Chronic Fatigue Syndrome: Schondorf R

Gerrity TR, Bates J, Bell DS, Chrousos G, Furst G, Hedrick T, Hurwitz B, Kula RW, Levine SM, Moore RC, Schondorf R. · Georgetown University Medical Center, Washington, DC, USA. · Neuroimmunomodulation. · Pubmed #12481153 No free full text.

Abstract: Chronic fatigue syndrome (CFS) is a serious health concern affecting over 800000 Americans of all ages, races and socioeconomic groups and both genders. The etiology and pathophysiology of CFS are unknown, yet studies have suggested an involvement of the autonomic nervous system (ANS). A symposium was organized in December 2000 to explore the possibility of an association between ANS dysfunction and CFS, with special emphasis on the interactions between ANS dysfunction and other abnormalities noted in the immune and endocrine systems of individuals with CFS. This paper represents the consensus of the panel of experts who participated in this meeting.

Schondorf R, Freeman R. · Dept. of Neurology, McGill University, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada. · Am J Med Sci. · Pubmed #10037115 No free full text.

Abstract: Chronic fatigue syndrome (CFS) or myalgic encephalomyelitis is a clinically defined syndrome characterized by persistent or relapsing debilitating fatigue for longer than 6 months in the absence of any definable medical diagnosis. The cause of this syndrome is unknown. Symptoms of orthostatic intolerance, such as disabling fatigue, dizziness, diminished concentration, tremulousness, and nausea, are often found in patients with CFS. In this review, we critically evaluate the relationship between orthostatic intolerance and CFS. Particular emphasis is placed on clinical diagnosis, laboratory testing, pathophysiology, and therapeutic management. It is hoped that this review will provide a stimulus for further study of this complex and disabling condition.

Schondorf R, Benoit J, Wein T, Phaneuf D. · Department of Neurology, McGill University, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada. · J Auton Nerv Syst. · Pubmed #10189122 No free full text.

Abstract: This study aims to investigate the prevalence and pathophysiology of orthostatic intolerance (OI) and its potential contribution to symptoms of a group of unselected patients with chronic fatigue syndrome (CFS). Seventy five patients (65 women, 10 men) with CFS were evaluated. During an initial visit, a clinical suspicion as to the likelihood of observing laboratory evidence of OI was assigned. Laboratory investigation consisted of beat-to-beat recordings of heart rate, blood pressure (Finapres), and stroke volume (impedance cardiograph) while supine and during 80 degrees head-up tilt (HUT), during rhythmic deep breathing (6 breaths/min) and during the Valsalva maneuver. The responses of 48 age-matched healthy controls who had no history of OI were used to define the range of normal responses to these three maneuvers. Forty percent of patients with CFS had OI during head-up tilt. Sixteen exhibited neurally-mediated syncope alone, seven tachycardia (> 35 bpm averaged over the whole of the head-up tilt) and six a mixture of tachycardia and syncope. Eight of 48 controls exhibited neurally-mediated syncope. The responses to the Valsalva maneuver and to deep breathing were similar in controls and patients. On average, the duration of disease and patient age were significantly less and the onset of symptoms was more often subacute in patients with OI than in those without OI. We conclude that there exists a clinically identifiable subgroup of patients with CFS and OI that differs from control subjects and from those with CFS without OI for whom treatment specifically aimed at improving orthostatic tolerance may be indicated.

Bailes S, Libman E, Baltzan M, Amsel R, Schondorf R, Fichten CS. · SMBD-Jewish General Hospital, Montreal, Canada. · J Psychosom Res. · Pubmed #16731235 No free full text.

Abstract: OBJECTIVE: Sleepiness and fatigue are conceptually distinct but pervasively confounded in research, measurement instruments, clinical settings, and everyday spoken language. The purpose of the present study was to construct two scales that represent unconfounded measures of sleepiness and fatigue, using widely used questionnaires. METHOD: Four questionnaires purporting to measure sleepiness [Stanford Sleepiness Scale (SSS); Epworth Sleepiness Scale (ESS)] or fatigue [Fatigue Severity Scale (FSS); Chalder Fatigue Scale (CFS)] were administered, as well as a battery measuring sleep, psychological, and health functioning variables, to three samples: 19 individuals with chronic fatigue syndrome, 14 with narcolepsy, and 11 normal control subjects. RESULTS: Analyses revealed two distinct sets of items (six sleepiness and three fatigue items) that were combined into two scales. These newly formed scales are only minimally correlated and represent separate constructs that have reasonably distinctive patterns of association. Findings were replicated and validated in a sample of 128 older individuals complaining of daytime sleepiness and/or fatigue. CONCLUSIONS: We conclude that (a) it is possible to derive empirically distinct sleepiness and fatigue scales from existing, commonly used self-report instruments, (b) the Empirical Sleepiness Scale is limited to the experience of daytime sleep tendency, while (c) the Empirical Fatigue Scale is associated more broadly with insomnia, psychological maladjustment, and poorer perceived health function. The important clinical implication of the new Empirical Sleepiness and Fatigue Scales is in the ability to identify "sleepiness which is not fatigue," a construct closely related to primary sleep disorders, such as sleep apnea/hypopnea syndrome, for which there is both available and effective treatment.

Fossey M, Libman E, Bailes S, Baltzan M, Schondorf R, Amsel R, Fichten CS. · S.M.B.D.-Jewish General Hospital, Montreal, Quebec, Canada. · J Behav Med. · Pubmed #15669445 No free full text.

Abstract: Without specific etiology or effective treatment, chronic fatigue syndrome (CFS) remains a contentious diagnosis. Individuals with CFS complain of fatigue and poor sleep--symptoms that are often attributed to psychological disturbance. To assess the nature and prevalence of sleep disturbance in CFS and to investigate the widely presumed presence of psychological maladjustment we examined sleep quality, sleep disorders, physical health, daytime sleepiness, fatigue, and psychological adjustment in three samples. individuals with CFS; a healthy control group; and individuals with a definite medical diagnosis: narcolepsy. Outcome measures included physiological evaluation (polysomnography), medical diagnosis, structured interview, and self-report measures. Results indicate that the CFS sample had a very high incidence (58%) of previously undiagnosed primary sleep disorder such as sleep apnea/hypopnea syndrome and restless legs/periodic limb movement disorder. They also had very high rates of self-reported insomnia and nonrestorative sleep. Narcolepsy and CFS participants were very similar on psychological adjustment: both these groups had more psychological maladjustment than did control group participants. Our data suggest that primary sleep disorders in individuals with CFS are underdiagnosed in primary care settings and that the psychological disturbances seen in CFS may well be the result of living with a chronic illness that is poorly recognized or understood.