This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (13)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Musculoskeletal Syndromes (Chronic Fatigue, Gulf War)  • Alert me on articles by topic  Social Bookmarking   What's this?

Jeanne Poole, MD; Richard Herrell, MS; Suzanne Ashton, BS; Jack Goldberg, PhD; Dedra Buchwald, MD

Arch Intern Med. 2000;160:3461-3468.

Background  The pathogenesis of chronic fatigue syndrome (CFS) is unknown. Neurally mediated hypotension (NMH) has been suggested as a common comorbid condition or a potential underlying cause.

Methods  We conducted a cotwin control study of 21 monozygotic twins who were discordant for CFS. One twin met the 1994 Centers for Disease Control and Prevention criteria for CFS, and the other twin was healthy and denied chronic fatigue. The twins were selected from a volunteer twin registry in which at least 1 member reported persistent fatigue. As part of a 7-day clinical evaluation, all 21 twin pairs were evaluated with a 3-stage tilt table test with isoproterenol hydrochloride for the assessment of NMH. The presence of NMH was defined as syncope or presyncope associated with a decrease of 25 mm Hg in blood pressure and no associated increase in heart rate.

Results  A positive tilt table test result was observed in 4 twins with CFS (19%) and in 4 healthy twins (19%). This difference was not statistically significant (matched pair odds ratio, 1.0; 95% confidence interval, 0.2-5.4; P>.90). Compared with the healthy twins, the twins with CFS reported more severe symptoms of CFS and NMH both in the week before and during the tilt table test.

Conclusions  These results do not support a major role for NMH in CFS. They highlight the importance of selecting well-matched control subjects, as well as the unique value of the monozygotic cotwin control design in the study of this illness.

From the Department of Medicine (Drs Poole and Buchwald and Ms Ashton), University of Washington, Seattle; the Department of Epidemiology, University of Illinois, Chicago (Mr Herrell and Dr Goldberg); and the Vietnam Era Twin Registry, Department of Veterans Affairs, Edward Hines, Jr, VA Hospital, Hines, Ill (Dr Goldberg).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Familial aggregation of fainting in a case-control study of neurally mediated hypotension patients who present with unexplained chronic fatigue
Lucas et al.
Europace 2006;8:846-851.
ABSTRACT | FULL TEXT  

Chronic Fatigue Syndrome: A Review
Afari and Buchwald
Am. J. Psychiatry 2003;160:221-236.
ABSTRACT | FULL TEXT  

A Measure of Heart Rate Variability Is Sensitive to Orthostatic Challenge in Women with Chronic Fatigue Syndrome
Yamamoto et al.
Exp. Biol. Med. 2003;228:167-174.
ABSTRACT | FULL TEXT  

Chronic Fatigue Syndrome
Natelson
JAMA 2001;285:2557-2559.
FULL TEXT