Impairments in cognitive performance in chronic fatigue syndrome are common, not related to co-morbid depression but do associate with autonomic dysfunction

Abstract:

OBJECTIVES: To explore cognitive performance in chronic fatigue syndrome (CFS) examining two cohorts. To establish findings associated with CFS and those related to co-morbid depression or autonomic dysfunction.

METHODS: Identification and recruitment of participants was identical in both phases, all CFS patients fulfilled Fukuda criteria. In Phase 1 (n = 48) we explored cognitive function in a heterogeneous cohort of CFS patients, investigating links with depressive symptoms (HADS). In phase 2 (n = 51 CFS & n = 20 controls) participants with co-morbid major depression were excluded (SCID). Furthermore, we investigated relationships between cognitive performance and heart rate variability (HRV).

RESULTS: Cognitive performance in unselected CFS patients is in average range on most measures. However, 0-23% of the CFS sample fell below the 5th percentile. Negative correlations occurred between depressive symptoms (HAD-S) with Digit-Symbol-Coding (r = -.507, p = .006) and TMT-A (r = -.382, p = .049). In CFS without depression, impairments of cognitive performance remained with significant differences in indices of psychomotor speed (TMT-A: p = 0.027; digit-symbol substitution: p = 0.004; digit-symbol copy: p = 0.007; scanning: p = .034) Stroop test suggested differences due to processing speed rather than inhibition. Both cohorts confirmed relationships between cognitive performance and HRV (digit-symbol copy (r = .330, p = .018), digit-symbol substitution (r = .313, p = .025), colour-naming trials Stroop task (r = .279, p = .050).

CONCLUSION: Cognitive difficulties in CFS may not be as broad as suggested and may be restricted to slowing in basic processing speed. While depressive symptoms can be associated with impairments, co-morbidity with major depression is not itself responsible for reductions in cognitive performance. Impaired autonomic control of heart-rate associates with reductions in basic processing speed.

Source: Robinson LJ, Gallagher P, Watson S, Pearce R, Finkelmeyer A, Maclachlan L, Newton JL. Impairments in cognitive performance in chronic fatigue syndrome are common, not related to co-morbid depression but do associate with autonomic dysfunction. PLoS One. 2019 Feb 5;14(2):e0210394. doi: 10.1371/journal.pone.0210394. eCollection 2019. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0210394 (Full article)

Silicone breast implants and depression, fibromyalgia and chronic fatigue syndrome in a rheumatology clinic population

Abstract:

INTRODUCTION: Silicone breast implants (SBI) may induce systemic autoimmune disease as part of autoimmune syndrome induced by adjuvants (ASIA). This syndrome bears similarities to fibromyalgia and chronic fatigue syndrome (CFS). We sought to determine whether there are any associations between SBI and depression, fibromyalgia and CFS in a rheumatology clinic population.

METHODS: The electronic files of rheumatology clinic patients at the Royal Adelaide Hospital between 2000 and 2017 were searched for patients who had received SBI prior to rheumatological diagnosis. Demographics, diagnosis, implant history and whether the patient had depression, fibromyalgia or CFS were recorded. Controls were rheumatology clinic patients, half of whom had systemic sclerosis (SSc) and the other half had systemic lupus erythematosus (SLE). They were matched to cases 3:1 for age (within 2 years) and gender.

RESULTS: Thirty patients had received SBI (mean age 47.9, 100% female). Twelve had a diagnosis of depression, 6 of fibromyalgia and 3 of CFS. Implant rupture was not associated with any of these (p = 1). There was no difference in the incidence of depression (p = 1), fibromyalgia (p = 0.76) or CFS (p = 0.3) between cases and SLE controls. When compared with SSc controls, there were significantly more patients with fibromyalgia and/or CFS in the case group (20.0% of cases vs 2.2% of SSc controls, p = 0.01) but no difference in depression (p = 0.12).

CONCLUSION: Fibromyalgia and CFS are more common in patients with silicone implants than SSc controls but not SLE controls. Prospective study of development of depression, fibromyalgia and CFS in recipients of SBI is required.

Source: Khoo T, Proudman S, Limaye V. Silicone breast implants and depression, fibromyalgia and chronic fatigue syndrome in a rheumatology clinic population. Clin Rheumatol. 2019 Jan 31. doi: 10.1007/s10067-019-04447-y. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/30706290

Onset Patterns and Course of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Abstract:

Background: Epidemiologic studies of myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS) have examined different aspects of this disease separately but few have explored them together.

