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Chronic Fatigue Syndrome in Childhood.

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SUMMARY: What causes chronic fatigue syndrome in once perfectly healthy children? Researchers set out to investigate the mystery, and its possible connection to brain function, by examining the cerebral blood flow of three children, ages 11, 12 and 13. These children had been diagnosed with CFS after developing the characteristic initial symptoms of CFS and then experiencing deterioration in their conditions. The researchers used various methods to assess blood flow in the brain. They compared the results to that of healthy subjects and found blood flow in the left temporal and occipital lobes was lower for two of their CFS patients. However, in the third patient, blood flow in the left basal glanglia and thalamus was actually much higher then the healthy subjects. One of the other evaluation methods (MR spectroscopy) also made a discovery; the patients with CFS had a much higher choline/creatine ration in their brains. Interestingly, none of the patients’ brains were found to have structural abnormalities. Based on these findings, the researchers conclude that brain function, rather than structure, may be a culprit in CFS symptoms.

ABSTRACT: Chronic fatigue occurring in previously healthy children and adolescents is one of the most vexing problems encountered by pediatric practitioners. We report three cases, 11, 12 and 13-year-old children, with chronic fatigue syndrome (CFS). They initially developed a low grade fever and generalized fatigue, followed by sleep disturbance and psychosomatic symptoms, and their performance ability deteriorated. They were diagnosed as having CFS on the basis of criteria. To investigate the brain function in CFS patients, we examined the regional cerebral blood flow by single-photon emission-computed tomography (SPECT) with 111 MBq [123I]-iodoamphetamine (123I-IMP) or xenon-computed tomography (Xe-CT), and brain metabolic levels by MR spectroscopy (MRS). Blood flow, expressed as the corticocerebellar ratio (CCR), in the left temporal and occipital lobes was markedly lower in cases 2 and 3 than that in healthy subjects reported by another investigator. In case 1, however, blood flow in the left basal ganglia and thalamus was markedly higher than in healthy subjects. The MR spectroscopy (MRS) study revealed remarkable elevation of the choline/creatine ratio in the patients with CFS. None of our patients exhibited evidence of focal structural abnormalities on MRI. These findings suggest that the various clinical symptoms in CFS patients may be closely related to an abnormal brain function.

Source: Tomoda A, Miike T, Yamada E, Honda H, Moroi T, Ogawa M, Ohtani Y, Morishita S, Department of Child Development, Kumamoto University School of Medicine, Japan. tomo@kaiju.medic.kumamoto-u.ac.jp , Brain Dev 2000 Jan;22(1):60-4. (PubMed)

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