Tag: 2000

Nighttime sleep and daytime functioning (sleepiness and fatigue) in less well-defined chronic rheumatic diseases with particular reference to the ‘alpha-delta NREM sleep anomaly’

Abstract:

For the past 25 years, the ‘alpha-delta NREM sleep abnormality’ has been used by some as a defining or legitimizing marker for poorly defined rheumatic diseases such as fibromyalgia and chronic fatigue syndrome. Comprehensive review of the literature reveals no support for such a conclusion. Most studies involve small numbers of patients. The lack of control subjects, non-standardized recording techniques, and confusion between tonic and phasic alpha frequency activity patterns make comparison difficult.

There is much evidence that this sleep EEG pattern is not only non-specific, but may actually reflect a sleep maintaining process. The ‘sleep fragmentation’ theory of the complaint of non-restorative sleep in this patient population is invalidated by the fact that conditions characterized by severe sleep fragmentation, such as obstructive sleep apnea, are not associated with musculoskeletal symtoms. It is difficult to attribute musculoskeletal symptoms to disorders of sleep in view of the fact that the only organ of the body known to benefit from sleep, or to be adversely affected by lack of sleep, is the brain. It is concluded that fibromyalgia and chronic fatigue syndrome are associated with subjective sleep complaints, but do not represent sleep disorders.

 

Source: Mahowald ML, Mahowald MW. Nighttime sleep and daytime functioning (sleepiness and fatigue) in less well-defined chronic rheumatic diseases with particular reference to the ‘alpha-delta NREM sleep anomaly’. Sleep Med. 2000 Jul 1;1(3):195-207. http://www.ncbi.nlm.nih.gov/pubmed/10828430

 

The difference in patterns of motor and cognitive function in chronic fatigue syndrome and severe depressive illness

Abstract:

BACKGROUND: Chronic fatigue syndrome (CFS) and major depressive disorder (MDD) share many symptoms and aetiological factors but may have different neurobiological underpinnings. We wished to determine the profile of the biological variables disturbed in CFS and MDD, and identify any critical factors that differentiate the disorders.

METHODS: Thirty patients with CFS, 20 with MDD and 15 healthy controls matched group-wise for age and sex were recruited. Subjects were given a detailed battery of motor and cognitive tests, including measures of psychomotor speed, memory and maximal voluntary muscle contraction in both the morning and evening that were balanced to avoid order effects.

RESULTS: CFS patients generally performed worse on cognitive tests than healthy controls, but better than patients with MDD. Both patient groups had markedly impaired motor function compared with healthy controls. MDD subjects showed a significantly greater diurnal improvement in maximal voluntary contraction than healthy controls.

CONCLUSIONS: Patients with CFS and MDD show similarly substantial motor impairment, but cognitive deficits are generally more marked in MDD. Diurnal changes in some functions in MDD may differentiate the disorder from CFS.

 

Source: Lawrie SM, MacHale SM, Cavanagh JT, O’Carroll RE, Goodwin GM. The difference in patterns of motor and cognitive function in chronic fatigue syndrome and severe depressive illness. Psychol Med. 2000 Mar;30(2):433-42. http://www.ncbi.nlm.nih.gov/pubmed/10824663

 

Demonstration of borna disease virus nucleic acid in a patient with chronic fatigue syndrome

Comment on: Borna disease virus in human brains with a rare form of hippocampal degeneration but not in brains of patients with common neuropsychiatric disorders. [J Infect Dis. 1999]

 

To the Editor

Czygan et al. [1]reported the detection of Borna disease virus (BDV) nucleic acid in 3 cases of a rare form of hippocampal degeneration, whereas the brains of patients with other neuropsychiatric disorders tested negative for BDV. Chronic fatigue syndrome (CFS) is another, more frequently diagnosed neuropsychiatric disease that is associated with BDV infection. However, the published findings are highly controversial. Nakaya et al. [2, 3] and Kitani et al. [4] showed both BDV-specific antibodies and RNA in a high percentage of Japanese patients with CFS. Bode et al. [5]isolated BDV from peripheral blood mononuclear cells (PBMC) of an American patient with CFS; however, in an earlier publication, Bode et al. [6], as well as Evengård et al. [7] and Yamaguchi et al. [8] in recent publications, did not find serologie evidence for BDV in patients with CFS. A possible explanation for the controversial results is that the term “chronic fatigue syndrome” probably includes several similar clinical conditions that may have different etiologies. In the study by Czygan et al. [1], brain tissue samples from patients who had CFS were not included. Unfortunately, none of the BDV sequences of the CFS cases mentioned above are available in the GenBank database.