Objective: Describe ME/CFS onset and course in one United States-based cohort.

Methods: One hundred and fifty subjects fitting Fukuda 1994 CFS criteria completed a detailed survey concerning the initial and subsequent stages of their illness. Descriptive statistics, graphs, and tables were used to illustrate prevalence and patterns of characteristics.

Results: The most common peri-onset events reported by subjects were infection-related episodes (64%), stressful incidents (39%), and exposure to environmental toxins (20%). For 38% of subjects, more than 6 months elapsed from experiencing any initial symptom to developing the set of symptoms comprising their ME/CFS. Over time, the 12 most common symptoms persisted but declined in prevalence, with fatigue, unrefreshing sleep, exertion-related sickness, and flu-like symptoms declining the most (by 20–25%). Conversely, cognitive symptoms changed the least in prevalence, rising in symptom ranking. Pregnancy, menopause, and menstrual cycles exacerbated many women’s symptoms. Fatigue-related function was not associated with duration of illness or age; during the worst periods of their illness, 48% of subjects could not engage in any productive activity. At the time of survey, 47% were unable to work and only 4% felt their condition was improving steadily with the majority (59%) describing a fluctuating course. Ninety-seven percent suffered from at least one other illness: anxiety (48%), depression (43%), fibromyalgia (39%), irritable bowel syndrome (38%), and migraine headaches (37%) were the most diagnosed conditions. Thirteen percent came from families where at least one other first-degree relative was also afflicted, rising to 27% when chronic fatigue of unclear etiology was included.

Conclusions: This paper offers a broad epidemiologic overview of one ME/CFS cohort in the United States. While most of our findings are consistent with prior studies, we highlight underexamined aspects of this condition (e.g., the evolution of symptoms) and propose new interpretations of findings. Studying these aspects can offer insight and solutions to the diagnosis, etiology, pathophysiology, and treatment of this condition.

Source: Lily Chu, Ian J. Valencia, Donn W. Garvert and Jose G. Montoya. Onset Patterns and Course of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Front. Pediatr., 05 February 2019. https://doi.org/10.3389/fped.2019.00012  https://www.frontiersin.org/articles/10.3389/fped.2019.00012/full (Full article)

Parliamentary Debate: Kids being taken into care by medics who refuse to believe ME is real

Press Release: January 25, 2019, John Siddle, ME Association (UK).

Children with the devastating illness ME face the threat of being taken into care because medics refuse to accept their disease is real, parliament was today told.

ME – myalgic encephalomyelitis – is a cruel disease affecting a quarter of a million people in the UK who are being “failed” in a “national disgrace”.

While classed as a neurological disease, the stigmatised condition is still considered wrongly by some health professionals to be psychological. It means that often patients struggle to get the support they so desperately need.

ME manifests as activity-induced muscle fatigue, post-exertional malaise, problems with cognitive function, widespread muscle pain, unrefreshing sleep and ongoing flu-like symptoms.

In the debate today – the first in 20 years on ME – the House of Commons was told how one in five children with the disease are being threatened with the prospect of being forced into care.

MP Carol Monaghan, who brought today’s motion, led calls for more funding for research and better medical training to help support patients.

She said: “There is currently no cure for ME and many with the condition experience inadequate care and support.

“But there are an estimated quarter of a million people in the UK suffering from ME, and currently we are letting these people down.

“The cause of the disease is unknown, but many patients report that it developed after a viral infection such as flu or glandular fever.

“Many adults cannot maintain employment or relationships with family and friends, while children frequently fall behind in school. The ignorance surrounding the condition makes it harder to access benefits with DWP assessors often deciding the sufferer is fit for work.”

Several quality of life research studies have shown that the level of disability in ME can be just as great than many other serious medical conditions, including cancer and multiple sclerosis.

While some people with ME do improve over the course of time, it is only a small minority that return to full normal health. And the disease is indiscriminate, affecting both sexes, all ages and all races.

Mrs Monaghan, (SNP, Glasgow North West) added:

“Some with severe ME spend their days in darkened rooms, unable even to watch TV or listen to music.  Even touch is intolerable. Many are tube fed. For these individuals, ME is a life sentence, but a life spent existing, not living.

“This condition is largely unknown because those affected are often hidden away. I commend the ME community for lobbying so successfully to ensure so many members are here today.

