From the Journal of Paediatrics and Child Health, 31 October 2013.
Original Article
Paediatric chronic fatigue syndrome: Complex presentations and protracted time to diagnosis
Sarah Knight(1,2,3,4,*), Adrienne Harvey(1,2,3,5), Lionel Lubitz(6), Kathy Rowe(6,7), Colette Reveley(6,7), Frederike Veit(7), Sabine Hennel(2), Adam Scheinberg(1,2,5,8).
1) Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
2) Victorian Paediatric Rehabilitation Service, Monash Children's, Melbourne, Victoria, Australia
3) Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
4) Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
5) Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Victoria, Australia
6) Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
7) Department of Adolescent Health, Royal Children's Hospital, Melbourne, Victoria, Australia
8) Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
*Correspondence: Dr Sarah Knight, Critical Care and Neurosciences, Murdoch Childrens Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Vic. 3052, Australia. Fax: 61 3 9345 5544; email: sarah.knight@mcri.edu.au
Abstract
AIM
The diagnosis and management of paediatric chronic fatigue syndrome (CFS) remain ongoing challenges for paediatric clinicians, particularly given its unknown aetiology and the little research on effective treatments for this condition. The aim of this study was to describe the presenting features of new patients attending a specialist chronic fatigue clinic at a tertiary-level Australian children's hospital.
METHOD
The medical records of all patients with an initial consultation at the chronic fatigue clinic over a 12-month period were reviewed using a standardised data collection template. Functional impact was based on school attendance and classified according to the National Institute of Health and Clinical Excellence guidelines (2007).
RESULTS
A total of 99 patients attending the clinic were identified. Of these, 59 were diagnosed with CFS. Median age was 15.4 years with almost two-thirds of patients of female sex. Median time between symptom onset and diagnosis was 15.5 months. There was a high occurrence of fatigue, sleep disturbance, pain, postexertional malaise, and autonomic and cognitive symptoms in the group. The functional impact of CFS was classified as mild for 20%, moderate for 66% and severe for 14% of patients.
CONCLUSIONS
Most young people diagnosed with CFS experience symptoms for a protracted period, with considerable functional impact prior to initial tertiary service consultation. This audit has identified important areas for research, practice development and education in relation to the management of patients with CFS.
http://www.ncbi.nlm.nih.gov/pubmed/24182640
From the Journal of Psychosomatic Research, November 2013. Epub 20 August 2013.
Undiagnosed and comorbid disorders in patients with presumed chronic fatigue syndrome.
Mariman A, Delesie L, Tobback E, Hanoulle I, Sermijn E, Vermeir P, Pevernagie D, Vogelaers D.
Department of General Internal Medicine, Infectious Diseases and Psychosomatic Medicine, University Hospital Ghent, Belgium; Center for Neurophysiologic Monitoring, University Hospital Ghent, Belgium. Electronic address: an.mariman@ugent.be.
Abstract
OBJECTIVE
To assess undiagnosed and comorbid disorders in patients referred to a tertiary care center with a presumed diagnosis of chronic fatigue syndrome (CFS).
METHODS
Patients referred for chronic unexplained fatigue entered an integrated diagnostic pathway, including internal medicine assessment, psychodiagnostic screening, physiotherapeutic assessment and polysomnography+multiple sleep latency testing. Final diagnosis resulted from a multidisciplinary team discussion. Fukuda criteria were used for the diagnosis of CFS, DSM-IV-TR criteria for psychiatric disorders, ICSD-2 criteria for sleep disorders.
RESULTS
Out of 377 patients referred, 279 (74.0%) were included in the study [84.9% female; mean age 38.8years (SD 10.3)]. A diagnosis of unequivocal CFS was made in 23.3%. In 21.1%, CFS was associated with a sleep disorder and/or psychiatric disorder, not invalidating the diagnosis of CFS. A predominant sleep disorder was found in 9.7%, 19.0% had a psychiatric disorder and 20.8% a combination of both. Only 2.2% was diagnosed with a classical internal disease. In the total sample, a sleep disorder was found in 49.8%, especially obstructive sleep apnea syndrome, followed by psychophysiologic insomnia and periodic limb movement disorder. A psychiatric disorder was diagnosed in 45.2%; mostly mood and anxiety disorder.
CONCLUSIONS
A multidisciplinary approach to presumed CFS yields unequivocal CFS in only a minority of patients, and reveals a broad spectrum of exclusionary or comorbid conditions within the domains of sleep medicine and psychiatry. These findings favor a systematic diagnostic approach to CFS, suitable to identify a wide range of diagnostic categories that may be subject to dedicated care.
From the British Journal of Opthalmology, 1 November 2013
PostScript
Letter
Vision-related symptoms as a clinical feature of chronic fatigue syndrome/myalgic encephalomyelitis? Evidence from the DePaul Symptom Questionnaire
Claire V Hutchinson(1), John Maltby(1), Stephen P Badham(1), Leonard A Jason(2)
1) College of Medicine, Biological Sciences and Psychology, School of Psychology, University of Leicester, Leicester, UK
2) Center for Community Research, DePaul University, Chicago, Illinois, USA
Correspondence to
Dr Claire V Hutchinson, College of Medicine, Biological Sciences and Psychology, University of Leicester, School of Psychology, Henry Wellcome Building, Lancaster Road, Leicester LE1 9HN, UK; ch190@le.ac.uk
Extract
Chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME) is a debilitating disorder, affecting at least 250 000 people in the UK. Marked by debilitating fatigue, its aetiology is poorly understood and diagnosis controversial. A number of symptoms overlap with other illnesses with the result that CFS/ME is commonly misdiagnosed. It is important therefore that significant clinical features are investigated. People diagnosed with CFS/ME consistently report that they experience vision-related symptoms associated with their illness1–3 and some of these reports are being verified experimentally.4 Although vision-related symptoms may represent a significant clinical feature of CFS/ME that could be useful in its diagnosis, they have yet to be included in clinical guidelines.
A recently developed, standardised measure designed to assess core CFS/ME symptoms, The DePaul Symptom Questionnaire (DSQ),5 includes four vision-related items: eye…
The end of the last paper *might* be useful…
but the subjects have simply responded to another new “fatigue” questionnaire – no proper diagnosis of either CFS or ME has been made.
I have a lot of eye troubles.
They won’t focus quickly enough between different distances, (a muscular problem) they don’t accommodate quickly between darker and brighter places, (again, muscular).
I have trouble processing visual information, I get sensory overload in a mall or supermarket or anywhere busy or with too much visual information to try to process. My brain cannot cope with that much information at once.
My brain also often completely misinterprets what I see.
The questionnaire refers to:
Blurred vision
Abnormal sensitivity to
light
Blind spots
Eye pain
Not very useful at all.
No real research again, then