Severe Chronic Fatigue Syndrome Research Articles

Home-based family focused rehabilitation for adolescents with severe Chronic Fatigue Syndrome.

The purpose of this article is to describe and evaluate a home based, family focused rehabilitative approach for severely affected housebound adolescents with Chronic Fatigue Syndrome (CFS). The main aims were to facilitate a return to school, improve physical functioning, reduce fatigue and assess any adverse effects of the intervention. Six housebound adolescents aged 11-18, diagnosed with CFS by a paediatrician, were assessed and treated at home by an experienced cognitive behaviour therapist. Outcomes were assessed 12 months after discharge from treatment. At 12 months follow-up all patients had returned to either school or college, and physical functioning had improved in most of the patients. Fatigue had reduced in some. No adverse effects of the intervention were reported. Severely affected adolescents with CFS showed improved physical functioning and social adjustment after a home-based rehabilitative approach. Although several patients showed improvements in physical functioning, they did not all show substantial improvements in fatigue. At this crucial stage of development, it is important to offer young people and their parents hope by stating that improvement is possible.

Cost-utility of home-based fatigue self-management versus usual care for the treatment of chronic fatigue syndrome

ABSTRACT Background: Chronic fatigue syndrome (CFS) is a complex chronic condition with large negative impact on patients’ function and quality of life. Efficacy and cost-effectiveness of cognitive behavioral intervention remain inconclusive. Objective: To evaluate the cost-utility of a home-based fatigue self-management (FSM) intervention as compared to usual care among primary care patients with severe CFS. Methods: An economic evaluation alongside of a randomized controlled study design was used. Cost and utility data were collected from 137 patients with severe CFS at baseline and 1-year follow-up. The FSM group (n = 89) received self-delivered cognitive behavioral self-management intervention and the usual care group (n = 48) received regular medical care. Cost was measured by total costs (direct, indirect, and intervention costs) during the follow-up period. Quality-adjusted life years (QALY), as the utility measure, were derived from the Medical Outcomes Survey Short Form-36. A societal perspective was adopted. Bootstrapped incremental cost-utility ratios (ICURs) and net monetary benefit (NMB) were calculated as measures of cost-effectiveness. Results: Baseline individual characteristics were similar between the two groups. The intervention was well received by the participants with only minimum attrition. At the end of one-year post-intervention, FSM dominated usual care in terms of ICUR in both the intention-to-treat analysis and the complete-cases-only analysis. Net monetary benefit analysis showed that FSM has higher probability of achieving positive net monetary across the entire range of possible societal willingness to pay for fatigue symptom management. Conclusions: In primary care patients with severe CFS, the low-cost FSM appears to be a cost-effective treatment.

Understanding severely affected chronic fatigue syndrome (CFS): the gravity of the situation

Objective: To describe how the effects of gravity may adversely affect the neuro-cardiovascular physiology of individuals with severe Chronic Fatigue Syndrome (CFS).Design: A narrative review of the literature relating to microgravity, orthostatic intolerance and severe CFS. Emphasis is placed on the clinical significance and implications for the management of patients with severe CFS, with suggestions for future rehabilitation and physical interventions.Results: Physiological functions in humans have evolved to counter the effects of gravity, in particular the neuro-cardiovascular system. Reducing exposure to gravity will result in deconditioning of these systems. Many of the symptoms experienced by astronauts returning to Earth are shared by those with severe CFS. Prolonged periods in the supine position create an environment similar to microgravity – the mechanism through which we propose orthostatic intolerance develops in CFS. However, there are also some physiological changes present in CFS which may exacerbate these changes. Studies have shown that some CFS individuals have hypovolaemia unrelated to deconditioning. This pre-existing hypovolaemia may make the neuro-cardiovascular system more vulnerable to the effects of bed rest in those individuals with CFS.Conclusion: Severely affected CFS individuals may be more susceptible to a specific type of deconditioning, related to reduced exposure to gravity, due to pre-existing vulnerabilities in their cardiovascular and autonomic nervous systems. Rehabilitation which targets the neuro-cardiovascular system and its response to upright posture may improve function and symptoms of severely affected CFS individuals.

