From the new, open-access journal, NeuroImage: Clinical, devoted to clinical neuroimaging, 8 January 2013.
Cerebral vascular control is associated with skeletal muscle ph in chronic fatigue syndrome patients both at rest and during dynamic stimulation
Jiabao He(a), Kieren G. Hollingsworth(a), Julia L. Newton(b), Andrew M. Blamire(a).
(a) Institute of Cellular Medicine & Newcastle Magnetic Resonance Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
(b) Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, United Kingdom
Cerebral blood flow (CBF) is maintained despite changing systemic blood pressure through cerebral vascular control, with such tight regulation believed to be under local tissue control.
Chronic fatigue syndrome (CFS) associates with a wide range of symptoms, including orthostatic intolerance, skeletal muscle pH abnormalities and cognitive impairment. CFS patients are known to have reduced CBF and orthostatic intolerance associates with abnormal vascular regulation, while skeletal muscle pH abnormalities associate with autonomic dysfunction.
These findings point to autonomic dysfunction as the central feature of CFS, and cerebral vascular control being influenced by factors outside of the brain, a macroscopic force affecting the stability of regional regulation. We therefore explored whether there was a physiological link between cerebral vascular control and skeletal muscle pH management in CFS.
Seventeen consecutive CFS patients fulfilling the Fukuda criteria were recruited from our local CFS clinical service. To probe the static scenario, CBF and skeletal muscle pH were measured at rest using MRI and 31P magnetic resonance spectroscopy (31P-MRS).
To examine dynamic control, brain functional MRI was performed concurrently with Valsalva manoeuvre (VM), a standard autonomic function challenge, while 31P-MRS was performed during plantar flexion exercise.
Significant inverse correlation was seen between CBF and skeletal muscle pH at rest (r = − 0.67, p < 0.01). Prolonged cerebral vascular constriction during the sympathetic phase of VM was associated with higher pH in skeletal muscle after plantar flexion exercise (r = 0.69, p < 0.008). In conclusion, cerebral vascular control is closely related to skeletal muscle pH both at rest and after dynamic stimulation in CFS.
From the new IACFS/ME journal Fatigue: Biomedicine, Health and Behaviour, 14 January 2012.
Energy conservation/envelope theory interventions
Leonard A Jason*, Molly Brown, Abigail Brown, Meredyth Evans, Samantha Flores, Elisa Grant-Hollier and Madison Sumnquist
Center for Community Research, DePaul University, Chicago, IL, USA.
Treatment approaches for patients with chronic fatigue syndrome (CFS, Myalgic Encehalomyelitis (ME) and Myalgic Encephalomyelitis/chronic fatigue syndrome (ME/CFS) have been controversial. This paper provides the theoretical and conceptual background for the Energy Envelope Theory to assist patients and reviews evidence of its treatment efficacy.
Over a 15-year period, efforts were directed to develop a non-pharmacologic intervention that endeavoured to help patients to self-monitor and self-regulate energy expenditures and learn to pace activities and stay within their energy envelope.
Studies show that the energy envelope approach, which involves rehabilitation methods, helps patients pace activities and manage symptoms and can significantly improve their quality of life.
From the Journal of Clinical and Experimental Rheumatology, 14 December 2012
The effect of dietary glutamate on fibromyalgia and irritable bowel symptoms
K. Holton, D. Taren, C. Thomson, R. Bennett, K. Jones
Departments of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA.
To examine the effects of a challenge with monosodium glutamate (MSG) as compared to placebo on the symptoms of fibromyalgia (FM), in participants who initially experienced >30% remission of symptoms on an excitotoxin elimination diet.
Fifty-seven FM patients who also had irritable bowel syndrome (IBS) were placed on a 4-week diet that excluded dietary additive excitotoxins including MSG and aspartame. Thirty-seven people completed the diet and 84% of those reported that >30% of their symptoms resolved, thus making them eligible to proceed to challenges. Subjects who improved on the diet were then randomised to a 2-week double-blind placebo-controlled crossover challenge with MSG or placebo for 3 consecutive days each week. The primary outcome measure was total symptom score. Secondary outcome measures included visual analogue pain scales (VAS for FM and IBS), an IBS Quality of Life Questionnaire (IBS QOL) and the Fibromyalgia Impact Questionnaire-Revised (FIQR). Repeated measures ANOVA was used to analyse crossover challenge results.
