Journal of Chronic Fatigue Syndrome: Volume 6, Issue 2, 2000

Volume 6, Issue 2, 2000

 * Editorial, by Roberto Patarca-Montero
 * Measuring Outcomes of Treatment in Chronic Fatigue Syndrome: A Comparison of Simple Questioning vs. Use of a Validated Outcome Instrument(Short Form 36)"'Abstract - Purpose: To compare the outcome of treatment of chronic fatigue syndrome measured by a validated outcome instrument to patients' perception of outcome based on simple questioning. Subjects and Methods: Results of a single self-report question (“Are you much better, better, about the same, worse or much worse?”) at the end of approximately one year of treatment of 45 patients were compared to results of the Short Form 36 obtained at the beginning and end of that year. Results: There was no correlation between the results of the single self-report question and the interval change in the Short Form 36 summary scales and 7 of 8 component scales. Conclusions: Appropriate outcomes measurements can increase reliability of clinical practice results as well as treatment trials. Studies based only on answers to simple self-report questions may yield unreliable results.'"
 * Four Cases of Pesticide Poisoning, Presenting as “ME,” Treated with a Choline and Ascorbic Acid Mixture"'Abstract - Objectives: 1. To demonstrate in four patients, in whom the correct diagnosis of pesticide poisoning had been missed, the injustices inflicted on them when they are told ME does not exist. 2. To show how closely the features of such poisoning, especially by organochlo-rines, resemble those of the much more classic ME which is usually due, at least in the author's practice in the northern region of the UK, to persistent enteroviral infection. 3. To draw attention to a new and apparently successful form of treatment with an oral mixture of choline and ascorbic acid. 4. To suggest reasons why this treatment merits further scientific investigation. Setting: A charity based private practice involved in the investigation of viral mediated disease. Subjects: Four patients, two male and two female, each referred with a diagnosis of ME. Intervention: a. Samples of blood were sent to Biolab Medical Unit where a variety of pesticide residues, including the very persistent organochlorines, were identified and progress in detoxification was monitored, b. All four cases were treated orally with a choline and ascorbic acid mixture. Results: After a variable number of months, during the early phase of which the blood levels of some of the toxins rose, possibly due to mobilization from fatty stores, all symptoms cleared as blood levels fell. Key Messages: The term ME comprises a number of clinical features, characterizing a patient who is ill. To refuse to recognize their existence does the patient much injustice. Some cases of ME may be found to have pesticide poisoning. The possibility of it should always be borne in mind. The source may be either in the UK or abroad. A positive enquiry and a single blood test will provide a diagnosis. Organochlorines may persist in the body for many years, as may the symptoms derived from them. A detoxification program based on oral administration of a choline and ascorbic acid mixture has shown much promise and deserves verification of its value. Conclusions: Amongst the group of clinical features known as ME, the possibility of pesticide poisoning should always be borne in mind. Treatment with choline and ascorbic acid mixture is worth trying, pending its more formal investigation.'"
 * Comparative Study of Antidepressants and Herbal Psychotropic Drugs in a Mouse Model of Chronic Fatigue"'Abstract - This study examined the effects and comparative efficacy of various antidepressants and herbal psychotropic drugs in a mouse model of chronic fatigue. Animals were subjected daily to forced swimming (Porsolt's forced swimming test) and the duration of the immobility period was recorded in 6-minute sessions on each day for 7 days. Chronic forced swimming resulted in significant increases in immobility time on day 7 as compared to day 1 in control mice. Pretreatment with imipramine (10 mg/kg, i.p.), desipramine (10 mg/kg, i.p.), tranyl-cypromine (10 mg/kg, i.p.), alprazolam (0.5 mg/kg, i.p.), fhioxetine (10 mg/kg, i.p.) and melatonin (10 mg/kg, i.p.) produced significant decreases in immobility time as compared to control on each day. Similar decreases in immobility periods were observed with herbal psychotropic preparations-Withania somnifera root extract (100 mg/kg, p.o.), BR-16A(r) (200 mg/kg, p.o.), siotone(r) granules (200 mg/kg, p.o.) and evening primrose oil (0.2 ml/20 g, p.o.). However, trazodone and ida-zoxan failed to modify the immobility times on all the days. The present observations underscore the established use of antidepressants in providing symptomatic relief of fatigue in Chronic Fatigue Syndrome (CFS) patients and further reinforce the potential therapeutic usefulness of herbal psychotropic preparations in CFS patients.'"
 * Sleep Disturbance in Patients with Chronic Fatigue Syndrome and Chronic Fatigue"'Abstract - To examine whether the identification of patients with Chronic Fatigue Syndrome can be made using more objective criteria than presently available (1), we compared 14 patients with Chronic Fatigue Syndrome and 12 patients with chronic fatigue (but who did not meet the criteria for Chronic Fatigue Syndrome) on sleep architecture, continuity, and sleep abnormalities from polysomnography recordings. No differences in sleep continuity or architecture were found between the two groups, except that patients with Chronic Fatigue Syndrome recorded significantly increased sleep latencies. There were no differences in the frequency of sleep disorders. Results indicated that apart from sleep latency, other sleep variables do not adequately differentiate patients with CFS from those with chronic fatigue and that other variables should be examined, which may validly diagnose patients with CFS.'"
