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Encephalomyelitis, Myalgic

Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), post-viral fatigue syndrome (PVFS) and various other names, is a syndrome of unknown and possibly multiple etiology, affecting the central nervous system (CNS), immune, and many other systems and organs. Most definitions other than the 1991 UK "Oxford", require a number of features, the most common being severe mental and physical depletion, which according to the 1994 Fukuda definition is "unrelieved by rest", and is usually made worse by even trivial exertion (controversially the Oxford and Fukuda require this to be optional only). more...

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However patients usually contend that they have many, often severe symptoms which are far more onerous, such as pain, muscle weakness, loss of brain function, hypersensitivity, orthostatic intolerance, immune and in some cases life-threatening cardiac and respiratory problems, and it is these symptoms exacerbated by extremely low stamina that cause greatest suffering, not "fatigue", which more properly describes a normal state of recovery unrelated to pathology. Some cases resolve or improve over time, and where available, treatments bring a degree of improvement to many others.

History

Originally studied since the late 1930s as an immunological neurological disorder under the medical term "myalgic encephalomyelitis" (ME), CFS has been classified by the World Health Organization (WHO) as a disease of the central nervous system since 1969. In 1992 and early 1993 the terms "post-viral fatigue syndrome" (PVFS) and "chronic fatigue syndrome" (CFS) were added to ME under the exclusive ICD-10 designation of G93.3.

Nomenclature

There are a number of different terms which have been at various times identified with this organic neuroimmune disorder.

Myalgic encephalomyelitis (ME, "inflammation of the brain and spinal cord with muscle pain") as a disease entity has been recognized and described in the medical literature since 1938, with the seminal paper being that by Wallis in 1957; Sir Donald Acheson's (a former Chief Medical Officer) major review of ME was published in 1959; in 1962 the distinguished neurologist Lord Brain included ME in his textbook of neurology, and in 1978 the Royal Society of Medicine accepted ME as a distinct clinical entity. In 1988 both the UK Department of Health and Social Services and the British Medical Association officially recognized it as a legitimate and potentially distressing disorder. Opponents to the term ME maintain there is no inflammation and that not all patients report muscle pain. United Kingdom and Canadian researchers and patients generally use this term in preference to CFS.
Chronic fatigue syndrome (CFS); this name was introduced in 1988 by a group of United States researchers based at the Centers for Disease Control and Prevention, and is used increasingly over other designations, particularly in the United States.
Chronic fatigue immune dysfunction syndrome (CFIDS); many people, especially patients in the United States, use the term CFIDS (pronounced ), which was originally an acronym for the above or "Chronic Fatigue & Immune Dysregulation Syndrome". This term was introduced by patients current with the biomedical research in an attempt to reduce the psychiatric stigma attached to "chronic fatigue", as well as the public perception of CFS as a psychiatric syndrome.
Post-viral syndrome (PVS or PVFS); this is a related disorder. According to original ME researcher Dr. Melvin Ramsay, "The crucial differentiation between ME and other forms of post-viral fatigue syndrome lies in the striking variability of the symptoms not only in the course of a day but often within the hour. This variability of the intensity of the symptoms is not found in post-viral fatigue states" (Ramsay 1989).
Chronic Epstein-Barr virus (CEBV) or Chronic Mononucleosis; the term CEBV was introduced by virologists Dr. Stephen Straus and Dr. Jim Jones in the United States. The Epstein-Barr virus, a neurotropic virus that more commonly causes infectious mononucleosis, was thought by Straus and Jones to be the cause of CFS. Subsequent discovery of the closely related human herpesvirus 6 shifted the direction of biomedical studies, although a vastly expanded and substantial body of published research continues to show active viral infection or reinfection of ME/CFS patients by these two viruses. As these viruses are also found in healthy controls, however, it is uncertain what role they play in CFS.
Low Natural Killer cell disease; this name is used widely in Japan. It reflects research showing a reduction in the number of natural killer cells in many CFS patients.
Yuppie Flu; this was a factually inaccurate nickname for CFS, first published in a November 1990 Newsweek article. It reflects the belief that CFS mainly affects the affluent ("yuppies"), and implies that it is a form of malingering or burnout. CFS, however, affects people of all races, genders, and social standings, and this nickname is inaccurate and considered offensive by patients. It is likely that this article contributed to the damaging public (and even medical) perception of CFS as a psychiatric or even psychosomatic condition.
Uncommonly used terms include Akureyri Disease, Iceland disease (in Iceland), Royal Free disease (after the location of an outbreak), raphe nucleus encephalopathy, and Tapanui flu (after the New Zealand town Tapanui where a doctor who investigated the disease lived).

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From Dynamic Chiropractic, 2/26/05 by Sutton, Brian

Lymphonia From Arthritis Treatment

The pharmaceutical company that manufactures the drug Remicade has updated the drug's safety profile to warn of an increased incidence of lymphoma as a side-effect of the medication. The drug blocks production of "tumor necrosis factor" (TNF) to decrease joint pain. Unfortunately, usage is associated with a threefold increase in lymphoma in rheumatoid arthritis patients. There have also been some reports of an increased susceptibility to tuberculosis infection and lowered white blood cell and platelet counts.1

1. Reuters, Oct. 8, 2004.

Heads Up for Steroid Treatments

After 30 years of using corticosteroid drugs to treat head injuries, medical professionals are being told that they may be causing more harm than good. One of the few studies ever done on the subject has been published recently in The Lancet; it reported that more people die within two weeks subsequent to a head injury if given steroids than those given a placebo.2 The study involved 10,000 patients and found a 17 percent increased mortality associated with the drugs. Injury severity and promptness of treatment did not affect the outcomes.