Patient change attributions in self-management of severe chronic fatigue syndrome

ABSTRACT Purpose: To identify patient change attributions arising from a home self-management intervention in severe chronic fatigue syndrome (CFS). Methods: This multi-method study of 126 participants with severe CFS collected data through phone interviews at 3-month follow-up in a self-management trial reported previously. Patient ratings (ranging from very much worse to very much better), were elicited on the global impression of change scale followed by this question: ‘Why do you think you are: “worse”, “unchanged”, “improved”’, etc.? The open-ended responses from participants were thematically organized and analyzed as study data. Results: Most improved participants referenced behavioral changes that included: increased relaxation, coping and stress reduction (44%), pacing (e.g. more rest, less exercise; 33%), and more physical activity/exercise (25%). For participants reporting ‘unchanged’ global ratings, the majority (63%) attributed their status to one or more of the following: nothing will help/illness acceptance/illness fluctuates without overall change (29%), everything is the same (24%) or does not know (17%). Participants with worsened global ratings most often attributed their decline to: changes in sleep (40.5%), deteriorating health (35%), specific life events (30%), and/or stress (30%). Treatment-assigned participants as compared to no treatment controls were significantly more likely (p = <.05) to cite increased awareness, relaxation/coping/stress reduction and pacing as their reasons for change. The frequency of active vs. passive coping categories also distinguished improved from non-improved patients. Conclusions: Patient attributions could be utilized by the clinician to shift patient perceptions of their illness status in a constructive direction, possibly leading to an enhanced quality of life.

Efficacy of two delivery modes of behavioral self-management in severe chronic fatigue syndrome

ABSTRACT Purpose: To assess the efficacy of fatigue self-management for severe chronic fatigue syndrome (CFS). Methods: This randomized trial enrolled 137 patients with severe CFS. Participants were randomized to one of three conditions: fatigue self-management with web diaries and actigraphs (FSM:ACT); fatigue self-management with less expensive paper diaries and pedometers (FSM:CTR); or an usual care control condition (UC). The primary outcome assessed fatigue severity at 3-month follow-up. Analysis was by intention-to-treat. Results: At 3-month follow-up, the FSM:CTR condition showed significantly greater reduction in fatigue severity compared to UC (p = .03; d = .58). No significant improvement was found at 12-month follow-up for the FSM:ACT or the FSM:CTR condition as compared to UC (p > .10). The combined active treatment conditions revealed significantly reduced fatigue at 3-month follow-up (p = .03), but not at 12-month follow-up (p = .24) compared to UC. Clinically significant improvements were found for 24–28% of the intervention groups as compared to 9% of the UC group. Attrition at 12-month follow-up was low (< 8%). Conclusion: Home-based self-management for severe CFS appeared to be less effective in comparison to findings reported for higher functioning groups. Home-based management may be enhanced by remotely delivered interventional feedback.

Chronic Disabling Fatigue in Adolescents

Chronic Disabling Fatigue in Adolescents

Natural killer cells in patients with severe chronic fatigue syndrome

Maintenance of health and physiological homeostasis is a synergistic process involving tight regulation of proteins, transcription factors and other molecular processes. The immune system consists of innate and adaptive immune cells that are required to sustain immunity. The presence of pathogens and tumour cells activates innate immune cells, in particular Natural Killer (NK) cells. Stochastic expression of NK receptors activates either inhibitory or activating signals and results in cytokine production and activation of pathways that result in apoptosis of target cells. Thus, NK cells are a necessary component of the immunological process and aberrations in their functional processes, including equivocal levels of NK cells and cytotoxic activity pre-empts recurrent viral infections, autoimmune diseases and altered inflammatory responses. NK cells are implicated in a number of diseases including chronic fatigue syndrome (CFS). The purpose of this review is to highlight the different profiles of NK cells reported in CFS patients and to determine the extent of NK immune dysfunction in subtypes of CFS patients based on severity in symptoms.Electronic supplementary materialThe online version of this article (doi:10.1007/s13317-013-0051-x) contains supplementary material, which is available to authorized users.

Assessment of Natural Killer Cell Receptors and Activity in Severe and Moderate Chronic Fatigue Syndrome.

