Chronic fatigue syndrome in childhood

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 thei r performance ability deteriorated. They were diagnosed as having CFS on th e basis of criteria. To investigate the brain function in CFS patients, we examined the regional cerebral blood flow by single-photon emission-compute d tomography (SPECT) with 111 MBq [I-123]-iodoamphetamine (I-123-IMP) or xe non-computed tomography (Xe-CT), and brain metabolic levels by MR spectrosc opy (MRS). Blood flow, expressed as the corticocerebellar ratio (CCR), in t he left temporal and occipital lobes was markedly lower in cases 2 and 3 th an that in healthy subjects reported by another investigator. In case 1, ho wever, blood flow in the left basal ganglia and thalamus was markedly highe r than in healthy subjects. The MR spectroscopy (MRS) study revealed remark able elevation of the choline/creatine ratio in the patients with CFS. None of our patients exhibited evidence of focal structural abnormalities on MR I. These findings suggest that the various clinical symptoms in CFS patient s mn he closely related to on abnormal brain function. (C) 2000 Elsevier Sc ience B.V. All rights reserved.