Firestormm
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Relationship between autonomic cardiovascular control, case definition, clinical symptoms, and functional disability in adolescent chronic fatigue syndrome: an exploratory study.
Biopsychosoc Med. 2013 Feb 7;7(1):5. doi: 10.1186/1751-0759-7-5.
Wyller VB, Helland IB.
Source
Department of Paediatrics, Oslo University Hospital and University of Oslo, Oslo, Norway. brwylle@online.no.
Abstract
Chronic Fatigue Syndrome (CFS) is characterized by severe impairment and multiple symptoms. Autonomic dysregulation has been demonstrated in several studies.
We aimed at exploring the relationship between indices of autonomic cardiovascular control, the case definition from Centers for Disease Control and Prevention (CDC criteria), important clinical symptoms, and disability in adolescent chronic fatigue syndrome.
38 CFS patients aged 12-18 years were recruited according to a wide case definition (ie. not requiring accompanying symptoms) and subjected to head-up tilt test (HUT) and a questionnaire. The relationships between variables were explored with multiple linear regression analyses.
In the final models, disability was positively associated with symptoms of cognitive impairments (p<0.001), hypersensitivity (p<0.001), fatigue (p=0.003) and age (p=0.007).
Symptoms of cognitive impairments were associated with age (p=0.002), heart rate (HR) at baseline (p=0.01), and HR response during HUT (p=0.02).
Hypersensitivity was associated with HR response during HUT (p=0.001), high-frequency variability of heart rate (HF-RRI) at baseline (p=0.05), and adherence to the CDC criteria (p=0.005).
Fatigue was associated with gender (p=0.007) and adherence to the CDC criteria (p=0.04).
In conclusion, a) The disability of CFS patients is not only related to fatigue but to other symptoms as well; b) Altered cardiovascular autonomic control is associated with certain symptoms; c) The CDC criteria are poorly associated with disability, symptoms, and indices of altered autonomic nervous activity.
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Cort has also covered this paper in his article dated February 18 2013.
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A New Focus: the More Severely Ill
In this study Wyller set out to figure out which symptoms contributed most to disability, what role the autonomic nervous system might play in producing those symptoms and where the standard definition for chronic fatigue syndrome fits into all that.
Wyller’s focus on more disabled patients suggests he believes you have to see it at its worst (and weirdest)… in order to understand at its more moderate; the most severely ill patients provide the best roadmap to learning for this disorder.
The most common denominators of this disease (fatigue, pain, poor sleep, etc.) are just too common to really tell you anything about cause. Since these symptoms can be caused by so many different things, taking this disorder to its limit and seeing what pops up there, and then reinterpreting it in the light of that, probably makes sense...