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Suzanne,

I have gone thru different periods of this illness with this symptom.

Sometimes I really believe it was a symptom of being

allergic/hypersensitive to a food or something else, which the tracking

down gets difficult but can be done.

Also, calcium often makes my heart race. As does, sometimes, ginger,

though I love it and it helps my gut.

Epinephrine will do that.

You really need to work hard trying to figure out the trigger. I did use

a beta blocker for this and didn't have bad side effects--it was

propanolol. I went up slowly.

In most people magnesium helps this symptom, though not in all.

Try to take a different beta blocker as they all have different side

effects. See what's in your supps and meds and try to think of allergies

to something. And also think about calcium.

It's best to find the trigger and eliminate it. But while

benzodiazapines are drugs I don't think are good for people, I have to

admit that I've used them both for the very symptom you speak of when

nothing else worked (as well as a muscle relaxant, for pain). They will

slow the heartbeat, as do beta blockers. Take a short acting one. You

need good doctoring to help you with this but there's a lot you can do to

figure this out.

Again, it could be something I know nothing of. I'm just sharing with

you that I have had , all thru the illness, trouble off and on with this

symptom, and the above is what I've experienced.

Good luck. I know that a rapid pulse and/or strong one is enormously

uncomfortable and so difficult to live with.

Judith Wisdom

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I had quite a lot of tachycardia on the 24-hour Holter monitoring test I did.

In my case, it seems related to orthostatic intolerance but is exacerbated

when I sit up for any period of time (I don't really spend time standing, but

that would be even worse). I found a definite connection to doxepin -- the

tachycardia was made much worse by doxepin, which indeed can worsen

orthostatic intolerance. If you are taking any tricyclic antidepressants,

you might want to see if these are causing the problem. I am guessing other

meds probably worsen OI symptoms too.

Peggy

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suzanne

this is a copy of the theory of Dr LErner that CFS is due to

chronic herpes infection of the heart. it details how he diagnoses

and treats it. have you have an EKG done? maybe you can send your

results to him for a consult...

bill

United States Patent 6,399,622

Lerner June 4, 2002

Method for diagnosing and alleviating the symptoms of chronic fatigue

syndrome

Abstract

A method for alleviating chronic fatigue syndrome with the

administration of antiviral agents. Based on clinical tests, chronic

fatigue syndrome is a persistent herpes virus infection including

incomplete virus multiplication and thus administration of antiviral

agents are shown to alleviate the symptoms associated with the

disorder. Based on therapeutic trials, patients receiving the

recommended antiviral treatment, have experienced significant

reduction or elimination of the symptoms associated with chronic

fatigue syndrome. A method of diagnosis of the chronic fatigue

syndrome is further disclosed.

Inventors: Lerner; A. (525 Harmon, Birmingham, MI 48009)

Appl. No.: 971291

Filed: October 3, 2001

Current U.S. Class: 514/263.38; 514/49

Intern'l Class: A61K 031/505; A61K 031/70

Field of Search: 514/258,259,260,49

References Cited [Referenced By]

U.S. Patent Documents

4544634 Oct., 1985 Krenitsky 435/119.

4695570 Sep., 1987 Krenitsky 514/261.

4897394 Jan., 1990 Zimmerman et al. 514/258.

4957924 Sep., 1990 Beauchamp 514/262.

5055296 Oct., 1991 Wagle et al. 424/553.

5061708 Oct., 1991 Krenitsky 514/262.

5079252 Jan., 1992 Beauchamp 514/262.

5189022 Feb., 1993 Bridge et al. 514/16.

5206008 Apr., 1993 Loria 424/45.

5213106 May., 1993 Lerner 128/696.

5267570 Dec., 1993 Preston 128/731.

5312817 May., 1994 Snorrason 514/141.

5357968 Oct., 1994 Lerner 128/696.

5405850 Apr., 1995 Blumenkopf 514/262.

5426028 Jun., 1995 Levy et al. 435/7.

5461042 Oct., 1995 Loria 514/182.

5464020 Nov., 1995 Lerner 128/696.

5491150 Feb., 1996 Aoki et al. 514/310.

5538856 Jul., 1996 Levy et al. 435/7.

5545550 Aug., 1996 Grossberg et al. 435/240.

5545670 Aug., 1996 Bissbort et al. 514/562.

5872123 Feb., 1999 Lerner 514/258.

6258818 Jul., 2001 Lerner 514/258.

Other References

" A New Cardiomyopathy: A Pilot Study of Intravenous Ganciclovir in a

Subset of the Chronic Fatigue Syndrome " , A. Lerner, et al.

Depts. of Medicine, Wm. Beaumont Hospital, Wayne State Univ., Sch. of

Med., Royal Oak, MI 1997 6:110-117.

" Perspectives on Interactions of Acyclovir with Epstein-Barr and

Other Herpes Virus " ph S. Pagano, M.D., and Alok K. Datta, Ph.D.

Acyclovir Symposium-The American Journal of Medicine 1982; 73; pp. 18-

26.

" Valacyclovir HC1 (Valtrex) Provides Simplified Dosing and Increased

Efficacy in the Treatment of Herpes Virus Infections " Int. Pharm.

Abstr. 1994; 31:2244-5. Abstract No. 3111836.

" The Chronic Fatigue Syndrome: A Comprehensive Approach to Its

Definition and Study " , Keiji Fukuda, M.D., et al ls of Internal

Medicine, vol. 121, No. 12, pp. 953-959.

" Lack of Evidence for Infection with Known Human and Animal

Retroviruses in Patients with Chronic Fatigue Syndrome " , Clin. Infec.

Disease 18, Suppl. 1, 1994, pp. S121-125.

" Long-Term Serological Follow-Up of Patients for Epstein-Barr Virus

After Recovery from Infectious Mononucleosis " , The Journal of

Infectious Diseases, S. Horwitz, vol. 151, No. 6, Jun., 1985, pp.

1150-1153.

" Studies on Enterovirus in Patients with Chronic Fatigue Syndrome " ,

J.W. Gow, et al Clinical Infectious Diseases, 1995; 18 (Suppl. 1),

pp. S126-129.

" Molecular Biology and Immunology of Cytomegalovirus " , D.

Griffiths and Jane E. Grundy, Biochem. J., (1987) vol. 241, pp. 313-

324.

" Herpes Simplex Encephalitis-Vidarabine Therapy and Diagnostic

Problems " , J. Whitley, et al; The New England Journal of

Medicine, Feb. 5, 1981; vol. 304, No. 6, pp. 313-318.

" In Situ Detection of Human Cytomegalovirus Immediately-Early Gene

Transcripts, etc. " Tzyy-Choou Wu, et al, AIDS, 1992, vol. 6, No. 8,

pp. 777-785.

" Cytomegalovirus as a Possible Cause of a Disease Resembling

Infectious Mononucleosis " E. Klemola and L. Kaariainen, British

Medical Journal, 1965, vol. 2, pp. 1099-1102.

" Infectious Mononucleosis " , C. Niederman, et al, Journal of The

American Medical Association, 1968, vol. 203, No. 3, pp. 205-209.

" Medical Consequences of Persistent Viral Infection " , Southern

and B.A. Oldstone, New England Journal of Medicine, vol. 314,

No. 6, pp. 359-367.

" Lack of Evidence for Infection with Known Human and Animal

Retroviruses in Patients with Chronic Fatigue Syndrome " , Walid

Heneine, et al, Clinical Infectious Diseases 1994; 18 (Suppl. 1), pp.

S121-S125.

" Repetitively Negative Changine T Waves at 24-h Electrocardiographic

Monitors in Patients with the Chronic Fatigue Syndrome " , A.

Lerner, et al; Chest vol. 104, No. 5, Nov. 1993, pp. 1417-1421.

" Abnormal Left Ventricular Myocardial Dynamics in Eleven Patients

with Chronic Fatigue Syndrome " , Clinical Nuclear Medicine, Aug. 1994,

vol. 19, No. 8, pp. 675-677.

" Abnormal Left Ventricular Myocardial Dynamics in Patients with the

Chronic Fatigue Syndrome in Birmingham, Michigan 1987-1994 " , A.

Lerner, et al, Wm. Beaumont Hospital, Royal Oak, MI; Wayne

State Univ., Detroit, MI; Univ. of Michigan, Ann Arbor.

" Immune Surveillance Against Epstein-Barr Virus " , Denis J. Moss, et

al, Immunology, vol. 4, 1992, pp. 97-104.

" A Second Site for Epstein-Barr Virus Shedding: The Uterine Cervix " ,

W. Sixbey, et al, The Lancet, Nov. 1986, pp. 1122-1124.

" Prolonged Inhibitory Effect of 9-(1,3-Dihydroxy-2-Propoxymethyl)

Guanine Against Replication of Epstein-Barr Virus " , Jung-Chung Lin,

et al, Journal of Virology, Apr., 1984, vol. 50, No. 1, pp. 50-55.

" Epstein-Barr Virus Replication in Oropharyngeal Epithelial Cells " ,

W. Sixbey, et al, The New England Journal of Medicine, vol. 310,

No. 19, 1984, pp. 1225-1230.

" Chronic Epstein-Barr Virus Infection Associated with Fever and

Interstitial Pneumonitis " , T. Schooley, et al, ls of

Internal Medicine, 1986, vol. 104, pp. 636-643.

" Long-Term Serological Follow-Up of Patients for Epstein-Barr Virus

After Recovery from Infectious Mononucleosis " , A. Horowitz,

et al, The Journal of Infectious Diseases, vol. 151, No. 6, Jun.

1985, pp. 1150-1153.

" Is Neurally Mediated Hypotension an Unrecognised Cause of Chronic

Fatigue? " , C. Rowe, et al, The Lancet, vol. 345, pp. 623-624.

" Chronic Fatigue Syndrome " , Principles and Practice of Infectious

Diseases-4th Ed., R. T. Schooley, 1995, pp. 1306-1310.