Event Abstract Back to Event Assessment of Natural Killer Cell Receptors and Activity in Severe and Moderate Chronic Fatigue Syndrome. Sharni L. Hardcastle1, 2, Ekua W. Brenu1, 2*, Don R. Staines2, 3 and Sonya M. Marshall-Gradisnik1, 2 1 Griffith University, School of Medical Sciences, Australia 2 Griffith University, Griffith Health Institute, Australia 3 Queensland Health, Australia Abnormalities in the immune system are a common finding within sufferers of Chronic Fatigue Syndrome (CFS). Research has consistently found compromised Natural Killer (NK) cell function in CFS subjects. The mechanism of the reduced NK function is unknown and however this may potentially be related to the presence of NK receptors. It is also unknown whether reduced NK function is further compromised within CFS subjects who are very severely affected by the disease. The purpose of this study was to examine NK activity and Killer Immunoglobulin-like Receptors (KIRs) in moderate (MFS) and severely affected CFS (SFS) subjects in comparison to controls. CFS subjects were characterised as either moderate or severely affected based on health and quality of life questionnaires. Severe subjects were housebound. Blood samples were collected s from controls (n=9; 50.9 + 2.5 years), MFS (n=9; 49.9+ 3.7years) and SFS subjects (n=9; 42.3 + 3.9 years). Using flow cytometry NK cells were measured for their activity based on their ability to lyse K562 cells and cell surface expression of KIRs. ANOVA was the statistical method used to assess all data collected. Preliminary data from CFS subjects showed significant reductions NK cell activity and an increase in KIR3DL1 in CFS subjects when compared to the controls. Results suggest that CFS patients have further compromised immune function, particularly reduced NK cell activity, when compared to controls. Additionally, increased levels of KIR, particularly KIR3DL1 in CFS patients, may potentially explain why these patients have a decrease in NK lysis. Keywords: CFS, Severe, Natural Killer, receptors, Lysis Conference: 15th International Congress of Immunology (ICI), Milan, Italy, 22 Aug - 27 Aug, 2013. Presentation Type: Abstract Topic: Innate immunity Citation: Hardcastle SL, Brenu EW, Staines DR and Marshall-Gradisnik SM (2013). Assessment of Natural Killer Cell Receptors and Activity in Severe and Moderate Chronic Fatigue Syndrome.. Front. Immunol. Conference Abstract: 15th International Congress of Immunology (ICI). doi: 10.3389/conf.fimmu.2013.02.01040 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 30 Jun 2013; Published Online: 22 Aug 2013. * Correspondence: Dr. Ekua W Brenu, Griffith University, School of Medical Sciences, Gold Coast, Queensland, 4222, Australia, e.brenu@griffith.edu.au Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Sharni L Hardcastle Ekua W Brenu Don R Staines Sonya M Marshall-Gradisnik Google Sharni L Hardcastle Ekua W Brenu Don R Staines Sonya M Marshall-Gradisnik Google Scholar Sharni L Hardcastle Ekua W Brenu Don R Staines Sonya M Marshall-Gradisnik PubMed Sharni L Hardcastle Ekua W Brenu Don R Staines Sonya M Marshall-Gradisnik Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Autonomic Dysfunction in Chronic Fatigue Syndrome

Symptoms of autonomic dysfunction are one of the characteristic features of the clinical condition known as chronic fatigue syndrome (CFS). In this study we examined the autonomic nerve functions in 1,099 patients with CFS and in 361 normal healthy controls. The autonomic nerve functions were studied in terms of heart rate variability and spectral analysis, and by using the maximal Lyapunov exponent (MLE) and chaotic analysis. The heart rate variability analysis revealed that both the logarithmic low-frequency power (Log LF) and logarithmic high-frequency power (Log HF) were reduced significantly with age in healthy subjects (p < 0.005). When we compared these parameters between the CFS patients and healthy controls according to age groups, there was no significant difference in Log LF between CFS and control except in the case of the 40's age group. However, Log HF decreased significantly in moderate and severe fatigue CFS groups in all age groups. All of the severe fatigue CFS age groups had a significant increase in the ratio of Log LF/HF as compared with that of the healthy controls. When we studied the change in these power values during sleep as compared with that during awake time, the HF power rose 3.03-fold in the controls and 1.86-fold in the CFS group during sleep as compared with that during the awake time; and this difference in fold increase during sleep between the CFS and control groups was significant (p < 0.05). Furthermore, the MLE for both the moderate and severe fatigue CFS groups was decreased significantly as compared with that of the healthy control group (p < 0.01). It is well known that autonomic nervous function differs greatly in individuals, but our present large research study indicates that there is no doubt that parasympathetic nervous dysfunction is involved in the pathophysiology of CFS patients with severe fatigue. We incorporated the evaluation of autonomic function into the Japanese CFS diagnostic criteria in 2012, because this evaluation might be a useful objective diagnostic tool for CFS.

