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Phenotypes of Chronic Fatigue Syndrome in Children and Young People




Arch Dis Child. 2009 Oct 19. [Epub ahead of print]


Phenotypes of Chronic Fatigue Syndrome in Children and Young People.


May M, Emond A, Crawley E. Bristol University, United Kingdom.



OBJECTIVE: To investigate the heterogeneity of chronic fatigue syndrome (CFS/ME) in children and young people. SETTING: Regional specialist CFS/ME service. Patients: Children and young people aged < 19 years old.


METHODS: Exploratory factor analysis was performed on symptoms present at assessment in 333 children and young people with CFS/ME. Linear and logistic regression analysis of data from self completed assessment forms was used to explore the associations between the retained factors and sex, age, length of illness, depression, anxiety and markers of severity (fatigue, physical function, pain and school attendance).


RESULTS: Three phenotypes were identified using factor analysis: Musculoskeletal (Factor 1) had loadings on muscle and joint pain and hypersensitivity to touch, and was associated with worse fatigue (regression coefficient 0.47, 95% CI 0.25, 0.68, p <0.001), physical function (regression coefficient -0.52, 95% CI -0.83, -0.22, p= 0.001) and pain. . Factor 2 (Migraine) loaded on noise and light hypersensitivity, headaches, nausea, abdominal pain and dizziness and was most strongly associated with physical function and pain. Sore throat phenotype, (Factor 3) had loadings on sore throat and tender lymph nodes and was not associated with fatigue or pain. There was no evidence that phenotypes were associated with age, length of illness or symptoms of depression (regression coefficient for association of depression with Musculoskeletal pain -0.02, 95% CI -0.27, 0.23, p= 0.87). The Migraine phenotype was associated with anxiety (0.40, 95% CI 0.06, 0.74, p=0.02).


Implications: CFS/ME is heterogeneous in children with 3 phenotypes at presentation that are differentially associated with severity and are unlikely to be due to age or length of illness.


PMID: 19843509 [PubMed - as supplied by publisher]



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  • In 2008 Dr. Jonathan Kerr published the results of a genetic study which identified 7 different subtypes of chronic fatigue syndrome (ME/CFS). The heterogeneity of the illness being a subject Kerr has worked hard to establish and describe.

    This study to my knowledge is the first to confirm that subtypes of ME/CFS are present specifically in children and young people. Despite the subtypes identified by Keer's team and this group differ taken together they confirm the complex nature of the illness and the need to delineate the different subsets of patients so that treatment can be better tailored to the individual.

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