" Acyclovir Treatment of the Chronic Fatigue Syndrome " , E.

Straus, et al, The New England Journal of Medicine, vol. 319, No. 26,

pp. 1692-1698.

" The Chronic Fatigue Syndrome--One Entity or Many? " , Morton N.

Swartz, The New England Journal of Medicine, vol. 319, No. 26, 1988,

pp. 1726-1728.

" The Relationship Between Neurally Mediated Hypotension and the

Chronic Fatigue Syndrome " , Issam Bou-Holaigah, et al, Journal of The

American Medical Association, vol. 274, No. 12, pp. 961-967.

" A Cluster of Patients with a Chronic Mononucleosis-like Syndrome: Is

Epstein-Barr Virus the Cause? " , G.P. Holmes, et al, Journal of The

American Medical Association, 1987, vol. 257, No. 17, pp. 2297-2302.

" Frequency of `Chronic Active Epstein-Barr Virus Infection` in a

General Medical Practice " , Dedra Buchwald, et al, Journal of The

American Medical Association, 1987, vol. 257, No. 17, pp. 2303-2307.

" The Epstein-Barr Virus: Host Balance in Acute Infectious

Mononucleosis Patients Receiving Acyclovir Anti-Viral Therapy " , Q.Y.

Yao, Int. J. Cancer, 1989, vol. 43, pp. 61-66.

" A Double-Blind, Placebo-Controlled Trial of Intravenous

Immunoglobulin Therapy in Patients with Chronic Fatigue Syndrome " ,

Lloyd, et al, The American Journal of Medicine, 1990, vol. 89,

pp. 561-568.

" A Controlled Trial of Intravenous Immunoglobulin G in Chronic

Fatigue Syndrome " P.K. , et al, The American Journal of

Medicine, 1990, vol. 89, pp. 554-560.

" Chronic Fatigue Syndrome: A Working Case Definition " , G.P. Holmes,

et al ls of Internal Medicine, 1988, vol. 108, pp. 387-389.

" Leukocyte-Transforming Agent: Prolonged Excretion by Patients with

Mononucleosis and Excretion by Normal Individuals " , H. Dean Golden,

et al, The Journal of Infectious Diseases, 1973, vol. 127, No. 4, pp.

471-473.

" Enhanced Serological and Virological Findings of Epstein-Barr Virus

in Patients with AIDS and AIDS-Related Complex " , Ciro V. Sumaya, et

al, The Journal of Infectious Diseases, 1986, vol. 154, No. 5, pp.

864-870.

" Human Herpes Virus-6: Clinical Implications of a Recently

Discovered, Ubiquitous Agent " , T. Leach, The Journal of

Pediatrics, 1992, vol. 121, No. 2, pp. 173-181.

" Summary: Viral Studies of Chronic Fatigue Syndrome " , Dharam V.

Ablashi, Clinical Infectious Diseases, 1994:18 (Suppl. 1), pp. S130-

S133.

" Epstein-Barr Virus-Specific IgA Serum Antibodies as an Outstanding

Feature of Nasopharyngeal Carcinoma " , Gertrude Henle, et al, Int. J.

Cancer, 1976, vol. 17, pp. 1-7.

" Viral Latency and Transformation: The Strategy of Epstein-Barr

Virus " , Klein, Cell, 1989, vol. 58, pp. 5-8.

" IgM Antibodies Specific for Epstein-Barr Virus in Infectious

Mononucleosis Without Heterophil Antibodies " , J. Nikoskelainen, et

al, British Medical Journal, 1974, vol. 4, pp. 72-75.

" Repression of Human Cytomegalovirus Major Immediate Early Gene

Expression in a Monocytic Cell Line " , J. H. Sinclair, et al, Journal

of General Virology (1992) vol. 73, pp. 433-435.

" Chest Pain and Palpitation " , Eugene Braunwald, on's Principles

of Internal Medicine (10th Ed.), (1983) pp. 25-31.

" Chronic Fatigue Syndrome-Information for Physicians " , National

Institute of Allergy and Infectious Diseases, National Institutes of

Health, Sep., 1996 pp. 1-16.

" Acyclovir Treatment of the Chronic Fatigue Syndrome " , Straus

et al., 1988 New England Journal of Medicine, Dec. 29, 1988, vol.

319, No. 26, pp. 1692-1698.

" New Cardiomyopathy: Pilot Study of Intravenous Ganciclovir in a

Subset of the Chronic Fatigue Syndrome " , A. Lerner et al.,

Departments of Medicine, Wm. Beaumont Hospital, Wayne State Univ.,

School of Medicine, 1997, 6:110-117.

" A Preliminary 6 Month Trial of Valacyclovir (VAL) in Chronic Fatigue

Syndrome (CFS) Using the Epstein-Barr Virus (EBV), Cytomegalovirus

(HCMV) Paradigm " , A. Lerner et al., Abstract for 36.sup.th

Annual Meeting of the Infectious Disease Society of America.

" The Human Herpesviruses " , edited by B. Roizman, R.J. Whitley & C.

, Raven Press Ltd., New York, 1993, Chapters 4, 5, 6 and 11.

" A Preliminary Randomized Double-Blinded Controlled Six Month Trial

of Valacyclovir in Chronic Fatigue Syndrome Using the Epstein-Barr

Virus/Cytomegalovirus Paradigm, " A. Lerner, et al., 36TH

Annual Meeting of the Infectious Diseases Society of America, Nov. 23-

15, 1998, Denver, CO.

" Stress/Rest Radionuclide Cardiac Ventriculography in Chronic Fatigue

Syndrome, " A. Lerner, et al., presented in part at the 35th

Annual Meeting of the Infectious Diseases Society of America, Sep.

15, 1997, San Francisco, CA.

Lerner, A. ; Zervos, Marcus; Chang, C.H.; Beqaj, Savedin;

Goldstein, ; O'Neill, ; Dworkin, ; Fitzgerald,

; and Deeter, G.; A Small Randomized Placebo-Controlled

Trial of the use of Antiviral Therapy for Patients with Chronic

Fatigue Syndrome, Clinical Infectious Diseases 2001, vol. 32, pp.

1657-1658.

Valcyte.TM. (valganciclovir hydrochloride tablets), pamphlet

published and distributed by Roche Pharmaceuticals, Roche

Laboratories, Inc., Nutley, NJ 07110, issued Mar. 2001.

Brown, Frances; Banken, Ludger; Saywell, Kay; and Arum, Inger;

Pharmacokinetics of Valganciclovir and Ganciclovir Following Multiple

Oral Dosages of Valganciclovir in HIV- and CMV-Seropositive

Volunteers, Adis International Limited; Clin Pharmacokinet Aug. 1999:

37 (2), 167-176.

Jung, , Ph.D.; and Dorr, Albert, Ph.D.; Single-Dose

Pharmacokinetics and Valganciclovir in HIV- and CMV-Seropositive

Subjects, Pharmacokinetics and Pharmacodynamics, J. Clin Pharmacol

1999; 39:800-804.

Primary Examiner: Travers;

Attorney, Agent or Firm: & Kushman P.C.

Parent Case Text

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. application Ser.

No. 09/663,729 filed Sep. 15, 2000, which is a continuation-in-part

of U.S. application Ser. No. 09/177,942 filed Oct. 23, 1998, now U.S.

Pat. No. 6,258,818 which, in turn, is a continuation-in-part of prior

U.S. application Ser. No. 08/802,776 filed Feb. 18, 1997, now U.S.

Pat. No. 5,872,123.

Claims

What is claimed is:

1. A method of diagnosing and alleviating the symptoms of chronic

fatigue syndrome in a patient exhibiting symptoms associated with

chronic fatigue syndrome, comprising:

evaluating the patient for serologic evidence of EBV and HCMV,

further comprising:

obtaining serum from the patient;

measuring the level of EBV IgM antibodies to the VCA in the serum;

measuring the level of EBV antibodies to the total EA in the serum;

measuring the level of HCMV IgM antibodies in the serum by measuring

antigens p52 and CM.sub.2 with the use of a light scattering

technique;

measuring the level of HCMV IgG antibodies in the serum by measuring

antigens p52 and CM.sub.2 with the use of a light scattering

technique;

monitoring the patient for T-wave abnormalities;

classifying EBV as the cause of the chronic fatigue syndrome when the

measurements show any one of the following: 1) an elevated level of

IgM antibodies to the VCA for EBV; and 2) presence of total EA

antibodies for EBV, in combination with the absence of IgM antibodies

for HCMV and a low level of IgG antibodies for HCMV;

classifying HCMV as the cause of the chronic fatigue syndrome when

the measurements show any one of the following: 1) an elevated level

of IgM antibodies for HCMV; and 2) an elevated level of IgG

antibodies for HCMV, in combination with a low level of IgM

antibodies to the VCA for EBV, and the absence of total EA antibodies

for EBV;

classifying a combination of EBV and HCMV as the cause of the chronic

fatigue syndrome when the measurements show any one of the following:

1) an elevated level of IgM antibodies to the VCA for EBV; and 2) the

presence of total EA antibodies for EBV, in combination with any of

the following: 1) an elevated level of IgM antibodies for HCMV; and

2) an elevated level of IgG antibodies for HCMV;

administering to the patient a therapeutically effective amount of

one or more pharmaceutically acceptable antiviral agents suitable for

EBV, HCMV or a combination thereof, wherein the one or more antiviral

agents are selected from the group consisting of valganciclovir, and

pharmaceutically acceptable derivatives and mixtures thereof; and

conducting supplemental tests to check for recurrent chronic fatigue

syndrome to determine an appropriate treatment period for the patient

to achieve continued alleviation of the symptoms of chronic fatigue

syndrome.

2. The method of claim 1, wherein the patient is administered 0.1 to

50 milligrams of valganciclovir per kilogram of body weight of the

patient over six hours.

