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

MRI results predict symptoms
Brain abnormalities detected by MRI are significantly related to self-reports of low physical function in CFS patients, according to a study in the International Journal of Neuroscience.

The study looked at 48 CFS patients who underwent MRI procedures after filling out Medical Outcomes Study SF-36, which measures patients’ self-reported health status. Abnormalities were grouped into five categories: lateral ventricular enlargement; gray matter and/or brain stem hyperintensities; subcortical white matter hyperintensities; cerebral atrophy; and left-right cerebral hemisphere asymmetries. Twenty-five of the 48 subjects showed brain abnormalities that fell into one of the five categories.

Researchers discovered a significant negative correlation between brain abnormalities and physical function as self-reported on SF-36. This effect held after controlling for the increased age of the subjects found to have abnormal MRI results (43.0 years +/- 9.7 vs. 33.5 years =/- 6.5 years).

The authors suggest that brain abnormalities in CFS are "as functionally significant as has been shown in the case of multiple sclerosis."

Cook DB et al. Relationship of brain MRI abnormalities and physical functional status in chronic fatigue syndrome. Intern J. Neuroscience. 2001; 107:1-6.

Study: Urinary free cortisol low in CFS patients
A new report in the American Journal of Psychiatry confirms that mild hypocortisolism accompanies CFS in many patients.

Researchers at King’s College Hospital in London report that urinary free cortisol levels were significantly lower in CFS patients than healthy controls, regardless of comorbid psychiatric conditions. Twenty-four hour urine samples were collected from 121 consecutive patients at the hospital’s CFS clinic and com-pared to 64 healthy controls.

Because the study was cross-sectional, researchers say they are unable to tell whether cortisol levels are a potential cause or by-product of CFS. The study is also limited because it drew from a tertiary-care patient base.

Cleare AJ et al. Urinary Free Cortisol in Chronic Fatigue Syndrome. American Journal of Psychiatry. 2001; 158:641-643.

CFS may increase lipoprotein peroxidation
CFS patients are at higher risk for peroxidation of both low-density lipoproteins (LDL) and very-low-density lipoproteins (VLDL), write the authors of a new study published in the journal Life Sciences.

The study compared 61 people with varying complaints of fatigue. The subjects were divided into two groups: those who met 1988 guidelines for CFS (n=33) and those with unexplained fatigue lasting at least one month (n=28). The CFS group showed significantly higher peroxidation levels, measured in vitro by formation of Thiobar-bituric Acid Reactive Substances (TBARS).

Researchers attribute the higher levels to the shorter amount of time that LDL and VLDL took before in vitro peroxidation in the CFS patients as compared to controls. They write that the intrinsic ability to resist peroxidation in somehow impaired by CFS.

The CFS patients also displayed lower levels of serum transferrin. The researchers speculate that this, coupled with phagocyte hyperactivity and lipid peroxidation, can cause extra oxidative stress in people with CFS. After additional study, antioxidant supplementation may be advisable.

Manuel y Keenoy B et al. Antioxidant status and lipoprotein peroxidation in chronic fatigue syndrome. Life Sciences. 2001; 68:2037-2049.

CFS abstracts wanted for scientific meeting
Abstracts are being sought for The Third International Clinical and Scientific Meeting for Chronic Fatigue Syndrome, to be held Dec. 1-2, 2001 in Sydney, Australia.

All CFS-related topics are welcome, including clinical case studies; physical findings; evidence of persistent infection; cytokines and symptomatology; membrane integrity (e.g., BBB & GIT); environmental exposures; and health management models.

Abstracts should be no longer than 300 words. Please indicate whether you would prefer an oral or poster presentation. The title should be brief and must clearly identify the nature of the study and the content of the presentation.

For questions about submission formats and deadlines, please contact Ellie Stein, MD, via e-mail at cdnpsych@telusplanet.net, or by phone in Canada at 403-685-4861.

Syncope: Evaluation and Management
Complaints of syncope are common among people with chronic fatigue syndrome (CFS). An article in the April 2001 issue of Clinician Reviews offers advice for evaluating and managing the condition.

• Syncope is, by definition, a transient condition that results from global decrease in cerebral profusion. Subtypes include cardiac syncope, often caused by arrhythmia; cough syncope; postural syncope, caused by a defect or instability in vasomotor reflexes; and vasodepressor syncope, which accounts for half of all episodes.
  
• Diagnosis: Check for prescribed, OTC and recreational drug use. About nine percent of syncope is caused by drug reactions. Rule out other diagnoses, such as anxiety/hyperventilation, hypoglycemia and head trauma.
  
• Management: Patients with diagnosed vasodepressor syncope could benefit from antihypertensives, including beta-blockers and calcium channel blockers. Those with chronic orthostatic intolerance could benefit from mineralocorticoid therapy.
  
• Prevention: Counsel patients with postural hypotension to rise slowly from bed, after spending a few seconds lightly exercising their legs. Sleeping with the feet elevated eight to 12 inches may help, as might wearing elastic stockings. High salt intake can increase fluid retention, but creates a long-term risk of hypertension.
  
• Education: Patients with recurring syncope should take precautions to avoid dangerous situations, such as driving an automobile or operating power tools. Cover sharp corners on furniture to lessen danger of injury during falls. Cover bathroom floors and bathtub floors with rubber mats. When feeling lightheaded, patients should lie on their backs with their legs elevated to improve blood flow to the head.