5.4 Evaluation of the evidence for other factors proposed to contribute to the pathophysiology of CFS

Neuromuscular disorder

• Muscle strength, endurance and recovery are normal (Holmes et al. 1987; Stokes et al. 1988; Riley et al. 1990; Lloyd et al. 1991b; Edwards et al. 1993; Gibson et al. 1993) (Level I)

• Conflicting evidence for a disturbance in mitochondrial function (McCully et al. 1996; Byrne 1985) (Level III-4)  

Metabolic disturbance

• Urinary excretion of protein metabolites may be altered (McGregor et al. 1996a, 1996b)  

Poisoning

• Levels of chlorinated hydrocarbons may be increased (Dunstan et al. 1995) (Level III-3)

• Chronic exposure to industrial solvents, insecticides or pesticides may cause an illness resembling CFS (Hoffman et al. 1986; Orbaek and Nise 1989; Behan 1996) (Level IV)

• Silicone breast implants may be associated with a syndrome resembling CFS (Goldenberg et al. 1990; Wolfe et al. 1990; Buchwald and Garrity 1994b; Solomon 1994; Vasey et al. 1994; Bridges 1995; Gatenby 1996) (Level IV)

• Ciguatera poisoning may precipitate a syndrome resembling CFS (Pearn 1996, 1997) (Level IV)

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