Description

TECHNICAL FIELD

This invention relates to a method of alleviating the symptoms

associated with chronic fatigue syndrome through the use of antiviral

agents.

BACKGROUND ART

Chronic fatigue syndrome (CFS) is a disorder which, until recently,

had no formalized name, received little attention and was believed by

the majority of the medical community to be a psychological rather

than medical disorder. However, as information about the disorder has

been disseminated, the symptoms associated with the disorder, as well

as the growing number of people afflicted with this disorder, have

steadily increased to alarming proportions. In fact, CFS is being

reported with increasing frequency throughout the world.

Chronic fatigue syndrome is a puzzling, exasperating illness whereby

previously healthy, vigorous and productive young or middle-aged

adults are suddenly afflicted with a persistent, overwhelming

fatigue. When such a severe debilitating fatigue extends beyond six

months and psychiatric disease is excluded, the condition has been

termed " chronic fatigue syndrome. " Despite the number of people

afflicted with chronic fatigue syndrome and the recent research

attention, to date, the cause of the disorder remains unknown.

The medical community has only recently defined the term " chronic

fatigue syndrome " to have a distinct and well-defined meaning. In the

Journal of the Royal Society of Medicine, Vol. 84, February, 1991,

chronic fatigue syndrome is defined as:

" A fatigue which is the principal symptom, which has a definite

onset, and is severe, disabling and affects both physical and mental

functioning, and furthermore that fatigue should have been present

for a minimum of six months at which it was present for more than 50%

of the time. "

One or more of the following symptoms are generally associated with

the syndrome, such as sleep disturbances (changes in the duration of

sleep and/or quality of sleep), impairments in concentration and

short-term memory, chronic and recurrent low-grade fever, and

musculoskeletal pain. The changes in the duration of sleep could be

hypersomnia or increased sleep, or insomnia or reduced sleep. The

changes of the quality of sleep are contemplated to be due to a

decrease of REM sleep. There is also generally a restriction or lack

of ability to perform an activity in the manner or within the range

considered normal for a healthy human being, (resulting from loss of

psychological or physiological function). There is further a definite

persistent change from a previous level of functioning.

Mood disturbances such as depressed mood, and anhedonia, anxious

mood, emotional stability, irritability, and severity of the mood

disturbances should be assessed on standards scales. For diagnosis

purposes, a patient's symptoms should be evaluated to determine

whether such symptoms are attributed by a psychological condition,

such as a depressive disorder rather than chronic fatigue syndrome.

It should thus be determined whether the disorder is sufficient to

meet the diagnostic criteria for major depressive disorders. In CFS

patients, myalgia, which is pain or aching felt in the muscles,

should be disproportionate to exertion. Such myalgia should be

distinguished from feelings of weakness and pain felt in other areas

such as the joints. Certain patients should be excluded from the

definition of CFS, such as patients with established medical

conditions known to produce chronic fatigue such as severe anemia.

Additionally, patients with schizophrenia, manic depressive illness,

substance abuse, eating disorders, or proven organic brain disease

should be excluded as chronic fatigue syndrome sufferers. However,

other generalized psychiatric disorders may be attributed to chronic

fatigue syndrome.

A variety of treatments have been suggested and utilized for the

treatment of chronic fatigue syndrome. In U.S. Pat. No. 5,312,817,

there is described a treatment of the chronic fatigue syndrome

wherein a pharmaceutically-acceptable cholinesterase inhibitor or a

prodrug therefore is administered for the treatment of fatigue

syndromes. This treatment is based on the understanding that the

mechanism of the fatigue could be an imbalance in the cholinergic

nicotinic transmitter system, both peripherally and centrally, which

decreases the acetylcholine in the central and peripheral synapses.

However, this therapy has proven ineffective, as this mechanism does

not properly describe the etiology of chronic fatigue syndrome.

In a further example, U.S. Pat. No. 5,055,296 discloses a treatment

involving the administration of mammalian liver extract. Yet another

example is provided in U.S. Pat. No. 5,013,739, whereby an opiate

receptor antagonist is administered as a treatment option. In

addition, a variety of drugs have been prescribed for symptomatic

relief including non-steroidal anti-inflammatory drugs, tricyclic

anti-depressants, sleep-inducing drugs, tranquilizers, anti-anxiety

and stress-relieving drugs such as androstenediol and

androstenetriol. Such symptomatic treatment efforts, while providing

temporary relief for one of the associated symptoms, have in general

provided no long-term treatment of the disorder as a whole.

In addition to the physical pain associated with this disorder, there

is also a severe mental and emotional toll placed on the CFS

sufferer. As a result of the prolonged and debilitating fatigue, and

flu-like symptoms, CFS sufferers are forced to reduce their level of

activity, and are often unable to lead what would be considered a

normal life.

Accordingly, there is a genuine need for a method of treating chronic

fatigue syndrome with a reliable, and effective technique which

allows a CFS sufferer to regain a normal level of activity without

the associated persistent fatigue characterized by the disorder.

DISCLOSURE OF INVENTION

It would be desirable to provide a method for alleviating the

symptoms associated with chronic fatigue syndrome by administering

antiviral agents to target the cause of the disorder. It would

further be desirable to provide a treatment for chronic fatigue

syndrome through administration of an antiviral drug which is

directed to the cause of chronic fatigue syndrome rather than one

that addresses a particular condition or symptom. It would be yet

further desirable to provide a long-term treatment approach whereby

chronic fatigue sufferers could resume a normal level of activity

without experiencing extreme fatigue.

In carrying out the above objects, a method is disclosed for

alleviating the symptoms of chronic fatigue syndrome, including

administering to a patient in need there of, a therapeutically

effective amount of one or more pharmaceutically acceptable antiviral

agents, wherein the one or more antiviral agents are selected from

the group consisting of acyclovir, ganciclovir, valacyclovir,

famciclovir, cidofovir, and pharmaceutically acceptable derivatives

and mixtures thereof.

There is further disclosed a method of diagnosing chronic fatigue

syndrome (CFS) in a patient, including the steps of: evaluating the

patient for serologic evidence of Epstein-Barr virus (EBV) and human

cytomegalovirus (HCMV) infection; and monitoring the patient for T-

wave abnormalities by 24-hour electrocardiographic (Holter)

monitoring to document the persistent cardiac pathology which is the

basis of the CFS. The serologic evidence of EBV and HCMV is obtained

by studying the level of antibodies of EBV and HCMV to detect the

presence of active and persistent multiplication of either or both of

the viruses. In conjunction therewith, tests are conducted to verify

the existence of a cardiomyopathy in the CFS patient. Based on the

results of the tests and the determination of the cause of CFS, the

patient is administered a specific antiviral agent suitable for EBV,

HCMV or the combination. Following initial antiviral treatment,

supplemental tests are conducted to check for recurrent CFS to

determine an appropriate treatment period for the patient to achieve

continued alleviation of the CFS symptoms.

There is yet another method of diagnosing CFS in a patient including

the steps of: evaluating the patient for serologic evidence by HCMV,

evaluating assays for non-structural early gene products; and

monitoring the patient for T-wave abnormalities by 24-hour Holter

monitoring to document the persistent cardiac pathology which is the

basis of the CFS.

The above objects and other objects, features, and advantages of the

present invention are readily apparent from the following detailed

description of the best mode for carrying out the invention.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1a is an illustration of a latent herpes virus genome sitting as

a closed nuclear episome;

FIG. 1b is an illustration of the herpes virus genome partially

opened;

FIG. 1c is an illustration of the herpes virus genome opened, in its

linear position;

FIG. 1d is an illustration of the complete herpes viral structure;

FIG. 2 is an illustration of the Copalis.RTM. light scattering

analytical equipment;

FIG. 3 is a graph depicting a 39-year old female patient's HCMV

antibody titer levels following the administration of antiviral

treatment; and

FIG. 4 is a graph depicting a 47-year old male patient's antibody

titer levels following the administration of antiviral treatment.

BEST MODE FOR CARRYING OUT THE INVENTION

As defined herein, a " therapeutically effective " amount of an

antiviral agent is the amount by which a patient's chronic fatigue

syndrome symptoms, such as severe fatigue, headaches, sore throats

and the like, decrease in frequency and/or intensity. In addition,

the term " alleviating " as used throughout th e specification refers

to relieving or reducing symptoms associated with chronic fatigue

syndrome and/or elimination of those symptoms.

Likewise, the term " pharmaceutically acceptable antiviral agent " is

defined to include those antiviral agents which, upon administration,

have no deleterious effect on the patient. Thus, where a particular

antiviral agent is unsuitable for a particular individual, that

antiviral agent would not be pharmaceutically acceptable and would

thus not be administered.

In general, the clinical symptoms and signs of chronic fatigue

syndrome resemble those of infectious mononucleosis. Symptoms common

to both illnesses include low-grade fevers, chills, sore throats,

painful anterior or posterior cervical or axillary lymph nodes,

muscle weakness, myalgias, generalized headaches, migratory

arthralgias, vague neuropsychological complaints and disturbances of

sleep without known medical cause. As with mononucleosis, a CFS

patient's attempt to exercise at levels previously tolerable, results

in a prolonged and more severe manifestation of the fatigue.

While CFS and infectious mononucleosis have several similarities,

patients with CFS do not have the severe dysphagia and gray exudative

pharyngitis often accompanied by submandibular adenopathy, associated

with infectious mononucleosis and its etiologic agent Epstein-Barr

virus (EBV). Our research has found in CFS sufferers the existence of

Epstein-Barr virus multiplication, purportedly within epithelial

cells of the pharynx and circulating B-lymphocytes of the blood. The

beta herpes virus, human cytomegalovirus (HCMV) is also believed to

cause infectious mononucleosis-type symptoms, without the exudative

pharyngitis. Mononucleosis and chronic fatigue syndrome thus have

certain similar symptoms.

