it is post-viral in origin with psychiatric and social antecedents 4. The sufferer attributes the fatigue and myalgia which persist beyond an initial infectious episode to a continuing viral infection, and interprets them as indicating that activity hinders recovery. A vicious circle is established in which avoidance of activity leads to deconditioning, depression and the perpetuation of symptoms. This view has encouraged the use of cognitive behaviour therapy to increase exercise in graded stages by inducing a more positive attitude towards activity an approach that has met with encouraging results5. Nevertheless, it would seem wrong to attribute CFS entirely to inactivity and sufferers’ illness attributions, if only because there are sufferers who are moderately active and working part-time. Such a model also has difficulty explaining why the symptoms fluctuate within a day, or over longer periods. Furthermore, many sufferers strongly believe that exercise, even in a carefully controlled schedule, will make them feel ill and prolong the complaint. They refuse to contemplate any such therapy 6.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1296740/pdf/jrsocmed00033-0038.pdf

 

Source: Gregg VH. Hypnosis in chronic fatigue syndrome. J R Soc Med. 1997 Dec;90(12):682-3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1296740/