Journal of Chronic Fatigue Syndrome: Volume 11, Issue 1, 2003

Volume 11, Issue 1, 2003

 * Editoral - Chronic Fatigue Syndrome Guidelines by Kenny De Meirleir & Neil McGregor
 * Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols"Abstract - Recent years have brought growing recognition of the need for clinical criteria for myalgic encephalomyelitis (ME), which is also called chronic fatigue syndrome (CFS). An Expert Subcommittee of Health Canada established the Terms of Reference, and selected an Expert Medical Consensus Panel representing treating physicians, teaching faculty and researchers. A Consensus Workshop was held on March 30 to April 1, 2001 to culminate the review process and establish consensus for a clinical working case definition, diagnostic protocols and treatment protocols. We present a systematic clinical working case definition that encourages a diagnosis based on characteristic patterns of symptom clusters, which reflect specific areas of pathogenesis. Diagnostic and treatment protocols, and a short overview of research are given to facilitate a comprehensive and integrated approach to this illness. Throughout this paper, “myalgic encephalomyelitis” and “chronic fatigue syndrome” are used interchangeably and this illness is referred to as “ME/CFS.”"
 * Monitoring a Hypothetical Channelopathy in Chronic Fatigue Syndrome: Preliminary Observations"'Abstract - This study was aimed at monitoring of a previously suggested channelopathy in Chronic Fatigue Syndrome, and at searching for possible explanations by means of immune system characteristics. Twenty-seven CFS patients and 20 age and sex matched healthy volunteers were recruited. RNase L-ratio, percent of the norm of whole body potassium content, serum electrolytes (sodium, calcium and potassium), immune cells, blood cell count and erythrocyte sedimentation rate were determined. More than fifty percent of our patients presented with abnormal whole body potassium content. Eight patients had increased, while six had depleted potassium content. Discriminant function analysis revealed that the CFS patients and control subjects could be differentiated on immunophenotyping with the predominant cell differences being the increase in CD19+ CD5+ (mature B-) cells and the decrease in CD3-CD16+ CD56+ (NK) cells in both the percentage and count distributions. The fall in NK-cells was very strongly associated with increases in the RNase L-ratio and falls in serum calcium levels. In addition, four patients with low serum calcium levels showed lower whole body potassium levels. In conclusion, these observations suggest a channelopathy in a subset of CFS patients, probably induced by the deregulated 2-5A RNase L antiviral pathway."
 * Gulf War Illnesses: Chemical, Biological and Radiological Exposures Resulting in Chronic Fatiguing Illnesses Can Be Identified and Treated"'Abstract - Gulf War illnesses involve multiple, complex chronic signs and symptoms that loosely fit the clinical criteria for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) and/or Fibro-myalgia Syndrome (FMS). Most Gulf War illness patients had multiple exposures: (a) complex chemical mixtures, including organophosphate pesticides, anti-nerve agents, carbamates and possibly nerve and blister agents, (b) radiological sources, subjecting patients to both heavy metal and radiation effects, and (c) biological sources, including bacteria and toxins and the effects of multiple vaccines. Chemically exposed patients may benefit by removing offending chemicals and depleting toxic chemicals from the patient's system and other symptomatic treatments. Patients with systemic infections, including mycoplasma and other chronic bacterial infections, can be treated with antibiotics and additional nutritional supplementation. Some patients may have their illness linked to radiological exposures, and a minority to battlefield stress. The vaccines are a prime suspect for immune dysfunction and chronic infections. The multiple, complex exposures resulted in poorly defined chronic illnesses, but subsets of Gulf War illness can be identified and effectively treated using appropriate procedures."