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Chronic Fatigue Syndrome (CFS): a literature review from a physiatric perspective

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By Jain SS, DeLisa JA • www.ProHealth.com • March 6, 1998


To examine the literature on chronic fatigue syndrome (CFS),
especially as it relates to cognitive deficits and exercise,
more than 200 articles related to CFS were selected from
computer-based research as well as pertinent articles noted in
the references of individual articles. All were relevant
articles on CFS, although articles in a foreign language were
excluded. CFS is a controversial diagnosis of exclusion, but
certain subgroups do appear to exist. It may represent
multiple diseases or multiple stages of the same disease.
Although cognitive deficits are commonly reported, the
measured impairments are relatively subtle and are in the area
of complex information processing speed, or efficiency.
Magnetic resonance imaging, single-photon emission computer
tomography, and neuroendocrine studies present preliminary
evidence suggestive of the cerebral involvement primarily in
the white matter. The weakness and fatigue may be the result
of alterations in the central nervous system, not in the
peripheral muscles. However, it is hard to separate the
documented weakness and endurance deficits from
deconditioning. Autonomic symptoms such as orthostatic
intolerance and a predisposition to neurally mediated syncope
may be explained by cardiovascular deconditioning, a postviral
idiopathic autonomic neuropathy, or both. The review points
out the need for more carefully designed studies of CFS that
focus on the relationship between neuropathology,
psychopathology and neuropsychologic functioning. The role of
exercise as a stimulus for exacerbation or in treatment needs
to be further studied using clear diagnostic criteria as well
as control groups that carefully match the activity level.




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