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CONTENTS EDITORIAL Chronic Fatigue Syndrome

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CONTENTS EDITORIAL Chronic Fatigue Syndrome Volume 11 Number 1 2003 CONTENTS EDITORIAL Chronic Fatigue Syndrome Guidelines 1 Kenny De Meirleir Neil McGregor Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols 7 Bruce M. Carruthers Anil Kumar Jain Kenny L. De Meirleir Daniel L. Peterson Nancy G. Klimas A. Martin Lerner Alison C. Bested Pierre Flor-Henry Pradip Joshi A. C. Peter Powles Jeffrey A. Sherkey Marjorie I. van de Sande Recent years have brought growing recognition of the need for clinical criteria for myalgic encephalomyelitis (ME), which is also called chronic fatigue syndrome (CFS). An Expert Subcommittee of Health Canada established the Terms of Refer- ence, and selected an Expert Medical Consensus Panel representing treating physi- cians, teaching faculty and researchers. A Consensus Workshop was held on March 30 to April 1, 2001 to culminate the review process and establish consen- sus for a clinical working case definition, diagnostic protocols and treatment pro- tocols. We present a systematic clinical working case definition that encourages a diagnosis based on characteristic patterns of symptom clusters, which reflect specific areas of pathogenesis. Diagnostic and treatment protocols, and a short overview of research are given to facilitate a comprehensive and integrated ap- proach to this illness. Throughout this paper, “myalgic encephalomyelitis” and “chronic fatigue syndrome” are used interchangeably and this illness is referred to as “ME/CFS.” KEYWORDS. Clinical case definition, myalgic encephalomyelitis, chronic fa- tigue syndrome, ME, CFS, diagnostic protocol, treatment protocol Monitoring a Hypothetical Channelopathy in Chronic Fatigue Syndrome: Preliminary Observations 117 Jo Nijs Christian Demanet Neil R. McGregor Pascale De Becker Michel Verhas Patrick Englebienne Kenny De Meirleir This study was aimed at monitoring of a previously suggested channelopathy in Chronic Fatigue Syndrome, and at searching for possible explanations by means of immune system characteristics. Twenty-seven CFS patients and 20 age and sex matched healthy volunteers were recruited. RNase L-ratio, percent of the norm of whole body potassium content, serum electrolytes (sodium, calcium and potas- sium), immune cells, blood cell count and erythrocyte sedimentation rate were de- termined. More than fifty percent of our patients presented with abnormal whole body potassium content. Eight patients had increased, while six had depleted po- tassium content. Discriminant function analysis revealed that the CFS patients and control subjects could be differentiated on immunophenotyping with the predomi- nant cell differences being the increase in CD19+ CD5+ (mature B-) cells and the decrease in CD3Ϫ CD16+ CD56+ (NK) cells in both the percentage and count dis- tributions. The fall in NK-cells was very strongly associated with increases in the RNase L-ratio and falls in serum calcium levels. In addition, four patients with low serum calcium levels showed lower whole body potassium levels. In conclusion, these observations suggest a channelopathy in a subset of CFS patients, probably induced by the deregulated 2-5A RNase L antiviral pathway. KEYWORDS. Chronic fatigue syndrome, channelopathy, immunity, RNase L, potassium Gulf War Illnesses: Chemical, Biological and Radiological Exposures Resulting in Chronic Fatiguing Illnesses Can Be Identified and Treated 135 Garth L. Nicolson Paul Berns Marwan Y. Nasralla Jörg Haier Nancy L. Nicolson Meryl Nass Gulf War illnesses involve multiple, complex chronic signs and symptoms that loosely fit the clinical criteria for Chronic Fatigue Syndrome/Myalgic Encephalo- myelitis (CFS/ME) and/or Fibromyalgia Syndrome (FMS). Most Gulf War illness patients had multiple exposures: (a) complex chemical mixtures, including organ- ophosphate pesticides, anti-nerve agents, carbamates and possibly nerve and blis- ter agents, (b) radiological sources, subjecting patients to both heavy metal and radiation effects, and (c) biological sources, including bacteria