A status report on chronic fatigue syndrome.

Abstract

Medical history has shown that clinical disease entities or syndromes are composed of many subgroups-each with its own cause and pathogenesis. Although we cannot be sure, we expect the same outcome for chronic fatigue syndrome (CFS), a medically unexplained condition characterized by disabling fatigue accompanied by infectious, rheumatological, and neuropsychiatric symptoms. Although the ailment clearly can occur after severe infection, no convincing data exist to support an infectious (or immunologic) process in disease maintenance. Instead, data point to several possible pathophysiological processes: a covert encephalopathy, impaired physiological capability to respond to physical and mental stressors, and psychological factors related to concerns about effort exacerbating symptoms. Each of these is under intense investigation. In addition, some data do exist to indicate that environmental agents also can elicit a state of chronic fatigue. We expect data to accumulate to support the belief that CFS has multiple causes.

Increasing orthostatic stress impairs neurocognitive functioning in chronic fatigue syndrome with postural tachycardia syndrome

“…Patients with POTS also report cognitive impairment, especially during orthostatic stress [10]. Overall, neurocognitive impairments may be the most debilitating aspects of CFS/POTS [2,3,16,17]. …”

The role of environmental factors in medically unexplained symptoms and related syndromes: conference summary and recommendations.

“…We agreed that reliance on quantitative measures of outcome that minimize susceptibility to experimenter bias needs to be developed; validated and combined neuroimaging techniques, discussed in the paper by Natelson and Lange (16), are one example. Markers of effect that can be used both in the laboratory and in the field need to be developed; for instance, common symptom scales, computerized neurobehavioral measures, and physiologic measures such as cortisol, heart rate variability, and neuroendocrine measures can be used in the field as well as in the laboratory.…”

Persistent Burnout Theory of Chronic Fatigue Syndrome

“…While high titers of HHV6, EBV and other virus antibodies are commonly found in patients, this is also sometimes found in healthy patients and simply reflects prior infection. Furthermore, some research shows no immune dysfunction in patients at all [12]. It is also well established that stressors such as examinations can cause large increases in herpesvirus antibody titers [13].…”