“Leading up to this debate, I have been asked repeatedly what I hope to achieve. Ultimately what I want, and what the ME community wants, is better treatment and care for those with ME.”

Child protection proceedings

The debate was told how one in five families caring for a child with the devastating disease ME have been referred for child protection proceedings.

The Commons told how an eight-year-old – Girl B – was almost taken from her family by social services after medics said her condition was psychological.

Mrs Monaghan continued: “B’s parents were warned that if they did not fully comply, child protection proceeding would be initiated. Social services specified graded exercise, despite being warned of the dangers. As a result, B deteriorated rapidly until she became wheelchair bound. “

Under threat of court action, the girl’s parents were then forced to take her to a children’s hospital and threatened with the prospect of their daughter being taken into foster care.

Mrs Monaghan continued: “B was in constant pain, unable to sit upright, with her head hanging down the side, crying in distress.

“This continued for five months and her parents were threatened that if B didn’t progress, she’d be transferred to a psychiatric unit or placed in foster care.”

It was only when the girl’s parents sought the intervention of the secretary of state, that the girl was allowed home and removed from the ‘at risk’ register.

Suspension of controversial therapies

Ms Monaghan, who also called for the suspension of controversial Graded Exercise Therapy and Cognitive Behaviour Therapy as recommended treatment programmes, added: “A firm diagnosis of ME protects the child from these proceedings but unfortunately paediatricians are often reluctant to give this – simply because they do not understand the condition – which leaves the child open to social service intervention.

“This is a national disgrace and needs urgent action. Children who are already blighted by ME must not be subjected to this trauma.”

Improving medical education

Steve Brine, parliamentary under-secretary for health, responded to the debate, saying that, “The Government do not for one-minute underestimate ME.”

“We know that the condition has a devastating impact,” adding, “we cannot for one minute begin to understand what it must be like to suffer from this condition.”

Mr Brine said nobody with ME should ever “be fobbed off by the medical profession.” He said that before the debate he had spoken with the chair of the Royal College of GPs – Prof. Helen Stokes-Lampard – and will organise a future discussion on improving medical education and awareness.

“The NICE guidance is clear on a number of important points. There is no one form of treatment to suit every patient; that is self-evident. The needs and preferences of patients should absolutely be taken into account. Doctors should explain that no single strategy will be successful for all patients, which is a hallmark of this condition.

“In common with people receiving any NHS care, ME patients have the absolute right to refuse or withdraw from any part of their treatment; nobody is making this happen. Those with severe symptoms may require access to a wider range of support, managed by a specialist.”

Research funding

On the subject of research funding for ME, Mr Brine said that it wasn’t the Governments responsibility to allocate specific funding, and that the problem lay with the quality of research applications.

He said, “The truth is – sometimes it is a hard and inconvenient truth to hear—there have not been good enough research proposals in the ME space, partly because of the stigma and partly because of the division in the medical community. We need people to come forward with good research proposals in this space; that can only be advantageous.”

In closing, Mrs Monaghan replied that, “On the question of medical research, I am sure that many researchers will have heard what he said. However, it is notable that although there is some excellent biomedical research going on just now, it is being funded by charities, and not by the Government. The Government need to take this seriously.”

The ME Association

The ME Association is at the forefront of improving access to care, treatment and research and removing the disease’s stigma.

Despite being recognised by the World Health Organisation as a neurological disease, and a report from the Chief Medical Officer of Health calling for more research and a network of hospital-based clinics, many doctors still don’t know how to diagnose and manage ME/CFS and lack or research means that we still don’t have any effective forms of treatment.

Dr Charles Shepherd, the charity’s medical adviser, added: “There are major problems with both undergraduate and postgraduate medical education on ME.

“Undergraduate education on ME is inadequate, or even non-existent, in many medical schools.  So, doctors are qualifying knowing little or nothing about the diagnosis or management of ME and without ever seeing a patient with ME. This is particularly so in medical schools where there is nobody carrying out research, or a clinician seeing patients with ME.

“Continuing lack of medical education means that many doctors in primary care/general practice are then unsure about how to make a diagnosis (leading to a late or misdiagnosis) and/or being unable to provide guidance on even basic aspects of management.

“This is a completely unacceptable situation for a disease that is twice as common as multiple sclerosis and where a new report has estimated that is costing the UK economy around £3.5 billion in lost taxes, healthcare and benefit costs.”