Analysis of Neutrophil Function in Severe and Moderately Affected Chronic Fatigue Syndrome Subjects.

Event Abstract Back to Event Analysis of Neutrophil Function in Severe and Moderately Affected Chronic Fatigue Syndrome Subjects. Sharni L. Hardcastle1, 2, Ekua W. Brenu1, 2*, Don R. Staines2, 3 and Sonya M. Marshall-Gradisnik1, 2 1 Griffith University, School of Medical Sciences, Australia 2 Griffith University, Griffith Health Institute, Australia 3 Gold Coast Public Health Unit , Queensland Health, Australia Research has commonly shown that people with Chronic Fatigue Syndrome (CFS) have immune system abnormalities. Decreases have been found in neutrophil respiratory burst in a CFS cohort. Reduced ability of neutrophils to eliminate pathogens can contribute to the impaired immune function in CFS subjects. It is unknown whether neutrophil function is more impaired in patients severely affected by CFS. The purpose of this study was to examine neutrophil activity including phagocytosis and respiratory burst in patients with severe CFS in comparison to those with moderate symptoms and non-fatigued controls. CFS subjects were characterised using the CDC Case Definition and the International Consensus Criteria for CFS. CFS subjects were then grouped as either moderate or severely affected based on health and quality of life questionnaires. Blood samples were taken from age and sex matched non-fatigued controls, moderately affected and severely affected CFS subjects. Response to E.coli bacteria was measured in neutrophils by assessing phagocytic activity and respiratory burst, these were then analysed on the flow cytometer. Preliminary data from CFS subjects showed differences in neutrophil function based on respiratory burst and phagocytic activity when compared to the control group. These results suggest that differences in neutrophil function in CFS patients may contribute to CFS related immune dysfunction. Keywords: CFS, Severe, Neutrophil, Respiratory Burst, Phagocyte Conference: 15th International Congress of Immunology (ICI), Milan, Italy, 22 Aug - 27 Aug, 2013. Presentation Type: Abstract Topic: Innate immunity Citation: Hardcastle SL, Brenu EW, Staines DR and Marshall-Gradisnik SM (2013). Analysis of Neutrophil Function in Severe and Moderately Affected Chronic Fatigue Syndrome Subjects.. Front. Immunol. Conference Abstract: 15th International Congress of Immunology (ICI). doi: 10.3389/conf.fimmu.2013.02.01039 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 30 Jun 2013; Published Online: 22 Aug 2013. * Correspondence: Dr. Ekua W Brenu, Griffith University, School of Medical Sciences, Gold Coast, Queensland, 4222, Australia, e.brenu@griffith.edu.au Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Sharni L Hardcastle Ekua W Brenu Don R Staines Sonya M Marshall-Gradisnik Google Sharni L Hardcastle Ekua W Brenu Don R Staines Sonya M Marshall-Gradisnik Google Scholar Sharni L Hardcastle Ekua W Brenu Don R Staines Sonya M Marshall-Gradisnik PubMed Sharni L Hardcastle Ekua W Brenu Don R Staines Sonya M Marshall-Gradisnik Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Patterns of food avoidance in chronic fatigue syndrome: is there a case for dietary recommendations?

To assess the dietary habits and food avoidance-behavior in patients with Chronic Fatigue Syndrome (CFS). Cross-sectional pilot study with 28 patients diagnosed with severe CFS. Eating habits were assessed with a food frequency questionnaire and 3-day food records. We analyzed variables related to dietary restrictions induced by symptoms or external information. The most prevalent restrictions were for dairy products and gluten-containing grains, with 22 and 15 restricting patients, respectively. Patients reported different digestive symptoms, which did not improve with the use of exclusion diets. Thirteen patients had received information against the intake of certain foods through different sources. Six cases of grains restriction and 11 of dairy were compatible with a counseling-induced pattern of exclusion. There is not a homogeneous pattern of food avoidance. Dietary restrictions should be based on a proven food allergy or intolerance. Dietary counseling should be based on sound nutritional knowledge.

