11/87. exercise intolerance resulting from a muscle-restricted mutation in the mitochondrial tRNA(Leu (CUN)) gene. BACKGROUND: Some patients presenting with isolated lifelong exercise intolerance and ragged-red fibres, harbour skeletal-muscle restricted mutations in their mitochondrial dna. AIM: To identify the molecular defect in a patient presenting with lifelong exercise intolerance, ragged-red fibres and deficiencies of complexes III and IV in skeletal muscle. methods: The muscle biopsy was studied for activities of the respiratory chain, histochemical stains, and sequencing the tRNA genes of mitochondrial dna. RESULTS: The patient had a heteroplasmic mutation in the tRNA(Leu (CUN)) gene of mitochondrial dna (G12334A). Clinical and morphological data as well as restriction fragment length polymorphism (RFLP) and single-fibre polymerase chain reaction (PCR) analyses strongly indicate that this molecular defect is the primary cause of the myopathy. CONCLUSION: Mutations in any mitochondrial gene should be considered in the differential diagnosis of patients with lifelong exercise intolerance, even when the neurological examination is normal. ( info) |
12/87. Cognitive behavioral therapy and fasting therapy for a patient with chronic fatigue syndrome. Cognitive behavioral therapy temporarily alleviated symptoms of a chronic fatigue syndrome patient but the anxiety about rehabilitation into work became stronger and his symptoms worsened. This patient was successfully rehabilitated by fasting therapy. Natural killer cell activity and serum acylcarnitine levels recovered after fasting therapy. Though fasting therapy transiently increased physical and mental subjective symptoms, the patient gained self-confidence by overcoming difficulties after fasting therapy. A combination of cognitive behavioral therapy and fasting therapy is promising as a treatment for chronic fatigue syndrome. ( info) |
| A 21 year old patient reported a relatively rapid onset of serious chronic fatigue syndrome (CFS), with her worst symptoms being cognitive impairments. Congruent with research on rapid onset CFS, she had no psychiatric history and specialized testing did not suggest that somatization was likely. neuroimaging and EEG research has documented brain dysfunction in cases of CFS. Therefore, a quantitative EEG was done, comparing her to a normative data base. This revealed excessive left frontal theta brainwave activity in an area previously implicated in SPECT research. Therefore, a novel treatment approach was utilized consisting of a combination of EEG neurofeedback and self-hypnosis training, both of which seemed very beneficial. She experienced considerable improvement in fatigue, vigor, and confusion as measured pre-post with the Profile of Mood States and through collaborative interviews with both parents. Most of the changes were maintained at 5, 7, and 9 month follow-up testing. ( info) |
14/87. Peripheral vestibular dysfunction in chronic fatigue syndrome. OBJECTIVE: To report left-sided peripheral vestibular failure as the cause of dizziness in a 12-year-old boy diagnosed as having chronic fatigue syndrome (CFS). DESIGN: Retrospective case report with review of literature and discussion. SETTING: Tertiary children's hospital. CONCLUSION: We recommend proper vestibular assessment for CFS patients presenting with dizziness, as effective treatment for peripheral vestibular disorder exists in the form of balance rehabilitation exercises. ( info) |
15/87. The symptoms and management of myalgic encephalomyelitis. Myalgic encephalomyelitis (ME), which is also known as chronic fatigue syndrome, is a chronic, debilitating illness with varying symptoms and patterns of progression. research has yet to establish its aetiology and pathogenesis, and there is no cure. A number of management strategies have proved effective, but these should always be tailored to the individual patient. Although no drug treatment has been developed specifically for ME, therapies used to manage the same symptoms in other conditions can provide some relief. Treatment and management should be planned in partnership with the patient. ( info) |
16/87. Homeopathic treatment of Chronic fatigue syndrome: three case studies using Jan Scholten's methodology. This paper explores the treatment of Chronic fatigue syndrome following a viral infection in young people. The methodology is based on that of Dr Jan Scholten, Holland, who has systematically described the homeopathic themes of all elements in the periodic table. Three case studies are presented, Cobaltum Phosphoricum, calcium Phosphoricum and cadmium Phosphoricum were prescribed. The common themes and the differentiating features of these Phosphate salts are described in detail to show how the homeopathic similimum is found and cure achieved. ( info) |