The motion was passed unanimously:

“That this House calls on the Government to provide increased funding for biomedical research into the diagnosis and treatment of ME, supports the suspension of Graded Exercise Therapy and Cognitive Behaviour Therapy as means of treatment, supports updated training of GPs and medical professionals to ensure they are equipped with clear guidance on diagnosis of ME and appropriate management advice to reflect international consensus on best practice, and is concerned about the current trends of subjecting ME families to unjustified child protection procedures.”


Comment on the Debate

Dr Charles Shepherd, Hon. Medical Adviser, ME Association

“Overall, I thought it was an excellent debate and although the House of Commons chamber looked rather empty at times, it is quite an achievement to get around 40 MPs to attend a backbench chamber debate for 90 minutes at the end of Thursday afternoon – when most are heading home to their constituencies.

“Carol Monaghan made an excellent opening speech which was followed by shorter speeches from over 20 MPs.

“MPs from all political parties made very similar points covering all the key concerns that have been put to them by the Forward ME Group in our briefing document – lack of medical education, need for biomedical research, NICE recommendations on CBT and GET, the PACE trial etc.

“Most MPs also referred to personal issues that had been raised by their constituents – some of which very clearly illustrated the need for an urgent change of attitude by some sections of the medical profession.

“A number of MPs made very thoughtful contributions (e.g. Nicky Morgan, Ben Lake, David Drew, Dr Phillipa Whitford) and others spoke with real passion (e.g. Stephen Pound).

“And while ministerial responses tend to be disappointing when it comes to actual action, I think that Steve Brine, Minister for Health, had clearly got the message about education, lack of biomedical research, bad management etc and that he will be talking to his advisers and colleagues about the points that were being made.

“One specific ministerial action, which is clearly going to happen, is a meeting with the President of the Royal College of General Practitioners to discuss GP education – which can obviously follow up the work that the Forward Group have been doing with the RCGP.

“So, a big thank you to Carol for securing this debate; thanks to all the MPs who turned up and spoke, and thanks to everyone who wrote to their MP to ask them to attend.

List of MPs who took part in the debate – in order of speaking:

1.      Carol Monaghan – SNP – Glasgow NW 2.      Ben Lake – Plaid Cymru – Ceredigion
3.      Sir David Amess – Con – Basildon 4.      Liz Twist – Lab – Blaydon
5.      Adrian Bailey – Lab – West Bromwich 6.      Nick Symonds – Lab – Torteen (Wales)
7.      Nicky Morgan – Con – Loughborough 8.      Liz McInnes – Lab – Haywd & Middleton
9.      Kevin Foster – Con – Torbay 10.   Patricia Gibson – SNP – Ayrshire & Arran
11.   Emma Lewell-Buck – Lab – South Shields 12.   Darren Jones – Lab – Bristol North West
13.   David Drew – Lab – Stroud 14.   Mohammed Yasin – Lab – Bedford
15.   Stephen Kerr – Con – Stirling 16.   Jim Shannon – DUP – Strangford
17.   Kelvin Hopkins – Ind – Luton North 18.   Dr Phillipa Whitford – SNP Health
19.   Stephen Pound – Lab – Ealing North 20.   Sharon Hodgson – Shadow Health
21.   Karen Lee – Lab – Lincoln 22.   Steve Brine – Health Minister
23.   Carol Monaghan – Concluding remarks

A number of other MPs – Justine Greening, Con, Putney, Julian Lewis, Con, New Forest East, Paula Sherrif, Lab, Dewsbury – made interventions. NB:  There were other MPs in the chamber for all or part of the debate but did not take part. See Hansard Volume 653.

Relationship Between Exercise-induced Oxidative Stress Changes and Parasympathetic Activity in Chronic Fatigue Syndrome: An Observational Study and in Patients and Healthy Subjects

Abstract:

PURPOSE: Oxidative stress has been proposed as a contributor to pain in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). During incremental exercise in patients with ME/CFS, oxidative stress enhances sooner and antioxidant response is delayed. We explored whether oxidative stress is associated with pain symptoms or pain changes following exercise, and the possible relationships between oxidative stress and parasympathetic vagal nerve activity in patients with ME/CFS versus healthy, inactive controls.