PATRONES DE EVITACIÓN ALIMENTICIA EN EL SÍNDROME DE FATIGA CRÓNICA; ¿HAY BASE PARA DAR RECOMENDACIONES DIETÉTICAS?

Objectives: To assess the dietary habits and food avoidance- behavior in patients with Chronic Fatigue Syndrome (CFS). Methods: Cross-sectional pilot study with 28 patients diagnosed with severe CFS. Eating habits were assessed with a food frequency questionnaire and 3-day food records. We analyzed variables related to dietary restrictions induced by symptoms or external information. Results: The most prevalent restrictions were for dairy products and gluten-containing grains, with 22 and 15 restricting patients, respectively. Patients reported different digestive symptoms, which did not improve with the use of exclusion diets. Thirteen patients had received information against the intake of certain foods through different sources. Six cases of grains restriction and 11 of dairy were compatible with a counseling-induced pattern of exclusion. Conclusions: There is not a homogeneous pattern of food avoidance. Dietary restrictions should be based on a proven food allergy or intolerance. Dietary counseling should be based on sound nutritional knowledge.

Chronic fatigue syndrome: illness severity, sedentary lifestyle, blood volume and evidence of diminished cardiac function

The study examined whether deficits in cardiac output and blood volume in a CFS (chronic fatigue syndrome) cohort were present and linked to illness severity and sedentary lifestyle. Follow-up analyses assessed whether differences in cardiac output levels between CFS and control groups were corrected by controlling for cardiac contractility and TBV (total blood volume). The 146 participants were subdivided into two CFS groups based on symptom severity data, severe (n=30) and non-severe (n=26), and two healthy non-CFS control groups based on physical activity, sedentary (n=58) and non-sedentary (n=32). Controls were matched to CFS participants using age, gender, ethnicity and body mass. Echocardiographic measures indicated that the severe CFS participants had 10.2% lower cardiac volume (i.e. stroke index and end-diastolic volume) and 25.1% lower contractility (velocity of circumferential shortening corrected by heart rate) than the control groups. Dual tag blood volume assessments indicated that the CFS groups had lower TBV, PV (plasma volume) and RBCV (red blood cell volume) than control groups. Of the CFS subjects with a TBV deficit (i.e. > or = 8% below ideal levels), the mean+/-S.D. percentage deficit in TBV, PV and RBCV were -15.4+/-4.0, -13.2+/-5.0 and -19.1+/-6.3% respectively. Lower cardiac volume levels in CFS were substantially corrected by controlling for prevailing TBV deficits, but were not affected by controlling for cardiac contractility levels. Analyses indicated that the TBV deficit explained 91-94% of the group differences in cardiac volume indices. Group differences in cardiac structure were offsetting and, hence, no differences emerged for left ventricular mass index. Therefore the findings indicate that lower cardiac volume levels, displayed primarily by subjects with severe CFS, were not linked to diminished cardiac contractility levels, but were probably a consequence of a co-morbid hypovolaemic condition. Further study is needed to address the extent to which the cardiac and blood volume alterations in CFS have physiological and clinical significance.

Serum 25-hydroxy Vitamin D Levels in Chronic Fatigue Syndrome: a Retrospective Survey

Patients with chronic fatigue syndrome (CFS) may be at risk of osteoporosis due to their relative lack of physical activity and excessive time spent indoors, leading to reduced vitamin D synthesis. We hypothesized that serum 25-OH vitamin D levels are lower in CFS patients than in the general British population. We performed a retrospective survey of serum 25-OH vitamin D levels in 221 CFS patients. We compared this to a group of patients attending the hospital for other chronic conditions and to a large British longitudinal survey of 45-year old women, using a variety of appropriate statistical approaches. 25-OH vitamin D levels are moderately to severely suboptimal in CFS patients, with a mean of 44.4 nmol/L (optimal levels >75 nmol/L). These levels are lower and the difference is statistically significant (p<0.0004) than those of the general British population from a recent national survey, but similar to those in patients with other chronic conditions. This data supports the recommendation made in recent NICE guidelines that all patients with moderate to severe CFS should be encouraged to obtain adequate sun exposure and eat foods high in vitamin D. Oral or intramuscular vitamin D supplementation should be considered for those whose levels remain suboptimal.

