Biochemical and muscle studies in patients with acute onset post-viral fatigue syndrome

Abstract:

AIMS: To investigate in detail various biochemical and pathophysiological indices of muscle pathology in acute onset post-viral fatigue syndrome (PVFS).

METHODS: Twenty three patients with PVFS (of mean duration 4.6 years) were subjected to needle biopsy for histomorphometry and total RNA contents. Plasma analysis included serology and creatine kinase activities. Indices of whole body mass were also measured–namely, whole body potassium content and plasma carnosinase activities.

RESULTS: About 80% of the patients had serology indicative of persistent enteroviral infection as determined by VP1 antigen assay. Only about 10% of that same group of patients had serological indications of current enterovirus infection by IgM assay; a separate subset of 10% showed antibody changes suggestive of reactivation of Epstein-Barr virus. Quantitative morphometric analysis of skeletal muscle fibres indicated that the quadriceps muscle was normal or displayed only minor abnormalities in 22 patients. The Quetelet’s Index (body mass index) and whole-body potassium values (index of lean body mass) were not affected in PVFS. The mean plasma carnosinase and creatinine kinase activities were also generally normal in these patients. The mean muscle RNA composition–mg RNA/mg DNA: was significantly reduced in acute onset PVFS by about 15%. The protein:DNA ratio was not significantly affected.

CONCLUSIONS: Patients with acute onset PVFS, therefore, lose muscle protein synthetic potential, but not muscle bulk. Histopathology is consistent with these observations. These perturbations may contribute to the apparent feature of perceived muscle weakness associated with the persistent viral infection in the muscle themselves.

 

Source: Preedy VR, Smith DG, Salisbury JR, Peters TJ. Biochemical and muscle studies in patients with acute onset post-viral fatigue syndrome. J Clin Pathol. 1993 Aug;46(8):722-6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC501456/

 

Chronic fatigue syndrome

Comment on: The chronic fatigue syndrome: what do we know? [BMJ. 1993]

 

Editor,-In P K Thomas’s succinct review of chronic fatigue syndrome, the extensive morbidity, misery, and misinformation that exists around this subject is not stated. The present situation is also not helped by the majority of medical practitioners having no education in, and little experience of, managing this common disorder.

Irrespective of the cause or the emotional response this syndrome produces in professionals, it creates considerable disability in our communities. The overall prevalence of people who suffer with intrusive fatigue is estimated at 150 000. Many of these (as yet unmeasured) are debilitated to such an extent that they are unable to work and are dependent on carers. It is interesting to note that within the NHS there is at the moment no single unit dedicated or equipped to assess, treat, and provide long term support for such patients. Limited facilities have been provided in beds that are earmarked for other disorders.

You can read the rest of this comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1678593/pdf/bmj00032-0058b.pdf

 

Source: Cox DL, Findley LJ. Chronic fatigue syndrome. BMJ. 1993 Jul 31;307(6899):328. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1678593/

 

Insomnia in the chronic fatigue syndrome

Editor,-Iain Duncan is mistaken in his assertion that the results of our study of patients with the chronic fatigue syndrome can be explained by daytime dozing. According to data from the diaries kept by the subjects in the study, the patients with the chronic fatigue syndrome slept for a mean of 11 minutes during the day and the healthy controls for 0 minutes. There was no association between either the time spent asleep or the time spent resting in bed during the day and the presence of any sleep disorder (or the time spent awake after the onset of sleep at night) in the patients with the chronic fatigue syndrome or the normal controls. Furthermore, in the few patients with the syndrome who wore their polysomnograph for the whole 24 hours there was no association between time spent asleep during the day and the time spent awake after the onset of sleep.

You can read the rest of this comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1678179/pdf/bmj00031-0056a.pdf

 

Source: Morriss R. Insomnia in the chronic fatigue syndrome. BMJ. 1993 Jul 24;307(6898):264. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1678179/

 

Human herpesvirus 6 and chronic fatigue syndrome

Abstract:

The cause of chronic fatigue syndrome (CFS) is still enigmatic. Using indirect immunofluorescence testing for measuring antibody against human herpesvirus 6 (HHV-6), this study investigated the association of CFS with infection by HHV-6. Seventeen patients (group A) fulfilling the Centers for Disease Control (CDC) definition for CFS were compared with eight patients (group B) with chronic fatigue but not meeting the CDC criteria.

