TGI Friday! Our regular round-up of recently reported ME/CFS research abstracts and related items | 24 May 2013

May 24, 2013

From Annals of Epidemiology, June 2013.

The adoption of chronic fatigue syndrome/myalgic encephalomyelitis case definitions to assess prevalence: a systematic review.

Johnston S, Brenu EW, Staines DR, Marshall-Gradisnik S.
Griffith Health Institute, School of Medical Sciences, National Centre for Neuroimmunology and Emerging Diseases, Griffith University, Parklands, QLD, Australia. Electronic address:



Prevalence estimates have been based on several case definitions of chronic fatigue syndrome (CFS). The purpose of this work is to provide a rigorous overview of their application in prevalence research.


A systematic review of primary studies reporting the prevalence of CFS since 1990 was conducted. Studies were summarized according to study design, prevalence estimates, and case definition used to ascertain cases.


Thirty-one studies were retrieved, and eight different case definitions were found. Early estimates of CFS prevalence were based on the 1988 Centers for Disease Control and Prevention, Australian, and Oxford. The 1994 Centers for Disease Control and Prevention, however, has been adopted internationally, as a general standard. Only one study has reported prevalence according to the more recent, Canadian Consensus Criteria. Additional estimates were also found according to definitions by Ho-Yen, the 2005 Centers for Disease Control and Prevention empirical definition, and an epidemiological case definition.


Advances in clinical case definitions during the past 10 years such as the Canadian Consensus Criteria have received little attention in prevalence research. Future assessments of prevalence should consider adopting more recent developments, such as the newly available International Consensus Criteria. This move could improve the surveillance of more specific cases found within CFS.

From the Journal of Observational Pain Medicine, 15 May 2013 (open access journal).

Looking for idiopathic intracranial hypertension in patients with chronic fatigue syndrome

Dr Nicholas Higgins(1), Prof. John Pickard(2), Prof. Andrew Lever(3)
(1) Consultant Neuroradiologist, Addenbrooke’s Hospital, Cambridge CB2 0QQ.
(2) Professor of Infectious Diseases, Addenbrooke’s Hospital, Cambridge CB2 0QQ.
(3) Professor of Neurosurgery, Addenbrooke’s Hospital, Cambridge CB2 0QQ.



Headache is common in chronic fatigue syndrome, a condition of unknown cause in which there are no clinical signs. Fatigue is common in idiopathic intracranial hypertension, a headache condition of unknown cause in which the only clinical signs are those of raised intracranial pressure, signs which may be absent. Might, therefore, idiopathic intracranial hypertension be present in some patients diagnosed with chronic fatigue syndrome? Could the two conditions be related?


From June 2007, patients attending a specialist clinic who fulfilled the diagnostic criteria for chronic fatigue syndrome and in whom headache was an especially prominent symptom were offered CT venography and lumbar puncture, looking for evidence of raised intracranial pressure.


Of the 20 patients who accepted lumbar puncture, eight had pressures of 20 cm H2O or greater, including three who had pressures of 25 cm H2O or greater. Mean pressure was 19 cm H2O.


Some patients with headache and a diagnosis of chronic fatigue syndrome have unrecognised and occult idiopathic intracranial hypertension. The possibility that the two conditions are related cannot be excluded.

From Undersea Hyperbaric Medicine, March-April 2013.

The efficacy of hyperbaric oxygen therapy in the management of chronic fatigue syndrome.

Akarsu S, Tekin L, Ay H, Carli AB, Tok F, Simşek K, Kiralp MZ.
Gülhane Military Medical Academy Haydarpasa Training Hospital, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey.



Chronic fatigue syndrome (CFS) is a chronic disease with social components that ensue secondary to the incapacity of the person to fulfill work, social and family responsibilities. Currently, there is no consensus regarding its treatment. The aim of this study was to determine the efficacy of hyperbaric oxygen (HBO2) therapy in CFS.


Sixteen patients included in the study were diagnosed with CFS according to the Fukuda criteria. Patients received 15 treatment sessions of HBO2 therapy over a period of three consecutive weeks (five days per week). The outcome measures (visual analog fatigue scale (VAFS). Fatigue Severity Scale (FSS) and Fatigue Quality of Life Score (FQLS) were assessed before the treatment and after completion of the 15 sessions.