Specific emphasis must however be placed on symptoms unique to

chronic fatigue syndrome. Such symptoms include: 1) light-headedness

or wooziness of varying severity and duration without known

antecedent cause; 2) a vague, dull, pressure-like chest ache,

generally in the substernal region and sometimes including the left

shoulder, which is exhibited with increasing fatigue at the end of

the day; and 3) palpitations. There is also often a fourth symptom,

tachycardia or rapid heart action, even with minimal or no exertion

by the sufferer. Based on the symptoms unique to chronic fatigue

syndrome, it is further hypothesized, that chronic fatigue syndrome

is essentially cardiac in origin, and that this cardiac basis unlocks

the key to the disorder.

Accordingly, while not wishing to be bound to any particular theory,

it is believed that the majority of cases of chronic fatigue syndrome

constitute either a continuing primary herpes virus infection,

specifically Epstein-Barr virus and/or human cytomegalovirus, or

alternatively, a reactivation infection with latent Epstein-Barr

virus and/or latent human cytomegalovirus. In some lesser number of

cases, herpes virus 6 (HHV-6), or other viruses, such as

enteroviruses may be involved. Seroepidemiologic studies indicated

the presence of EBV and/or HCMV in CFS sufferers. Our research has

further indicated for CFS sufferers the existence of IgM antibodies

to the EBV viral capsid antigen (VCA) or EBV antibodies to diffuse

early antigen (EA), the latter depicting EBV transactivators for the

lytic cycle indicating current virus multiplication. In CFS

sufferers, there may additionally or alternatively be a significant

IgG immunoreactive antibody (ELISA) to HCMV, with/without an IgM

(ELISA) antibody titer to HCMV.

The understood virologic cause of CFS thus verifies that previous

seroepidemiologic studies attempting to show a singular virologic

causation to CFS including singular searches for EBV or HCMV

antibodies would have naturally yielded uniformly negative results.

At least fifteen different viruses, bacteria and parasites have been

previously suspected as " singular " etiologic agents of CFS. However,

there has been, to date, no serologic association with any human

virus. It is believed that the previous studies were designed in a

way that actually masked the possibility of finding a major two-virus

causality.

Instead, the extra-chromosomal herpes virus episome persists for the

life of th e chronically infected cell. The persistent infection and

recrudescent infection characteristic of the herpes virus is common

in EBV and HCMV and is consistent with the chronic recrudescent

illness of CFS. The unique aspect of this cellular injury,

particularly in the heart, is that it appears to be a degenerative

disease which does not elicit an inflammatory response from the host.

The result is a cardiomyopathy of unknown cause.

The two proposed major causative herpes viruses, EBV and HCMV, are

characterized by persistent infections. In a non-permissive,

persistent infection, a complete infectious virus is not produced.

This is referred to as incomplete herpes virus multiplication.

Intracellular infection produces a metabolically altered host cell,

however, no progeny capable of infecting a new susceptible cell are

created. The host human is unsuccessful in totally inactivating the

virus and placing it in the latent state. The virus likewise is

unsuccessful in completing its reproductive cycle and produces

incomplete virus. The result is cellular metabolic aberration and, if

severe enough, cell death--called apoptosis.

The herpes virus is described as three states of infection: 1)

virulent; 2) latent; and 3) incomplete virus multiplication. It is

also theoretically possible at the same time to have both infections

with a portion of it being virulent and a portion of it being

incomplete virus multiplication.

FIG. 1 is a depiction showing latent herpes virus genome. The herpes

viruses in question are hu man cytomegalovirus and human Epstein-Barr

virus which are believed to cause chronic fatigue syndrome. In the

most optimum circumstance after infection with either of the two

aforementioned herpes viruses, t he virus sits as a closed nuclear

episome as shown in FIG. 1a in a non-integrated fashion with the

cellular genome. The herpes virus is double-stranded. It is complete

and it is theoretically making no gene product, FIG. 1a.

The herpes virus genome is capable of making over 200 gene products

and 200 separate proteins. In FIG. 1c the latent double-stranded DNA

has opened--is in its linear position and ready to produce its gene

products and the proteins of the complete virus. In FIG. 1b, the

herpes virus genome is partially opened from its cellular state and

is able to produce some proteins of the virus. Some of the gene

products are produced but no complete virus is developed. This then

is incomplete virus replication. In FIG. 1d, we see the complete

viral structure 10. It consists of a central double-stranded complete

virus DNA 12 surrounded by an icosahedral capsid containing 162

identical, symmetrical, capsomers. The outer portion of the complete

virion is a double-layered lipid membrane 16 which is punctuated by

glycoprotein spikes 18. These glycoprotein spikes 18 are the means of

attachment of this herpes virus to susceptible cells allowing entry

and new infection of a previously uninfected cell. The human

response, the immune system, responds to the antigenic stimulus of

the structural proteins available to the human host by these

glycoprotein spikes 18.

Between the herpes virus bilayer 16 and the viral capsid 14 is an

amorphous structure known as the tegument 20. This tegument 20

contains nonstructural proteins which are necessary for

multiplication of the virus. It contains a number of viral enzymes

and factors necessary for viral assembly. A complete herpes virus

virion 10 is depicted in FIG. 1d. Antibodies to structural

glycoprotein, for instance gB and gH of human cytomegalovirus, are

produced. In the case of incomplete virus replication, the herpes

virus genome is partially opened and producing some proteins. These

aberrant proteins are not wanted in the healthy cellular matrix and

efforts to rid the matrix of these partial viral gene products is

made by the process of exocytosis. By this process of exocytosis,

nonstructural gene products (e.g. UL44 and UL57) reach the

extracellular space and are thus available to the human host immune

system so that specific antibodies may be produced to these

nonstructural gene products, UL44 and UL57. These nonstructural gene

products are behind the virus bilayer 16 and are not exposed to

antibody production when whole complete virus multiplication occurs.

There is evidence that supports the theory that both HCMV and EBV are

cardiotropic for the human myocyte. Based on our research, it is

believed that the human cardiac myofiber, like the B-lymphocyte for

EBV and the mononuclear progenitor cell for HCMV, is a site of non-

infectious episome-mediated persistent infection. This is different

from the human epithelial cell of the pharynx which produces mainly

whole infectious EBV virus. HCMV immediate-early gene transcripts

have been detected in the heart by in-situ hybridization techniques

in patients with HIV-associated cardiomyopathy. Likewise, the EBV

genome was detected by polymerase chain reaction amplification of DNA

extracted from the heart at autopsy. An intense mononuclear cell

infiltrate in the myocardium consisted essentially of T-cells without

identifiable B-cells. This inflammatory response is the result of

complete virus multiplication.

Accordingly, our research has indicated that CFS is a non-permissive,

persistent herpes virus infection of the heart, wherein EBV and/or

HCMV nucleic acids are present in the hearts of CFS patients. This

hypothesis was generated based in part upon endomyocardial biopsies

of patients with CFS. HCMV nucleic acids by polymerase chain reaction

have been found in biopsies of the heart from CFS patients.

The research conducted revealed that all CFS patients have abnormal

oscillating T-wave flattenings and T-wave inversions detectable from

24-hour electrocardiographic (Holter) monitoring. An initial 24-hour

electrocardiographic T-wave study compared CFS patients to random non-

CFS patients, from an internal medicine practice, wherein both

patient groups were restricted to an age less than 50 years old to

minimize the occurrence of chronic diseases in both populations.

Notably, chronic diseases such as hypertensive vascular disease,

electrolyte abnormalities and coronary artery disease may produce

similar oscillating abnormal T-waves. However, since people suffering

from CFS are generally young, such chronic diseases rarely afflict

CFS sufferers and can thus be excluded as the causative agent.

Oscillating T-wave abnormalities described also occur in about 5% of

normal patients when they assume an upright position. For these same

patients, resting twelve-lead standard ECG, T-waves describing left

ventricular electrical depolarization are upright, and the resultant

ECG is normal. The 2-D echocardiogram also generally is normal,

however, the 24-Hr. ECG recordings (Holter monitoring) are abnormal

with oscillating T-wave flattenings or T-wave inversions

characteristically incident with the onset of sinus tachycardias, and

subsequently, reverting to normal T-wave configurations with the

return of normal sinus rhythms. While these abnormal T-waves are not

specific to CFS, they occur similarly with diverse conditions such as

coronary artery disease, hypertensive vascular disease and

electrolyte abnormalities, but the abnormal T-waves detected via

Holter monitoring were seen much more frequently in 24 random CFS

patients than 116 time, place and age-matched random non-CFS

patients. Based on our analysis, the abnormal T-waves at 24-Hr. ECG

recordings in CFS patients are not " artifacts, " and are a significant

sign of CFS. The abnormal Holter monitoring in CFS patients is

evidence that CFS is a cardiomyopathy. Moreover, we have found that

the additional symptoms of a dull chest ache coming on at the end of

the day not related to exercise, light-headedness or wooziness and

palpitations are CFS symptoms attributable to cardiac involvement by

these viruses.

Holter monitoring is further utilized and discussed in more detail in

U.S. Pat. No. 5,454,020 issued to A. Lerner on Nov. 7, 1995; U.S.

Pat. No. 5,357,968 issued to A. Lerner on Oct. 25, 1995; and U.S.

Pat. No. 5,213,106 issued to A. Lerner on May 25, 1993.

An initial group of CFS patients, additionally, demonstrated abnormal

left ventricular dynamics characterized by a decreased or falling

ejection fraction, abnormal wall motion or dilatation by radionuclide

stress multiple gaited acquisition (MUGA) studies. Furthermore,

consecutive case series of CFS patients from a single referral center

at Birmingham, Mich. during the years 1987-1993 demonstrated abnormal

left ventricular dynamic function in 24.1% of 87 patients undergoing

radionuclide ventriculography by the radioisotopic gaited pool

method.

