Quantitative assessment of cerebral ventricular volumes in chronic fatigue syndrome.

Departments of Psychiatry and Radiology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, 30 Bergen Street, Newark, NJ 07107, USA.
Applied Neuropsychology (Impact Factor: 1.97). 02/2001; 8(1):23-30. DOI: 10.1207/S15324826AN0801_4
Source: PubMed

ABSTRACT Previous qualitative volumetric assessment of lateral ventricular enlargement in chronic fatigue syndrome (CFS) has provided evidence for subtle structural changes in the brains of some individuals with CFS. The aim of this pilot study was to determine whether a more sensitive quantitative assessment of the lateral ventricular system would support the previous qualitative findings. In this study, we compared the total lateral ventricular volume, as well as the right and left hemisphere subcomponents in 28 participants with CFS and 15 controls. Ventricular volumes in the CFS group were larger than in control groups, a difference that approached statistical significance. Group differences in ventricular asymmetry were not observed. The results of this study provide further evidence of subtle pathophysiological changes in the brains of participants with CFS.

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    ABSTRACT: DEFINITION Chronic fatigue syndrome (CFS) is a complex illness de-fined by unexplained disabling fatigue as its core feature and a combination of other accompanying symptoms, such as diffuse pain, subjective cognitive impairment, and sleep problems. Similar symptom constellations have been described for at least two centuries and a changing list of names has been used to label them: neurasthenia, neuromyasthenia, myalgic encephalomyelitis, myalgic en-cephalopathy, poliomyelitis-like illness, Akureyri disease, postviral fatigue, and chronic mononucleosis are some examples (Straus, 1991; Briggs and Levine, 1994). The first formal case definition of the illness, published in the USA in 1988 (Holmes et al., 1988), suggested the name "chronic fatigue syndrome" or CFS. In 1994, an interna-tional collaborative group that included authors of the previous case definitions published the current CFS re-search case definition (Fukuda et al., 1994). The 1994 case definition requires at least 6 months of persistent fatigue; this fatigue cannot be substantially alleviated by rest, is not the result of ongoing exertion, and is associated with substantial reductions in occupational, social, and per-sonal activities. In addition, at least four of the following eight symptoms must occur with fatigue in a 6-month period: (1) impaired memory or concentration; (2) sore throat; (3) tender glands; (4) aching or stiff muscles; (5) multijoint pain; (6) new headaches; (7) unrefreshing sleep; and (8) postexertional fatigue. Medical conditions that may explain the prolonged fatigue as well as a number of psychiatric diagnoses exclude a patient from the diag-nosis of CFS (Reeves et al., 2003). More recently, efforts have been made to assess case-defining symptoms of CFS objectively. Persons are classified as having CFS if they meet the following three empirically derived criteria as assessed by psychometrically evaluated questionnaires (Reeves et al., 2005): (1) severe fatigue; (2) substantial functional impairment; and (3) presence of substantial accompanying symptoms. Because CFS is a diagnosis of exclusion, a thorough medical history and assessment are required before the diagnosis can be formally established. As outlined in a recommendation of the International CFS Study Group (Reeves et al., 2003), the following medical conditions should be considered as permanent exlcusions: (1) organ failure (e.g., emphysema, cirrhosis, cardiac failure, chronic renal failure); (2) chronic infections (e.g., ac-quired immunodeficiency syndrome (AIDS), hepatitis B or C); (3) rheumatic and chronic inflammatory dis-eases (e.g., systemic lupus erythematosus, Sj€ ogren's syndrome, rheumatoid arthritis, inflammatory bowel disease, chronic pancreatitis); (4) major neurologic dis-eases (e.g., multiple sclerosis, neuromuscular diseases, epilepsy or other diseases requiring ongoing medication that could cause fatigue, stroke, head injury with resid-ual neurologic deficits); (5) diseases requiring systemic treatment (e.g., organ or bone marrow transplantation, systemic chemotherapy, radiation of brain, thorax, ab-domen, or pelvis); (6) major endocrine diseases (e.g., hy-popituitarism, adrenal insufficiency); and (7) primary sleep disorders (e.g., sleep apnea, narcolepsy). Temporary medical exclusions include treatable con-ditions that require evaluation over time to determine the extent to which they contribute to the fatigu-ing illness. These encompass four general categories: (1) conditions discovered at onset or initial evaluation (e.g., effects of medications, sleep deprivation, untreated hypothyroidism, untreated or unstable diabetes mellitus, active infection); (2) conditions that resolve (e.g., preg-nancy until 3 months postpartum, breastfeeding, major surgery until 6 months postoperation, minor surgery until *Correspondence to:
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    ABSTRACT: Centers for Disease Control criteria for chronic fatigue syndrome (CFS) specifically recognize that patients can have both CFS and depression. The clinician's challenge is to judge for each individual patient whether the complaint of fatigue is primarily depression, physical illness, such as CFS, or a combination of both. This review differentiates CFS and fibromyalgia, discussed as “chronic fatigue syndrome and related immune deficiency syndromes” (CFIDS), from depression in terms of physical signs, symptoms, biological parameters, brain imaging, immunology, and treatment. The review focuses on practical applications of research findings with a further focus on future ability to show clear biologic separation and specific treatment. When depressive symptoms exist with those of CFS, accurate differentiation can usually be accomplished by focusing on diagnostic criteria. Presence of multiple physical signs and symptoms of CFIDS may be of great value. In terms of laboratory testing, a single helpful test may be measuring the plasma cortisol, which is usually high in depression and low in CFS. Future research should focus on the combination of plasma cortisol with an index of serotonin function, which is high in CFIDS and low in depression. Additional research should focus on neuroimaging and immune differentiation. Combination of multiple tests should result in a significant and clinically useful separation between CFIDS and major depressive disorder (MDD). In treating patients with significant depression or MDD with CFIDS, one should think of the noradrenergic approach using bupropion or low-dose tricyclic antidepressants in combination with a selective serotonin reuptake inhibitor, especially sertraline, to aid improvement of global, pain, and immunologic parameters. Alternatively, serotonin norepinephrine reuptake inhibitors (venlafaxine and duloxetine) should be considered. Future treatment research should focus on larger placebo-controlled, double-blind trials of these and other antidepressants as well as the evaluation of psychostimulants, electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS).
    Journal of Chronic Fatigue Syndrome 12/2011; 13(4).
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    ABSTRACT: Recent years have brought growing recognition of the need for clinical criteria for myalgic encephalomyelitis (ME), which is also called chronic fatigue syndrome (CFS). An Expert Subcommittee of Health Canada established the Terms of Reference, and selected an Expert Medical Consensus Panel representing treating physicians, teaching faculty and researchers. A Consensus Workshop was held on March 30 to April 1,2001 to culminate the review process and establish consensus for a clinical working case definition, diagnostic protocols and treatment protocols. We present a systematic clinical working case definition that encourages a diagnosis based on characteristic patterns of symptom clusters, which reflect specific areas of pathogenesis. Diagnostic and treatment protocols, and a short overview of research are given to facilitate a comprehensive and integrated approach to this illness. Throughout this paper, “myalgic encephalomyelitis” and “chronic fatigue syndrome” are used interchangeably and this illness is referred to as “ME/CFS.”
    Journal of Chronic Fatigue Syndrome 12/2011; 11(1).

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