HBO2 therapy was well tolerated, with no complications. After treatment, patients' scores were found to have improved with respect to VAFS, FSS and FQLS (all p<0.005).CONCLUSIONSWe may infer that HBO2 therapy decreases the severity of symptoms and increases the life quality of CFS patients. It may be a new treatment modality for the management of CFS. However, further studies with larger sample sizes and control groups are definitely awaited.

From Neuroendocrinology Letters, 20 May 2013 [Epub ahead of print].

Case definitions and diagnostic criteria for Myalgic Encephalomyelitis and Chronic fatigue Syndrome: from clinical-consensus to evidence-based case definitions.

Morris G, Maes M.
Mumbles Head, Pembrey llanelli, UK.


The symptom spectrum of Myalgic Encephalomyelitis (ME) was first detailed in 1959 and later operationalised into a diagnostic protocol (Melvin Ramsey). In 1988 the Holmes case definition coined the term chronic fatigue syndrome (CFS). Fukuda's Centers for Disease Control and Prevention criteria are very heterogeneous and comprise patients with milder symptoms than the Holmes case definition. The CDC Empirical Criteria for CFS lack sensitivity and/or specificity.

Other CFS definitions, e.g. the Oxford criteria, delineate people with idiopathic fatigue. Some authors make the clinical CFS diagnosis when
slightly increased self-rated fatigue scores are present.

In 2011, Carruthers' International Consensus Criteria attempted to restore the focus on selecting people who suffer from ME.

Cognitive bias in criteria construction, patient selection, data collection and interpretation has led to the current state of epistemological chaos with ME, CFS, CFS/ME and ME/CFS, and CF being used interchangeably.

Moreover, none of the above mentioned classifications meet statistically based criteria for validation. Diagnostic criteria should be based on statistical methods rather than consensus declarations. Ongoing discussions about which case definition to employ miss the point that the criteria did not pass appropriate external validation.

In 2012, Maes et al. performed pattern recognition methods and concluded that CFS patients (according to Fukuda's criteria) should be divided into those with CFS or ME, on the basis that people with ME display a worsening of their illness following increases in physical or cognitive activity.

Both ME and CFS are complex disorders that share neuro-immune disturbances, which are more severe in ME than in CFS.

This paper expands on that strategy and details a range of objective tests, which confirm that a person with ME or CFS has a neuro-immune disease. By means of pattern recognition methods future research should refine the Maes' case definitions for ME and CFS by including well-scaled symptoms, staging characteristics and neuro-immune biomarkers, including immune-inflammatory assays, bioenergetic markers and brain imaging.

From Optometry and Vision Science, 17 May 2013 [Epub ahead of print].

Patterns of Abnormal Visual Attention in Myalgic Encephalomyelitis.

Hutchinson CV, Badham SP.
College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, Leicestershire; and School of Psychology, University of Warwick, Coventry, United Kingdom.



To experimentally assess visual attention difficulties commonly reported by those with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).


Twenty-nine ME/CFS patients and 29 controls took part in the study. Performance was assessed using the Useful Field of View (UFOV), a spatial cueing task and visual search.


Patients and controls performed similarly on the processing speed subtest of the UFOV. However, patients exhibited marginally worse performance compared with controls on the divided attention subtest and significantly worse performance on the selective attention subtest.

In the spatial cueing task, they were slower than controls to respond to the presence of the target, particularly when cues were invalid. They were also impaired, relative to controls, on visual search tasks.


We have provided experimental evidence for ME/CFS-related difficulties in directing visual attention. These findings support the subjective reports of those with ME/CFS and could represent a potential means to improve diagnosis.

