Julian Stewart

Julian Mark Stewart, MD, PhD, is the Director of the Center for Hypotension, and a Professor of Pediatrics and Physiology, New York Medical College, Hawthorne, New York, United States.

2017 Pediatric Primer
Dr. Rowe was one of the authors of the 2017 Pediatric Primer published in Frontiers in Pediatrics.
 * Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Diagnosis and Management in Young People: A Primer (OPEN ACCESS/FULL TEXT). Authors: Peter C. Rowe, Rosemary A. Underhill, Kenneth J. Friedman, Alan Gurwitt, Marvin S. Medow, Malcolm S. Schwartz, Nigel Speight, Julian M. Stewart, Rosamund Vallings and Katherine S. Rowe Abstract:Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex disease that affects children and adolescents as well as adults. The etiology has not been established. While many pediatricians and other health-care providers are aware of ME/CFS, they often lack essential knowledge that is necessary for diagnosis and treatment. Many young patients experience symptoms for years before receiving a diagnosis. This primer, written by the International Writing Group for Pediatric ME/CFS, provides information necessary to understand, diagnose, and manage the symptoms of ME/CFS in children and adolescents. ME/CFS is characterized by overwhelming fatigue with a substantial loss of physical and mental stamina. Cardinal features are malaise and a worsening of symptoms following minimal physical or mental exertion. These post-exertional symptoms can persist for hours, days, or weeks and are not relieved by rest or sleep. Other symptoms include cognitive problems, unrefreshing or disturbed sleep, generalized or localized pain, lightheadedness, and additional symptoms in multiple organ systems. While some young patients can attend school, on a full or part-time basis, many others are wheelchair dependent, housebound, or bedbound. Prevalence estimates for pediatric ME/CFS vary from 0.1 to 0.5%. Because there is no diagnostic test for ME/CFS, diagnosis is purely clinical, based on the history and the exclusion of other fatiguing illnesses by physical examination and medical testing. Co-existing medical conditions including orthostatic intolerance (OI) are common. Successful management is based on determining the optimum balance of rest and activity to help prevent post-exertional symptom worsening. Medications are helpful to treat pain, insomnia, OI and other symptoms. The published literature on ME/CFS and specifically that describing the diagnosis and management of pediatric ME/CFS is very limited. Where published studies are lacking, recommendations are based on the clinical observations and practices of the authors.

A Consensus Manual for the Primary Care and Management of Chronic Fatigue Syndrome
Dr. Stewart was a member of the 2002 writing committee for A Consensus Manual for the Primary Care and Management of Chronic Fatigue Syndrome sponsored by The Academy of Medicine of New Jersey and the New Jersey Department of Health and Senior Services, Joseph F. John, Jr., MD, Editor and James M. Oleske, MD, MPH, Associate Editor.

Notable studies

 * 2014, Phenylephrine Alteration of Cerebral Blood Flow During Orthostasis; Effect on N-Back Performance in Chronic Fatigue Syndrome
 * 2013, What is brain fog? An evaluation of the symptom in postural tachycardia syndrome.
 * 2012, Increased ventricular lactate in chronic fatigue syndrome. III. Relationships to cortical glutathione and clinical symptoms implicate oxidative stress in disorder pathophysiology
 * 2012, Orthostatic Tolerance Testing in a Prospective Cohort of Adolescents With Chronic Fatigue Syndrome and Recovered Controls Following Infectious Mononucleosis
 * 2012, Postural neurocognitive and neuronal activated cerebral blood flow deficits in young chronic fatigue syndrome patients with postural tachycardia syndrome
 * 2011, Increasing orthostatic stress impairs neurocognitive functioning in chronic fatigue syndrome with postural tachycardia syndrome
 * 2000, Orthostatic Intolerance: A Review with Application to the Chronic Fatigue Syndrome

Open letters

 * 2017, An open letter to Psychological Medicine about “recovery” and the PACE trial