From Neurorehabilitation and Neural Repair, 7 August 2015 (e-published ahead of print).
No Reduction of Severe Fatigue in Patients With Postpolio Syndrome by Exercise Therapy or Cognitive Behavioral Therapy: Results of an RCT.
Koopman FS(1), Voorn EL(2), Beelen A(2), Bleijenberg G(3), de Visser M(2), Brehm MA(2), Nollet F(2).
1) University of Amsterdam, Amsterdam, The Netherlands s.koopman@amc.uva.nl.
2) University of Amsterdam, Amsterdam, The Netherlands.
3) Radboud University Medical Centre, Nijmegen, The Netherlands.
Abstract
BACKGROUND
People with postpolio syndrome (PPS) commonly experience severe fatigue that persists over time and negatively affects functioning and health-related quality of life (HRQoL).
OBJECTIVES
To study the efficacy of exercise therapy (ET) and cognitive behavioral therapy (CBT) on reducing fatigue and improving activities and HRQoL in patients with PPS.
METHODS
We conducted a multicenter, single-blinded, randomized controlled trial. Over 4 months, severely fatigued patients with PPS received ET, CBT, or usual care (UC). The primary end point (fatigue) was assessed using the subscale fatigue severity of the Checklist Individual Strength (CIS20-F). Secondary end points included activities and HRQoL, which were assessed with the Sickness Impact Profile and the 36-Item Short-Form, respectively. End points were measured at baseline and at 4, 7, and 10 months.
RESULTS
A total of 68 patients were randomized. No differences were observed between the intervention groups and UC group for fatigue (mean differences in CIS20-F score = 1.47, 95%CI = -2.84 to 5.79, for ET versus UC; and 1.87, 95%CI = -2.24 to 5.98, for CBT versus UC), activities, or HRQoL.
CONCLUSIONS
Our results demonstrate that neither ET nor CBT were superior to UC in reducing fatigue in severely fatigued PPS patients. Further research should investigate explanations for the lack of efficacy of these 2 currently advised approaches in clinical practice, which may provide clues to improving treatment aimed at reducing fatigue in PPS.
From the Journal of Psychosomatic Research, 17 July 2015 [Epub ahead of print].
A comparison of patients with Q fever fatigue syndrome and patients with chronic fatigue syndrome with a focus on inflammatory markers and possible fatigue perpetuating cognitions and behaviour.
Keijmel SP(1), Saxe J(2), van der Meer JW(3), Nikolaus S(4), Netea MG(5), Bleijenberg G(6), Bleeker-Rovers CP(7), Knoop H(8).
1) Radboud Expertise Centre for Q fever, Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, Nijmegen, The Netherlands; Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, Nijmegen, The Netherlands; Expert Centre for Chronic Fatigue, Radboud university medical center, Nijmegen, The Netherlands. Electronic address: Stephan.Keijmel@radboudumc.nl.
2) Radboud Expertise Centre for Q fever, Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, Nijmegen, The Netherlands; Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, Nijmegen, The Netherlands. Electronic address: j_saxe@gmx.de.
3) Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, Nijmegen, The Netherlands. Electronic address: Jos.vanderMeer@radboudumc.nl.
4) Expert Centre for Chronic Fatigue, Radboud university medical center, Nijmegen, The Netherlands. Electronic address: Stephanie.Nikolaus@radboudumc.nl.
5) Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, Nijmegen, The Netherlands. Electronic address: Mihai.Netea@radboudumc.nl.
6) Expert Centre for Chronic Fatigue, Radboud university medical center, Nijmegen, The Netherlands. Electronic address: Gijs.Bleijenberg@radboudumc.nl.
7) Radboud Expertise Centre for Q fever, Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, Nijmegen, The Netherlands; Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, Nijmegen, The Netherlands. Electronic address: Chantal.Bleeker-Rovers@radboudumc.nl.
8) Expert Centre for Chronic Fatigue, Radboud university medical center, Nijmegen, The Netherlands. Electronic address: Hans.Knoop@radboudumc.nl.