From Biomed Central Trials, 21 May 2013

An open-label study of effects of acupuncture on chronic fatigue syndrome and idiopathic chronic fatigue: study protocol for a randomized controlled trial

Jung-Eun Kim(1), Kwon-Eui Hong(2), Hyeong-Jun Kim(3), Jin-Bong Choi(4), Yong-Hyeon Baek(5), Byung-Kwan Seo(5), Sanghun Lee(1), Kyung-Won Kang(1), Min-Hee Lee(1), Joo-Hee Kim(1), Seunghoon Lee(1), So-Young Jung(1), Hee-Jung Jung(1), Mi-Suk Shin(1), Sun-Mi Choi(1,*): corresponding author Email:
(1) Department of Medical Research, Korea Institute of Oriental Medicine, Acupuncture, Moxibustion & Meridian Research Group, 1672 Yuseongdae-ro, Yuseong-gu, Daejeon, South Korea
(2) Department of Acupuncture & Moxibustion, Daejeon University, 176-9 Daeheung-ro, Jung-gu, Daejeon, South Korea
(3) Department of Oriental Gynecology, Semyung University, 65 Semyung-ro, Jecheon, Chungbuk, South Korea
(4) Department of Oriental Rehabilitation Medicine, Dongshin University, 141 Weolsan-ro, Nam-gu, Gwangju, South Korea
(5) Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul, South Korea



Even though chronic fatigue syndrome and idiopathic chronic fatigue are quite common, there are no clearly known causes. Most treatments are therefore symptomatic in nature, and chronic fatigue syndrome and idiopathic chronic fatigue patients are highly interested in using oriental medicine or complementary and alternative medicine treatment. Acupuncture, one of the major treatments used in oriental medicine, is effective in treating various diseases. This study will attempt to analyze the effectiveness and safety of acupuncture in the treatment of chronic fatigue by comparing the two treatment groups (body acupuncture, Sa-am acupuncture) and the control group (usual care).


This study consists of a four-center, three-arm, randomized, controlled, and open-label trial. One hundred and fifty participants are randomly divided into treatment groups A and B and a control group. The treatment groups will receive acupuncture treatments either two or three times per week for a total of 10 sessions over a period of 4 weeks. The control group will not receive acupuncture treatments and will continue their usual care during this period. The primary outcome variable is the Fatigue Severity Scale, which will be utilized 5 weeks after randomization. Secondary outcome variables are the Fatigue Severity Scale at 13 weeks, a short form of the Stress Response Inventory, the Beck Depression Inventory, the Numeric Rating Scale, and the EuroQol-5 Dimension at 5 and 13 weeks after randomization.


This study will provide evidence with high external validity on the effectiveness and safety of acupuncture as a treatment for chronic fatigue syndrome and idiopathic chronic fatigue.

TGI Friday!
Clinical Research Information Service KCT0000508

3 thoughts on “TGI Friday! Our regular round-up of recently reported ME/CFS research abstracts and related items | 24 May 2013”

  1. Maes and Morris can separate ME, CFS and Chronic Fatigue scientifically. Fabulous news. Makes the NICE guidelines and fatigue research look medieval.

  2. Indeed – then somebody else starts up on acupuncture, taking it straight back to before the dark ages!
    It has been clearly demonstrated that it doesn’t matter where the needles are placed during acupuncture. It’s a placebo effect “treatment”.

  3. Very interesting collection of research items this week giving lots of scope for follow up research:_

    Eg. Idiopathic intracranial hypertension in ME/cfs – caused by ?? – autonomic dysfunction? abberant antibody response? or misdiagnosis of CFS when patient has intracranial hypertension, or caused by accidental injury (eg car/horse accident) etc etc ? Great possibilities for follow up research.

    Eg. Efficacy of hyperbaric oxygen therapy in ME/cfs: possible follow up questions – why is the patient not absorbing O2 normally from their environment on daily basis, ?problem with oxygen carrying capacity of red blood cells? problem with iron/heam? excessive red cell apoptosis due to ??, or inability of body to recognise and redress oxygen/carbon dioxide balance due to disturbed homeostasis etc.

    Eg. Abnormal visual attention in ME/CFS – wow the follow up research for this is potentially exponential. There is footage of ME patients with eyeballs rolling for eg (and I had this sign early on in my illness, it really worried people!) – Is this sympathetic nervous system ‘overload’? infection?, excessive antibody production?, pesticide poisoning, do some have milder form of CJD? etc etc. Get the neurologists onto this immediately! 🙂 (& where have they been all this time anyway)?

    Great research studies this week. Thanks for posting.

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