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Chronic Fatigue Syndrome (CFS): a hypothesis focusing on the autonomic nervous system

  [ 111 votes ]   [ Discuss This Article ] • January 6, 1999

Chronic fatigue syndrome is a debilitating illness of unknown
aetiology, with estimated levels of prevalence of up to about
8. 7/100 000 in the U.S.A. Like pain fatigue it is a personal,
emotionally rich experience, which may originate from
peripheral or central sites (or both). The nature of the
symptoms is complex and reflects the interaction of the
patient with the environment and cultural milieu. Accordingly
the common use of the same terminology for different types of
fatigue may be misleading. Autonomic activation is a key
component of both real and simulated physical exercise.
Alterations in autonomic nervous system activity are a key
component of several physiopathological conditions.

In chronic
fatigue syndrome disturbances in autonomic activity, and in
other homoeostatic mechanisms, such as the hormonal and immune
systems, have been reported recently. In this review we
followed the hypothesis that in chronic fatigue syndrome the
paradoxical condition of disturbing somatic symptoms in the
absence of organic evidence of disease might be addressed by
focusing on attending functional correlates. In particular we
addressed possible alterations in cardiovascular autonomic
control, as can be assessed by spectral analysis of R-R
interval and systolic arterial pressure variability. With this
approach, in subjects complaining of unexplained fatigue, we
obtained data suggesting a condition of prevailing sympathetic
modulation of the sino-atrial node at rest, and reduced
responsiveness to excitatory stimuli.

Far from considering the
issue resolved, we propose that in the context of the multiple
physiological and psychological interactions involved in the
perception and self-reporting of symptoms, attendant changes
in physiological equivalents might furnish a convenient
assessment independent from subjective components. Indices of
sympathetic modulation could, accordingly, provide
quantifiable signs of the interaction between subject's
efforts and environmental demands, independently of self
descriptions, which could provide convenient measurable
outcomes, both for diagnosis and treatment titration in
chronic fatigue syndrome.

Pagani M, Lucini D

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