You can read the rest of this comment here: http://jid.oxfordjournals.org/content/181/5/1860.long

 

Source: Nowotny N, Kolodziejek J. Demonstration of borna disease virus nucleic acid in a patient with chronic fatigue syndrome. J Infect Dis. 2000 May;181(5):1860-2. http://jid.oxfordjournals.org/content/181/5/1860.long (Full article)

 

Cognitive behaviour therapy for adults with chronic fatigue syndrome

Update in: Cognitive behaviour therapy for chronic fatigue syndrome in adults. [Cochrane Database Syst Rev. 2008]

 

Abstract:

OBJECTIVES: 1. To systematically review all randomised controlled trials of cognitive-behaviour therapy (CBT) for adults with chronic fatigue syndrome (CFS); 2. To test the hypothesis that CBT is more effective than orthodox medical management or other interventions in adults with CFS.

SEARCH STRATEGY: 1. Electronic searching of bibliographic databases, including Medline, PsycLIT, Biological Abstracts, Embase, SIGLE, Index to Theses, Index to Scientific and Technical Proceedings, and Science Citation Index, using multiple search terms in order to perform a highly sensitive search. 2. Electronic searching of the Trials Register of the Depression, Anxiety and Neurosis group. 3. Citation lists of relevant studies and reviews were perused for other relevant trials. 4. Contact with the principal authors of relevant studies, and with researchers in the field.

SELECTION CRITERIA: All randomised controlled trials were included in which – adult patients with CFS; – received CBT or a control intervention, being either orthodox medical management or another intervention; – and whose outcomes were assessed in an appropriate way. CBT could be either type ‘A’ (encouraging return to ‘normal’ levels of rest and activity) or type ‘B’ (encouraging rest and activity which were within levels imposed by the disorder).’

DATA COLLECTION AND ANALYSIS: The two reviewers worked independently throughout the selection of trials and data extraction, comparing findings only when there was disagreement. Relevant trials were allocated to one of three quality categories. Full data extraction, using a standardised data extraction sheet, was performed on studies which were of high or moderate quality. Trials of low quality were excluded from the review. The comparisons made to test the review hypothesis were of type ‘A’ CBT versus other intervention(s), and of type ‘B’ CBT versus other intervention(s). Functional outcome was used as the main outcome for comparison, but other appropriate outcomes were compared where possible. Results were synthesised using the Review Manager software. For dichotomous data, the odds ratio was calculated for each study. For continuous data, effect sizes were obtained and the standardised mean difference, with 95% confidence intervals, was calculated.

MAIN RESULTS: Only three relevant trials of adequate quality were found. These trials demonstrated that CBT significantly benefits physical functioning in adult out-patients with CFS when compared to orthodox medical management or relaxation. It is necessary to treat about two patients to prevent one additional unsatisfactory physical outcome about six months after treatment end. CBT appeared highly acceptable to the patients in these trials. There is no satisfactory evidence for the effectiveness of CBT in patients with the milder forms of CFS found in primary care or in patients who are so disabled that they are unable to attend out-patients. Additionally, there is no satisfactory evidence for the effectiveness of group CBT.

REVIEWER’S CONCLUSIONS: Cognitive behaviour therapy appears to be an effective and acceptable treatment for adult out-patients with chronic fatigue syndrome. CFS is a common and disabling disorder. Its sufferers deserve the medical profession to be more aware of the potential of this therapy to bring lasting functional benefit, and health service managers to increase its availability. Further research is needed in this important area. Trials should conform to accepted standards of reporting and methodology. The effectiveness of CBT in more and less severely disabled patients than those usually seen in out-patient clinics needs to be assessed. Trials of group CBT and in-patient CBT compared to orthodox medical management, and of CBT compared to graded activity alone, also need to be conducted.

 

Source: Price JR, Couper J. Cognitive behaviour therapy for adults with chronic fatigue syndrome. Cochrane Database Syst Rev. 2000;(2):CD001027. http://www.ncbi.nlm.nih.gov/pubmed/10796733

Personality in adolescents with chronic fatigue syndrome

Abstract:

Our aim was to study the presence of personality traits and disorder in adolescents with Chronic Fatigue Syndrome (CFS). Personality was then compared to other measures of functioning such as presence of psychiatric disorder and rating on the Child Behavior Checklist 4-18 (CBCL) and in relation to CFS outcome.

Twenty-five adolescents with CFS followed-up after contacts with tertiary paediatric/psychiatric clinics were compared with 15 matched healthy controls. Interviews and questionnaires from parents and youngsters included Personality Assessment Schedule (PAS), Kiddie-SADS Psychiatric Interview, Child Behavior Checklist. CFS subjects were significantly more likely than controls to have personality difficulty or disorder.