In an effort to diagnose CFS, using electron microscopy,

cardiomyopathic changes including myofiber hypertrophy, myofiber

disarray and degenerative change in myofibers have been seen. On rare

occasions, inflammatory myocarditis is evident. Infectious HCMV is

not found in the heart, peripheral blood or urine of this HCMV-CFS

subset of patients. Based on the evidence gathered, it is believed

conclusively that CFS is a major newly discovered cardiomyopathy.

On the basis of this research, chronic fatigue syndrome is understood

further to be a persistent, non-permissive herpes virus infection of

the heart. CFS patients have abnormal Holter monitoring reflecting

that cardiomyopathy. Additionally, the majority of CFS patients have

the appropriate serologic markers of persistent EBV and/or HCMV

infections. Research has led to the understanding that HCMV and/or

EBV nucleic acids are present in myofibers (myocytes) of cardiac

tissues of the CFS patients which are detectible by polymerase chain

reaction (PCR) or in-situ hybridization techniques. Additionally, it

is believed that EBV and/or HCMV nucleic acids will not be present in

the myofibers of EBV or HCMV serologically positive, non-CFS patients

undergoing similar cardiac biopsies. We have further observed that

patients with acute primary EBV infectious mononucleosis who recover

rapidly have normal Holter monitoring throughout their illnesses. It

is thus believed that these EBV-infected patients have no

cardiomyopathies. On the contrary, patients with prolonged illnesses

of acute primary EBV-infectious mononucleosis exhibit abnormal Holter

monitoring which substantiates our understanding of the mechanism of

CFS.

Given the pathologic physiology of herpes virus infections in humans,

the etiologic diagnosis resulting from this research is not

contradictory. Just like CFS, herpes simplex virus encephalitis

(HSVE) boggled the medical community and etiologic identification due

to the rising antibodies in serum which may or may not be present at

a given time. Diagnosis of HSVE required isolation of herpes simplex

virus, Type 1 from the brains of patients with encephalitis.

Rowe, Bou-Halaigah, Kan and Calkins recently reported that CFS

patients exhibited an abnormal blood pressure response in an upright

tilt position. The Relationship Between Neurally Mediated Hypotension

and the Chronic Fatigue Syndrome, JAMA, 1995; 274: 961-967. This

abnormal response was explained to be the result of an abnormal

neural reflex caused by CFS. Our research disproves this theory,

rather CFS is a cardiomyopathy inducing the reported abnormal cardiac

response, which is further supported by the abnormal T-wave findings

at Holter monitoring we have discovered.

Having tracked the etiologic agents of CFS, an intense study of EBV

and HCMV followed. Epstein-Barr virus infection starts in the

oropharyngeal epithelium. The cells in this region are permissive for

virus replication and thus a persistent active lytic infection

continues in this region for many years. It is believed that in the

primary infection level, Epstein-Barr virus infects B lymphocytes.

Similarly, the cellular sites for latency for HCMV are the

mononuclear phagocyte and its progenitor cells. In the case of HCMV,

when the monocyte differentiates into the macrophage or histiocyte,

infectious HCMV virus production ensues with an associated

irreversible destruction of the infected cell.

Epstein-Barr virus is the prototype for the lymphocryptovirus genus.

The lymphocryptovirus is a closely related member of the gamma herpes

virus family. The host range of these viruses in-vitro is restricted

to primary lymphocytes of the immunoglobulin-producing lineage (B-

lymphocytes). The lymphocytes are also a site of latent virus

infection in-vivo. In-vivo, most human EBV infection starts in the

oropharyngeal epithelium. Epithelium cells allow herpes virus

replication and thus a persistent, active lytic infection continues

for many years. During the course of primary infection, EBV infects B

lymphocytes. EBV does not usually replicate in B lymphocytes but

instead establishes latent infection. Early in human infection, EBV-

infected B lymphocytes can be found in large numbers in peripheral

blood and tissues.

Much evidence supports the understanding that lymphocytes or similar

cell type are the major site of latent infection for EBV and are

important in the dissemination of infection to distal epithelial

surfaces or in continuously reactivating the oropharyngeal

epithelium. The EBV infection generally follows a specific pattern of

events. In a first instance, the virus initiates infection of the

oropharyngeal epithelium, where it can produce symptomatic

pharyngitis. B-lymphocytes are then infected as they reside in close

proximity to the oropharyngeal epithelium. The lymphocytes then carry

the virus to other organs and to epithelial surfaces, including the

oropharynx. Furthermore, persistent replication in the oropharynx is

likely dependent on lymphocyte reinfection of oropharyngeal

epithelial cells. After the primary EBV infection, the emergence of

Burkitt's lymphoma, Hodgkin's disease, and nasopharyngeal carcinoma

is believed to be linked to EBV.

Most human peripheral blood B lymphocytes are susceptible to EBV

infection. The cells become latently infected and are driven to

proliferate by the latent virus genome. People infected with EBV have

B lymphocytes in the peripheral blood which are able to proliferate

into long-term lymphoblastoid cell lines in vitro. All cell lines

that grow out of the peripheral blood of normal humans are EBV-

infected B lymphocytes. Thus, EBV provides B cells with the ability

to multiply indefinitely.

The persistence of EBV in human populations appears to be dependent

on oropharyngeal multiplication of virus, and salivary spread to the

oropharynx of uninfected humans. Most disease manifestations are

related to lytic infection in oropharyngeal epithelial cells, to

latent virus infection in tonsillar or peripheral blood B lymphocytes

or to immune responses to virus-infected cells.

Human cytomegalovirus (HCMV) like all of the herpes viruses, has in

common certain distinguishing features, including virion and genome

structure and the ability to establish persistent and latent

infections. In addition to these common herpes virus features, HCMV

has certain distinct characteristics, such as salivary gland tropism,

species specificity and slow growth in cultured cells. HCMV infects

50% to 80% of the population. HCMV can be structurally distinguished

from other herpes viruses by subtle ultrastructural differences in

the virion appearance, for example, the HCMV envelope generally

appears more pleomorphic in relation to other herpes viruses. HCMV

generally produces cell enlargement with intranuclear inclusions

similar to those produced by herpes simplex and varicella zoster

virus. The sources of HCMV include oropharyngeal secretions, urine,

cervical and vaginal excretions, spermatic fluids, breast milk, feces

and blood.

With HCMV, a large reservoir of latently infected individuals remains

a significant threat to the immunocompromised host. The virus

persists years after the primary infection. However, the virus is

detectible only for a few weeks to a few months following primary

infection. The polymorphonuclear leukocyte is the main source of HCMV

in the blood, but monocytes and occasionally T lymphocytes may harbor

HCMV in a form as yet unknown.

Table 1 describes the antibody response to whole virus infection

which results in antibodies to viral structural epitopes and a

response to nonstructural viral epitopes such as would be seen in

incomplete viral replication. Two common viral epitopes that are

structural are human cytomegalovirus HCMV gB and HCMV gH. These are

antigenic epitopes which are structural. These structural epitopes

can be recognized by ELISA (enzyme linked immunoassay) or what is

referred to as the Copalis.RTM. Multiplex light scatter method

( " Copalis.RTM. method " ). Copalis.RTM. (coupled particle light

scattering) is the proprietary technology of Diasorin, Inc.

This Copalis.RTM. method to CM.sub.2 and p52 measures IgM antibodies

to HCMV non-structural gene products. The non-structural gene

products are UL44, UL57. These gene products have been produced in E-

coli. The UL44 and UL57 refer to the open reading frames (ORF) of the

human cytomegalovirus genome. The UL44 has the function of a

polymerase processivity factor known as p52. The UL57 is the second

gene product which may be measured by the Copalis.RTM. method and its

function is as a single-stranded (ss) DNA binding protein CM.sub.2.

These are nonstructural gene products which are extruded from a cell

with incomplete human cytomegalovirus multiplication. The

Copalis.RTM. method measures antibodies to these two gene products

with the purified antigens produced in E-coli. Table 1 shows the

types of herpes virus infection with antibody responses to both

structural and nonstructural viral epitopes.

TABLE 1

HERPES VIRUS INFECTION

Structural Viral Epitopes Non-Structural Viral

(e.g. HCMVgB, HCMVgH) Epitope (e.g. HCMV)

Stage of Infection IgM IgG IgM, CM.sub.2, p52

Virulent (Complete) X X

Latent X

Incomplete X X

Mixed X X X

In virulent virus infection, the infected cell is destroyed. Cellular

inflammation in the classical sense results. Specific antibodies to

structural epitopes of human cytomegalovirus for instance gB and gH

result. This results in IgM and IgG antibodies. The IgM antibody, of

course, is short-lived usually less than six weeks, and the IgG

antibody is long-lived. In classical virulent infection no antibodies

would be produced to nonstructural viral epitopes, hereinafter

referred to as p52 (to UL44 and UL57) and CM.sub.2 (UL57). In latent

infection there is no complete virus produced. There is no IgM to

structural epitopes gB and gH antibody. IgG antibody, of course, is

present because there is past infection and, of course, there is no

antibody to p52 or CM.sub.2. In incomplete viral multiplication, no

IgM antibodies to structural epitopes are produced. Of course, IgG

antibodies are stable and present. In incomplete viral

multiplication, IgM antibodies are produced to nonstructural epitopes

(Table 1). Finally in mixed virulent and incomplete (or complete and

incomplete viral replication/multiplication), one may have IgM

antibodies and IgG antibodies to structural epitopes and IgM

antibodies to nonstructural epitopes.

The Copalis.RTM. CMV Mutliplex assay is a homogenous test for the

simultaneous determination of acute infection stages or immune status

to Cytomegalovirus using coupled particle light scattering. Sized

microparticles, coated with one of three antigens (p52, CM.sub.2, and

CMV viral particle (VP)) are dried in the reaction cup. Early phase

IgM antibodies are detected by both the CM.sub.2 and the p52

antigens. Antibody response to the CM.sub.2 antigen but not to the

p52 antigen continues through the convalescent stage of acute

infection. Antibodies to the VP may appear during acute infection but

shall persist during life. Reactivity just (sucrose-density purified

tissue culture produced complete HCMV cytomegalovirus) to the VP is

characteristic of prior infection (indicative of immune status).

