The pathophysiology of chronic fatigue syndrome in adolescents

Abstract

Chronic 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. <br> 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.<br> 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. <br> These results suggest disturbances of central autonomic control characterized by abnormal homeostat resetting, linking CFS to stress/distress. A sustained arousal theory is proposed.