- Last Updated: 05 December 2015 05 December 2015
G.Broderick (Edmonton, Canada) looked at the links between lymphocyte metabolites and the clinical course of post-infectious fatigue in a group of adolescents following infectious mononucleosis (IM). They were followed over 2 years and 3 clinical courses were distinguished. 1) sustained increase in fatigue after early partial remission 2) a monotonic decrease in fatigue and 3) slow decrease in fatigue after a peak at 12 months. They surveyed lymphocyte gene expression. 107 genes were differentially expressed. 40% were linked to immune metabolism and 20% to immune signalling and cell functioning. Gene expression supports directed functional interaction. Processes are linked to the biochemistry of the stress response. Phenylalanine metabolic activity supported the separation of the fatigue sub-groups. High activity was linked to a more favourable prognosis. Results correlated with the clinical course over 2 years.
T.Miike (Hyogo, Japan) presented a fascinating overview of the daily life of children in Japan, with emphasis on their vulnerability for developing CFS. These children are subject to sleep deprivation as a result of modern daily life in Japan, and developed abnormal sleep rhythms. He discussed the importance of reducing risk of developing CFS by attention to children’s daily life and lifestyle in Japan.
S.Tajema (Kobe, Japan) confirmed the relationship in Japan between the abnormal biological clock system and childhood chronic fatigue. At their newly-formed centre, they are now treating this disorder. In the study, the treatment of children with CFS with bright light therapy, thermal therapy (20 minutes of 60̊C to the head), medication (melatonin, clonidine and sedative psychotropics), CBT and lifestyle training over 8 weeks was presented. Circadian rhythm and sleep disorders were much improved, but other symptoms of CFS were not significantly improved at this time. Recovery from the sleep disturbances is looked on as the first stage of improvement for these patients.
K.Rowe (Melbourne, Australia) had seen 788 paediatric patients (aged 6-18) between 1991 and 2009, and she presented follow-up to look at the natural history of the illness. The average duration of the illness was 5 years, with a range of 1-15 years. By 5 years, 60% reported recovery. By 12 years 88% reported recovery, but in approximately 1/3 of these they reported conscious monitoring of their workload. Less than 5% were not working or studying, often due to factors other than CFS, such as marrying or having children. 90% completed or intended to complete post-secondary training. Treatments used were studied and the only alternative practitioners who were deemed helpful were those providing relief of muscle pain with massage or who provided good dietary advice. Restrictive diets and supplements did not reach placebo levels of response. The important issues were balancing life to include social contact, physical activity, educational input and a commitment to attend at least one activity each week. Ability to engage in education was the best predictor of functional outcome. She concluded that the outcomes for young people in Australia with this illness are generally positive although prolonged.