Wednesday, September 21, 2005

Judy Foreman LA Times: Physiology of ME/CFS/CFIDS begins to take shape

Good news. There are now at least three research studies that I know of concentrating on identifying the gene responsible for chronic fatigue. Two are in the UK and one in the US [see below copied article]. It is likely there are more studies going on as this particular field of enquiry may lead to a blood test and treatment. See earlier posts here regarding Dr Gow's research at University of Glasgow, Scotland, UK.

Here is a copy (bold emphasis is mine) of an article September 19, 2005, special to the Los Angeles Times, by Judy Foreman entitled. I am copying it here in full incase the link becomes broken. Note the report quotes Dr. Anthony Komaroff, a chronic fatigue expert and editor in chief of
CFS: Research Update, as saying brain abnormalities in many patients with CFS that are consistent with the symptoms patients describe.

Physiology of chronic fatigue begins to take shape;
The brain, hormones, the immune system -- all those and more may figure in the syndrome.


"Many doctors and others have dismissed people with chronic fatigue syndrome as depressed, lazy or just plain whiny. Now a slew of research -- more than 2,000 scientific papers by some counts -- is suggesting that chronic fatigue is not a psychiatric illness, but a nasty mix of immunological, neurological and hormonal abnormalities.

Several types of brain scans, for instance, have shown abnormalities -- such as different patterns of blood flow to certain regions of the brain -- in patients with chronic fatigue, and other studies have shown that patients have difficulty thinking and processing information and are unable to do several mental tasks at once.

"There are objective brain abnormalities in many patients with CFS that are consistent with the symptoms patients describe," said Dr. Anthony Komaroff, a chronic fatigue expert and editor in chief of Harvard Health Publications, a division of Harvard Medical School.

Chronic fatigue, which has no known cure, is more than feeling tired all the time. Definitions vary, but the one used by the federal government says the condition is characterized by persistent, unexplained fatigue that lasts at least six months, as well as four of the following: sore throat, tender lymph nodes, muscle pain, multi-joint pain, headaches, unrefreshing sleep, malaise after exercise and impaired memory or concentration.

The syndrome -- which can come on after an acute infection, a head injury or a major life stress, or from no obvious triggers at all -- affects 800,000 to 2.5 million Americans, most of them women, said Dr. William Reeves, chief of chronic fatigue syndrome research at the federal Centers for Disease Control and Prevention. But the ailment is tricky to diagnose because its symptoms overlap with those of other conditions, such as depression, Gulf War syndrome and fibromyalgia.

A federal study now underway is designed to measure the activity of thousands of genes in 190 people, some with the disease, some without, to find a distinctive genetic fingerprint for chronic fatigue. The ultimate goal, Reeves said, is a blood test for the condition.

"This illness is a nightmare that is extraordinary," said Dr. David Bell, a specialist in Lyndonville, N.Y. "If you're lucky, you get over CFS in a couple of years. If you're not, it stays with you for the rest of your life."

Jean Harrison, 52, a former art restorer who lives in Salem, Mass., has been unlucky. She thinks she had mild chronic fatigue starting when she was 6, but she wasn''t diagnosed until she was 41, when her symptoms got worse.

"For a long time, my doctor thought I was depressed, so I exercised ... But when the doctor realized I kept getting much worse after exercise, she concluded I had CFS. I was thrilled to finally get a diagnosis, after all those years of people saying, 'What's wrong with you?'"

Now Harrison is "almost housebound," she said. "If I do too much, I can end up being asleep for days. If I haven't overextended, I can be awake for seven to eight hours. If I have supper with my family on a Sunday, I have to spend all day Monday in bed. It's a devastating illness."

Like Harrison, many people with chronic fatigue are first told they have depression. But the afflictions are quite different; depression triggers an increase in the stress hormone cortisol, and chronic fatigue triggers a decline, said Harvard's Komaroff. Although depression gets better with drugs such as Prozac, the fatigue of CFS does not.

Harrison's response to exercise is typical of many chronic fatigue patients, perhaps because in them, exercise triggers the release of fatigue-inducing immune chemicals called cytokines. People with the disease sometimes can exercise as hard as healthy people -- they just feel awful for a day or two afterward, Reeves said.

"There is considerable evidence from published studies that in CFS the immune system is overactive," Komaroff said.

In research published last spring, Christopher Snell at the University of the Pacific in Stockton showed that some people with chronic fatigue syndrome experience a flare-up of symptoms after exercise. Paradoxically, though, a 2004 analysis of data pooled from five separate studies showed that very gradual increases in aerobic exercise can reduce fatigue in some patients.

Given the complexity of chronic fatigue syndrome, perhaps it's not surprising that treatments are piecemeal and not very effective, and that some doctors get almost as discouraged as their patients.

"Very few doctors are willing to care for CFS patients because it is such a downer," said Dr. Hugh Calkins, director of electrophysiology at Johns Hopkins Medical Institutions in Baltimore.

Still, experts point to some remedies that might help relieve some symptoms. In doses five to 10 times lower than those used for depression, tricyclic antidepressants such as Elavil can improve sleep, Komaroff said.

And cognitive behavior therapy, which teaches people to reevaluate their negative thoughts and behaviors, does help some people with chronic fatigue to make optimal use of the little energy they have.

But mostly, it's a game of patience -- and hope that the strides in research will translate into better diagnosis and, ultimately, better treatments for chronic fatigue."

1 Comments:

Blogger adin Burroughs said...

*Finally*. I know I'm still battling the "he's just depressed" thing, even with Neuropsych, GI, Infectious Disease, Endinocronoligist results that all point to something nasty.

September 22, 2005  

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