and toxins and the effects of multiple vaccines. Chemically exposed patients may benefit by remov- ing offending chemicals and depleting toxic chemicals from the patient’s system and other symptomatic treatments. Patients with systemic infections, including mycoplasma and other chronic bacterial infections, can be treated with antibiotics and additional nutritional supplementation. Some patients may have their illness linked to radiological exposures, and a minority to battlefield stress. The vaccines are a prime suspect for immune dysfunction and chronic infections. The multiple, complex exposures resulted in poorly defined chronic illnesses, but subsets of Gulf War illness can be identified and effectively treated using appropriate procedures. KEYWORDS. Gulf War Syndrome, Fibromyalgia Syndrome, Chronic Fatigue Syndrome, chemical exposures, infections, uranium, antibiotics, vaccines, chemi- cal and biological warfare SPECIAL 25%-OFF DISCOUNT! Order a copy of this book with this form or online at: http://www.haworthpressinc.com/store/product.asp?sku= Use Sale Code BOF25 in the online bookshop to receive 25% off! 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We will never share, rent, or exhange your e-mail address or fax number. We regard such actions as an invasion of your privacy. Order From Your Local Bookstore or Directly From The Haworth Press, Inc. 10 Alice Street, Binghamton, New York 13904-1580 • USA Call Our toll-free number (1-800-429-6784) / Outside US/Canada: (607) 722-5857 Fax: 1-800-895-0582 / Outside US/Canada: (607) 771-0012 E-Mail your order to us: [email protected] Please Photocopy this form for your personal use. www.HaworthPress.com BOF03 For more information or to order the Journal of Chronic Fatigue Syndrome, visit http://www.haworthpressinc.com/store/product.asp?sku=J092 • or call (800) HAWORTH (in US and Canada) or (607) 722-5857 (outside US and Canada) • or fax (800) 895-0582 (in US and Canada) or (607) 771-0012 (outside US and Canada) For a list of related links, visit http://www.haworthpressinc.com/store/product.asp?sku=J092 Urge your library to subscribe today! With your library’s print subscription, the electronic edition of the journal can be made available campus-wide to all of the library’s users! ALL HAWORTH MEDICAL PRESS BOOKS AND JOURNALS ARE PRINTED ON CERTIFIED ACID-FREE PAPER Indexing, Abstracting & Website/Internet Coverage This section provides you with a list of major indexing & ab- stracting services. That is to say, each service began covering this periodical during the year noted in the right column. Most Web- sites which are listed below have indicated that they will either post, disseminate, compile, archive, cite or alert their own Website users with research-based content from this work. (This list is as current as the copyright date of this publication.) Abstracting, Website/Indexing Coverage . Year When Coverage Began • Abstracts in Anthropology. 1995 • AIDS Abstracts . 1995 • Behavioral Medicine Abstracts . 1996 • Centre Regional d’Exploration des Myalgias <http://www.infomyalgie.com> . 1998 • CFS-NEWS . 1999 • CINAHL (Cumulative Index to Nursing & Allied Health Literature) <www.cinahl.com> . 1995 • CNPIEC Reference Guide: Chinese National Directory of Foreign Periodicals . 1995 • EMBASE/Excerpta Medica Secondary Publishing Division <URL: http://www.elsevier.nl>. 1995 • FINDEX <www.publist.com> . 1999 • Greenfiles. 1995 (continued) • Human Resources Abstracts (HRA) . 1995 • Index Guide to College Journals (core list compiled by integrating 48 indexes frequently used to support undergraduate programs in small to medium sized libraries) . 1999 • Journal of College Science Teaching (Abstracts Section). 1995 • Leeds Medical Information. 1995 • MANTIS (Manual, Alternative & Natural Therapy) <www.healthindex.com> . 1999 • ME and CFS Capita Selecta Quarterly, UK. 1995 • National Library of Medicine “Abstracts Section” . 1999 • Nutrition Research Newsletter “Abstracts Section”. 1995 • Occupational Therapy Index/AMED Database . 2000 • Pediatric Pain Letter . 1999 • Pharmacist’s Letter “Abstracts Section” . 1995 • Published
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