Chronic Fatigue Syndrome: What Role Does the Autonomic Nervous System Play in the Pathophysiology of This Complex Illness?

Gerrity, Timothy R.; Bates, Janet H.; Bell, David S.; Chrousos, George P.; Furst, Gloria; Hedrick, Terry E.; Hurwitz, Barry E.; Kula, Roger W.; Levine, Susan; Moore, Rebecca C.; Schondorf, Ronald

doi:10.1159/000067176

Cited by 30 publications

(23 citation statements)

References 3 publications

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“…[70][71][72][73][74][75][76][77][78][79][80] A consensus panel of autonomic experts concluded that the literature provided strong evidence for exaggerated venous pooling, diminished red cell mass, reduced plasma volume, disordered sympathetic activity, impaired baroreflex function, and reduced cerebral perfusion. 80,81 The most frequently observed disorders on autonomic testing are postural orthostatic tachycardia syndrome, neurally mediated hypotension, and heart rate variability during head-up tilt testing. Investigators have reported a strong correlation between symptoms of autonomic dysfunction, as assessed by the Composite Autonomic Symptom Scale (COMPASS), and fatigue, as assessed by a validated instrument, the Fatigue Impact Scale.…”

Section: Cognitionmentioning

confidence: 99%

Role of Infection and Neurologic Dysfunction in Chronic Fatigue Syndrome

Komaroff

Cho²

2011

Semin Neurol

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Chronic fatiguing illnesses following well-documented infections and acute "infectious-like" illnesses of uncertain cause have been reported for many decades. Chronic fatigue syndrome (CFS) was first formally defined in 1988. There is considerable evidence that CFS is associated with abnormalities of the central and autonomic nervous systems. There also is evidence linking several infectious agents with CFS, although no agent has been proven to be a cause of the illness. Most of the infectious agents that have been linked to CFS are able to produce a persistent, often life-long, infection and thus are a constant incitement to the immune system. Most also have been shown to be neuropathogens. The evidence is consistent with the hypothesis that CFS, in some cases, can be triggered and perpetuated by several chronic infections that directly or indirectly affect the nervous system, and that symptoms are a reflection of the immune response to the infection.

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Section: Cognitionmentioning

confidence: 99%

Role of Infection and Neurologic Dysfunction in Chronic Fatigue Syndrome

Komaroff

Cho²

2011

Semin Neurol

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“…Different autonomic symptoms have been found in CFS patients such as hypotension, brady-tachycardia and hemodynamic instability in head-tilt test, representing an autonomic dysfunction [15]. Naschitz et al [16] proposed a diagnostic test for CFS based on the degree of heart rate and blood pressure as an expression of the autonomic dysfunction, but the test has not been accepted in common practice.…”

Section: Autonomic Dysfunctionmentioning

confidence: 99%

Infection and vaccination in chronic fatigue syndrome: Myth or reality?

Appel

Chapman

Shoenfeld³

2007

Autoimmunity

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Chronic fatigue syndrome (CFS) is characterized by severe disabling fatigue lasting for more than 6 months associated with physical and mental disturbances such as headache, arthralgia, myalgia, memory impairment, sore throat and tender lymph nodes. The exact pathogenesis is still unknown. Several models were proposed to explain its etiology including chronic infection, endocrine dysfunction, autonomic imbalance, depression, decreased immunity states and an aberrant reaction to infection. No convincing evidence was found to support any of the suggested pathogenic mechanisms. The current concept is that CFS pathogenesis is a multi factorial condition in which an infective agent cause an aberrant immune response characterized by a shift to Th-2 dominant response. When the response fails to be switched-off, a chronic immune activation occurs and clinically expressed as the symptomatology of CFS. Vaccinations are used in order to stimulate the immune system to induce a persistent immunity against the favorable antigens. Several syndromes that contain chronic fatigue as one of their symptoms, such as "Gulf war syndrome" and macrophagic myofasciitis were related to vaccinations. Can vaccinations induce the aberrant immune response of CFS? Little is known about this issue. There are some reports on CFS occurring after vaccination, but few prospective and retrospective studies failed to find such an association. A working group of the Canadian Laboratory Center for Disease Control (LCDC) that was founded in order to examine the suspected association between CFS and vaccinations concluded that there is no evidence that relates CFS to vaccination. Further studies are requested to examine this issue since it is very conceivable that if infection can lead to CFS, vaccination may also lead to it in the same immune-mediated pathogenesis.

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“…The severe debilitating fatigue of CFS (chronic fatigue syndrome) is commonly accompanied by a cluster of symptoms that suggest an underlying chronic or episodic cardiovascular and autonomic dysfunction [1]. Previous studies have shown that, when compared with healthy control subjects, CFS patients have postural tachycardia and orthostatic intolerance predisposing to pre-syncopal symptoms and a precipitous fall in BP (blood pressure) [2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Chronic fatigue syndrome: illness severity, sedentary lifestyle, blood volume and evidence of diminished cardiac function

et al. 2009

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The study examined whether deficits in cardiac output and blood volume in a CFS (chronic fatigue syndrome) cohort were present and linked to illness severity and sedentary lifestyle. Follow-up analyses assessed whether differences in cardiac output levels between CFS and control groups were corrected by controlling for cardiac contractility and TBV (total blood volume). The 146 participants were subdivided into two CFS groups based on symptom severity data, severe (n=30) and non-severe (n=26), and two healthy non-CFS control groups based on physical activity, sedentary (n=58) and non-sedentary (n=32). Controls were matched to CFS participants using age, gender, ethnicity and body mass. Echocardiographic measures indicated that the severe CFS participants had 10.2% lower cardiac volume (i.e. stroke index and end-diastolic volume) and 25.1% lower contractility (velocity of circumferential shortening corrected by heart rate) than the control groups. Dual tag blood volume assessments indicated that the CFS groups had lower TBV, PV (plasma volume) and RBCV (red blood cell volume) than control groups. Of the CFS subjects with a TBV deficit (i.e. > or = 8% below ideal levels), the mean+/-S.D. percentage deficit in TBV, PV and RBCV were -15.4+/-4.0, -13.2+/-5.0 and -19.1+/-6.3% respectively. Lower cardiac volume levels in CFS were substantially corrected by controlling for prevailing TBV deficits, but were not affected by controlling for cardiac contractility levels. Analyses indicated that the TBV deficit explained 91-94% of the group differences in cardiac volume indices. Group differences in cardiac structure were offsetting and, hence, no differences emerged for left ventricular mass index. Therefore the findings indicate that lower cardiac volume levels, displayed primarily by subjects with severe CFS, were not linked to diminished cardiac contractility levels, but were probably a consequence of a co-morbid hypovolaemic condition. Further study is needed to address the extent to which the cardiac and blood volume alterations in CFS have physiological and clinical significance.

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Chronic Fatigue Syndrome: What Role Does the Autonomic Nervous System Play in the Pathophysiology of This Complex Illness?

Cited by 30 publications

References 3 publications

Role of Infection and Neurologic Dysfunction in Chronic Fatigue Syndrome

Role of Infection and Neurologic Dysfunction in Chronic Fatigue Syndrome

Infection and vaccination in chronic fatigue syndrome: Myth or reality?

Chronic fatigue syndrome: illness severity, sedentary lifestyle, blood volume and evidence of diminished cardiac function

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