| Ten patients with self diagnosed enlarged lymph glands were referred to a general medicine outpatient clinic and careful examination did not confirm lymphadenopathy. All patients also complained of severe chronic fatigue associated with aches and miscellaneous somatic symptoms, and fulfilled criteria for diagnosis of chronic fatigue syndrome (CFS). Phantom lymphadenopathy may be a symptom in some people with CFS, and possible reasons for this are discussed. ( info) |
| In this report we present four patients who were found to have both an eating disorder and the chronic fatigue syndrome (CFS). Two of the patients presented for evaluation of an eating disorder and also had CFS, while two of the patients presented for evaluation of CFS and also had an eating disorder. In all four patients the eating disorder preceded the CFS. We consider the question of whether the occurrence of these two disorders in the same patients is merely a coincidence; whether an eating disorder can act as a precipitant for CFS, perhaps through the exacerbation of an underlying vascular instability; and whether overlapping etiologies may predispose some adolescents to develop both disorders. We also discuss similarities (including diagnostic dilemmas, cultural influences, psychological correlates, demographic similarities, perceptual biases, and cardiovascular effects) encountered in the management of both of these disorders. ( info) |
19/87. Clinical assessment, management and outcomes of a group of adolescents presenting with complex medico-psychosocial conditions. BACKGROUND: Adolescents with complex medico-psychosocial presentations are often seen as a management challenge. The Medical family therapy model provides a useful framework for working with these patients in the context of a multidisciplinary approach to treatment. MATERIALS AND methods: A retrospective case analysis of 38 patients referred over a two-year period to the Department of adolescent medicine was carried out. These patients met DSM-IV criteria for somatoform disorder or had a diagnosis of chronic fatigue syndrome (CFS). Duration of symptomatology, diagnosis, the presence of psychiatric conditions in the young person and their immediate family and the type and duration of the intervention were examined in relation to outcome. Two case presentations illustrate the complexity of the assessment and treatment process. RESULTS: Clinicians rated 47% of patients who engaged with the service as improved. There was no relationship between diagnosis, length of intervention and outcome. No significant differences emerged between the group of young people diagnosed with CFS and those with somatoform disorders in terms of outcome. Nine patients presented with symptoms which were similar or identical to those of one of their parents. Physical illness was more likely to be reported as a precipitating factor in the CFS group. Poor school attendance and psychiatric morbidity were linked to poor outcome. CONCLUSIONS: A comprehensive evaluation of presenting symptomatology and focussed intervention with measurable outcomes are important aspects of the clinical approach to complex medico-psychosocial conditions in adolescents. Families' beliefs about the presenting symptomatology and experiences of illness should be explored. ( info) |
20/87. Does graded activity increase activity? A case study of chronic fatigue syndrome. The reliance on self-report outcome measures in clinical trials of graded activity-oriented cognitive-behavior therapy in chronic fatigue syndrome (CFS) makes it difficult to draw definitive conclusions about actual behavioral change. The participant in this case study was a 52-year-old married male with CFS who was working full-time. Outcome measures included a step counter to objectively measure physical activity as well as a daily diary measure of exercise activity and in vivo ratings of perceived energy, fatigue, and affect. The following psychometric instruments were also used: the CFS Symptom Inventory, the SF-36, the Beck depression Inventory, and the Beck anxiety Inventory. The 26-session graded activity intervention involved gradual increases in physical activity. From baseline to treatment termination, the patient's self-reported increase in walk time from 0 to 155 min a week contrasted with a surprising 10.6% decrease in mean weekly step counts. The final follow-up assessment revealed a "much improved" global rating, substantial increases in patient-recorded walk time and weight lifting intensity, yet a relatively modest increment in weekly step counts. It appeared that improvement was associated with mood-enhancing, stress-reducing activities that were substituted for stress-exacerbating activities. ( info) |