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Posted to Co-Cure Fri, 12 Jan 2001 19:36:06 -0500 by Fred Springfield

CFS and the Chernobyl Accident Experience

Full Title: Vegetative-Vascular Dystonia and Osteoalgetic Syndrome or Chronic Fatigue Syndrome as a Characteristic After-Effect of Radioecological Disaster: The Chernobyl Accident Experience
Journal: Journal of Chronic Fatigue Syndrome, Vol. 7(3) 2000, pp. 3-16
Author: Konstantin N. Loganovsky, MD, PhD (Cand. Med. Sci.)
Affiliation: Konstantin N. Loganovsky is Leading Scientist, Neurology Department, Institute of Clinical Radiology, Scientific Center for Radiation Medicine, Academy of Medical Sciences of Ukraine, WHO Collaborating Center for Radiation Accident Management, 53 Melnikov Street, 04050, Kiev-50, Ukraine (E-mail: kosti@morion.kiev.ua).
The author expresses cordial thanks for creative advice and the support of Professor Pierre Flor-Henry (Canada).

ABSTRACT.
The aim of this study was to determine whether the Chronic Fatigue Syndrome (CFS) definition could be applicable to the assessment of the medical aftermath of radioecological disasters and to investigate a possible psychophysiological basis of fatigue in Chernobyl accident survivors.

One hundred randomly selected clean-up workers of the Chernobyl accident who presented with complaints of fatigue were examined neuropsychiatrically using MMPI profiles, Quantitative Electroencephalography (QEEG) and Somatosensory evoked potentials (SSEP). Twenty-six percent of them met the CFS diagnostic criteria. Their absorbed radiation doses were less than 0.3 Sv, an exposure level that is not expected to produce a clear deterministic radiation effect. Clinical symptomatology included persistent fatigue, odd skin sensations, bizarre feelings in bones, muscles and joints, irritability, headache, vertigo, pain in the chest area, emotional lability, irritability, lack of concentration and memory, cognitive deterioration, depression signs and sleep disorders.

Liquidators with CFS had the characteristic MMPI profile with increased hypochondria, depression, clear hypochondria, schizophrenia, hysteria, psychasthenia, and bizarre sensory perception scales. Spectral analysis of QEEG showed lateralised (left-sided) increase of O-power (P < 0.001) and lateralised (left-sided) decrease of alpha-power (P < 0.001) and lateralised (left-sided) increase of beta-power (P < 0.01). SSEP were characterized by increased latencies and decreased amplitudes. SSEP significantly differed by topographic abnormalities in the left temporoparietal area in liquidators with CFS. Associations between schizophrenia-like, hypochondriac and psychasthenic psychopathology and an increase of latency of SSEP P300 and N400 in liquidators with CFS were revealed.

Thus, “Vegetative-Vascular Dystonia” and “Osteoalgetic Syndrome” cases following exposure to ionizing radiation as a result of the Chernobyl accident can be classified as CFS cases. The psychophysiological basis of fatigue in liquidators consists of dysfunction of the cortico-limbical structures of the left, dominating, hemisphere. CFS is one of the most important consequences of radio-ecological disaster, which results from an interaction of different hazardous environmental factors.

KEYWORDS.
Chronic Fatigue Syndrome, Vegetative-Vascular Dystonia, Osteoalgetic Syndrome, ionizing radiation, Chernobyl accident, radloecological disaster

INTRODUCTION

Health after-effects of exposure to ionizing radiation, especially by small doses (those that do not provoke radiation sickness), in the former USSR were conceptualized as “Vegetative-Vascular Dystonia” (Autonomous Nervous System Dysfunction) and “Osteoalgetic syndrome” (if chronic exposure with osteotropic radionuclides incorporation occurs) on the basis of studies of the medical aftermath of ~radioecological disasters in the radiochemical industry. Fatigue, headache, palpitations, osthealgia, myalgia, arthralgia, difficulty concentrating, dizziness, heat/cold intolerance, mood swings, diaphoresis, depression, anxiety, seizures were among the characteristic symptoms for these disorders (1-3).

