Heterogeneity in Chronic Fatigue Syndrome (CFS): evidence from magnetic resonance spectroscopy of muscle

It has been shown previously that some patients with chronic

fatigue syndrome show an abnormal increase in plasma lactate

following a short period of moderate exercise, in the

sub-anaerobic threshold exercise test (SATET). This cannot be

explained satisfactorily by the effects of ‘inactivity’ or

‘deconditioning’, and patients with abnormal lactate responses

to exercise (SATET +ve) have been found to have significantly

fewer Type 1 muscle fibres in quadriceps biopsies than SATET

-ve patients. We performed phosphorus magnetic resonance

spectroscopy on forearm muscles of 10 SATET +ve patients, 9

SATET -ve patients and 13 sedentary volunteers. There were no

differences in resting spectra between these groups but at the

end of exercise, intracellular pH in the SATET +ve patients

was significantly lower than in both the SATET – ve cases and

controls (P < 0.03), and the SATET +ve patients also showed a

significantly lower ATP synthesis rate during recovery (P <

0.01), indicating impaired mitochondrial oxidative

phosphorylation. These observations support other evidence

which indicates that chronic fatigue syndrome is a

heterogeneous disorder, and confirms the view that some

chronic fatigue syndrome patients have a peripheral component

to their fatigue.

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