Personality features significantly more common amongst them were conscientiousness, vulnerability, worthlessness and emotional lability. There was a nonsignificant association between personality disorder and worse CFS outcome. Personality difficulty or disorder was significantly associated with psychological symptoms and decreased social competence on the CBCL but it was distinguishable from episodic psychiatric disorder. Personality difficulty and disorder are increased in adolescents with a history of CFS. Personality disorder may be linked to poor CFS outcome.

 

Source: Rangel L, Garralda E, Levin M, Roberts H. Personality in adolescents with chronic fatigue syndrome. Eur Child Adolesc Psychiatry. 2000 Mar;9(1):39-45. http://www.ncbi.nlm.nih.gov/pubmed/10795854

 

Elevated, sustained peroxynitrite levels as the cause of chronic fatigue syndrome

Abstract:

The etiology of chronic fatigue syndrome (CFS) has been both obscure and highly contentious, leading to substantial barriers to both clear diagnosis and effective treatment.

I propose here a novel hypothesis of CFS in which either viral or bacterial infection induces one or more cytokines, IL-1beta IL-6, TNF-alpha and IFN-gamma. These induce nitric oxide synthase (iNOS), leading to increased nitric oxide levels. Nitric oxide, in turn, reacts with superoxide radical to generate the potent oxidant peroxynitrite. Multiple amplification and positive feedback mechanisms are proposed by which once peroxynitrite levels are elevated, they tend to be sustained at a high level.

This proposed mechanism may lower the HPA axis activity and be maintained by consequent lowered glucocorticoid levels. Similarities are discussed among CFS and autoimmune and other diseases previously shown to be associated with elevated peroxynitrite. Multiple pharmacological approaches to the treatment of CFS are suggested by this hypothesis.

Comment in: Nitric oxide and the etiology of chronic fatigue syndrome: giving credit where credit is due. [Med Hypotheses. 2005]

 

Source: Pall ML. Elevated, sustained peroxynitrite levels as the cause of chronic fatigue syndrome. Med Hypotheses. 2000 Jan;54(1):115-25. http://www.ncbi.nlm.nih.gov/pubmed/10790736

 

The symptoms of chronic fatigue syndrome are related to abnormal ion channel function

Abstract:

The pathogenesis of chronic fatigue syndrome (CFS) is unknown but one of the most characteristic features of the illness is fluctuation in symptoms which can be induced by physical and/or mental stress. Other conditions in which fluctuating fatigue occurs are caused by abnormal ion channels in the cell membrane.

These include genetically determined channelopathies, e.g. hypokalemic periodic paralysis, episodic ataxia type 2 and acquired conditions such as neuromyotonia, myasthenic syndromes, multiple sclerosis and inflammatory demyelinating polyneuropathies.

Our hypothesis is that abnormal ion channel function underlies the symptoms of CFS and this is supported also by the finding of abnormal cardiac-thallium201 SPECT scans in CFS, similar to that found in syndrome X, another disorder of ion channels. CFS and syndrome X can have identical clinical symptoms. CFS may begin after exposure to specific toxins which are known to produce abnormal sodium ion channels.

Finally, in CFS, increased resting energy expenditure (REE) occurs, a state influenced by transmembrane ion transport. The hypothesis that ion channels are abnormal in CFS may help to explain the fluctuating fatigue and other symptoms.

Comment in:

Chronic fatigue syndrome and channelopathies. [Med Hypotheses. 2000]

Re: Letter from professors Waxman and Ptacek (Med Hypotheses 2000; 55: 457). [Med Hypotheses. 2000]

 

Source: Chaudhuri A, Watson WS, Pearn J, Behan PO. The symptoms of chronic fatigue syndrome are related to abnormal ion channel function. Med Hypotheses. 2000 Jan;54(1):59-63. http://www.ncbi.nlm.nih.gov/pubmed/10790725

 

Attributions in chronic fatigue syndrome and fibromyalgia syndrome in tertiary care

Abstract:

OBJECTIVE: To evaluate the attributions of patients with chronic fatigue syndrome (CFS) and fibromyalgia (FM) consulting at a university fatigue and pain clinic.

METHODS: Consecutive attenders (n = 192) who met the CFS criteria (n = 95) or FM criteria (n = 56) or who had medically unexplained chronic pain and/or fatigue without meeting both criteria (CPF) (n = 41) were evaluated. All subjects completed an extended form of the Cause of Illness Inventory. Descriptive statistics, frequency analyses, chi-square tests, one-way analysis of variance, and sequential Fisher least significant difference tests were performed.