Antibody detection, made by the Copalis.RTM. Immunoassay System, is

reported qualitatively for the IgM analytes and semi-quantitatively

for the total analyte.

Copalis.RTM. (Coupled Particle Light Scattering) technology is based

on the use of high-resolution light scattering analysis to measure

particle coupling. As generally depicted in FIG. 2, particles flowing

singly through a finely focused optical beam generate a unique light

scatter pattern. This scatter pattern is classified into a

Copalis.RTM. histogram for data analysis.

The Copalis.RTM. CMVplex Antibody Assay is based on the principle of

antibody dependent particle aggregation as measured by the amount of

light scattered. A typical antibody reactivity pattern (IgM and/or

IgG) in the patient sample allows diagnosis of the infection as

seronegative, acute or past infections. The CMVplex Test Cup has

polystyrene microparticles of three sizes each coated with different

specific antigens dried in the bottom. The Test Cup is reconstituted

with reaction buffer by the instrument. The sample is then

transferred into the reaction well and the mixture is agitated for 10

minutes. Upon completion of the agitation, the reaction mixture is

transferred to the optical system for analysis.

The level of aggregation is determined by discrimination of particle

sizes and unreacted particles (monomers) as detected by the optical

system. The quantity of assay particles remaining as monomers is

compared to that of an unreacted baseline negative calibrator. A

ratio is established between the counts of the two monomer particles.

This ratio is reported as the Copalis.RTM. Test Result (CTR). The CTR

is then converted into a numerical unit, Copalis.RTM. Index (CI),

which determines the cutoff thresholds for each marker.

Interpretation of results is based upon the CI. Results for the IgG

marker (VP) are reported semi-quantitatively and qualitatively for

the IgM markers (p52 and CM.sub.2).

Copalis.RTM. CMVplex Antibody Assay--Sized polystyrene microparticles

are coated with the following antigens:

1.6.mu. Viral Particle (VP) obtained from HCMV infected fibroblast

cell culture detects long-lasting IgG reactivity

1.7.mu. recombinant p52 protein full UL44 protein sequence detects

IgM reactivity to early phase of acute infection

1.8.mu. CM.sub.2 recombinant protein chimeric antigen containing part

of UL44 and part of UL57 detects IgM to both the early and

convalescent phases of the acute infection

The Copalis.RTM. light scattering technique thus allows for detection

and precise measurement of antibodies to HCMV. It should be noted

that p52 and CM.sub.2 antibody may also be detected by ELISA methods.

The EA antibody is measured in the diagnosis of the chronic fatigue

syndrome due to Epstein-Barr virus infection. This polymeric EA

antibody to diffuse early antigen products is an antibody to as many

as 12 nonstructural gene products, which are transactivators for the

lytic cycle of Epstein-Barr virus so that the paradigm of complete

and incomplete viral multiplication in antibodies in structural and

nonstructural epitopes outlined for human cytomegalovirus relates to

human Epstein-Barr virus as well. Both, of course, are members of the

herpes virus family. The exact number and role of these EBV early

proteins remains unclear. These early proteins are involved in

transactivation and initiation of the lytic cycle. There are diffuse

(EA-D) and (EA-R) restricted components.

In general, herpes viruses such as EBV and HCMV, are characterized by

several key properties: (1) their role as a significant pathogen

responsible for a variety of diseases; (2) the ability of the herpes

virus to remain latent in their host for life, and to be reactivated

at or near the site of initial infection; and (3) to multiply

efficiently and irreversibly destroy the cells that they infect.

While it is known that antiviral agents are effective in the

treatment of viral infections, there are a number of problems

associated with such antiviral agents. As the herpes viruses are

intracellular parasites which use multiple biochemical pathways of

the infected host cell, there are problems associated with achieving

clinically useful antiviral activity without also adversely affecting

normal host cell metabolism and causing toxicity.

As a selective inhibitor of herpes virus multiplication, acyclovir

represents an important advance in antiviral therapy. Acyclovir was

synthesized in 1974 by Beauchamp and Schaeffer of Burroughs Wellcome

Company. Acyclovir, 9-((2-hydroxyethoxy) methyl) guanine E,

demonstrated significant in vitro antiviral activity against herpes

viruses, specifically, HSV, varicella zoster virus (VZV) and EBV.

Acyclovir is an acyclic analogue of guanosine. The inhibitory

activity of acyclovir is highly selective. The enzyme thymidine

kinase (TK) of normal uninfected cells does not effectively use

acyclovir as a substrate. However, TK encoded by the herpes simplex

virus converts acyclovir into acyclovir monophosphate, a nucleotide

analogue. The monophosphate is further converted into diphosphate by

cellular guanylate kinase and into triphosphate by a number of

cellular enzymes. Acyclovir triphosphate interferes with herpes

simplex virus DNA polymerase and inhibits viral DNA replication.

Acyclovir is preferentially taken up and selectively converted to the

active triphosphate form by herpes virus-infected cells. Acyclovir

triphosphate binds viral DNA polymerase, acting as a DNA chain

terminator. Because acyclovir is taken up selectively by virus-

infected cells, the concentration of acyclovir triphosphate is 40 to

100 times higher in infected cells than in uninfected cells.

Furthermore, viral DNA polymerase exhibits a 10 to 30-fold greater

affinity for acyclovir triphosphate than do cellular DNA polymerases.

The higher concentration of the active triphosphate metabolite in

infected cells plus the affinity for viral polymerases results in the

very low toxicity of acyclovir for normal host cells.

Acyclovir is available in ointment, capsule and intravenous

formulations. Oral acyclovirs or other similar anti-viral drugs are

indicated in the management of most cases of primary or initial

genital herpes in all patient populations and as long-term

suppressive therapy in normal adults with frequently recurrent

genital herpes. Oral acyclovir also is used for prophylaxis and

treatment of immunocompromised patients with a history of clinical

evidence of an active HSV infection. Intravenous acyclovir is used in

the treatment of severe primary or initial herpes genitalis of

immunocompetent patients, some initial and recurrent mucocutaneous

HSV infections in immunocompromised patients, neonatal HSV infections

and HSVE in infants, children and adults.

Although EBV and HCMV do not have virus-specific TKs, replication of

the EBV and HCMV DNA is significantly impaired. Acyclovir's in vitro

antiviral activity is considerably greater in HSV than HCMV.

In addition, acyclovir has an excellent safety profile and is well-

tolerated by most patients. The major adverse effect of acyclovir is

alteration of renal function. Adequate hydration of patients can

prevent renal concretion of drug as it is eliminated by the kidney

preventing renal dysfunction.

More recently, Burroughs Wellcome has introduced Valtrex.RTM.

(valacyclovir hydrochloride) the hydrochloride salt of L-valyl ester

of acyclovir. Valacyclovir hydrochloride is L-valine, 2-[(2-amino-1,6-

dihydro-6-oxo-9H-purin-9-yl)methoxy]ethylester, monochloride.

Valacyclovir has the molecular formula C.sub.13 H.sub.20 N.sub.6

O.sub.4,HCl, a molecular weight of 360.80 and the following

structural formula: ##STR1##

Valacyclovir hydrochloride has a maximum solubility in water at

25.degree. C. of 174 mg/ml.

After oral administration, valacyclovir is rapidly absorbed from the

gastrointestinal tract. Valacyclovir is nearly completely converted

to acyclovir and an L-valine by first-path intestinal and/or hepatic

metabolism. Valacyclovir is rapidly converted to acyclovir, which has

in vitro and in vivo inhibitory activity, against herpes simplex

virus Types 1 (HSV-1) and 2 (HSV-2) and varicella-zoster virus (VZV).

Of these three herpes viruses, acyclovir has highest antiviral

effectiveness against herpes simplex virus type 1. The inhibitory

activity of acyclovir is highly selective to its affinity for the

enzyme thymidine kinase (TK) and encoded by HSV, VZV and Epstein-Barr

virus. Thymidine kinase converts acyclovir into acyclovir

monophosphate, a nucleotide analog. The monophosphate is further

converted into diphosphate by cellular guanylate kinase and into

triphosphates, a finite number of cellular enzymes. In vitro,

acyclovir triphosphate stops replication of herpes viral DNA. This is

accomplished in three ways: (1) competitive inhibition of viral DNA

polymerase; (2) incorporation and termination of the growing viral

DNA chain; and (3) inactivation of the viral DNA polymerase. The

greater antiviral activity of acyclovir against HSV compared to VZV

is due to its more efficient phosphorylation by the viral thymidine

kinase (TKN). The bioavailability of acyclovir after administration

of valacyclovir is 54.5%.+-.9.1% as determined following a one gram

oral dose of valacyclovir and a 350 milligram intravenous acyclovir

dose.

Valacyclovir is the preferred antiviral agent due to its relatively

high bioavailability. As a result of valacyclovir's increased

absorption, as compared to acyclovir for example, less frequent

dosages of valacyclovir are required to reach effective antiherpetic

levels.

Another antiviral agent, ganciclovir, or 9-(1,3-dihydroxy-2-

propoxymethyl) guanine, has increased in vitro activity against all

herpes viruses as compared to acyclovir, including an 8 to 20 times

greater activity against HCMV. While toxicity concerns prevent the

use of ganciclovir for a relatively benign HCMV, in other HCMV cases,

ganciclovir has become an important antiviral treatment option. While

the mode of action of ganciclovir against HCMV and EBV is not

entirely known, it has been suggested that these viruses may induce a

kinase that efficiently promotes the obligatory initial

phosphorylation of ganciclovir to its monophosphate derivative.

