Chronic fatigue syndrome: understanding a complex illness

Holgate, Stephen T.; Komaroff, Anthony L.; Mangan, D F; Wessely, Simon

doi:10.1038/nrn3087

Cited by 90 publications

(73 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although prolonged and disabling fatigue is present in 10–25% of patients presenting to general practitioners,1 a diagnosis of CFS requires that patients experience persistent or relapsing fatigue for at least 6 consecutive months and have four or more of the following symptoms: postexertional malaise, impaired memory or concentration, unrefreshing sleep, muscle pain, multi‐joint pain without redness or swelling, tender cervical or axillary lymph nodes, sore throat, and headache 2, 3. Although the cause of CFS remains unknown, altered central nervous system (CNS) function is believed to play an important role,4 including altered perception of fatigue and pain, deficits in the cognitive functions of concentration and memory, mood changes of depression and anxiety, and sleep disturbance 1. Accordingly, neuroimaging studies have investigated possible brain changes associated with CFS 5, 6, 7, 8.…”

mentioning

confidence: 99%

Progressive brain changes in patients with chronic fatigue syndrome: A longitudinal MRI study

Shan

Kwiatek

Burnet

et al. 2016

Magnetic Resonance Imaging

View full text Add to dashboard Cite

PurposeTo examine progressive brain changes associated with chronic fatigue syndrome (CFS).Materials and MethodsWe investigated progressive brain changes with longitudinal MRI in 15 CFS and 10 normal controls (NCs) scanned twice 6 years apart on the same 1.5 Tesla (T) scanner. MR images yielded gray matter (GM) volumes, white matter (WM) volumes, and T1‐ and T2‐weighted signal intensities (T1w and T2w). Each participant was characterized with Bell disability scores, and somatic and neurological symptom scores. We tested for differences in longitudinal changes between CFS and NC groups, inter group differences between pooled CFS and pooled NC populations, and correlations between MRI and symptom scores using voxel based morphometry. The analysis methodologies were first optimized using simulated atrophy.ResultsWe found a significant decrease in WM volumes in the left inferior fronto‐occipital fasciculus (IFOF) in CFS while in NCs it was unchanged (family wise error adjusted cluster level P value, P FWE < 0.05). This longitudinal finding was consolidated by the group comparisons which detected significantly decreased regional WM volumes in adjacent regions (P FWE < 0.05) and decreased GM and blood volumes in contralateral regions (P FWE < 0.05). Moreover, the regional GM and WM volumes and T2w in those areas showed significant correlations with CFS symptom scores (P FWE < 0.05).ConclusionThe results suggested that CFS is associated with IFOF WM deficits which continue to deteriorate at an abnormal rate. J. Magn. Reson. Imaging 2016;44:1301–1311.

show abstract

mentioning

confidence: 99%

Progressive brain changes in patients with chronic fatigue syndrome: A longitudinal MRI study

Shan

Kwiatek

Burnet

et al. 2016

Magnetic Resonance Imaging

View full text Add to dashboard Cite

show abstract

“…those areas involved in the control of eye movements and balance in standing position (area TE), social behaviour, mood and decision making (area TG) [26]. It is worth remembering that most of these functions are altered to various degree in ME/ CFS patients [2,4]. As a matter of fact, many of the neurocognitive deficits used to define the syndrome (difficulty in processing information, slowed thought, impaired concentration, disorientation, cognitive overload, difficulty with making decisions, slowed speech, acquired or exertional dyslexia, short-term memory loss, poor working memory) [2] seem to pertain to functions controlled by the temporal lobe.…”

Section: Cadmium and Neuronal Cell Death In Me/cfsmentioning

confidence: 99%

“…As in many syndrome, it is likely that there are multiple causes leading to a common clinical picture. Although a trigger cannot be necessarily considered an etiological agent, according to a recent review, several events may act as triggers, from external environmental or infectious events, such as chemical exposure or infections, to psychological and social factors that may be critical in maintaining the chronic condition of the syndrome [4]. The hypothesis of a retrovirus being associated with ME/CFS was postulated in 2009 [5], but further studies rejected this hypothesis [6], and, as of today, the causes of ME/CFS remain obscure.…”

