Vegard Bruun Wyller
(foto: Helse Sør-Øst)
Volgens een studie van vermoeidheidsdeskundige Bruun Wylller en Ingrid Helland
wordt de invaliditeit niet alleen bepaalt door "vermoeidheid",
maar ook door cognitieve klachten en "hypersensitiviteit"" voor prikkels,
zijn cognitieve klachten gerelateerd aan de verhoogde hartslag in rust
en de verhoogde toename van de hartslag in orthostatische "staande") positie, en
zegt de diagnose CVS (Fukuda-criteria) zeer weinig over de beperkingen/invaliditeit.
Merkwaardig genoeg, of eigenlijk ook niet gelet op zijn zienswijze,
pleit Bruun Wyller voor verruiming voor de diagnosecriteria, i.p.v. aanscherping, en
worden de internationale consensus-criteria voor ME ter discussie gesteld.
Uiteraard worden hypersensitiviteit en autonome dysfunctie/orthostatische klachten
toegeschreven aan psychologische factoren die "uit de lucht komen vallen"...
Citaten uit het studierapport:
It is generally acknowledged that
an experience of cognitive impairments is an essential part of CFS.
...
Symptoms of cognitive impairments were associated with
age (p=0.002), heart rate (HR) at baseline (p=0.01), and HR response during HUT (p=0.02).
...
This finding complies with previous reports of
an association between orthostatic test results and clinical symptoms [36-39] and
suggests that head-up tilt testing might become a valuable diagnostic tool in CFS;
...
Although different explanations are possible,
this is congruent with theories suggesting that
most CFS symptoms are manifestations of
a single, underlying pathophysiological mechanism [12,34],
and questions the validity of highly specified, multidimensional case definitions [35].
...
Thus, within
a broadly defined population of CFS patients,
the subgroup adhering to the CDC criteria
is not characterized by a certain level of disability,
nor is this subgroup specifically related to those indices of
altered cardiovascular autonomic control that predicts clinical symptoms.
...
These results, in concert with other findings suggesting that
all chronic fatigue states share a relatively stereotyped set of symptoms [47],
add to the concerns about the validity of the CDC definition,
in particularly among adolescents [18-20].
Indeed, a large epidemiological survey suggests that
CFS should be lumped together with several other functional disorders,
such as fibromyalgia and irritable bowel syndrome [48].
Relationship between autonomic cardiovascular control, case definition,
clinical symptoms, and functional disability in adolescent chronic fatigue syndrome:
An exploratory study.
Biopsychosoc Med. 2013 Feb 7;7(1):5.doi: 10.1186/1751-0759-7-5.
Wyller VB, Helland IB.
ABSTRACT:
Chronic Fatigue Syndrome (CFS) is characterized by
severe impairment and multiple symptoms.
Autonomic dysregulation has been demonstrated in several studies.
We aimed at exploring the relationship
between indices of autonomic cardiovascular control,
the case definition from Centers for Disease Control and Prevention (CDC criteria),
important clinical symptoms, and
disability in adolescent chronic fatigue syndrome.
38 CFS patients aged 12-18 years were recruited
according to a wide case definition (ie. not requiring accompanying symptoms) and
subjected to head-up tilt test (HUT) and a questionnaire.
The relationships between variables were explored
with multiple linear regression analyses.
In the final models,
disability was positively associated with symptoms of cognitive impairments (p<0.001),
hypersensitivity (p<0.001), fatigue (p=0.003) and age (p=0.007).
Symptoms of cognitive impairments were associated with
age (p=0.002), heart rate (HR) at baseline (p=0.01), and HR response during HUT (p=0.02).
Hypersensitivity was associated with HR response during HUT (p=0.001),
high-frequency variability of heart rate (HF-RRI) at baseline (p=0.05), and
adherence to the CDC criteria (p=0.005).
Fatigue was associated with gender (p=0.007) and adherence to the CDC criteria (p=0.04).
In conclusion,
a) The disability of CFS patients is not only related to fatigue but to other symptoms as well;
b) Altered cardiovascular autonomic control is associated with certain symptoms;
c) The CDC criteria are poorly associated with
disability, symptoms, and indices of altered autonomic nervous activity.
PMID: 23388153
Keywords
Adolescents, Chronic fatigue syndrome,
Autonomic cardiovascular control, Diagnostic criteria
http://www.bpsmedicine.com/content/7/1/5/abstract
http://www.bpsmedicine.com/content/pdf/1751-0759-7-5.pdf
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