Abstract
OBJECTIVE
Comparison of Q fever fatigue syndrome (QFS) and chronic fatigue syndrome (CFS) patients, with a focus on markers of inflammation and fatigue-related cognitive-behavioural variables.
METHODS
Data from two independent prospective studies on QFS (n=117) and CFS (n=173), respectively, were pooled and analyzed.
RESULTS
QFS patients were less often female, had a higher BMI, and had less often received treatment for depression before the onset of symptoms. After controlling for symptom duration and correcting for differences in diagnostic criteria for QFS and CFS with respect to the level of impairment and the presence of additional symptoms, differences in the proportion of females and BMI remained significant. After correction, QFS patients were also significantly older.
In all analyses QFS patients were as fatigued and distressed as CFS patients, but reported less additional symptoms. QFS patients had stronger
somatic attributions, and higher levels of physical activity. No differences were found with regard to inflammatory markers and in other fatigue-related cognitive-behavioural variables. The relationship between cognitive-behavioural variables and fatigue, previously established in CFS, could not be confirmed in QFS patients with the exception of the negative relationship between physical activity and fatigue.
CONCLUSION
Differences and similarities between QFS and CFS patients were found. Although the relationship between perpetuating factors and fatigue previously established in CFS could not be confirmed in QFS patients, the considerable overlap in fatigue-related cognitive-behavioural variables and the relationship found between physical activity and fatigue may suggest that behavioural interventions could reduce fatigue severity in QFS patients.
From the Journal of Translational Medicine, 14 August 2014.
Polymorphism in COMT is associated with IgG3 subclass level and susceptibility to infection in patients with chronic fatigue syndrome.
Madlen Löbel(1,*), Agnes Anna Mooslechner(1), Sandra Bauer(1), Sabrina Günther(1), Anne Letsch(3), Leif G Hanitsch(1), Patricia Grabowski(1), Christian Meisel(1,2), Hans‐Dieter Volk(1,4) and Carmen Scheibenbogen(1,4).
1) Institute for Medical Immunology, Charité‐Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1/Südstraße 2, 13353 Berlin, Germany.
2) Immunology Department, Labor Berlin GmbH, Charité University Medicine Berlin, Campus Virchow, Berlin, Germany.
3) Department of Hematology, Oncol‐ ogy, Charité Campus Benjamin Franklin, Berlin, Germany.
4) Berlin‐Brandenburg Center for Regenerative Therapies (BCRT), Charité University Medicine Berlin, Berlin, Germany.
Abstract
BACKGROUND
Chronic fatigue syndrome (CFS) is considered as a neuroimmunological disease but the etiology and pathophysiology is poorly understood. Patients suffer from sustained exhaustion, cognitive impairment and an increased sensitivity to pain and sensory stimuli. A subset of patients has frequent respiratory tract infections (RRTI). Dysregulation of the sympathetic nervous system and an association with genetic variations in the catechol-O-methyltransferase (COMT) and glucocorticoid receptor genes influencing sympathetic and glucocorticoid metabolism were reported in CFS.
Here, we analyzed the prevalence of SNPs of COMT and glucocorticoid receptor-associated genes in CFS patients and correlated them to immunoglobulin levels and susceptibility to RRTI.
METHODS
We analyzed blood cells of 74 CFS patients and 76 healthy controls for polymorphisms in COMT, FKBP5 and CRHR1 by allelic discrimination PCR. Serum immunoglobulins were determined by immunoturbidimetric technique, cortisol levels by ECLIA.
RESULTS
Contrary to previous reports, we found no difference between CFS patients and healthy controls in the prevalence of SNPs for COMT, FKBP5 and CRHR1. In patients with the Met/Met variant of COMT rs4680 we observed enhanced cortisol levels providing evidence for its functional relevance. Both enhanced IgE and diminished IgG3 levels and an increased susceptibility to RRTI were observed in CFS patients with the Met/Met variant. Such an association was not observed in 68 non-CFS patients with RRTI.
CONCLUSION
Our results indicate a relationship of COMT polymorphism rs4680 with immune dysregulation in CFS providing a potential link for the association between stress and infection susceptibility in CFS.