2. The Lancet, Oct. 2, 2004.

Clot Risk From HRT

Researchers from the University of Vermont in Colchester are reporting a doubled risk of blood clots in women using a combination of estrogen and progesterone in their hormone replacement therapy regimen. Clots are a concern because of their potential for traveling to the lungs, which can result in death. This placebo-controlled study collected data from 16,000 postmenopausal women during the 1990s. Risk was highest for women who were overweight, older, or had a genetic predisposition. Aspirin usage did not have an impact. The FDA recommends that women on one of these regimens use the smallest dose possible for only a short period of time.3

3. Reuters, Oct. 5, 2004.

Transfusions Risky for Heart Patients

An analysis of three studies involving 24,000 patients concludes that something about blood transfusions causes a dramatic increase in mortality among acute heart patients. Researchers found that a blood transfusion tripled the likelihood that the gatient would die within 30 days. The reasons are unclear, but some suspect that the transfused blood is lacking in vital substances, such as nitrous oxide, which is a factor in oxygen replenishment.4

4. JAMA, Oct. 6, 2004.

Fatigue From Inactivity

A British group studying myalgic encephalomyelitis (ME) report that the condition appears to be more prevalent in inactive children. "ME" is similar to, and often used interchangeably with, chronic fatigue syndrome (CFS). Researchers followed the medical history of more than 16,000 individuals from birth to age 30, and noticed a higher incidence of the disorder in those who were the least active. Other contributing factors were being female and having a higher social status. They found no relationship to obesity, academic ability, birth order, allergies, or psychological problems.5

5. Reuters, October 5, 2004.

Fast Growth Problems

A study published in The Lancet suggests that the growth boost given by enriched infant formulas may not necessarily be a good thing.6 Researchers found that the cholesterol profiles of adolescents who had been breast-fed as babies were 14 percent better than the cholesterol profiles of adolescents who were given formula. Those who analyze such statistics say that this would roughly translate to a similar decrease in heart disease risk.7 The study involved 216 pre-term individuals.

6. The Lancet, May 15, 2004.

7. Associated Press, May 13, 2005.

Hazardous Vapors Affect Fetus

Pregnant women who work around solvents and other inhalable chemicals risk a detrimental effect on their unborn children, according to research by Canada's Hospital for Sick Children and the University of Toronto. This study compared 32 children of mothers in such a situation to a control group. The exposed mothers worked around a variety of chemicals such as ethanol, mineral spirits, and acrylic resins. Jobs included medical lab technician, dry cleaner, nail salon attendant, painter, photo lab worker, science teacher, embalmer, and hair stylist. The researchers found that subjects' children, when tested between the ages of 3 and 9, scored lower on language skills, attention, and memory.8

8. Archives of Pediatrics and Adolescent Medicine, October 2004.

Mediterranean Diet for the Gallbladder

Researchers examining the benefits of a diet high in vegetable oil, nuts, and fish are reporting a preventive effect on gallstones. Their study, published in the Annals of Internal Medicine, finds a nearly 20 percent protection gained from such a diet.9 The study involved more than 45,000 men over about 15 years.

9. AM, Oct. 5, 2004.

Colic From Smoke

According to a study from Brown University, babies who are exposed to cigarette smoke in utero (via a mother who smokes) are about twice as likely to develop colic.10 Nicotine is thought to be to blame, as it affects the balance of digestive proteins. The study was an analysis of a number of previous works involving thousands of infants.

10. Pediatrics, October 2004.

Walk for Mental Clarity

Reports published in the Journal of the American Medical Association11 suggest that a daily stroll may help to prevent dementia in elderly individuals. One study found that men could almost halve the risk if they took a two-mile stroll each day. Another study in the same issue noted that women who exercise regularly have mental abilities typical of those several years younger.

11. JAMA, Sept. 22, 2004.

Drug Usage Decline/Increase

The 2003 National Survey on Drug Use and Health has found that on average, fewer young Americans are using illegal drugs such as marijuana, LSD and ecstasy.12 Unfortunately, more are abusing prescription drugs. This survey found that the recreational use of pain relievers and other medications increased by 15 percent from the previous year among those ages 18-25. Presumably, the decrease in illegal drug use was due to increased awareness of the dangers from public awareness campaigns and such. Too bad there are no similar programs for prescription drugs.

12. Associated Press, Sept. 9, 2004.

Preventing the Flu

In the wake of the recent flu vaccination shortage, medical experts are advising people on steps to take to avoid the flu that sound remarkably like those many of us have heard from our grandmothers. Recommendations include careful hygiene, plenty of rest, a balanced diet, and lots of fluids.13 Stress management is also an important factor. Frequent, thorough hand-washing, avoiding crowds and sneezers, and regular exercise are also highly recommended.

13. Associated Press, Oct. 9, 2004.

This article is available online at www.chiroweb.com/columnist/ sutton. You may also leave a comment or ask a question at his "Talk Back" forum at the same location.

Brian Sutton, DC. Previous articles, a "Talk Back" forum and a brief biography of the author are available online at www.chiroweb.com/columnist/sutton.

Brian Sutton, DC

Colorado Springs, Colorado

BSuttonDC@earthlink.net

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