Recently, a valine ester prodrug--valganciclovir--was developed to

improve the bioavailability of ganciclovir. As compared to

ganciclovir, valganciclovir, the 1-valyl ester of ganciclovir, was

rapidly and extensively hydrolyzed to ganciclovir, resulting in

significantly greater bioavailability compared to 1000 mg oral

ganciclovir (60.9% vs. 5.6%, respectively). With significantly

greater oral absorption, valganciclovir is believed to be at least as

effective as intravenous ganciclovir and thus--preferred for the

treatment of HCMV related chronic fatigue syndrome--valganciclovir

provides an alternative to intravenous ganciclovir, and eliminates

the risk and inconvenience of long term, daily intravenous

administration.

Another effective antiviral agent is Vistide.RTM., or cidofovir, 1-

[(s)-3-hydroxy-2-(phosphonomethoxy)propyl]cytosine dihydrate with the

molecular formula of C.sub.8 H.sub.14 N.sub.3 O.sub.6 P.2H.sub.2 O

and a molecular weight of 315.22. Cidofovir again suppresses

replication of the herpes virus by selective inhibition of viral DNA

synthesis. Cidofovir is incorporated into the growing viral DNA chain

which results in reductions in the rate of viral DNA synthesis.

Famvir.TM., famciclovir is also believed to have antiviral activity

against herpes virus 1. Famciclovir is 2-[2-(2-amino-9H-purin-9-yl)

ethyl]-1,3-propanediol diacetate. With a molecular formula of

C.sub.14 H.sub.19 N.sub.5 O.sub.4 and a molecular weight of 321.3.

Famciclovir undergoes rapid biotransformation to the active antiviral

compound penciclovir, which has inhibitory activity against herpes

simplex virus types 1 and 2 and varicella zoster virus (VZV).

Famciclovir is the diacetyl 6-deoxy analog of the active antiviral

compound penciclovir. The absolute bioavailability of famciclovir is

77.+-.8%, as determined from the administration of a 500 mg

famciclovir oral dose and a 400 mg penciclovir intravenous dose. In

herpes simplex virus 1 and herpes simplex virus 2, viral thymidine

kinase phosphorylates penciclovir to its monophosphate form which, in

turn, is converted to penciclovir triphosphate by cellular kinases.

In addition, several additional compounds have demonstrated activity

against the herpes viruses, antiviral agents which are currently

undergoing clinical trial evaluation. Foscarnet sodium (trisodium

phosphonoformate) a pyrophosphate analog of phosphono-acetic acid,

has potent in vitro and in vivo activity against herpes viruses.

Foscarnet inhibits the DNA polymerase of all human herpes viruses by

blocking the pyrophosphate binding site which thus prevents chain

elongation. A second newly developed antiviral agent is bromovinyl

arabinosyl uracil which has exhibited significant inhibition of the

herpes simplex virus Type 1, Epstein-Barr virus and the VZV.

Fluroiodoarabinosyl cytosine and its related compounds offer another

potent inhibitor of herpes viruses. Like acyclovir, this antiviral

agent and its activity depends on phosphorylation by herpes virus TK.

However, this antiviral agent and its analogs are understood to have

greater activity than acyclovir and significant activity against VZV

and HCMV. Additionally, (S)-1-((3-hydroxy-2-phosphonyl methoxy)propyl)

adenine (HPMPA) is yet another antiviral agent which includes a new

class of nucleotide analogs with in vitro activity against HSV 1 and

2, HCMV, VZV and EBV.

Valacyclovir is the preferred antiviral agent for CFS treatment where

the etiologic agent is isolated to EBV, due to its relatively high

bioavailability. As a result of valacyclovir's increased absorption,

as compared to acyclovir for example, less frequent, smaller total

dosages of valacyclovir are required to reach effective anti-herpetic

levels. Similarly, for CFS treatment, where the etiologic agent is

isolated to HCMV, ganciclovir is the preferred antiviral agent. As a

result of its increased inhibition of HCMV, ganciclovir is the

preferred treatment agent.

The antiviral agent can be administered by any method appropriate,

including oral, rectal, nasal, topical, vaginal and parenteral,

including subcutaneous, intramuscular, intravenous, intradermal,

intrathecal, and epidural. The preferred method is oral.

The amount of antiviral agent required to constitute

a " therapeutically effective " amount will vary based on a number of

factors including the severity of the chronic fatigue syndrome and

the identity and chemical make-up of the patient.

In general, to provide a therapeutically effective amount of the

antiviral agent, a suitable effective dose will be in the range of

0.1 to 20 grams per day and preferably in the range between 0.3 and

15 grams per day. An optimum dose is about 0.5 to 10 grams per day.

The dosage, of course, varies with the body weight of the patient and

so for a 70 kg individual, a dose of 4 grams per day is optimum

(e.g., 10 mg. per kg. valacyclovir every 6 hours). In view of

toxicity considerations, a maximum for a 70 kg individual is 8-12

grams per day. The desired dose is preferable presented as 2, 3, 4 or

more smaller doses administered at appropriate intervals throughout

the day. These smaller doses may be administered in unit dosage

forms.

In particular for valacyclovir, a patient would be administered a

dosage in the range of 0.1 to 50 mg/kg body weight of the patient to

50 mg/kg of body weight of valacyclovir, hydrochloride per dosing

interval, generally every six hours. The dosing interval is

determined by the bioavailability of the antiviral agent and its

excretion from the body. In the preferred embodiment, the patient

would be administered a dosage in the range of 0.3 to 40 mg/kg of

body weight of valacyclovir, hydrochloride orally every six hours. In

the most preferred embodiment, a patient would be administered 10

mg/kg of body weight of valacyclovir, hydrochloride every six hours.

These dosage ranges were selected to approximate the pharmacokinetics

of intravenous acyclovir, at a dosage schedule of 10 mg/kg of body

weight every eight hours intravenously.

The treatment period for a CFS patient varies on a case-by-case

basis. It is believed that for some, CFS is an ongoing and persistent

problem requiring continued treatment. The duration of the therapy

depends on the intensity of the CFS as affected by the therapy. One

indicator of an improvement in EBV-isolated CFS patients is a

decrease in the level of IgM antibodies to the VCA for EBV.

Generally, the therapy duration is proportional to the intensity of

the CFS manifestation. Accordingly, following administration of an

anti-viral agent, supplemental tests are helpful to check for

recurrent CFS and to determine the treatment duration.

While valacyclovir and ganciclovir are the preferred antiviral

agents, other antiviral agents which demonstrate anti-herpetic action

may be used for the treatment of chronic fatigue syndrome as well.

Such antiviral agents may also be effectively administered, for

example by oral methods, or as larger doses in time delay

formulations. Included among this group of antiviral agents are

acyclovir, valacyclovir, famciclovir, cidofovir, and other herpetic

antiviral agents and pharmaceutically acceptable derivatives of these

antiviral agents. Such pharmaceutically acceptable derivatives

include salts, hydrolyzable esters and chelates of the antiviral

agents and such similar derivatives which have no negative

pharmaceutical effect on the patient upon administration and are

thus, " pharmaceutically acceptable. " A pharmaceutically acceptable

salt is preferably an acidic salt derived from an appropriate acid,

for example, hydrochloric, sulfuric, phosphoric, maleic, fumaric,

citric, tartaric, lactic, acetic or p-toluenesulphonic acid.

Particularly preferred are the hydrochloride salts.

Having generally described this invention, a further understanding

can be obtained by reference to certain specific examples which are

provided herein for purposes of illustration only and are not

intended to be limiting unless otherwise specified.

EXAMPLES

The present inventor has analyzed the effectiveness of various

antiviral agents as a method of treatment for patients having chronic

fatigue syndrome. As a result of these patient trials, it was found

that administration of antiviral agents, even in small doses and over

a small period of time, contributed to a significant improvement in

the clinical symptoms and signs and to the normalization of the

disorder.

Tests for EBV and HCMV as Etiologic Agents of CFS

Example 1

Serum antibody titers to Epstein-Barr virus (EBV) and cytomegalovirus

(HCMV) were assayed in a consecutive case series of 98 patients with

the chronic fatigue syndrome (CFS) at a first clinic visit to a

single referral center in Birmingham, Mich. from 1987-1994. Twenty-

four percent of the CFS patients had evidence of a cardiomyopathy

documented by the presence of abnormal left ventricular dynamics at

stress/rest (MUGA) tests. Antibodies to Epstein-Barr virus (EBV)

immunofluorescent total early antigens (EA-D) and cytomegalovirus

(HCMV) IgM and IgG enzyme immunoassays (ELISA) were measured. The

prevalence of these antibodies was compared to that in a non-CFS

group of control persons from the same area. Approximately 50% of CFS

and non-CFS patients had concurrent EBV multiplication when tested by

the presence of an elevated EA antibody titer to the (EAD) diffuse

complex which neutralizes EBV encoded DNA polymerase. Elevated IgM

HCMV antibodies were uncommon (<10%) in all groups. Approximately 40%

of the CFS patients and non-CFS controls had no IgG HCMV antibody.

These data are consistent with our understanding that CFS is a

persistent cardiomyopathic infection caused by EBV or HCMV, or the

two herpes viruses, in combination.

In our additional research efforts, 87 patients with the chronic

fatigue syndrome (CFS) studied at a single referral center in

Birmingham, Mich. exhibited a primary myocardial disease of unknown

cause. These patients exhibited abnormal oscillating T-wave

flattenings and T-wave inversions at Holter monitoring, abnormal left

ventricular dynamics in stress/rest (MUGA) tests in 24.1% of 87 CFS

patients undergoing this study, histopathologic evidence of a

cardiomyopathy at right ventricular endomyocardial biopsy and a

salutary response to ganciclovir in a small preliminary subset of CFS

patients with evidence of cytomegalovirus (HCMV) infection, with no

concurrent multiplication of Epstein-Barr virus. These findings are

consistent with the cardiac disease that is understood to be the

basic pathologic mechanism of the fatigue, exercise intolerance,

light-headedness, left chest ache and palpitations of CFS patients.

