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Relationship between autonomic cardiovascular control, case definition, clinical symptoms...

Firestormm

Senior Member
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Location
Cornwall England
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.

...
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...
 

Firestormm

Senior Member
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Location
Cornwall England
Some interesting comments from our Norwegian friends beneath Cort's article. Apparently they do not appreciate Wyller's stance on CFS in general practice or his promotion - allegedly - of 'Wessely-school' approaches. Best read the comments for yourself - they don't detract from the published paper and this exploratory study, but may lend some context.
 
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Some interesting comments from our Norwegian friends beneath Cort's article. Apparently they do not appreciate Wyller's stance on CFS in general practice or his promotion - allegedly - of 'Wessely-school' approaches. Best read the comments for yourself - they don't detract from the published paper and this exploratory study, but may lend some context.

Hey, if someone from the BPS school wants to branch out into actual biological investigations and seriously investigate case definitions more focused than "fatigue", I'll be the first to throw them a "welcome to reality" party :balloons:

The authors are suggesting actual objective method for diagnosing a symptom and treating it:
This finding complies with previous reports of an association between orthostatic test results and clinical symptoms and suggests that head-up tilt testing might become a valuable diagnostic tool in CFS; however, this would require validation in a larger patient population, combined with a refinement of test procedures. Also, the results indicate, in line with scattered case reports , that direct pharmaceutical treatment of cardiovascular autonomic alterations might improve clinical symptoms in CFS.

They seem to be saying that autonomic dysfunction is unrelated to having psychological or social problems. This implies they are rejecting the theory that cognitive and behavioral factors cause deconditioning which causes autonomic dysfunction:
Thus, within a broadly defined population of CFS patients, the subgroup adhering to the CDC criteria is not characterized by a certain level of disability, nor is this subgroup specifically related to those indices of altered cardiovascular autonomic control that predicts clinical symptoms. The latter is in accordance with a previous study from our group, which failed to demonstrate a relation between autonomic dysregulation and psychosocial load in adolescent CFS.

And this is very sensible, so long as it's done in a scientific manner that is free of certain BPS biases in favor of psychological explanations:
One approach to clarify this issue in further studies would be to apply wider inclusion criteria than has been common so far, and thereafter perform subgroup analyses based on different case definitions.

There's a brief CBT plug (only mentioned in one paragraph), which isn't too bad for being in a BPS journal. They still seem to be hypothesizing that CBT can improve functionality in some manner that isn't particularly clear:
Also, cognitive behavioral therapy (CBT) appears to be the best documented treatment strategy for CFS, in adults as well as in adolescents, even though opponents of CBT tend to claim that the effect is overstated. CBT is not designed to improve cognitive function per se; still, it is noteworthy that the results of this study suggest that improving cognitive functions might have an independent, positive effect upon patients’ functional level even when their experience of fatigue is unaltered.

I agree with the criticism regarding the seeming embrace of lumping "functional" disorders in together ... but they seem to suggest doing so in the context of searching for subgroups, rather than as an excuse to close the book on investigations into symptoms that are presumed to be irrelevant.

The general impression I get is that the authors had a strong and never-questioned belief in BPS explanations of medically unexplained symptoms - but on the other hand, they've made observations that they are willing to examine more closely, even though they imply that their BPS beliefs are incorrect in some ways.

They might be in the process of compromising those BPS beliefs ... allowing for some aspects to be altered, such as assumptions of causation being replaced with the simple reality of unexplained correlation, and not trying to bend all data to fit a pre-determined view of the disease.

They're definitely not Wessely school in this paper, even if they are still BPS.
 

taniaaust1

Senior Member
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13,054
Location
Sth Australia
In conclusion, a) The disability of CFS patients is not only related to fatigue but to other symptoms as well;

Doh!! One would think its obvious that the more symptoms and things going wrong a person has.. the more disabled they may be but obviously that just isnt something the medical profession seems to have understood before.
..........

Im so happy thou that they are looking at symptoms other then that dreaded "Fatigue" one we are all so sick of hearing about.
 
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15,786
Doh!! One would think its obvious that the more symptoms and things going wrong a person has.. the more disabled they may be but obviously that just isnt something the medical profession seems to have understood before.
..........

Im so happy thou that they are looking at symptoms other then that dreaded "Fatigue" one we are all so sick of hearing about.

It's a bit odd because his lumping of ME/CFS with IBS etc is usually based on the "it's really all just fatigue" argument. Hence my thinking that he might be starting to turn in a different direction (hopefully a better one).
 

Seven7

Seven
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3,444
Location
USA
I was miraculous cured of my "decondition" the exact day I treated OI :rolleyes: . Went from been unable to sit up long periods of time, and walking was a dream, to be able to exercise with No PEM. I am up to 3miles with no consequence.

I am on florinef and midodrine.