The MFSI and Fatigue Severity Scale are also useful tools, as well as the DePaul Symptom Questionnaire.1 Laboratory data which I consistently find to be abnormal include: Decreased NK cell numbers, decreased NK cell function, elevated EBV antibody titers, elevated HHV6 antibody titers, and, to a lesser extent, elevated cytomegalovirus antibody titers. Some patients have obtained perfusion Single Photon Emission Computed Tomography (SPECT) scans which show diffuse hypoperfusion consistent with findings in the literature.13,14

Response to valacyclovir is slow, as often an interval of 3 months or more is necessary. Duration of treatment is variable, ranging from 8 months to years. Cessation of antiviral treatment can sometimes precipitate a relapse of symptoms.


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These data are also consistent with prior studies of antiviral treatment of SEID. Lerner and colleagues found significant and persistent improvement in symptoms and in cardiovascular function in SEID patients who were treated with the valacyclovir.15,16 Montoya and colleagues reported a 75% response rate to another antiviral, valganciclovir, in SEID patients with high IgG titers to EBV and HHV-6.17 Antiviral therapy may be a powerful tool in the fight against SEID.

Theodore Henderson, MD., PhD, is a psychiatrist in Denver, Colo., who specializes in the diagnosis of complex adult, child, and adolescent psychiatric cases. His website is www.childpsychiatristdenver.com.

References

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  2. Institute of Medicine. Beyond myalgic encephalomyelitis/chronic fatigue syndrome: redefining an illness. www.iom.edu/Reports/2015/ME-CFS.aspx. Accessed February 21, 2015.
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  4. Henderson TA. Valacyclovir treatment of chronic fatigue in adolescents. Adv Mind Body Med. 2014; 28(1):4-14.
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  8. Smucker MR, et al. Normative and reliability data for the Children’s Depression Inventory. J Abnorm Child Psychol. 1986;14(1):25-39.
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  10. Hann DM, et al. Measurement of fatigue in cancer patients: development and validation of the Fatigue Symptom Inventory. Qual Life Res. 1998; 7(4):301-310.
  11. Stein KD, et al. Further validation of the multidimensional fatigue symptom inventory-short form. J Pain Symptom Manage. 2004; 27(1):14-23.
  12. White PD, et al. PACE trial management group. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet. 2011; 377(9768):823-36.
  13. MacHale SM, et al. Cerebral perfusion in chronic fatigue syndrome and depression. Br J Psychiatry. 2000; 176:550-556.
  14. Schmaling KB, et al. Single-photon emission computerized tomography and neurocognitive function in patients with chronic fatigue syndrome. Psychosom Med. 2003; 65(1):129-136.
  15. Lerner AM, et al. A six-month trial of valacyclovir in the Epstein-Barr virus subset of chronic fatigue syndrome: improvement in left ventricular function. Drugs Today (Barc). 2002; 38(8):549-561.
  16. Lerner AM, et al. Valacyclovir treatment in Epstein-Barr virus subset chronic fatigue syndrome: thirty-six months follow-up. In Vivo. 2007; 21(5):707-713.
  17. Kogelnik AM, et al. Use of valganciclovir in patients with elevated antibody titers against Human Herpesvirus-6 (HHV-6) and Epstein-Barr Virus (EBV) who were experiencing central nervous system dysfunction including long-standing fatigue. J Clin Virol. 2006; 37(suppl 1):S33-S38.