The pathophysiology of chronic fatigue syndrome in adolescents
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AbstractChronic fatigue syndrome (CFS) is a disabling disease with unknown pathophysiology, but recent evidence suggests autonomic dysfunction. We have therefore explored cardiovascular and thermoregulatory autonomic responses.
A consecutive sample of 15/27 CFS patients 12-18 years old and a volunteer sample of 33/57 healthy controls having equal distribution of gender and age participated. Symptoms were charted using a questionnaire. Experiments included a) head-up tilt, b) lower body negative pressure with handgrip, and c) local skin cooling.
CFS patients reported symptoms of altered cardiovascular and thermoregulatory responses. At rest, they had a higher heart rate (HR), blood pressure (BP), total peripheral resistance (TPR), tympanic temperature (TT) and plasma catecholamines. During orthostatic stress, CFS patients had a greater increase in HR, BP, TPR, and low-frequency HR-variability, but when isometric exercise was added, they had a smaller increase in HR, BP and TPR. During local skin cooling, CFS patients had a greater decrease in TT and a smaller decrease in acral skin blood flow.
These results suggest disturbances of central autonomic control characterized by abnormal homeostat resetting, linking CFS to stress/distress. A sustained arousal theory is proposed.
Paper 1: Chronic fatigue and orthostatic intolerance effectively treatedby propranolol
Paper 2: Usefulness of an abnormal cardiovascular response duringlow-grade head-up tilt-test for discriminating adolescentswith chronic fatigue from healthy controls
Paper 3: Sympathetic predominance of cardiovascular regulationduring mild orthostatic stress in adolescents with chronicfatigue
Paper 4: Altered sympathetic cardiovascular control duringorthostatic stress and isometric exercise in chronic fatiguesyndrome
Paper 5: Abnormal thermoregulatory responses in adolescents withchronic fatigue syndrome: relation to clinical symptoms