Fatigue, physical anergia, headache, lumbago, neuralgia, myalgia, arthralgia are also typical for Atomic bomb survivors in Hiroshima and Nagasaki. These symptoms were integrated in “Genbaku Bura Bura Disease—Atomic Bomb Chronic Disease” of radiation, and are not psychogenic in origin (4-5).

It should be noted that even now the terminology Vegetative-Vascular Dystonia is commonly used in the countries of the former USSR. This diagnosis refers to etiologically heterogeneous abnormalities of the diencephalic-limbic-reticular complex, which manifest with lability of heart rate and blood pressure, diaphoresis, headache, chest pain, back pain, pain in limbs, vertigo, fatigue, weakness, irritability, affective lability, anxiety, memory and concentration deterioration, sleep disorders, and meteotropia. Vegetative-Vascular Dystonia was the first typical diagnosis seen among Chernobyl accident survivors (6).

Experts of the International Chernobyl Project (IAEA, 1992) stressed the differences between diagnoses of mental and nervous system disorders in the USSR and Western countries. In this respect, terms, such as “Vegetative-Vascular Dystonia,” are not accepted in the West, where such disorders are usually classified as post-traumatic stress disorder (PTSD), anxiety, depression or somatoform disorders. According to the opinion of the IAEA experts, USSR medical doctors are physiologically- and neurologically-oriented in their diagnosis of mental disorders whereas medical practitioners of other countries aim to classify symptoms on empirical and pragmatic base (7).

However, the latter interpretation results in an underestimation of the health effects of ionizing radiation and an overestimation of the role of psychogenic traumatization following nuclear accidents. The Russian conception of “Vegetative-Vascular Dystoni” in irradiated patients is closer to Penfield’s “Diencephalic Autonomic Epilepsy,” with a paroxysmal activity focus at the hypothalamus, and to the etiologically heterogeneous radiation-psychogenic “Diencephalosis,” which was described in Atomic bomb survivors who developed Acute Radiation Sickness (8-10).

The incidence and prevalence rate of Vegetative-Vascular Dystonia among radiation-exposure survivors is significantly higher than those of the general population. Moreover, Vegetative-Vascular Dystonia among survivors is associated with endocrine and immune disorders. However, such disorders are underestimated and misinterpreted by a majority of Western experts as somatoform disorders resulting from psychological stress only. To bridge the gap between East and West, we proposed, at the International Conference “The Effects of Low and Very Low Doses of Ionizing Radiation on Human Health,” June 16-18, 1999, University of Versailles, World Council of Nuclear Workers (ii), that Chronic Fatigue Syndrome (CFS) is one of the most important health problems among Chernobyl accident survivors, a malady which could be triggered by low and very low doses of ionizing radiation together with psychoemotional stress. The data of this study was also kindly preliminary presented by Prof. Pierre Flor-Henry (Alberta Hospital Edmonton, Canada) as a poster at the 10th World Congress of the International Organization of Psychophysiology (lOP), Sydney, Australia, 8-13 February, 2000 (12).

CFS is characterized by unexplained persistent fatigue, myalgia, headache, cognitive, emotional and other disorders. The diagnosis of CFS is based on a number of clinical criteria and the exclusion of other diseases (13-15). CFS is a systemic disease with dysfunction of the main regulatory systems—nervous, endocrine and immune—and a predominance of cortico-limbic and hypothalamic-pituitary-adrenal axis abnormalities. Dysfunction of the hypothalamic-pituitary-adrenal axis and of the sympathetic component of the autonomic nervous system provide a reaction to stress, are the keypoints for understanding CFS symptomatology.

The aim of this study was to determine whether the CFS definition could be applicable to the medical aftermath symptomatology seen after radioecological disasters and to investigate the possible psychophysiological basis of fatigue among Chernobyl accident survivors.
____________________

[Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com   Website: www.HaworthPress.com ]

© 2000 by The Haworth Press, Inc. All rights reserved.