RESULTS: In total, 48 patients reported physical causes only and 10 patients psychosocial causes only; the majority (70%) mentioned both types of causes. With regard to the contents, “a chemical imbalance in my body” (61%), “a virus” (51%), “stress” (61%), and “emotional confusion” (40%) were reported most frequently. The diagnostic label did not have a significant influence on number and type of attributions. Small to moderate effect sizes were registered concerning the association of specific attributions and diagnosis, sex, duration of the symptoms, contact with a self-help group, and premorbid depression.

CONCLUSION: The majority of patients with CFS, FM, and CPF reported a great diversity of attributions open to a preferably personalized cognitive behavioral approach. Special attention should be paid to patients with symptoms existing for more than one year and those who had previous contacts with a self-help group. They particularly show external, stable, and global attributions that may compromise feelings of self-efficacy in dealing with the illness.

 

Source: Neerinckx E, Van Houdenhove B, Lysens R, Vertommen H, Onghena P. Attributions in chronic fatigue syndrome and fibromyalgia syndrome in tertiary care. J Rheumatol. 2000 Apr;27(4):1051-5. http://www.ncbi.nlm.nih.gov/pubmed/10782836

 

Integrity of the growth hormone/insulin-like growth factor system is maintained in patients with chronic fatigue syndrome

Abstract:

GH deficiency states and chronic fatigue syndrome (CFS) share several characteristics, and preliminary studies have revealed aspects of GH dysfunction in CFS.

This study assessed indexes of GH function in 37 medication-free CFS patients without comorbid psychiatric illness and 37 matched healthy controls. We also assessed GH function before and after treatment with low dose hydrocortisone, which has been shown recently to reduce fatigue in CFS. We measured basal levels of serum insulin-like growth factor I (IGF-I), IGF-II, IGF-binding protein-1 (IGFBP-1), IGFBP-2 and IGFBP-3 together with 24-h urinary GH excretion. We also performed 2 dynamic tests of GH function: a 100-microg GHRH test and an insulin stress test using 0.15 U/kg BW insulin.

There were no differences between patients and controls in basal levels of IGF/IGFBP or in urinary GH excretion. GH responses to both the GHRH test and the insulin stress test were no different in patients and controls.

CFS patients did have a marginally reduced suppression of IGFBP-1 during the insulin stress test. Hydrocortisone treatment had no significant effect on any of these parameters. There is no evidence of GH deficiency in CFS. At the doses used, hydrocortisone treatment appears to have little impact on GH function.

 

Source: Cleare AJ, Sookdeo SS, Jones J, O’Keane V, Miell JP. Integrity of the growth hormone/insulin-like growth factor system is maintained in patients with chronic fatigue syndrome. J Clin Endocrinol Metab. 2000 Apr;85(4):1433-9. http://www.ncbi.nlm.nih.gov/pubmed/10770178

 

Nutritional strategies for treating chronic fatigue syndrome

Abstract:

Despite considerable worldwide efforts, no single etiology has been identified to explain the development of chronic fatigue syndrome (CFS). It is likely that multiple factors promote its development, sometimes with the same factors both causing and being caused by the syndrome.

A detailed review of the literature suggests a number of marginal nutritional deficiencies may have etiologic relevance. These include deficiencies of various B vitamins, vitamin C, magnesium, sodium, zinc, L-tryptophan, L-carnitine, coenzyme Q10, and essential fatty acids. Any of these nutrients could be marginally deficient in CFS patients, a finding that appears to be primarily due to the illness process rather than to inadequate diets. It is likely that marginal deficiencies not only contribute to the clinical manifestations of the syndrome, but also are detrimental to the healing processes.

Therefore, when feasible, objective testing should identify them and their resolution should be assured by repeat testing following initiation of treatment. Moreover, because of the rarity of serious adverse reactions, the difficulty in ruling out marginal deficiencies, and because some of the therapeutic benefits of nutritional supplements appear to be due to pharmacologic effects, it seems rational to consider supplementing CFS patients with the nutrients discussed above, along with a general high-potency vitamin/mineral supplement, at least for a trial period.

Comment in: Nutritional strategies for treating chronic fatigue syndrome. [Altern Med Rev. 2001]

 

Source: Werbach MR. Nutritional strategies for treating chronic fatigue syndrome. Altern Med Rev. 2000 Apr;5(2):93-108. http://www.altmedrev.com/publications/5/2/93.pdf (Full article)