TO TABLE OF
the Autonomic Nervous
By Mark Giuliucci
Chronic fatigue and immune dysfunction syndrome
CFIDS) is a complex disease that involves many
body systems. In their search for a cause and cure, researchers are examining
CFIDS affects the immune system, hormone
systems and numerous other body processes.
Canadian researcher Ronald Schondorf, MD, PhD, and his team at
are focusing on whether
CFIDS creates changes in the autonomic nervous
system (ANS). The ANS controls involuntary body functions, including heart beat,
digestion, gland secretions and sweating.
Dr. Schondorf is looking to answer three specific
- Do people with
widespread ANS dysfunction?
- Can a questionnaire be used to identify
CFIDS patients who have ANS
- Does ANS dysfunction occur whether or not a person is
The Chronicle asked Dr. Schondorf to explain his work, and what
he hopes to find.
Q: What do we know about ANS dysfunction and
A: We have already shown that about 40 percent of people with
the disease have orthostatic intolerance, a form of ANS dysfunction. They have
trouble with dizziness, lightheadedness and other symptoms when they stand up.
This is related to how fast the heart beats and changes in blood pressure. These
changes may also occur after you eat or when you are hot.
What’s not really known is whether
affects other autonomic functions. Are
these functions somehow altered in people with
? That’s what we’re looking to document.
Q: How will you conduct your research?
A: Not everything can be studied easily. You can study the
bladder or the gut, but the tests are very invasive. So we are studying sweating
and cardiovascular changes while the subjects are standing. We can get at these
Some people with autonomic dysfunction sweat less in certain
spots, and more in others. We already know that some people with
CFIDS get drenching sweats, while others have
no problem with this at all. Our study will help us discover how widespread the
problem really is in people with
could also give us a hint about other autonomic problems. Maybe if one part of
the system gets attacked, another part will be affected as well.
Q: How can this knowledge help patients?
A: It may give us insight into the underlying pathophysiology of
the disease — that is, how
CFIDS affects the
normal working of the body. I would certainly not say that everything about
CFIDS can be explained by changes in the
autonomic nervous system. But perhaps studying the role of ANS dysfunction in
CFIDS can help us identify groups of
individuals for whom intervention can be made. In some cases, treatments for
autonomic problems might help.
It also can help provide objective proof that something isn’t
right with them. It could provide validation that they are sick, which is
important to many patients.
Q: Are you talking about a clinical test for
A: A test could be a two-edged sword. On one hand, it provides
insurance companies with some degree of comfort when paying claims. But if you
don’t show these particular symptoms, the insurance company could use it against
you. Even if a doctor with tremendous knowledge of
CFIDS gives you a diagnosis of
CFIDS, an insurance company could say, “Too
bad, you don’t show anything on the test.”
Q: What about the questionnaire?
A: Many tests for
autonomic disorders, like the tilt table test, are very expensive and very
invasive. A questionnaire that screens people with
CFIDS for autonomic problems could be a
tremendous benefit to the patient.
If you actually come up with a validated questionnaire, then
doctors could screen you in the office. They could stratify patients and decide
where more testing needs to be done. Physicians could avoid giving unnecessary
tests. Nobody likes standing and being tested for 45 minutes. Many people have
to travel great distances to get testing. They have to pay out of pocket. Maybe
we could help avoid some of that.
A questionnaire has been developed by the Mayo Clinic to see if
people in the general population have obvious autonomic disorders. Perhaps this
is something we can use, or modify, to identify people with
CFIDS who have more subtle autonomic
But this may prove very difficult. Many people with
CFIDS have a lot of symptoms that are difficult
to explain. Often they are much more disabled or attach a lot more meaning to
certain symptoms than other people. We’ll have to see how it goes.
Q: Can you explain your third goal, to uncover what role
deconditioning might play?
A: Some people may show abnormalities in the autonomic system
simply because they’re deconditioned. If you’ve had the flu for a few days and
have been lying down most of that time, you may feel quite dizzy when you stand
up. That’s a very mild form of deconditioning; you have been inactive and are
not used to standing up.
We hope to see how much of a role —if any — inactivity plays in
CFIDS cases. We expect that ANS dysfunction
will be independent of how much activity a
CFIDS patient gets.
This whole area can be controversial. There’s a political twist.
It could be that autonomic dysfunction is a genuine problem related to
CFIDS. Or maybe not — in which case some people
will say that people with
CFIDS are bringing
this on themselves by becoming deconditioned. My argument is that the data are
the data, and we’ll have to see what it shows. We need to find out.
Editor’s Note: Dr. Schondorf’s research is being funded by a
grant from The CFIDS Association