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Posted to Co-Cure Thu, 11 Jan 2001 09:20:40 -0800 by Melissa O'Toole

Hormonal Responses to Exercise in CFS

Full Title: Hormonal Responses to Exercise in Chronic Fatigue Syndrome.
Journal: Neuropsychobiology 2001 Jan;43(1):34-41
Authors: Ottenweller JE, Sisto SA, McCarty RC, Natelson BH
Affiliation: Department of Neurosciences, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, N.J., USA.
NLM Citation: PMID: 11150897

Chronic fatigue syndrome (CFS) is a debilitating disease characterized by severe, unexplained fatigue and postexertional exacerbation of symptoms. We examined basal endocrine function in a group of CFS patients and a carefully matched group of sedentary controls.

The subjects then completed a graded, maximal exercise test on a treadmill, and additional blood samples were drawn 4 min and a day after the end of exercise.

There were no differences in basal hormone levels before exercise.

Plasma adrenocorticotropin, epinephrine, prolactin and thyrotropin responses 4 min after exercise were lower in the CFS group, but the growth hormone response may have been exaggerated, and the plasma norepinephrine response was similar to that in controls.

The next day, there were no differences in hormone levels between the groups, which suggests that long-term changes in endocrine function are unlikely to be a cause of the prolonged fatigue that occurs in CFS patients after a bout of exertion.

Copyright © 2001 S. Karger AG, Basel

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Posted to Co-Cure Thu, 11 Jan 2001 12:41:53 -0500 by Kimberly Hare

Insomnia and Alpha Sleep in Chronic Non-Organic Pain as Compared to Primary Insomnia

Full Title: Insomnia and Alpha Sleep in Chronic Non-Organic Pain as Compared to Primary Insomnia.
Journal: Neuropsychobiology 2001 Jan;43(1):54-58
Authors: Schneider-Helmert D, Whitehouse I, Kumar A, Lijzenga C
Affiliation: Pain Clinic, Kirschgarten, Basel, Switzerland.
NLM Citation: PMID: 11150900

A considerable proportion of chronic non-organic pain patients suffer from insomnia, and alpha sleep has been suggested to be specifically associated with fibromyalgia. However, the clinical significance of those symptoms is not clear. This study was carried out to investigate this question.

Twenty-six middle-aged, non-organic pain patients complaining of persistent insomnia were compared with 25 chronic primary insomniacs in a polysomnographic investigation. Alpha sleep was measured by automatic EEG analysis. A postsleep inventory allowed a separation of those pain patients with actual pain in the recording night to examine its possible influence on sleep.

Both groups of patients displayed severe disturbance of sleep maintenance. The pain group did not differ in any of the insomnia variables or in sleep stages from chronic primary insomniacs. The occurrence of alpha sleep was high in either group which suggests that this is not a phenomenon specifically related to pain syndromes. A comparison of the pain subgroups revealed no difference between those with or without actual pain in the recording night.

It is concluded that insomnia in chronic pain is of the same type and degree as primary insomnia. Apparently, the chronic process made insomnia so persistent that there was no response to actual night-time pain. Our study suggests that the interpretation of insomnia as secondary to pain, as it is usually made by the pain patients themselves, is a misattribution. It is suggested that insomnia in chronic pain patients should be taken seriously and treated by its specific methods.

Copyright © 2001 S. Karger AG, Basel

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Posted to Co-Cure Thu, 11 Jan 2001 11:20:57 -0500 by Fred Springfield

Fludrocortisone acetate to treat NMH in CFS

Full Title: Fludrocortisone acetate to treat neurally mediated hypotension in chronic fatigue syndrome: A randomized controlled trial.
Journal: JAMA 2001 Jan 3;285(1):52-9
Authors: Rowe PC, Calkins H, DeBusk K, McKenzie R, Anand R, Sharma G, Cuccherini BA, Soto N, Hohman P, Snader S, Lucas KE, Wolff M, Straus SE
Address: Brady 212, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287, USA.
NLM Citations: PMID: 11150109, UI: 20583385

CONTEXT: Patients with chronic fatigue syndrome (CFS) are more likely than healthy persons to develop neurally mediated hypotension (NMH) in response to prolonged orthostatic stress.

