From the European Review for Medical and Pharmacological Sciences, Eur Rev Med Pharmacol Sci 2013; 17 (21): 2847-2852
Treatment of 741 italian patients with chronic fatigue syndrome
U. Tirelli, A. Lleshi, M. Berretta, M. Spina, R. Talamini, A. Giacalone
Department of Medical Oncology, Division of Medical Oncology A,
National Cancer Institute of Aviano, Pordenone, Italy. firstname.lastname@example.org
Chronic Fatigue Syndrome (CFS) is a distinctive syndrome characterized by specific symptoms cluster. CFS mostly affects women and often results in severe functional limitation. Its prevalence varies from 0.4 to 2.5% in the general population. In our prior
studies on the clinical features of 205 CFS patients we founded immunological and brain abnormalities. In this paper we illustrate our caseload on CFS treatment.
PATIENTS AND METHODS
From January 2000 to December 2005, we evaluated all the patients admitted at the CFS Unit of the Aviano National Cancer Institute, for staging procedures and treatments. Patients not meeting the Fukuda diagnostic criteria were excluded.
250 male and 491 female (median age 35.5 and 39.3 years, respectively) were enrolled and treated for CFS. As expected, CFS resulted from previous infectious disease in all patients. Female patients showed to be more affected by symptoms than male patients.
The treatment schedules followed by the patients included nutritional supplements alone, corticosteroids, antidepressant/sedative drugs, and antiviral/immunoglobulin drugs. Antiviral/ immunoglobulin drugs achieved the best response (15.3% positive responses vs. 8.3% negative responses; OR 0.44, CI 0.26-0.74, p = 0.002).
The carrying out of 4 or more treatments showed a protective effect (OR 0.46, CI 0.28-0.77, p = 0.003). This finding was confirmed in the multivariate analysis, adjusted by type of drugs (OR 0.49, CI 0.28-0.84, p = 0.009) and number of treatments carried out (OR 0.51, CI 0.30-0.86, p = 0.01); these two variables were independent.
These findings show that the antiviral/immunoglobulin approach has a longer positive disease free survival in comparison with other approaches. However, CSF still remains a difficult disease to be effectively treated.
From Fatigue: Biomedicine, Health & Behavior, the official journal of the International Association of CFS/ME, 19 November 2913
The role of clinical guidelines for chronic fatigue syndrome/myalgic encephalomyelitis in research settings
S.C. Johnston(a,*), E.W. Brenu(a), D.R. Staines(a,b), & S.M. Marshall-Gradisnik(a)
a) School of Medical Sciences, Griffith Health Institute, National Centere for Neuroimmunology and Emerging Diseases, Griffith Universityt, Parklands, Australia
b) Gold Coact Public Health Unit, Queensland Health, Robina, Ausatralia.
Chronic fatigue syndrome, also known as myalgic encephalomyelitis (CFS/ME) is a particularly difficult illness to identify. To aid in classifying patients for research as well as clinical care, potential cases may be evaluated according to clinical guidelines.
The purpose of this paper is to provide an overview of three sets of guidelines currently available: the Centers for Disease Control and Prevention (CDC) Toolkit; the International Association
for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (IACFS/ME) Primer; and the International Consensus Primer.
These guidelines were examined and compared with respect to required symptoms, laboratory and investigative protocols, and exclusionary and comorbid conditions. The comparisons were also
intended to evaluate the guidelines in light of new research that advances the clinical understanding of CFS/ME and assists in identifying patients.
Guidelines vary significantly in the symptoms and comorbidities considered in light of the differing symptom requirements of three case definitions. There is also no specification on how symptoms should be measured, contributing to the significant heterogeneity found in CFS/ME.
Further revision of clinical guidelines, preferably based on a definition that is well-informed by current empirical studies, is recommended to ensure that guidelines are applied with consistency and understanding in both research and clinical settings.