Chronic Fatigue Syndrome

1. Hypothalamus

   Annotations:

   • http://www.hindawi.com/journals/isrn.neuroscience/2013/784520/
2. Immunological/virological abnormalities

   Annotations:

   • http://www.microbediscovery.org/blog/2014/05/19/dr-ian-lipkin-blog-part-1-of-9/
   1. xenotropic murine leukemia virus-related virus (XMRV) scandal...original findings retracted and XMRV not a CFS cause

      Annotations:

      • http://discovermagazine.com/2013/march/17-shadow-virus
      • http://www.nytimes.com/2009/10/13/health/13fatigue.html?ref=health
   2. if antiviral drugs lessened CFS symptoms-->compelling evidence for viral explanation
   3. deficiency in natural killer cells & reduction in killing power in remaining killer cells
   4. Borna Virus & West Nile Virus
      1. Dr. Lipkin's Study

         Annotations:

         • http://www.microbediscovery.org/blog/2014/05/19/dr-ian-lipkin-blog-part-1-of-9/
         1. "Drs Lipkin and Hornig have now completed a study of blood plasma, and spinal fluid. Their team have not yet found any pathogens clearly related to the disease, but they did discover some intriguing immune biomarkers in the blood plasma and spinal fluid studies, suggesting immune dysregulation in ME/CFS patients."
         2. Virus could be in white blood cells
         3. changes in microbiome > immune activation > symptoms of ME/CFS

            Annotations:

            • http://phoenixrising.me/archives/20926
3. Heritability of disease/clustered outbreaks

   Annotations:

   • "One family history study of chronic fatigue syndrome, three twin studies of prolonged fatigue, and one twin study of chronic fatigue syndrome have been published.****look up articles
   1. genetic predispositions?
4. Neuroimaging research
   1. Some MRI studies have detected significantly more abnormalities in the subcortical white matter of chronic fatigue syndrome subjects; other studies could not replicate
5. White matter brain lesions
6. microbiomes

   Annotations:

   • http://phoenixrising.me/archives/20926
   • http://phoenixrising.me/archives/21929
7. Pilot study of BDNF
   1. CFS patients showed significantly lower levels of constitutive (unstimulated) PBMC production of BDNF proteins
8. chemical sensitivity
   1. stigmatized because symptoms are nonspecific and have evidence is lacking

1. No single etiology known, diagnosis by symptoms

Annotations:

• https://mail-attachment.googleusercontent.com/attachment/u/0/?ui=2&ik=c3f375c898&view=att&th=14668ccb87580d38&attid=0.1&disp=safe&realattid=f_hw15j40q1&zw&saduie=AG9B_P9RSUjKH36l2F2KsDO41jP1&sadet=1402582265802&sads=cqiO59vGpjlrtwMcMQzcoVaheRM

1. Fatigue
   1. >6 months
   2. Persistent and debilitating
   3. PEM: Post-Exertional Malaise

      Annotations:

      • http://solvecfs.org/post-exertional-malaise-perception-and-reality/
      • http://solvecfs.org/guest-post-dr-larry-baldwin-on-post-exertional-debility-in-mecfs/#at_pco=smlre-1.0&at_si=5399b5100495834e&at_ab=per-1&at_pos=0&at_tot=4
      1. Self-reported measure/no objective clinical test
      2. Exercise lowers pain threshold in CFS & raises pain threshold in healthy
      3. CFS patients do not recover from muscle exertion as quickly as sedentary controls
      4. After exertion, cognitive tests show CFS patients have increased perception of effort and deficits of cognitive processing
         1. Cognitive deficits distinguished CFS from controls and depressed
2. Rheumatism
3. Symptom-based/clinical diagnosis without distinguishing physical examination or lab findings
4. Cognitive Impairment
5. Sleep Problems
6. Pain
7. Orthostatic Intolerance

1. Focus mainly on symptom therapy
2. energy envelope theory
   1. working within energy levels
   2. gradually increasing activity levels

1. Medical conditions that explain prolonged fatigue exclude a patient from CFS diagnosis
   1. eating disorders, psychotic disorders, bipolar disorder, melancholic depression (before onset of symptoms), substance abuse within 2 years of fatigue onset
2. Comorbidity
   1. Concurrence of multiple illnesses can occur (and, frequently, does occur) in CFS patients, if the illnesses occur after onset of fatigue/symptoms, it does not exclude patients from CFS diagnosis
      1. Frequent overlapping conditions: fibromyalgia, multiple chemical sensitivities, IBS, temporomandibular joint disorder
         1. Could possibly be different manifestations of same biomedical/psychosocial processes
            1. Critics are concerned with arbitrary classifications/case definitions

1. 3 to 5 times more common in women than men

1. 1994 CDC
   1. 6 months of persistent fatigue that substantially reduces a person's level of activity
   2. 4 or more symptoms: impaired memory or concentration, postexertional fatigue, sore throat, tender glands, aching or stiff muscles, multi-joint pain, (new) headaches, unrefreshing sleep
2. CCC
3. Fukuda (1994)
   1. unexplained, persistent or relapsing fatigue lasting six or more months, of definite onset, which is not alleviated by rest, and results in substantial activity reductions from previous levels of work, study and social and personal activities