No significant difference was found between the two groups for 30 parameters including sex, age, exposure to children and serology for Epstein-Barr virus, cytomegalovirus, herpes simplex virus, and toxoplasma. Univariate analysis showed that patients in group A complained more frequently of a sore throat, headache and of recurrent type of fatigue.

These three parameters are discriminant in identifying patients who will meet the CDC case definition of CFS. The titre of antibody against HHV-6 in group A (1:99) was significantly higher than in group B (1:15) (P=0.007). Elevated HHV-6 titres suggests that this virus could be a cofactor in the pathogenesis of CFS.

 

Source: Eymard D, Lebel F, Miller M, Turgeon F. Human herpesvirus 6 and chronic fatigue syndrome. Can J Infect Dis. 1993 Jul;4(4):199-202. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3250792/  (Full article)

 

Chronic fatigue: electromyographic and neuropathological evaluation

Abstract:

Single fibre electromyography of extensor digitorum communis muscle (EDC) was performed on 35 patients with chronic fatigue, the majority of whom also had creatine kinase estimation and biopsy of EDC.

The subjects were categorised as having an acute-onset post-viral fatigue syndrome, a non-specific chronic fatigue or possible muscle disease in view of pronounced myalgia.

Of 11 subjects who had myalgia as a significant symptom, abnormalities in fibre density were found in 6, and 5 of these had some non-specific abnormalities on muscle biopsy, with creatine kinase levels being normal in all cases. Fibre density estimation may be a useful way of identifying a subgroup of chronic fatigue sufferers with a possible primary muscle disorder.

 

Source: Connolly S, Smith DG, Doyle D, Fowler CJ. Chronic fatigue: electromyographic and neuropathological evaluation. J Neurol. 1993 Jul;240(7):435-8. http://www.ncbi.nlm.nih.gov/pubmed/8410086

 

Cognitive impairment in patients with chronic fatigue: a preliminary study

Erratum in: J Neurol Neurosurg Psychiatry 1993 Oct;56(10):1142

Abstract:

Subjective impairment of memory and concentration is a frequent complaint in sufferers from chronic fatigue. To study this, 65 general practice attenders identified as having chronic fatigue were administered a structured psychiatric interview and a brief screening battery of cognitive tests.

Subjective cognitive impairment was strongly related to psychiatric disorder, especially depressed mood, but not fatigue, anxiety, or objective performance. Simple tests of attention and concentration showed some impairment but this was influenced by both fatigue and depression.

Subjects with high levels of fatigue performed less well on a memory task requiring cognitive effort, even in the absence of depression. There was no evidence for mental fatiguability. The relationship between depression, fatigue, and cognitive function requires further research.

 

Source: McDonald E, Cope H, David A. Cognitive impairment in patients with chronic fatigue: a preliminary study. J Neurol Neurosurg Psychiatry. 1993 Jul;56(7):812-5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1015065/ (Full article)

 

The chronic fatigue syndrome: what do we know?

Abnormally persistent or recurrent fatigue is a feature of many disorders. Recently, particular attention has been devoted to people whose life is dominated by protracted and disabling fatigue. Such cases are now usually categorised as the chronic fatigue syndrome, the postviral fatigue syndrome, or myalgic encephalomyelitis. Two recent publications bring together current ideas on the topic.

The historical background is important. Although the chronic fatigue syndrome has been advanced as a malaise of the latter part of this century, such cases are not a new phenomenon: they were particularly common during the latter part of the last century. The New York physician George Beard applied the label “neurasthenia” to them although the term was more widely used. After becoming an exceedingly common diagnosis it waned at the time of the first world war.