Section: Introductionmentioning

confidence: 99%

Could cadmium be responsible for some of the neurological signs and symptoms of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

et al. 2012

View full text Add to dashboard Cite

a b s t r a c tAccording to the World Health Organization, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/ CFS) is a neurological disease characterized by widespread inflammation and multi-systemic neuropathology. Aetiology and pathogenesis are unknown, and several agents have been proposed as causative agents or as factors perpetuating the syndrome. Exposure to heavy metals, with particular reference to mercury and gold in dental amalgams, has been considered among the triggers of ME/CFS. Here we hypothesize that cadmium, a widespread occupational and environmental heavy metal pollutant, might be associated with some of the neurological findings described in ME/CFS. In fact, ME/CFS patients show a decrease of the volume of the gray matter in turn associated with objective reduction of physical activity. Cadmium induces neuronal death in cortical neurons through a combined mechanism of apoptosis and necrosis and it could then be hypothesized that cadmium-induced neuronal cell death is responsible for some of the effects of cadmium on the central nervous system, i.e. a decrease in attention level and memory in exposed humans as well as to a diminished ability for training and learning in rats, that are symptoms typical of ME/CFS. This hypothesis can be tested by measuring cadmium exposure in a cohort of ME/CFS patients compared with matched healthy controls, and by measuring gray matter volume in un-exposed healthy controls, exposed non-ME/CFS subjects, un-exposed ME/CFS patients and exposed ME/CFS patients. In addition, we hypothesize that cadmium exposure could be associated with reduced cerebral blood flow in ME/CFS patients because of the disruptive effects of cadmium on angiogenesis. In fact, cadmium inhibits angiogenesis and low global cerebral flow is associated with abnormal brain neuroimaging results and brain dysfunction in the form of reduced cognitive testing scores in ME/CFS patients. This hypothesis can be tested by measuring cerebral cortex blood flow in un-exposed healthy controls, exposed non-ME/CFS subjects, un-exposed ME/CFS patients and exposed ME/CFS patients. If our hypothesis is demonstrated correct, the consequences could affect prevention, early diagnosis, and treatment of ME/CFS. Implications in early diagnosis could entail the evaluation of symptoms typical of ME/CFS in cadmium-exposed subjects as well as the search for signs of exposure to cadmium in subjects diagnosed with ME/CFS. Nutritional supplementation of magnesium and zinc could then be considered, since these elements have been proposed in the prophylaxis and therapy of cadmium exposure, and magnesium was demonstrated effective on ME/CFS patients' symptom profiles.

show abstract

“…Chronic Fatigue Syndrome also affects physical func-tioning and the emotional behavior of those affected. To date, clear diagnostic criteria allow-ing for unambiguous diagnosis of CFS have not been established [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

“…Chronic fatigue syndrome (CFS) is a condi-tion in which fatigue represents the main symptom. However, comprehensive examination and exclusion of other comorbidities is required prior to establishing the diagnosis of CFS [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Chronic fatigue syndrome in 57-year-old woman

et al. 2014

View full text Add to dashboard Cite

AbstractChronic fatigue syndrome (CFS) is characterized by unexplained fatigue lasting for more than 6 months and accompanied by flulike symptoms. It most commonly affects women aged between 30 and 60 years. To date, clear diagnostic criteria allowing for unambiguous diagno-sis of CFS have not been established. We present a case of a 57-year-old woman with chronic fatigue syndrome in order to showcase the symptoms of this condition and propose a diagnos-tic protocol.

show abstract

Chronic fatigue syndrome: understanding a complex illness

Cited by 90 publications

References 6 publications

Progressive brain changes in patients with chronic fatigue syndrome: A longitudinal MRI study

Progressive brain changes in patients with chronic fatigue syndrome: A longitudinal MRI study

Could cadmium be responsible for some of the neurological signs and symptoms of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Chronic fatigue syndrome in 57-year-old woman

Contact Info

Product

Resources

About