The MSG challenge, as compared to placebo, resulted in a significant return of symptoms (total symptom score, p<0.02); a worsening of fibromyalgia severity as determined by the FIQR (p<0.03); decreased quality of life in regards to IBS symptoms (IBS QOL, p<0.05); and a non-significant trend toward worsening FM pain based on visual analogue scale (VAS, p<0.07). CONCLUSIONS These findings suggest that dietary glutamate may be contributing to FM symptoms in some patients. Future research on the role of dietary excitotoxins in FM is warranted.
From the Journal of Clinical Sleep Medicine, 15 December 2012
Vitamin D, Race, and Excessive Daytime Sleepiness
David E. McCarty(1), Aronkumar Reddy(1), Quinton Keigley(2), Paul Y. Kim(1), Andrew A. Marino (1).
(1) Division of Sleep Medicine, Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, LA
(2) School of Medicine, Louisiana State University, Shreveport, LA
First, to determine whether serum vitamin D levels were correlated with excessive daytime sleepiness (EDS) in patients with or without vitamin D deficiency (VitDd). Second, to assess whether race affected the relation between vitamin D levels and EDS.
Serum 25-hydroxyvitamin D (25OHD) was measured by immunoassay in a consecutive series of 81 sleep clinic patients who complained of sleep problems and nonspecific pain (25OHD < 20 ng/mL ' VitDd). Sleepiness was determined using the Epworth Sleepiness Scale score ([ESSs] ESSs ≥ 10 ' EDS). Correlations were assessed using Pearson r. RESULTS In patients without VitDd (25OHD ≥ 20 ng/mL), ESSs was inversely correlated with vitamin D concentration (r = 0.45, p < 0.05). The group consisted of 6% black patients, compared with 35% for the entire cohort. Among the patients who had VitDd (25OHD < 20 ng/mL), ESSs was directly correlated with 25OHD in black (r = 0.48, p < 0.05) but not white patients. In black patients, mean ESSs in patients with VitDd were higher and 25OHD levels were lower p < 0.05). CONCLUSIONS The results suggested the novel possibility that VitDd-related disease has a yet-to-be-identified mechanistic role in the presentation of sleepiness, sleep disorders, or both. Further research is needed to clarify the mechanism(s) involved in producing the complex relationships noted.
From the Journal of Psychosomatic Research, January 2013 (downloadable two page article).
Editorial: Functional somatic syndromes may be either “polysyndromic” or “monosyndromic”
Peter D. White⁎ Wolfson Institute of Preventive Medicine, Barts and the London Medical School, Queen Mary University of London, London, EC1M 6BQ, UK. Department of Psychological Medicine, St Bartholomew’s Hospital, London, EC1A 7BE, UK
From the Journal of Psychosomatic Research, January 2013.
Mindfulness therapy for somatization disorder and functional somatic syndromes — Randomized trial with one-year follow-up
Lone Overby Fjorback, Mikkel Arendt, Eva Ørnbøl, Harald Walach, Emma Rehfeld, Andreas Schröder, Per Fink
The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
To conduct a feasibility and efficacy trial of mindfulness therapy in somatization disorder and func- tional somatic syndromes such as fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome, defined as bodily distress syndrome (BDS).
We randomized 119 patients to either mindfulness therapy (mindfulness-based stress reduction and some cognitive behavioral therapy elements for BDS) or to enhanced treatment as usual (2-hour specialist medical care and brief cognitive behavioral therapy for BDS). The primary outcome measure was change in physical health (SF-36 Physical Component Summary) from baseline to 15-month follow-up.
The study is negative as we could not demonstrate a different development over time for the two groups (F(3,2674)=1.51, P=.21). However, in the mindfulness therapy group, improvement was obtained toward the end of treatment and it remained present at the 15-month follow-up, whereas the enhanced treatment as usual group achieved no significant change until 15-month follow-up. The change scores aver- aged half a standard deviation which amounts to a clinically significant change, 29% changed more than 1 standard deviation. Significant between-group differences were observed at treatment cessation.
Mindfulness therapy is a feasible and acceptable treatment. The study showed that mindfulness therapy was comparable to enhanced treatment as usual in improving quality of life and symptoms. Nevertheless, considering the more rapid improvement following mindfulness, mindfulness therapy may be a potentially useful intervention in BDS patients. Clinically important changes that seem to be comparable to a CBT treatment approach were obtained. Further research is needed to replicate or even expand these findings.