5.3: Evaluation of the evidence for disturbance of central nervous system function as a factor in the pathophysiology of CFS

Neuroendocrine function

• Impaired hypothalamic-pituitary-adrenal (HPA) axis activation has been demonstrated (Demitrack et al. 1991; Bearn et al. 1995; Cleare et al. 1995) (Level III-2)

• Conflicting evidence for reduced levels of insulin-like growth factors (IGFs) (Buchwald et al. 1996c; Allain et al. 1997) (Level III-4)  

Sleep

• Disturbances of sleep maintenance (e.g., frequent awakenings) are prevalent (Whelton et al. 1992; Morriss et al. 1993; Krupp et al. 1993; Buchwald et al. 1994; Fischler et al. 1997) (Level III-2)

• Circadian rhythm may be disturbed (Williams et al. 1996) (Level III-3)

• Sleep disruption or circadian rhythm disturbance may perpetuate musculoskeletal symptoms (Moldofsky and Scarisbrick 1976; Moldofsky 1993; Leese et al. 1996) (Level III-3)  

Sympathetic nervous system function

• Altered blood pressure responses to postural change, consistent with neurally mediated hypotension, have been demonstrated (Bou-Holaigah et al. 1995; Freeman and Komaroff 1997) (Level III-2)

• Reduced sympathetic nervous system markers have been demonstrated (Demitrack et al. 1992; Clauw et al. 1995) (Level III-2)  

Neurotransmitter function

• Conflicting evidence for an increased sensitivity of serotonin and dopamine receptors to antagonists (Bakheit et al. 1992; Cleare et al. 1995; Bearn et al. 1995; Sharpe et al. 1996) (Level III-4)  

Mood

• Changes in biological markers (e.g., HPA axis function, immunity, sleep architecture) in patients with major depression are different from those in patients with CFS (Lloyd et al. 1992; Cleare et al. 1995; Fischler et al. 1997) (Level III-2)  

Brain structure

• Conflicting evidence for an increased prevalence of white matter abnormalities on magnetic resonance imaging (Simon et al. 1991; Buchwald et al. 1992; Costa et al. 1992, 1995; Ichise et al. 1992; Natelson et al. 1993; Schwartz et al. 1994a, 1994b; Cope et al. 1995; Goldstein et al. 1995; Osmanagaoglu et al. 1995; Patterson et al. 1995; Fischler et al. 1996) (Level III-4)

• Regional cerebral blood flow studies (e.g., SPECT) have found conflicting results (Simon et al. 1991; Buchwald et al. 1992; Costa et al. 1992, 1995; Ichise et al. 1992; Natelson et al. 1993; Schwartz et al. 1994a, 1994b; Cope et al. 1995; Goldstein et al. 1995; Osmanagaoglu et al. 1995; Patterson 1995 et al. 1995; Fischler et al. 1996) (Level III-4)  

Cognitive performance

• Attention and concentration are impaired (Fischler et al. 1996; Johnson et al. 1996; Marcel et al. 1996; Marshall et al. 1996, 1997; Michiels et al. 1996; Moss-Morris et al. 1996; Wearden and Appleby 1996; Kane et al. 1997; Landro et al. 1997; Vollmer-Conna et al. 1997b) (Level I)

• Conflicting evidence for impaired visual and auditory memory (Fischler et al. 1996; Johnson et al. 1996; Marcel et al. 1996; Marshall et al. 1996, 1997; Michiels et al. 1996; Moss-Morris et al. 1996; Wearden and Appleby 1996; Kane et al. 1997; Landro et al. 1997; Vollmer-Conna et al. 1997b) (Level III-4)

Back to text of Part 2.

Back to text of Part 5.