This first wave in the history of chronic fatigue was followed by a second wave, which can be dated to 1934. Nevertheless, cases of chronic fatigue did not simply disappear in the intervening period. The “effort syndrome” had a considerable vogue at that time. “Fibrositis,” a term introduced by Sir William Gowers in 1894 to designate the occurrence of diffuse muscle aching and pain without detectable explanation, evolved into “fibromyalgia.” This currently popular diagnosis has many overlapping features with the chronic fatigue syndrome, as did the effort syndrome.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1677985/pdf/bmj00024-0007.pdf

 

Comment in:

Functional hypoglycaemia postulated as cause of chronic fatigue syndrome. [BMJ. 1993]

Chronic fatigue syndrome. [BMJ. 1993]

 

Source: Thomas PK. The chronic fatigue syndrome: what do we know? BMJ. 1993 Jun 12;306(6892):1557-8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1677985/

 

ABC of sleep disorders. Sleep problems in patients with medical illness

Sleep complaints are ubiquitous in patients with medical illness. A recent survey of outpatients attending hospital clinics indicated that the vast majority of patients reported sleep disruption concomitant with their condition. The proportion with complaints (> 70%) was more than twice that among control subjects. Doctors rarely ask about sleep problems in the context of medical illness despite the fact that the patient’s first complaint disruption of sleep architecture in may be that a particular symptom caused sleep disruption.

There are specific reasons for sleep disruptions in patients with medical illness-for example, people are often deprived of sleep before an operation. Polysomnography has shown that there is a preoperative of sleep) reduction in slow wave sleep and that this is related to the anticipated importance of surgery. The increase in deep sleep that occurs after an operation is thought to facilitate the healing process.

A variety of sleep variables may be influenced by specific disorders and each of these effects is likely to differ. A decrease in deep (slow wave) sleep, for example, may lead to a sensation of having low energy, whereas repeated interruption of sleep may lead to daytime sleepiness.

Drugs may also disrupt sleep architecture by suppressing rapid eye movement (REM) sleep or by causing a withdrawal effect during the night. In both cases the drug clearly alters sleep, but the impact on health and recovery may differ.

Fatigue is common in several medical conditions. Clinicians, researchers, and patients themselves claim that the fatigue experienced in certain medical conditions differs qualitatively from the experience of tiredness or sleepiness. However, there have been few attempts to separate these states. In this article we provide an overview of the impact of medical disorders on sleep.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1677972/pdf/bmj00023-0050.pdf

 

Source: Shapiro CM, Devins GM, Hussain MR. ABC of sleep disorders. Sleep problems in patients with medical illness. BMJ. 1993 Jun 5;306(6891):1532-5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1677972/

 

Analysis of neuropsychological functioning in patients with chronic fatigue syndrome

Abstract:

Memory impairment dominates the cognitive complaints of patients with chronic fatigue syndrome (CFS). Twenty CFS patients were available for studies with a clinical and experimental battery composed of memory and cognitive tests. The results on objective testing indicated that the CFS patients had some mild memory impairment, but only on tasks requiring conceptually driven encoding and retrieval processes. There were no associations between the nature of the precipitating illness, self ratings of fatigue, physical findings, or laboratory determination and objective memory performance or self report of memory functioning. These generally negative results indicate that memory impairment in CFS patients is typically mild and involves memory processes that participate in conceptualising information.

 

Source: Grafman J, Schwartz V, Dale JK, Scheffers M, Houser C, Straus SE. Analysis of neuropsychological functioning in patients with chronic fatigue syndrome. J Neurol Neurosurg Psychiatry. 1993 Jun;56(6):684-9. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC489620/ (Full article)

 

Amma therapy: a holistic approach to chronic fatigue syndrome

Abstract:

A significant number of people suffering with chronic fatigue syndrome have become more and more discouraged by the traditional medical approach, which seems to lack the proper perspective on the disease. Unfortunately, very little published information is available about specific holistic health management practices used for these patients. It is the purpose of this article to examine a specific holistic practice, called Amma Therapy, as an alternative approach for the management of this syndrome.

 

Source: Young A. Amma therapy: a holistic approach to chronic fatigue syndrome. J Holist Nurs. 1993 Jun;11(2):172-82. http://www.ncbi.nlm.nih.gov/pubmed/8277135