OBJECTIVE: To examine the efficacy of fludrocortisone acetate as monotherapy for adults with both CFS and NMH.

DESIGN: Randomized, double-blind, placebo-controlled trial conducted between March 1996 and February 1999.

SETTING: Two tertiary referral centers in the United States.

PATIENTS: One hundred individuals aged 18 to 50 years who satisfied Centers for Disease Control and Prevention criteria for CFS and had NMH provoked during a 2-stage tilt-table test. Eighty-three subjects had adequate outcome data to assess efficacy.

INTERVENTION: Subjects were randomly assigned to receive fludrocortisone acetate, titrated to 0.1 mg/d (n = 50) or matching placebo (n = 50) for 9 weeks, followed by 2 weeks of observation after discontinuation of therapy.

MAIN OUTCOME MEASURE: Proportion of subjects in each group with at least a 15-point improvement on a 100-point global wellness scale.

RESULTS: Baseline demographic and illness characteristics between the groups were similar; CFS had been present for at least 3 years in 71%. Using an intention-to-treat analysis, 7 subjects (14%) treated with fludrocortisone experienced at least a 15-point improvement in their wellness scores compared with 5 (10%) among placebo recipients (P =.76). No differences were observed in several other symptom scores or in the proportion with normal follow-up tilt test results at the end of the treatment period.

CONCLUSIONS: In our study of adults with CFS, fludrocortisone as monotherapy for NMH was no more efficacious than placebo for amelioration of symptoms. Failure to identify symptomatic improvement with fludrocortisone does not disprove the hypothesis that NMH could be contributing to some of the symptoms of CFS. Further studies are needed to determine whether other medications or combination therapy are more effective in treating orthostatic intolerance in patients with CFS.

Full Text

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Posted to Co-Cure Tue, 9 Jan 2001 20:56:14 -0800 by Melissa O'Toole

Fatigue in disease-free cancer patients compared with fatigue in patients with CFS

Full Title: Fatigue in disease-free cancer patients compared with fatigue in patients with chronic fatigue syndrome.
Journal: Support Care Cancer 2001 Jan;9(1):11-7
Authors: Servaes P, van der Werf S, Prins J, Verhagen S, Bleijenberg G
Affiliation: Dutch Fatigue Research Group, Department of Medical Psychology (118), University Hospital Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
P.Servaes@cksmps.azn.nl
NLM Citations: PMID: 11147137, UI: 21023870

The goal of our work was to assess fatigue in disease-free cancer patients with help of a validated fatigue questionnaire. Furthermore, we wished to analyse the relationship between severe fatigue and former treatment modalities, problems of concentration and motivation, physical activity, functional impairment, depression and anxiety and finally, to compare severely fatigued disease-free cancer patients and patients with Chronic Fatigue Syndrome (CFS).

The participants were 85 adult cancer patients and 16 patients with CFS. The cancer patients were all disease-free and had been off treatment for a minimum of 6 months. They were asked to participate in this study by their physician when they came to the hospital for control visits.

Patients who were willing to participate completed four questionnaires. The Checklist Individual Strength was used to measure fatigue. In addition, the Beck Depression Inventory, the Spielberger Trait Anxiety Inventory and the Nottingham Health Profile were used.

Results indicate that 19% of the disease-free cancer patients were severely fatigued. Their fatigue experience is comparable to that of patients with CFS. Severe fatigue is associated with problems of concentration and motivation, reduced physical activity, emotional health problems and pain. Furthermore, a relation was found between fatigue and depression and anxiety. No relation was found between fatigue and type of cancer, former treatment modalities, duration of treatment and time since treatment ended.

In conclusion, for one fifth of a group of disease-free cancer patients fatigue is a severe problem long after treatment. In addition to fatigue, these patients experience several psychological and physical problems.

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