Journal of Chronic Fatigue Syndrome: Volume 8, Issue 2, 2000-2001

Volume 8, Issue 2, 2000-2001

 * Editorial by Roberto Patarca-Montero
 * Effective Treatment of Chronic Fatigue Syndrome and Fibromyalgia—A Randomized, Double-Blind, Placebo-Controlled, Intent-To-Treat Study"'Abstract - Background: Hypothalamic dysfunction has been suggested in fibromyalgia (FMS) and chronic fatigue syndrome (CFS). This dysfunction may result in disordered sleep, subclinical hormonal deficiencies, and immunologic changes. Our previously published open trial showed that patients usually improve by using a protocol which treats all the above processes simultaneously. The current study examines this protocol using a randomized, double-blind design with an intent-to-treat analysis. Methods: Seventy-two FMS patients (38 active:34 placebo; 69 also met CFS criteria) received all active or all placebo therapies as a unified intervention. Patients were treated, as indicated by symptoms and/or lab testing, for: (1) subclinical thyroid, gonadal, and/or adrenal insufficiency, (2) disordered sleep, (3) suspected neurally mediated hypotension (NMH), (4) opportunistic infections, and (5) suspected nutritional deficiencies. Results: At the final visit, 16 active patients were “much better,” 14 “better”, 2 “same,” 0 “worse,” and 1 “much worse” vs. 3, 9, 11, 6, and 4 in the placebo group (p < .0001, Cochran-Mantel-Haenszel trend test). Significant improvement in the FMS Impact Questionnaire (FIQ) scores (decreasing from 54.8 to 33.2 vs. 51.4 to 47.7) and Analog scores (improving from 176.1 to 310.3 vs. 177.1 to 211.9) (both with p < .0001 by random effects regression), and Tender Point Index (TPI) (31.7 to 15.5 vs. 35.0 to 32.3, p < .0001 by baseline adjusted linear model) were seen. Long term follow-up (mean 1.9 years) of the active group showed continuing and increasing improvement over time, despite patients being able to discontinue most treatments. Conclusions: Significantly greater benefits were seen in the active group than in the placebo group for all primary outcomes. An integrated treatment approach appears effective in the treatment of FMS/CFS.'"
 * Chronic Fatigue Syndrome and Abnormal Biological Rhythms in School Children"'Abstract - Chronic fatigue syndrome occurring in previously healthy children and adolescents is one of the most vexing problems encountered by pediatric practitioners. To investigate the biological rhythms in the pediatric patients with CFS, we examined sleep pattern, circadian rhythm of core body temperature (CBT), and plasma cortisol in 41 patients, aged between 10 and 19 years, who did not have any physical or psychiatric disorders, but had non-specific complaints, and were suspected to have a circadian rhythm disturbance. They were diagnosed as having CFS on the basis of published criteria. Circadian variation of CBT in the CFS patients did not present a clear rhythm, and appearance time of their lowest CBT was significantly delayed compared to healthy subjects. Amplitude of circadian CBT changes, fitted to a cosinor curve by the least square method, was significantly smaller in the patients than in healthy subjects. Moreover, circadian rhythm of plasma cortisol in the patients appeared to be quite different, compared to healthy subjects. These findings suggest that their clinical psychosomatic symptoms (e.g., fatigue and sleep disturbance) might be closely related to the desynchronization of their biorhythms, particularly the circadian rhythm of body temperature and cortisol rhythm.'"
 * Cobalamin Used in Chronic Fatigue Syndrome Therapy Is a Nitric Oxide Scavenger "'Abstract - Cobalamin (vitamin B12) in the form of hydroxocobalamin or cyanocobalamin injections has been widely used to treat chronic fatigue syndrome (CFS). Hydroxocobalamin is a nitric oxide scavenger and is proposed here to act as such a scavenger in CFS treatment. Its possible efficacy in CFS treatment, if further substantiated, may provide confirmation of a prediction of the elevated nitric oxide/peroxynitrite theory of CFS etiology. This interpretation of the possible role of cobalamin in CFS treatment suggests a useful perspective for confirming and optimizing this treatment.'"
 * Orthostatic Intolerance: A Review with Application to the Chronic Fatigue Syndrome "'Abstract - The symptoms of the chronic fatigue syndrome closely match those of chronic orthostatic intolerance and research suggests that orthostatic intolerance plays a role in the symptomatology of CFS. Recent investigations support the hypothesis that findings in CFS patients result at least in part from impaired blood pressure and heart rate regulation. Orthostatic intolerance has been implicated. Effective and specific treatment for chronic orthostatic intolerance can only be developed when a specific etiology or etiologies are discovered.'"
 * Effect of Modafinil on Fatigue Associated with Neurological Illnesses"'Abstract - Fatigue is a common symptom of a variety of neurological illnesses, such as Alzheimer's disease, chronic fatigue syndrome, multiple sclerosis, Parkinson's disease, and stroke. Fatigue severely impairs productivity, performance, social functioning, and quality of life. Modafinil (PROVIGIL(r)) has been shown to significantly improve fatigue associated with multiple sclerosis and depression. Here, a retrospective review of the medical charts of 25 patients treated with modafinil for fatigue associated with various neurological illnesses was conducted. Modafinil was effective for the treatment of fatigue in 21 of 25 patients (84%), and was well tolerated. Therefore, modafinil appears to be a potentially attractive candidate for the treatment of fatigue associated with neurological disorders.'"
 * Chronic Fatigue Syndrome: The Yeast Concept"'Abstract - Many theories abound as to the cause of CFS, but none have been proven conclusively. Because of the prevalence of the condition in many different countries throughout the world, it is becoming increasingly necessary to find a common link in the causative mechanism. The cause must be present at an international level. The overgrowth of bowel yeast and its infiltration through the bowel wall into the blood stream would appear to be the starting point in the development of CFS. This invasion of yeast can occur for different reasons. Therapeutic interventions based on the years of hypothesis are suggested.'"