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Winter 2000

Research Briefs

Following is news of current publications and research efforts under way related to chronic fatigue syndrome (CFS)-also called chronic fatigue and immune dysfunction syndrome (CFIDS).

CFS is real medical condition
Dr. Anthony Komaroff of Harvard University makes a compelling argument in the February 2 issue of The American Journal of Medicine that the symptoms of CFS have their basis in biology.

He debunks the notion that CFS involves symptoms that are only imagined or amplified because of underlying psychiatric distress by reviewing the concrete evidence of central nervous system pathology, neuroendocrine abnormalities and chronic immune activation.

"It is time to put [the psychiatric] hypothesis to rest and to pursue biological clues. in our quest to find answers for patients suffering from this syndrome," Komaroff concludes.

Komaroff AL. The biology of chronic fatigue syndrome. Am J Med. 2000;108:169-71.

More evidence against depression
A group of researchers has found that small adrenal glands may be related to poor adrenal functioning in CFS. Patients studied had adrenal glands that were only half the size of those found in the control group. This helps delineate CFS from major depression, as depression patients typically have enlarged glands (up to 70% enlargement during a depressive episode).

The atrophy of the adrenals in CFS is likely related to other CFS research findings, including low levels of cortisol and DHEA and to neurally mediated hypotension. Since this was a small study and only CFS patients with demonstrated adrenal insufficiency were included, it remains to be seen whether this finding applies to all CFS patients or only to a subset of those who meet the CDC's case definition.

Scott LV et al. Small adrenal glands in chronic fatigue syndrome: a preliminary computer tomography study. Psychoneuroendocrinology. 1999;24:759-68.

Brain abnormalities in CFS studied
The brain MRIs of CFS patients without a psychiatric diagnosis since the onset of their illness differ from those with a psychiatric diagnosis or controls. Researchers at the New Jersey Medical School found that CFS patients with no psych diagnosis showed a significantly larger number of abnormalities in the frontal lobes of the brain; they hypothesize that the changes could explain the more severe cognitive impairment previously reported in this subset of patients.

Lange G et al. Brain MRI abnormalities exist in a subset of patients with chronic fatigue syndrome. J Neurol Sci. 1999; 171: 3-7.

Another recent study showed patients with CFS have slowed reaction times, poorer short-term memory and reduced neural activity prior to movement compared to controls, suggesting that the central motor mechanisms accompanying motor response may be impaired. However, the researchers from the University of California at Irvine found that neural process related to sensory perception and response to certain stimuli were unaffected.

Gordon R et al. Cortical motor potential alterations in chronic fatigue syndrome. Int J Molec Med. 1999; 4: 493-99.

Can recovery be predicted?
Complete recovery from CFS may be rare. When researchers at the Ohio University of Osteopathic Medicine mailed a follow-up questionnaire to 341 patients who had become ill for an average of nine years prior to ascertain "recovery rate," only 12% of the respondents reported "recovery." The study did show considerable overlap in illness severity between recovered groups, suggesting accurate prediction of recovery in individual patients is not currently feasible.

Pheley, AM et al. Can we predict recovery in chronic fatigue syndrome? Minn Med. 1999;82:52-6. 

Melatonin replacement not merited?
Melatonin, a pineal hormone involved in the synchronization of circadian rhythms, is sometimes used to treat CFS. However, a study examining the relationship between melatonin and cortisol levels in a small group of pre-menopausal women showed there was no significant difference in melatonin levels between CFS patients and controls, and no desyn-chronization of circadian rhythms in either group.

Korszun A et al. Melatonin levels in women with fibro-myalgia and chronic fatigue syndrome. J Rheumatol. 1999;36:3675-80.

Severe cases may have poor prognosis
A recent study suggests that only about four percent of patients with severe CFS recover. Dr. Nancy Hill and colleagues at the New Jersey Medical School in Newark found that only one out of 23 patients "recovered fully" during four years of follow-up after being diagnosed with severe CFS, according to the 1988 CDC definition.

However, while only one of the patients was considered to be recovered, nine demonstrated improvements in their clinical symptoms during the study. Not surprisingly, those who improved clinically also demonstrated improvements in mood. Of the 15 patients who were characterized as "disabled" at the beginning of the study, 12 were still unable to work at last follow-up.

Hill, NF et al. Natural history of severe chronic fatigue syndrome. Arch Phys Med Rehabil. 1999;80:1090-94.

NIAID funds research centers
The National Institute of Allergy and Infectious Diseases (NIAID) has announced research awards totaling $1.9 million in first year funding to support three CFS cooperative research centers. The centers will address the basic science, clinical and epidemiological aspects of CFS, including causes, characteristics and treatment. The grants were awarded to Dr. Dedra Buchwald of the University of Washington in Seattle, Dr. Nancy Klimas of the University of Miami and Dr. Benjamin Natelson of the University of Medicine and Dentistry in Newark, NJ.

Medical Crossfire explores treatment
The peer exchange journal Medical Crossfire recently featured CFS on its cover and in a lengthy article that presents a debate among experts about various treatment options. "The most important point for primary care physicians is accepting that the patient does have a disorder well recognized by the medical establishment, and validating that the person is sick," says Dr. Paul Levine of the George Washington University School of Public Health. "Effective treatment focuses on relieving the most distressing symptoms and improving functioning."

Chronic fatigue syndrome: Can it be treated? Medical Crossfire. 1999;1:37-45.

CDC PEER REVIEWS CFS PROGRAM
On Nov. 15-16, 1999, the Centers for Disease Control and Prevention (CDC) asked 10 outside experts to critique its internal CFS research program and make recommendations for future directions. The panel made many recommendations, including expanding CDC’s general epidemiology work to include studies of long-term effects, economic impact, quality of life, clustering of cases in families, and adolescents and minorities. Reviewers also noted that CDC should re-emphasize the search for a pathogenic cause of CFS, especially viruses and agents that are difficult to identify through standard culture techniques. The agency has said that the comments of the peer reviewers will inform a "reinvigorated" CFS research program.