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Phenotypes of Chronic Fatigue Syndrome in Children and Young People - Source: Archives of Disease in Childhood, Apr 2009

  [ 49 votes ]   [ 1 Comment ]
By Margaret May, Alan Emond, Esther Crawley • www.ProHealth.com • October 22, 2009


Phenotypes of Chronic Fatigue Syndrome in Children and Young People - Source: Archives of Disease in Childhood, Apr 2009

[Note: Phenotypes are differentiating sets of traits or characteristics.]

Objective: To investigate the heterogeneity of chronic fatigue syndrome (CFS/ME) in children and young people.

Setting: Regional specialist CFS/ME service.

Patients: Children and young people aged under 19 years old.

Methods: Exploratory factor analysis was performed on symptoms present at assessment in 333 children and young people with CFS/ME.

Linear and logistic regression analysis of data from self completed assessment forms was used to explore the associations between the retained factors and sex, age, length of illness, depression, anxiety and markers of severity (fatigue, physical function, pain and school attendance).

Results:
Three phenotypes were identified using factor analysis:

Musculoskeletal (Factor 1) had loadings on muscle and joint pain and hypersensitivity to touch, and was associated with worse
- Fatigue (regression coefficient 0.47, 95% CI 0.25, 0.68, p <0.001),
- Physical function (regression coefficient -0.52, 95% CI -0.83, -0.22, p=0.001)
- And pain.

Factor 2 (Migraine) loaded on noise and light hypersensitivity, headaches, nausea, abdominal pain and dizziness and was most strongly associated with physical function and pain.

Sore throat phenotype (Factor 3) had loadings on sore throat and tender lymph nodes and was not associated with fatigue or pain.

There was no evidence that phenotypes were associated with age, length of illness, or symptoms of depression (regression coefficient for association of depression with Musculoskeletal pain -0.02, 95% CI -0.27, 0.23, p= 0.87).

The Migraine phenotype was associated with anxiety (0.40, 95% CI 0.06, 0.74, p=0.02).

Implications: CFS/ME is heterogeneous in children with 3 phenotypes at presentation that:

• Are differentially associated with severity

• And are unlikely to be due to age or length of illness.

Source: Archives of Disease in Childhood, online Oct 19, 2009; print Apr 2010. PMID: 19843509, by May M, Emond A, Crawley E. Bristol University, UK. [E-mail: esther.crawley@bristol.ac.uk]





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possible explanation
Posted by: Sandy10m
Oct 29, 2009
One possible explanation for the migraine/anxiety subgroup is that those children had some sort of head injury before onset of symptoms. The reason I say this is that I recently discovered one possible mechanism to explain the onset of my migraine and CFS/FM symptoms. There are 2 names, the most common is Positional Cervical Spinal Cord Compression (which has a wonderful article in the Journal of Pain, if you have access). The other name is Meningeal Compression, which has been adapted by the followers of Dr. Paul Whitcomb (mainly chiropractors who treat the condition). Both are the same thing, indicating that particularly neck injuries (like whiplash) can reduce the space inside the spine that the spinal cord can move in. The cord gets pinched by the neck bones in certain positions, resulting in migraines, immune system deficiencies, and lots more. The anxiety comes from the spinal cord being pressed on a certain bundle of nerves that stimulates the sympathetic nervous system, including the adrenal and thyroid glands. When these are stimulated 24/7, you get anxiety and Type A personality traits. That is, until you run out of adrenaline and thyroid hormone years later, and then you get full-blown CFS/FM. It's one possible explanation, anyway.
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