TO TABLE OF CONTENTS
is news of current publications and
research efforts underway related to chronic fatigue syndrome (CFS)—also called chronic fatigue and immune
dysfunction syndrome (CFIDS).
Treatment trial for
Patients with CFS are more likely than
healthy persons to develop neurally mediated hypotension (NMH), a disorder that involves a precipitous
drop in systolic blood pressure (at least 20-25 mm Hg) in response to prolonged orthostatic stress. A
recent study found that fludrocortisone (Florinef), often used to treat low blood pressure, used alone
does not alleviate the symptoms of CFS patients better than a placebo.
Researchers at Johns Hopkins
University and the National Institute of Allergy and Infectious Diseases studied 100 adults diagnosed
with CFS and NMH. The 1994 consensus criteria were used to diagnose CFS, and NMH was identified by a two-stage
tilt-table test performed by the Hopkins group.
Half of the patients received Florinef and half
received a placebo for nine weeks. Based on standardized, daily self-ratings of overall wellness and other
measures of illness severity, there was no significant difference in benefit. Approximately 14% of
those treated with Florinef had a notable improvement in overall well-being compared with 10% in the placebo
The researchers cautioned that lack of symptomatic improvement with Florinef does not disprove
the hypo-thesis that NMH could be contributing to some CFS symptoms, particularly because combination
therapy is typically used in the treatment of NMH.
Further studies are needed to determine whether
other medications, used in combination or alone, would be more effective in treating NMH in CFS patients.
et al. Fludrocortisone acetate to treat NMH in chronic fatigue syndrome. JAMA. 2001; 285: 52-9.
Sleep disorders and CFS
According to a study conducted by
a group of Belgian researchers, CFS cannot be attributed solely to a somatic expression of a primary sleep
disorder (PSD) or sleepiness.
Forty-six CFS patients were clinically examined and underwent two
nights of all-night monitoring during sleep. Of the patients studied, 54% did not have PSD and 69%
had no sleepiness. While 46% of the CFS patients showed signs of one type of sleep disorder—sleep apnea—none
were diagnosed with narcolepsy or hypersomnia.
No association was found between the presence of
a sleep disorder and the patient’s clinical status. Objective and subjective measures of sleepiness were
not associated with CFS, and CFS patients without a PSD could not be distinguished clinically from those
with a PSD or sleepiness.
Le Bon O et al. How significant are primary sleep disorders and sleepiness
in chronic fatigue syndrome? Sleep Research Online. 2000; 3:43-8.
Possible motor cortex impairment
at the University
of California compared the motor cortex excitability of 14 CFS patients to 14 age-matched healthy controls.
The researchers used transcranial magnetic stimulation (TMS) to elicit motor-evoked potentials while subjects
performed repetitive, bilateral opening-closing movements of the index finger onto the thumb. Evoked potentials
were measured at regular intervals following periods of exercise.
The rate of movement was significantly
slower in the CFS subjects than in the controls, while the threshold of TMS needed to elicit potentials
was significantly higher in the individuals with CFS.
Although the controls exhibited a
delayed facilitation of evoked potentials after 15-30 minutes of rest, delayed facilitation was absent
in the CFS patients.
These findings add weight to other groups’ evidence that CFS leads to
measurable neurocognitive impairment.
Starr A et al. Motor cortex excitability in chronic fatigue
syndrome. Clin Neuro-physiol. 2000; 111: 2025-31.
Evidence of neuro-endocrine abnormalities
Several studies have suggested
hypoactivation of the hypothalamic-pituitary-adrenal axis in CFS. One possible determinant of this abnormality
is reduced secretion of corticotropin-releasing hormone (CRH).
Researchers at Cornell University
tested this hypothesis by measuring adrenocorticotropic hormone (ACTH) and cortisol response to a one-hour
infusion of vasopressin in 19 CFS patients and 19 controls. Because CRH and vasopressin act together to
stimulate ACTH secretion, the response to the vasopressin infusion acts as an indirect measure of hypothalamic
The CFS patients had a reduced ACTH response and more rapid cortisol response to
the infusion than the controls, providing evidence of endocrine abnormalities.
Altemus M et
al. Abnormalities in response to vasopressin infusion in chronic fatigue syndrome. Psychoneuroendocrinol.
2001: 26: 175-88.
Pain perception in CFS vs FM
CFS and fibromylagia
(FM) patients report having
pain, but only those with FM but not CFS exhibit abnormal pain responses to mild levels of stimulation
University of Alabama at Birmingham researchers suggest that differences in pain perception
between FM and CFS patients may be due to different abnormalities in the neuroendocrine axes, central
neuropeptide levels, and functional brain activity.
They point to studies that show FM patients
have higher levels of substance P than CFS patients, no cortical abnormalities, and hypoperfusion of the
thalamus, while CFS patients have higher plasma 5-HIAA levels than FM patients, a high number of coritcal
white matter lesions, and brain stem hypoperfusion at rest.
The researchers call for further study
to translate these findings into treatment solutions.
Bradley LA et al. Pain complaints in
patients with fibromyalgia vs. chronic fatigue syndrome. Current Rev Pain. 2000; 4: 148-57.
GRANTS FOR CFS RESEARCH
The CFIDS Association
of America’s Research
Grants Program provides financial support for promising pilot research studies that enable investigators
to collect sufficient data to effectively compete for government or other private funding. Since its inception
in 1987, the Association has funded more than $3.3 million in CFIDS research grants.
provides annual grants for broad, multi-objective research studies and Contract Grants for specific, single-objective
research studies. Annual grants are typically $20,000 to $80,000 and contract grants range from $5,000
to $25,000. If you would like further information about the Association’s Research Grants Program, please
contact Vicki Walker, Research Grants Officer, by e-mail at email@example.com
or telephone 704/364-0466.