Abstract
The aim of present paper is to identify clinical phenotypes in a cohort of patients affected of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Ninety-one patients and 22 healthy controls were studied with the following questionnaires, in addition to medical history: visual analogical scale for fatigue and pain, DePaul questionnaire (post-exertional malaise, immune, neuroendocrine), Pittsburgh sleep quality index, COMPASS-31 (dysautonomia), Montreal cognitive assessment, Toulouse-Piéron test (attention), Hospital Anxiety and Depression test and Karnofsky scale. Co-morbidities and drugs-intake were also recorded. A hierarchical clustering with clinical results was performed. Final study group was made up of 84 patients, mean age 44.41 ± 9.37 years (66 female/18 male) and 22 controls, mean age 45 ± 13.15 years (14 female/8 male). Patients meet diagnostic criteria of Fukuda-1994 and Carruthers-2011. Clustering analysis identify five phenotypes. Two groups without fibromyalgia were differentiated by various levels of anxiety and depression (13 and 20 patients). The other three groups present fibromyalgia plus a patient without it, but with high scores in pain scale, they were segregated by prevalence of dysautonomia (17), neuroendocrine (15), and immunological affectation (19). Regarding gender, women showed higher scores than men in cognition, pain level and depressive syndrome. Mathematical tools are a suitable approach to objectify some elusive features in order to understand the syndrome. Clustering unveils phenotypes combining fibromyalgia with varying degrees of dysautonomia, neuroendocrine or immune features and absence of fibromyalgia with high or low levels of anxiety-depression. There is no a specific phenotype for women or men.
Highlights
Myalgic Encephalomyelitis (ME) was proposed by Acheson as the name for a group of epidemic outbreaks that took place between 1945 and 1955 in different countries
ME normally begins with a viral infection affecting the respiratory system or gastrointestinal tract, which is followed by severe, persistent “central” fatigue accompanied by headaches, vertigo, muscle weakness, sleep disorders, paresthesia, dysautonomia, blurred vision, diplopia, anosmia, ataxia, emotional problems, etc
The current study presents an extensive and precise analysis of a series of patients diagnosed with ME, known to the scientific community as Chronic Fatigue Syndrome (CFS) expressing itself in the literature in a dual terminology (ME/CFS), in order to identify phenotypes, which would help us gain a better understanding of the syndrome, and define biomarkers
Summary
Myalgic Encephalomyelitis (ME) was proposed by Acheson as the name for a group of epidemic outbreaks that took place between 1945 and 1955 in different countries. The symptoms presented by these patients were similar to those shown by people suffering from poliomyelitis and included: fatigue, depression, muscle weakness, headaches and paresthesia, among others [1]. Similar descriptions can be found in the literature under names such as epidemic neuromyasthenia, vegetative neuritis, post-viral fatigue syndrome, raphe nucleus encephalopathy, chronic mononucleosis syndrome or exertion intolerance, among others [3]. These conditions can arise in isolated form, but generally appear within the context of epidemics [4]. Laboratory tests (including cerebrospinal fluid) and brain Structural Magnetic Resonance imaging are in general normal or unspecific [6,7,8]
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