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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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    • "However, other studies found no white-matter differences between CFS and healthy controls (Cope et al., 1995; Greco et al., 1997). Further studies examining structural differences found larger ventricular volumes in CFS than in a control group (Lange et al., 2001) and reduced gray-matter volume (Okada et al., 2004; de Lange et al., 2005). Interestingly, it was shown that gray-matter reductions were associated with CFS symptoms, such as fatigue severity (Okada et al., 2004), and a reduction in physical activity (de Lange et al., 2005). "
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    • "However, other studies found no white-matter differences between CFS and healthy controls (Cope et al., 1995; Greco et al., 1997). Further studies examining structural differences found larger ventricular volumes in CFS than in a control group (Lange et al., 2001) and reduced gray-matter volume (Okada et al., 2004; de Lange et al., 2005). Interestingly, it was shown that gray-matter reductions were associated with CFS symptoms, such as fatigue severity (Okada et al., 2004), and a reduction in physical activity (de Lange et al., 2005). "
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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:
    08/2011;
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    • "The presence of cerebral atrophy could also cause reductions in BP values. There have been no reports to date of cerebral atrophy in CFS, however, the main findings being an increased number of white matter hyperintensities in some studies (Cope and David 1996; Lange et al 1999; Wessely et al 1998), although a nonsignificant degree of lateral ventricular enlargement was seen in one study (Lange et al 2001). Although some evidence suggests hippocampal atrophy in depression (Campbell et al 2004), only one MRI study has assessed hippocampal size in CFS; this found no change in hippocampal volume, but there was a reduced concentration of N-acetylaspartate in the right hippocampus (Brooks et al 2000). "
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    ABSTRACT: Research from neuroendocrine challenge and other indirect studies has suggested increased central 5-HT function in chronic fatigue syndrome (CFS) and increased 5-HT1A receptor sensitivity. We assessed brain 5-HT1A receptor binding potential directly using the specific radioligand [11C]WAY-100635 and positron emission tomography (PET). We selected 10 patients from a tertiary referral clinic who fulfilled the CDC consensus criteria for CFS. To assemble a homogenous group and avoid confounding effects, we enrolled only subjects who were completely medication-free and did not have current comorbid psychiatric illness. We also scanned 10 healthy control subjects. There was a widespread reduction in 5-HT1A receptor binding potential in CFS relative to control subjects. This was particularly marked in the hippocampus bilaterally, where a 23% reduction was observed. There is evidence of decreased 5-HT1A receptor number or affinity in CFS. This may be a primary feature of CFS, related to the underlying pathophysiology, or a finding secondary to other processes, such as previous depression, other biological changes or the behavioral consequences of CFS.
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