Conclusions

This was an excellent and exciting meeting, perhaps the best CFS/ME conference yet. Information was so overwhelming that two weeks later I am still trying to sort it out! It is clear from the number and quality of papers submitted that CFS/ME research is beginning to thrive, and that several other nations now rival the US in this field. Particularly productive this year were Japan, Belgium, Spain, Sweden and the United Kingdom.

Two salient events during the conference were the IACFS vote to change the name to CFS/ME, and the introduction of the Pediatric Case Definition. I am sure that these recommendations will have both profound and positive consequences.

There were several themes that ran through the conference:

• Researchers are looking more at specific symptoms such as fatigue, pain, and sleep, rather than the syndrome as a whole.
• Genomics and proteomics are clearly confirming previous theories of pathophysiology, and look hopeful as a means toward a marker for the illness, clues as to causation, and a way of subtyping subjects.
• As research becomes "deeper" or more molecular, the differences between CFS/ME and FM are more distinct.
• The importance of subtyping is more recognized. At this time many researchers consider such subtypes as male/female, acute/insidious onset, severity, and whether fibromyalgia is present or not.
• The Center for Disease Control is strongly encouraging specific instruments for documenting symptoms, function, and compliance with the Fukuda Criteria, but these are not yet widely used. As a result, it is not clear what is meant when an author states that his subjects "meet international (or CDC) criteria."
• And clearly the concept of viruses or latent infections as perpetuators of CFS/ME are back in favor.

So what have I learned personally that will aid me in diagnosis and treatment?

• First of all, I will recommend testing for elastase, RNaseL, C-reactive protein, selected cytokines, and NK Cell Activity, because they are objective markers of pathophysiology and severity, and they can monitor response to therapy.
• I will recommend a test-retest approach to cardio-pulmonary exercise testing, because it confirms for disability purposes reduced functional capacity as well as post-exertional malaise.
• I will recommend more overnight sleep studies because a majority of PWCs and PWFs have treatable sleep disorders that can be identified and monitored only by polysomnography.
• I will encourage a more multi-disciplinary approach, especially supportive counselors for those who are deeply depressed or catastrophizing.
• I will look for lipid abnormalities and evidence of metabolic syndrome in our patients, and address these problems more aggressively.
• I will recommend exploration of chronic illness models (such as Bruce Campbell's Self Help Course) as a means for group counseling and support. While graded exercise programs may be too aggressive for many patients, interval exercise and heart-rate-limited exercise programs are safe and effective therapies.
• I will test more for HHV-6a and EBV reactivation, and consider cautious administration of valgancyclovir and/or high dose valcyclovir.
• I will be recommending trials of acetyl-carnitine, d-ribose, replacement lipids (such as NTFactor^TM), and antioxidants based on favorable reports presented at this conference.

Charles W. Lapp, MD, Director
Hunter-Hopkins Center, P.A., Charlotte, North Carolina
January 29, 2007

The above information reflects the personal opinions of the author only, and is not meant to be an exact or exhaustive review of the IACFS conference. This material is copyrighted, but may be reprinted with permission of the author and with appropriate credit. Contact This email address is being protected from spambots. You need JavaScript enabled to view it. . (© 2007)