METHODS: The present study reports secondary outcomes from a previous work. Data from 36 participants were studied (women with ME/CFS and healthy controls). Subjects performed a submaximal exercise test with continuous cardiorespiratory monitoring. Levels of thiobarbituric acid-reactive substances (TBARSs) were used as a measure of oxidative stress, and heart rate variability was used to assess vagal activity. Before and after the exercise, subjects were asked to rate their pain using a visual analogic scale.

FINDINGS: Significant between-group differences in pain at both baseline and following exercise were found (both, P < 0.007). In healthy controls, pain was significantly improved following exercise (P = 0.002). No change in oxidative stress level after exercise was found. Significant correlation between TBARS levels and pain was found at baseline (r = 0.540; P = 0.021) and after exercise (r = 0.524; P = 0.024) in patients only. No significant correlation between TBARS and heart rate variability at baseline or following exercise was found in either group. However, a significant correlation was found between exercise-induced changes in HRV and TBARS in healthy controls (r = -0.720; P = 0.001).

IMPLICATIONS: Oxidative stress showed an association with pain symptoms in people with ME/CFS, but no exercise-induced changes in oxidative stress were found. In addition, the change in parasympathetic activity following exercise partially accounted for the change in oxidative stress in healthy controls. More research is required to further explore this link.

Copyright © 2018. Published by Elsevier Inc.

Source: Polli A, Van Oosterwijck J, Nijs J, Marusic U, De Wandele I5Paul L, Meeus M, Moorkens G, Lambrecht L, Ickmans K. Relationship Between Exercise-induced Oxidative Stress Changes and Parasympathetic Activity in Chronic Fatigue Syndrome: An Observational Study and in Patients and Healthy Subjects. Clin Ther. 2019 Jan 18. pii: S0149-2918(18)30611-8. doi: 10.1016/j.clinthera.2018.12.012. [Epub ahead of print]  https://www.ncbi.nlm.nih.gov/pubmed/30665828

Cytokine profiles in patients with Q fever fatigue syndrome

Abstract:

Background: Q fever fatigue syndrome (QFS) is a state of prolonged fatigue following around 20% of acute Q fever cases. It is thought that chronic inflammation plays a role in its aetiology. To test this hypothesis we measured circulating cytokines and the exvivo cytokine production in patients with QFS and compared to various control groups.

Materials/methods: Peripheral blood mononuclear cells (PBMCs), whole blood, and serum were collected from 20 QFS patients, 19 chronic fatigue syndrome (CFS) patients, 19 Q fever seropositive controls, and 25 age- and sex-matched healthy controls. Coxiella-specific ex-vivo production of tumor necrosis factor (TNF)α, interleukin (IL)-1β, IL-6, and interferon (IFN) was measured, together with a total of 92 circulating inflammatory proteins.

Results: PBMCs of QFS patients produced more IL-6 (P = 0.0001), TNFα (P = 0.0002), and IL-1β (P = 0.0005) than the various control groups when stimulated with Coxiella antigen. QFS patients had distinct differences in circulating inflammatory markers compared to the other groups, including higher concentrations of circulating IL-6 and IFNγ.

Conclusion: QFS patients showed signs of chronic inflammation compared to asymptomatic Q fever seropositive controls, CFS patients, and healthy controls, of which the monocyte-derived cytokines TNFα, IL-1β, and especially IL-6, are likely crucial components.

Source: Raijmakers, Ruud P.H. et al. Cytokine profiles in patients with Q fever fatigue syndrome. Journal of Infection , Volume 0 , Issue 0 , DOI: https://doi.org/10.1016/j.jinf.2019.01.006

Chronic fatigue syndrome in the emergency department

Abstract:

PURPOSE: Chronic fatigue syndrome (CFS) is a debilitating disease characterized by fatigue, postexertional malaise, cognitive dysfunction, sleep disturbances, and widespread pain. A pilot, online survey was used to determine the common presentations of CFS patients in the emergency department (ED) and attitudes about their encounters.

METHODS: The anonymous survey was created to score the severity of core CFS symptoms, reasons for going to the ED, and Likert scales to grade attitudes and impressions of care. Open text fields were qualitatively categorized to determine common themes about encounters.

RESULTS: Fifty-nine percent of respondents with physician-diagnosed CFS (total n=282) had gone to an ED. One-third of ED presentations were consistent with orthostatic intolerance; 42% of participants were dismissed as having psychosomatic complaints. ED staff were not knowledgeable about CFS. Encounters were unfavorable (3.6 on 10-point scale). The remaining 41% of subjects did not go to ED, stating nothing could be done or they would not be taken seriously. CFS subjects can be identified by a CFS questionnaire and the prolonged presence (>6 months) of unremitting fatigue, cognitive, sleep, and postexertional malaise problems.