 * Chronic Fatigue Syndrome: Evidence Supporting the Hypothesis of a Behaviorally-Activated Neuromodulator of Fatigue"'Abstract - Chronic Fatigue Syndrome (CFS) is a disorder characterized by a prolonged, debilitating fatigue of unknown etiology. In addition, patients with CFS frequently report enhanced fatigue symptoms following even mild physical exertion, and their tolerance for physical exercise is limited relative to healthy individuals. The physiological mechanisms underlying the excessive fatigue and weakness common to this disorder remain an issue of scientific debate. Collectively, the available data suggest that fatigue in CFS is not due to any neuromuscular dysfunction, per se, but possibly is caused or influenced by some centrally acting mediator that is released during behavioral activities that require physical or mental exertion. In addition to persistent fatigue, there is growing evidence that many CFS patients exhibit alterations in hypothalamic-pituitary-adrenal (HPA) axis and autonomic function, including the inability to maintain the blood pressure response to orthostatic challenge. When an individual engages in mental or physical behavioral activation, there is a release of numerous centrally acting neuromodulators, some of which have been postulated to influence fatigue. This paper examines the evidence supporting a common pathway through which these centrally-mediated psychological and autonomic abnormalities may be linked. It is hypothesized that as a consequence of behavioral activation there is an abnormality in neuromodulator release or action in individuals with CFS, and that this abnormal neuromodulator activity results in increased fatigue. Furthermore, it is postulated that the CNS initiates a counter-regulatory mechanism to reduce the activity of those systems responsible for the production of the neuromodulator; and that the consequence of this counter-regulatory maneuver is the prevailing dysregulation of the autonomic and HPA axes and other dysfunctional cardiovascular and immunological sequelae.'"
 * The Human/Animal Interaction in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Look at 127 Patients"'Abstract - Objective: To evaluate the interaction between Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) patients and domestic animals (pets). Design: Retrospective study of criteria-met ME/CFS patients using a standardized questionnaire which included patient comments. Setting: University medical center and ME/CFS support groups throughout the United States. Patients: A total of 127 patients met the surveillance criteria of the Centers for Disease Control and Prevention (CDC) for the establishment of the diagnosis of ME/CFS and were included in the study. Measurements: Information from the standardized questionnaire was compiled and appropriate statistical tests, including mean, median, Z test, multivariant analysis, and Chi-square test, were used. This information was compared to national statistical information on animal interaction compiled by the American Veterinary Medicine Association. Results: The most striking result of the study was the association between ME/CFS patients and animals (usually indoor pets) and the number of animals per ME/CFS patient. Ninety-seven percent of the ME/CFS patients had animal contact (expected national contact: 57.9%), with only 2 males and 2 females not reporting animal contact. Reported dog ownership/household for ME/CFS males was 9.5 and for ME/CFS females was 7.9 (expected national average: 1.52). Reported cat ownership/household for ME/CFS males was 6.1 and for ME/CFS females was 8.7 (expected national average: 1.95). One hundred and six of the respondents (83.5%) reported that their animals (pets) had atypical diseases with symptoms which mimicked ME/CFS in humans. Of the 106 ME/CFS patients, 100 (94.3%) either were the primary caregiver for the sick animals or had intimate contact (sleeping with, being bitten or scratched by, or kissing the animal). Conclusions: ME/CFS patients have a significant animal interaction and a large number of these animals have atypical or unusual diseases which at least mimic ME/CFS.'"
 * Abnormal Signs Found in Animals of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients: A Look at 463 Animals"'Abstract - Objective: To evaluate the abnormal signs found in the domestic animals (pets) of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) patients. Design: Retrospective study of the domestic animals (pets) of criteria-met ME/CFS patients using a standardized questionnaire which included patient comments. Setting: University medical center and ME/CFS support groups throughout the United States. Patients: A total of 127 patients met the surveillance criteria of the Centers for Disease Control and Prevention (CDC) for the establishment of the diagnosis of ME/CFS and were included in the study. This group of patients had a total of 463 domestic animals (pets), of which 348 animals demonstrated abnormal signs and 115 were considered healthy. Measurements: Information from the standardized questionnaire was compiled and appropriate statistical tests, including mean, median, Z test, multivariant analysis, and Chi-square test, were used. Results: One hundred six (83%) of the 127 ME/CFS surveyed reported that at least one of their animals (predominantly domestic pets) showed a wide range of unusual or atypical signs, many of which mimicked the signs and symptoms of ME/CFS. The sick animals' signs were divided into General (40%), Neurological (35%), Gastrointestinal (10%), Reticuloendothelial/Blood (9%), Neoplasia (4%), and Endocrine (2%). One of the most striking result of the study was that 113 of the 127 ME/CFS patients surveyed felt their ME/CFS symptoms were somehow associated with their animals contact. Ninety (71%) of the 127 ME/CFS patients reported that they were the primary caretakers for multiple animals. Other less common findings were: the onset of ME/ CFS being associated with obtaining the animal; the onset of ME/CFS being associated with a flea bite episode; prior residents having sick animals and ME/CFS; other family member contracting ME/CFS from their close association with the sick animal (as opposed to their association with the family members who had ME/CFS); ME/CFS symptoms decreasing after the pet leaving or dying. Conclusions: A large number of animals of ME/CFS patients have atypical or unusual diseases which at least mimic ME/CFS. Most of the 127 ME/CFS patients surveyed have significant animal interactions.'"
 * The Pathophysiology of Chronic Fatigue Syndrome and Related Neurosomatic Disorders