Guided self-instructions for people with chronic fatigue syndrome: randomised controlled trial

A minimal intervention, based on cognitive-behavioural therapy for chronic fatigue syndrome and consisting of self-instructions combined with email contact, was tested in a randomised controlled trial (ISRCTN27293439). A total of 171 patients participated in the trial: 85 were allocated to the intervention condition and 86 to the waiting-list condition. All patients met the Centers for Disease Control and Prevention criteria for chronic fatigue syndrome. An intention-to-treat analysis showed a significant decrease in fatigue and disability after self-instruction. The level of disability was negatively correlated with treatment outcome. Guided self-instructions are an effective treatment for patients with relatively less severe chronic fatigue syndrome.

Severe Chronic Fatigue Syndrome (CFS/ME): Recovery is Possible

The recovery of individuals with very severe chronic fatigue syndrome/ myalgic encephalomyelitis (CFS/ME) is possible with successful multidisciplinary management. This case vignette aims to highlight the beneficial outcome of using occupational therapy lifestyle management and the Canadian Occupational Performance Measure to identify perceived problems in occupational performance and indicate change. The current management strategies in CFS/ME are discussed briefly and the challenges of the management of severe CFS/ME are described, indicating a need for a supportive team and specialist inpatient services. In 2003, the Department of Health released funds in England to develop more widely accessible CFS/ME services. This case study illustrates a positive outcome for one individual with severe CFS/ME, following admission to a specialist inpatient facility. It is hoped that it may aid other therapists working with and developing services for people with severe presentations of CFS/ME.

1625 Pathological findings in a case of severe Chronic Fatigue Syndrome

1625 Pathological findings in a case of severe Chronic Fatigue Syndrome

Recovery from chronic fatigue syndrome with modafinil

Chronic fatigue syndrome (CFS) is a syndrome in which the defining symptom is marked physical and mental fatigue (Fukuda et al., 1994). The aetiology and pathophysiology are as yet not determined. Treatment is often unsatisfactory, and only cognitive behavioural therapy (CBT) and graded exercise therapy (GET) have proved themselves to be of significant benefit, for some patients, in a recent systematic review (Whiting et al., 2001). In terms of pharmacological treatments, the antidepressant SSRI, fluoxetine, is most commonly used, but has been shown to be of little or no benefit in treating the fatigue of CFS in randomized controlled trials (Wearden et al., 1998). Clearly, more effective treatments need to be identified. Modafinil is a central nervous stimulant used in the treatment of narcolepsy. There are as yet no reports of its use in treatment of CFS. The case of a patient with severe CFS who made a good recovery with this drug is reported.

Mismatched double-stranded RNA: polyI:polyC12U.

Mismatched double-stranded RNA: polyI:polyC12U.

Baroreceptor reflex and integrative stress responses in chronic fatigue syndrome.

Altered cardiovascular responses to mental and postural stressors have been reported in chronic fatigue syndrome (CFS). This study examined whether those findings may involve changes in baroreceptor reflex functioning. Chronotropic baroreceptor reflex (by sequential analysis) and cardiovascular stress responses were recorded during postural (5-minute of active standing) and cognitive (speech task) stress testing in patients with CFS grouped into cases with severe (N = 21) or less severe (N = 22) illness, and in 29 matched control subjects. Patients with CFS had a greater decline in baroreceptor reflex sensitivity (BRS) during standing, although only those with severe CFS were significantly different from the controls. Systolic blood pressure declined during standing in the control group but was maintained in the CFS patients. In contrast, the patients with less severe CFS had blunted increases in blood pressure during the speech task, which could not, however, be explained by inadequate inhibition of the baroreceptor reflex, with all groups showing an appropriate reduction in BRS during the task. These results indicate that in CFS, deficiencies in orthostatic regulation, but not in centrally mediated stress responses, may involve the baroreceptor reflex. This study also suggests that classifying patients with CFS on illness severity may discriminate between patients with abnormalities in peripheral vs. central mechanisms of cardiovascular stress responses.