CONCLUSION: This is the first investigation of the presentation of CFS in the ED and indicates the importance of orthostatic intolerance as the most frequent acute cause for a visit. The self-report CFS questionnaire may be useful as a screening instrument in the ED. Education of ED staff about modern concepts of CFS is necessary to improve patient and staff satisfaction. Guidance is provided for the diagnosis and treatment of CFS in these challenging encounters.

Source: Timbol CR, Baraniuk JN. Chronic fatigue syndrome in the emergency department. Open Access Emerg Med. 2019 Jan 11;11:15-28. doi: 10.2147/OAEM.S176843. eCollection 2019.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6333158/ (Full article)

Activity in Chronic Fatigue Syndrome: An Observational Study and in Patients and Healthy Subjects

Abstract:

PURPOSE: Oxidative stress has been proposed as a contributor to pain in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). During incremental exercise in patients with ME/CFS, oxidative stress enhances sooner and antioxidant response is delayed. We explored whether oxidative stress is associated with pain symptoms or pain changes following exercise, and the possible relationships between oxidative stress and parasympathetic vagal nerve activity in patients with ME/CFS versus healthy, inactive controls.

METHODS: The present study reports secondary outcomes from a previous work. Data from 36 participants were studied (women with ME/CFS and healthy controls). Subjects performed a submaximal exercise test with continuous cardiorespiratory monitoring. Levels of thiobarbituric acid-reactive substances (TBARSs) were used as a measure of oxidative stress, and heart rate variability was used to assess vagal activity. Before and after the exercise, subjects were asked to rate their pain using a visual analogic scale.

FINDINGS: Significant between-group differences in pain at both baseline and following exercise were found (both, P < 0.007). In healthy controls, pain was significantly improved following exercise (P = 0.002). No change in oxidative stress level after exercise was found. Significant correlation between TBARS levels and pain was found at baseline (r = 0.540; P = 0.021) and after exercise (r = 0.524; P = 0.024) in patients only. No significant correlation between TBARS and heart rate variability at baseline or following exercise was found in either group. However, a significant correlation was found between exercise-induced changes in HRV and TBARS in healthy controls (r = -0.720; P = 0.001).

IMPLICATIONS: Oxidative stress showed an association with pain symptoms in people with ME/CFS, but no exercise-induced changes in oxidative stress were found. In addition, the change in parasympathetic activity following exercise partially accounted for the change in oxidative stress in healthy controls. More research is required to further explore this link.

Copyright © 2018. Published by Elsevier Inc.

Source: Polli A, Van Oosterwijck J, Nijs J, Marusic U, De Wandele I, Paul L, Meeus M, Moorkens G, Lambrecht L, Ickmans K. Activity in Chronic Fatigue Syndrome: An Observational Study and in Patients and Healthy Subjects. Clin Ther. 2019 Jan 18. pii: S0149-2918(18)30611-8. doi: 10.1016/j.clinthera.2018.12.012. [Epub ahead of print]  https://www.ncbi.nlm.nih.gov/pubmed/30665828

The Importance of Accurate Diagnosis of ME/CFS in Children and Adolescents: A Commentary

Abstract:

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic illness that causes a range of debilitating symptoms. While most research has focused on adults, the illness also presents in children and adolescents. Many physicians find it difficult to diagnose the illness. In this commentary paper, we discuss a range of salient themes that have emerged from our ongoing research into the prevalence of ME/CFS in children and adolescents.

We discuss reasons why pediatric prevalence estimates vary widely in the literature, from almost 0% to as high as 3%. We argue that there is considerable misdiagnosis of pediatric cases and over-inflation of estimates of pediatric ME/CFS. Many children and teenagers with general fatigue and other medical complaints may meet loose diagnostic criteria for ME/CFS. We make recommendations for improving epidemiological research and identifying pediatric ME/CFS in clinical practice.

Source: Keith James Geraghty and Charles Adeniji. The Importance of Accurate Diagnosis of ME/CFS in Children and Adolescents: A Commentary. Front. Pediatr., 21 January 2019 | https://doi.org/10.3389/fped.2018.00435 (Full article)