Chronic fatigue syndrome is a common chronic health condition, especially for women, occurring across ethnic groups. Earlier findings suggesting that CFS is a syndrome primarily affecting white, middle-class patients were not supported by our findings.

Carnitine is essential for mitochondrial energy production. Disturbance in mitochondrial function may contribute to or cause the fatigue seen in Chronic Fatigue Syndrome (CFS) patients. Previous investigations have reported decreased carnitine levels in CFS. Orally administered L-carnitine is an effective medicine in treating the fatigue seen in a number of chronic neurologic diseases. Amantadine is one of the most effective medicines for treating the fatigue seen in multiple sclerosis patients. Isolated reports suggest that it may also be effective in treating CFS patients. Formal investigations of the use of L-carnitine and amantadine for treating CFS have not been previously reported. We treated 30 CFS patients in a crossover design comparing L-carnitine and amantadine. Each medicine was given for 2 months, with a 2-week washout period between medicines. L-Carnitine or amantadine was alternately assigned as fist medicine. Amantadine was poorly tolerated by the CFS patients. Only 15 were able to complete 8 weeks of treatment, the others had to stop taking the medicine due to side effects. In those individuals who completed 8 weeks of treatment, there was no statistically significant difference in any of the clinical parameters that were followed. However, with L-carnitine we found statistically significant clinical improvement in 12 of the 18 studied parameters after 8 weeks of treatment. None of the clinical parameters showed any deterioration. The greatest improvement took place between 4 and 8 weeks of L-carnitine treatment. Only 1 patient was unable to complete 8 weeks of treatment due to diarrhea. L-Carnitine is a safe and very well tolerated medicine which improves the clinical status of CFS patients. In this study we also analyzed clinical and laboratory correlates of CFS symptomatology and improvement parameters.

Peripheral blood lymphocytes from 17 patients with autism were separated on a Ficoll-Hypaque density gradient. Patients had normal numbers of T and B cells and T cell subsets. Although CD4:CD8 ratios were normal for the whole group (2.09 ± 0.97), 6 patients had elevated ratios (>2.2) and 5 had decreased ratios (<1.5). Mitogen-induced proliferation (concanavalin-A and phytohemagglutinin) was normal as was the autologous mixed lymphocyte reaction for the whole group. There was an abnormally increased percentage of DR+ (activated) T lymphocytes in 11 patients. With increasing age percentage of DR+ lymphocytes decreased. No patient had interleukin-2 (IL-2) receptor+ cells. Similar investigations performed on blood samples from 8 girls with Rett syndrome produced normal results. 11 of 17 autistic patients had an abnormally increased percentage of DR+ but not IL·2 receptor+ lymphocytes suggesting ‘incomplete’ activation, a finding which is seen in autoimmune diseases. The decrease in activated cells with increasing age suggests that there may be an autoimmune process which is more active earlier in life in a subset of autistics.

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