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.
ResumenPresentamos la evolución de la terminología y los criterios diagnósticos para el síndrome de fatiga crónica/encefalomielitis miálgica.Este síndrome es una entidad compleja y controvertida, de etiología desconocida, que aparece en la literatura médica en 1988, si bien desde el siglo XIX se identificaron cuadros clínicos de fatiga crónica idiopática con diferentes nombres, desde neurastenia, neuromiastenia epidémica y encefalomielitis miálgica benigna hasta la actual propuesta de enfermedad de intolerancia al esfuerzo (postesfuerzo). Todos ellos aluden a un estado crónico de fatiga generalizada de naturaleza desconocida, con limitaciones al esfuerzo físico y mental, acompañado de un conjunto de síntomas que comprometen diversos sistemas orgánicos.La Clasificación Internacional de Enfermedades (CIE-10) encuadra este síndrome en el apartado de trastornos neurológicos (G93.3), aunque todavía no se hayan encontrado hallazgos anatomopatológicos que lo clarifiquen.Se han documentado múltiples alteraciones orgánicas, pero no se ha establecido una biología común que aclare los mecanismos que subyacen a esta dolencia. Se enuncia como una disfunción neuroinmunoendocrina, con un diagnóstico exclusivamente clínico y por exclusión.Diversos autores han propuesto incluir el síndrome de fatiga crónica/encefalomielitis miálgica dentro de los síndromes de sensibilidad central, aludiendo a la sensibilización central como el sustrato fisiopatológico común para este síndrome y otros.El papel del médico de familia es clave en la enfermedad, para la detección de aquellos pacientes que presenten una fatiga de naturaleza desconocida que se prolonga de forma continua o intermitente durante más de 6 meses, al objeto de realizar un diagnóstico temprano y establecer un plan de actuación frente a una enfermedad crónica con unos altos niveles de morbilidad en la esfera física y mental.ObjetivoRealizar una revisión bibliográfica de la terminología y criterios diagnósticos del síndrome de fatiga crónica/encefalomielitis miálgica, al objeto de aclarar conceptualmente la enfermedad, como utilidad en el diagnóstico a los médicos de Atención Primaria.
The maintained attention is the cause of great functional limitations in CFS/ME, a disease that mainly affects women in the central period of life. Cognitive function is explored using the Montreal Cognitive Assessment, the maintained attention using the Toulouse-Piéron test with which the Global Index of Attention and Perception (GIAP) is obtained, the fatigue using the visual analog scale and the perception of effort using the modified Borg scale. The final sample were 84 patients (66 women/18 men) who met diagnostic criteria (Fukuda-1994, Carruthers-2011) and 22 healthy controls (14 women/8 men). Most of patients maintain normal cognitive function, showing low or very low attention score in the 70% of patients with a marked cognitive fatigue compared to the control group (p < 0.05). There were no significant differences between genders in GIAP or fatigue for CFS/ME; however, sick women perceive cognitive effort higher than men. Deficits in sustained attention and the perception of fatigue, so effort after performing the proposed test are a sensitive and reliable indicator that allows us to substantiate a clinical suspicion and refer patients for further studies in order to confirm or rule out CFS/ME.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.