Chronic fatigue syndrome in childhood

      Abstract

      Chronic fatigue occurring in previously healthy children and adolescents is one of the most vexing problems encountered by pediatric practitioners. We report three cases, 11, 12 and 13-year-old children, with chronic fatigue syndrome (CFS). They initially developed a low grade fever and generalized fatigue, followed by sleep disturbance and psychosomatic symptoms, and their performance ability deteriorated. They were diagnosed as having CFS on the basis of criteria. To investigate the brain function in CFS patients, we examined the regional cerebral blood flow by single-photon emission-computed tomography (SPECT) with 111 MBq [123I]-iodoamphetamine (123I-IMP) or xenon-computed tomography (Xe-CT), and brain metabolic levels by MR spectroscopy (MRS). Blood flow, expressed as the corticocerebellar ratio (CCR), in the left temporal and occipital lobes was markedly lower in cases 2 and 3 than that in healthy subjects reported by another investigator. In case 1, however, blood flow in the left basal ganglia and thalamus was markedly higher than in healthy subjects. The MR spectroscopy (MRS) study revealed remarkable elevation of the choline/creatine ratio in the patients with CFS. None of our patients exhibited evidence of focal structural abnormalities on MRI. These findings suggest that the various clinical symptoms in CFS patients may be closely related to an abnormal brain function.

      Keywords

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      References

        • Holmes G.P.
        • Kaplan J.E.
        • Grantz N.M.
        • Komaroff A.L.
        • Schonberger L.B.
        • Strauss S.E.
        • et al.
        Chronic fatigue syndrome: a working case definition.
        Ann Intern Med. 1988; 108: 387-389
        • Marshall G.S.
        Report of a workshop on the epidemiology, natural history, and pathogenesis of chronic fatigue syndrome in adolescents.
        Pediatrics. 1999; 134: 395-405
        • Bell K.M.
        • Cookfair D.
        • Bell D.S.
        • Reese P.
        • Cooper L.
        Risk factors associated with chronic fatigue syndrome in a cluster of pediatric cases.
        Reviews of Infectious Diseases. 1991; 13: S32-S38
        • Miike T.
        • Tomoda A.
        School refusal and chronic fatigue syndrome (in Japanese).
        Physical Science. 1993; 29: 709-716
        • Tomoda A.
        • Miike T.
        • Uezono K.
        • Kawasaki T.
        • et al.
        A school refusal case with biological rhythm disturbance and melatonin therapy.
        Brain Dev. 1994; 16: 71-76
        • Tomoda A.
        • Miike T.
        • Honda T.
        • Fukuda K.
        • Kai Y.
        • Nabeshima M.
        • et al.
        Single-photon emission computed tomography for cerebral blood flow in school phobias.
        Curr Ther Res. 1995; 56: 1088-1093
        • Tomoda A.
        • Miike T.
        • Yonamine K.
        • Adachi K.
        • Shiraishi S.
        Disturbed circadian core body temperature rhythm and sleep disturbance in school refusal children and adolescents.
        Biol Psyc. 1997; 41: 810-813
        • Bolwig T.G.
        Regional cerebral blood flow in affective disorders.
        Acta Psychiat Scand. 1993; 371: 48-53
        • Ichise M.
        • Salit I.E.
        • Abbey S.E.
        • Chung D.G.
        • Gray B.
        • Kirsch J.C.
        • et al.
        Assessment of regional cerebral perfusion by 99mTc- HMPAO SPECT in chronic fatigue syndrome.
        Nucl Med Commun. 1992; 13: 757-772
        • Schwartz R.B.
        • Garada B.M.
        • Komaroff A.L.
        • Tice H.M.
        • Gleit M.
        • Jolesz F.A.
        • et al.
        Detection of intracranial abnormalities in patients with chronic fatigue syndrome: comparison of MR imaging and SPECT.
        AJR. 1994; 162: 935-941
        • Schwartz R.B.
        • Komaroff A.L.
        • Garada B.M.
        • Gleit M.
        • Doolittle T.H.
        • Bates D.W.
        • et al.
        SPECT imaging of the brain: Comparison of findings in patients with chronic fatigue syndrome. AIDS dementia complex, and major unipolar depression.
        AJR. 1994; 152: 943-951
        • Buckley P.F.
        • Moore C.
        • Long H.
        • et al.
        1H-Magnetic resonance spectroscopy of the left temporal and frontal lobes in schizophrenia: Clinical, neurodevelopmental, and cognitive correlates.
        Biol Psych. 1994; 36: 792-800
        • Furusawa M.
        • Morishita S.
        • Kira M.
        • et al.
        Evaluation of school refusal with localised proton MR spectroscopy.
        Asian Oceanian J Radiology. 1998; 3: 170-174
        • Tzika A.A.
        • Ball W.S.
        • Vigneron D.B.
        • Dunn R.S.
        • Kirks D.R.
        Clinical proton MR spectroscopy of neurodegenerative disease in childhood.
        Nucl Med Commun. 1993; 14: 1267-1281
        • Schiepers C.
        • Verbruggen A.
        • Casaer P.
        • Schiepers C.
        • Verbruggen A.
        • Casaer P.
        • DeRoo M.
        • et al.
        Normal brain perfusion pattern of Technetium-99m-ethylcysteinate dimer in children.
        J Nucl Med. 1997; 38: 1115-1120
        • Fukuda K.
        • Straus S.E.
        • Hickie I.
        • et al.
        The chronic fatigue syndrome: a comprehensive approach to its definition and study.
        Ann Intern Med. 1994; 121: 953-959
        • Lenkinski R.E.
        • Schnall M.D.
        MR spectroscopy and the biochemical basis of neurological disease.
        in: Atlas S.W. Magnetic resonance imaging of the brain and spine. Raven Press, New York1991: 1110-1115
        • Boyko O.B.
        • Charles H.C.
        • Krishnan R.R.
        • Payne M.
        • Moore D.
        • Lazeyras F.
        Brain choline depression: elucidation with localized proton MR spectroscopy.
        78th RSNA Scientific Program. 1992; : 125