The controversy surrounding the possible causes of chronic fatigue syndrome (CFS) resurfaced this month, after results published in the Archives of Paediatrics and Adolescent Medicine showed that children with the disease had higher levels of oxidative stress and white blood cell apoptosis than controls—findings suggesting that the children with CFS are fighting a viral infection.
The theory that CFS may be viral in origin first came to prominence in October, 2009, when a study in Science showed that 68 (67%) of 101 patients with CFS who were tested were infected with the murine leukaemia virus XMRV, compared with eight (37%) of 218 controls. A string of negative results followed, with several groups unable to detect any trace of XMRV in patients with CFS. But a study published recently in Proceedings of the National Academy of Sciences reported a strong association between CFS and a murine virus very similar to XMRV. However, it is impossible to say at this stage whether these murine leukaemia viruses cause CFS, or whether they are bystander infections.
It is already established that many cases of CFS are preceded by an acute viral infection. Studies in cohorts of patients with infectious mononucleosis caused by Epstein–Barr virus (EBV) show that a small proportion do not recover from post-infection fatigue, and subsequently go on to develop CFS. But it seems unlikely that CFS is a consequence of EBV, because most people make a full recovery.
There is a general consensus that CFS is a heterogeneous family of disorders, and it seems most likely that these disorders arise from a constellation of pathophysiological causes. The results in the Archives of Paediatrics and Adolescent Medicine received great media attention. But they do not prove that CFS is a physical disease. CFS is still far from being a well-defined entity. When the totality of available evidence is considered, the uncertainty around our understanding of the physical–psychological interaction taking place in patients with CFS only strengthens the case for giving research into chronic fatigue the high priority it deserves.
I do not at all understand the overwhelmingly negative reaction to this article. After reading most of the comments I expected to see an article flushed with psychological innuendo's but that's not what I see at all. As I see it, Lancet - a very respected and traditional journal -is leaving the door open for ME/CFS.
children with the disease had higher levels of oxidative stress and white blood cell apoptosis than controls—findings suggesting that the children with CFS are fighting a viral infection.
#1. First they report that ME/CFS adolescents with high rates of oxidative stress may be fighting a viral infection! (What more do you want? When the last time pre-XMRV that Lancet or any major journal suggested a viral infection was the cause?
Actually in a way they are not wrong stating that the theory that ME/CFS came to 'prominence' in Oct. 2009; that is when it became prominent in the research world and the media. I forgive them for missing the Defreitas study 18 or so years ago or HHV-6/EBV - which have never made a splash in the media or even in the research world outside of CFS.
It is already established that many cases of CFS are preceded by an acute viral infection. Studies in cohorts of patients with infectious mononucleosis caused by Epstein–Barr virus (EBV) show that a small proportion do not recover from post-infection fatigue, and subsequently go on to develop CFS. But it seems unlikely that CFS is a consequence of EBV, because most people make a full recovery.
This is a little sketchy. Actually most people in that study did recover, I think, but it took quite awhile. Still it was only one study and other studies do not suggest that. I think they are inaccurate here.
This is the biggy..
There is a general consensus that CFS is a heterogeneous family of disorders, and it seems most likely that these disorders arise from a constellation of pathophysiological causes.
It seems most likely these disorders arise from a constellation of
pathophysiological causes. Nothing about behavior here - no psychology - the consensus is these disorders are biological in nature. So they don't annoint XMRV as 'it' in CFS - the most prestigious medical journal in the UK (180 years old!) just said CFS arises from biological causes. I'll take that from them gladly.
CFS is still far from being a well-defined entity. When the totality of available evidence is considered, the uncertainty around our understanding of the physical–psychological interaction taking place in patients with CFS only strengthens the case for giving research into chronic fatigue the high priority it deserves.
So they backtrack a bit...but then they say the confusion about ME/CFS means research should get high priority...and in the context of this article that means physiological research - I'll take that too!
I don't expect these prestigious medical journals to do an about face (although at times Lancet just about did). Sure you can find negative things in it but for Lancet to do this for me was a big step forward.