Serologic Evidence. In an effort to obtain supportive serologic

evidence that the human cardiac myocyte harbors EBV, HCMV or both

viruses in CFS patients, we assayed EBV serum antibody total Early

Antigen (EA) and IgM antibodies to the viral capsid antigen (VCA) and

HCMV IgM and IgG serum antibodies.

However, the diagnosis of another important herpes virus infection,

namely, herpes simplex virus (HSV) encephalitis was not possible by

tests of specific HSV antibodies in serum. Brain biopsy with

isolation of HSV, type 1 or type 2 from affected sites was necessary

for diagnosis. It is thus believed that this is also the case for the

cardiomyopathy of the CFS.

Patients. From Jan. 1, 1987 through Dec. 31, 1994, ninety-eight CFS

patients were seen in a single infectious diseases referral center in

Birmingham, Mich. CFS patients met diagnostic criteria outlined by

the Centers for the Disease Control and Prevention. CFS cases here

are a consecutive case series. Each CFS patient demonstrated abnormal

oscillating T-wave flattenings and inversions at Holter monitoring.

Twenty-four percent of the CFS patients also demonstrated abnormal

left ventricular dynamics by radioisotopic gaited blood pool method.

Rest/stress myocardial perfusion studies (thallium 201 or TC-99m

sestamibi) or, as necessary, cardiac catheterizations excluded

ischemic cardiomyopathy in each case. CFS patient's demographic data

were similar to other series. The mean age here was 42.3.+-.10.6

years, and 87% were women. The duration of CFS was 12.2.+-.11.3

months. Other diagnoses were hypercholesterolemia (12%), obesity (6%)

and hypertensive vascular disease (3%). No patient had diabetes

mellitus.

Antibody Titers. At the initial clinical visit of each CFS patient,

EBV total early antigens (EA) immunofluorescent antibody titers

(Roche Laboratories, Columbus, Ohio) and cytomegalovirus (HCMV) IgM

enzyme immunoassays (ELISA) (Detroit Biomedical Laboratories,

Detroit, Mich.) and HCMV ELISA IgG titers (Metpath Laboratories,

Teteboro, N.J.) were assayed. The ELISA capture assays includes the

steps of capturing the IgG and IgM species onto the solid phase by

anti-human immunoglobulin followed by the addition of antigen and

labeling the antibodies. With regard to IgM assays, this ELISA method

reduces the potential interference of rheumatoid factor. During the

EBV infectious lytic cycle, antigen is expressed which can be divided

into a diffuse (EA-D) complex and a cytoplasmic restricted (EA-R)

complex. We assayed the EA-D. The 52/50 KD.sub.a EA-D protein complex

neutralizes EBV encoded DNA polymerase activity. EBV EA antibody

indicates recent EBV multiplication (e.g. within 90 days). Likewise,

HCMV ELISA IgM enzyme immunoassays indicate recent virus

multiplication. A positive HCMV ELISA IgG titer does not

differentiate concurrent from past HCMV infection. As a control group

to the CFS patients, similar serum antibody titers were measured in

20 random well individuals from the same area. They were 60% women

with a mean age of 32 years.

Results

The prevalence of EBV EA antibodies were similar in all CFS patients,

both those with and those without abnormal left ventricular dynamics.

The prevalence of these EBV antibodies were also the same in non-CFS

well persons. Approximately one-half of each of the groups, CFS and

non-CFS, had concurrent persistent multiplication of EBV as indicated

by an EA antibody titer of .gtoreq.10. Similarly, IgG HCMV antibodies

were present in approximately 60% of each group. However, HCMV, IgM

antibodies were uncommon (<10%).

The research revealed: 1) approximately half of the CFS patients

studied had " no evidence of EBV multiplication, " when first seen and

2) approximately 40% of the CFS patients had " never been infected

with HCMV " . These data then are consistent with our understanding

that CFS is a persistent infection with either EBV " or " HCMV or, EBV,

together with HCMV in the same patient. Proof of this hypothesis

requires endomyocardial biopsies of CFS patients with tests of the

cardiac tissues for EBV and HCMV nucleic acids by polymerase chain

reactions or in-situ hybridization.

Antiviral treatment for an appropriately selected patient is an

antiviral drug such as valacyclovir for CFS patients with EBV--

positive cardiac biopsies, and an antiviral agent such as ganciclovir

for CFS patients with HCMV-positive cardiac biopsies. Dual

appropriate anti-viral, anti-HCMV plus anti-EBV therapy is indicated

in CFS patients with combined EBV-HCMV infections.

Example 2

EBV-Isolated CFS Patients--Test of Antiviral Treatment. Ten CFS

patients, in whom singular Epstein-Barr virus persistent infection

was demonstrated, were treated and studied over a six month period.

EBV active infection was documented by EBV VCA IgM antibodies and/or

EBV EA elevated antibody titers. All of these patients had their

energy levels reduced by 50% or more and were partially or entirely

non-functional, unable to work or maintain a household. These ten

patients had no diseases or complicating conditions which could have

accounted for their chronic fatigue syndrome symptoms and they had no

prior psychiatric diseases.

Each patient's functional status was recorded as a statistically

validated energy index (EI). At each out-patient visit, subjective

evaluation of the patient's functional status was recorded using this

energy index. The energy index records the average subjective

vitality of the patient in the immediate 14 days prior to this

specific out-patient visit. When minor illnesses such as the common

cold complicated a visit, evaluation of the EI for a patient was

delayed until the intercurrent problem receded.

Prior to the initiation of the antiviral treatment and following

approximately six months of treatment, objective evaluations of the

ability to work and the energy index of each of the ten patients was

analyzed. Following the treatment, each of the patients were able to

fully engage in his/her activity level at work or home.

Pursuant to the energy index, a patient with a 0 energy index (EI) is

bedridden. With an energy index of 1 or 2, any activity by the

patient leads to overwhelming, incapacitating fatigue. Such patients

are generally light-headed, unable to think clearly, and

concentration is difficult for any extended period of time (over 60

minutes). Left-sided chest aches, palpitations, sore throats and

feverishness are frequent. These patients may be out of bed for

intermittent, brief periods of the day.

Patients with an energy index between 3 and 5 can, with great effort,

be out of bed for several hours each day doing non-physical

activities. Any exertion significantly worsens the fatigue. These

patients express variable light-headedness, inability to think

clearly or read normally. Left-sided chest aches, palpitations, sore

throats and feverishness occur often. Patients within this energy

range cannot perform a 40 hour sedentary job or maintain the duties

of a homemaker including such activities as cooking and cleaning. In

general, CFS patients have an energy index of 5 or less.

Patients with an energy index between 6 and 9 can assume normal

activities and maintain a 40 hour work week and, with pacing,

maintain a household. Such patients rarely exhibit light-headedness,

foggy thinking, chest aches, palpitations, feverishness and sore

throats. These patients can do light physical work or exercise in

moderation without fatigue.

Patients with an energy index of 10 have normal energy levels,

stamina and a sense of well-being. Light-headedness, difficulties in

concentrating and reading ability and chest aches, palpitations, sore

throats and feverishness are absent.

This energy index and its validity were tested by the method of

construct validity. (Ref. Isaacs and W. B. Handbook and

Research Evaluation, page 119 Instrumentation and Measurement. Edis

E. San Diego, Calif., publishers). In an effort to test the validity

of the energy index a random sample of 22 non-CFS persons was

compared to 20 CFS patients. The non-CFS persons were 17 women and 5

men with a mean age of 35 years, a median age of 38 years and an

overall range between 19 and 62 years. The mean energy index of the

non-CFS patients was 9.9, with a median energy index of 10. The CFS

patients were 17 women and 3 men with a mean age of 41, median age of

42 and an overall range in years between 16 and 53. The mean energy

index of the CFS group was 3.6, with a median of 4. Under Fischer's

exact test and T-tests, the gender and ages of the CFS and non-CFS

groups were similar. The energy indices of the two groups were

markedly different. The power of this T-test is 1. The effect size of

these data is 0.25. In comparison, a small effect size is 0.2. A

medium effect size is 0.5 and a large effect size is 0.8. Under this

scale, the energy index evaluation is a validated term, with a small

effect size.

During the initial and final clinical visits, each CFS patient was

studied to determine the IgM antibodies to the EBV viral capsid

antigen (VCA), total early antigens (EA), and enzyme immunoassays

(ELISA) to HCMV IgM and HCMV ELISA IgG titers. An IgM EBV VCA

antibody titer indicates infectious lytic EBV multiplication within

the most recent 3 month period. During the EBV infectious lytic

cycle, antigen is expressed which can be divided into a diffuse (EAD)

complex and a cytoplasmic restricted EAR complex (EAR). As a result,

each patient's EAD was assayed. The presence of EBV EA antibody

indicates current EBV multiplication. Likewise, an elevated

cytomegalovirus or Epstein-Barr virus IgM antibody indicates recent

EBV or HCMV multiplication, respectively. The EBV VCA antibody IgM

titers were done by the ELISA method. As a control group, similar

serum antibody titers were measured in 20 non-CFS individuals. In the

non-CFS control group, the mean HCMV IgG titer was 240.

Dosage. Each of the patients was administered an oral dose of

valacyclovir at 10 mg/kg by mouth every six hours.

Demographics. There were nine women and one man. Their ages ranged

from 20-67 years. Their mean age was 43.3 years. None of these ten

CFS patients had coronary artery disease as proven by either cardiac

catheterization or T.sub.c 99 sestamibi cardiac stress testing. Two

of the ten patients had abnormal left ventricular dynamics by stress

MUGA testing. All ten patients had abnormal oscillating T-wave

flattenings or T-wave inversions as detected through Holter

monitoring studies.

Results

EI Pre and Post Therapy. The mean EI for the 10 patients with EBV CFS

was 4.7 and the EI range was 3.5 to 5.5. At the completion of

therapy, the same EBV CFS patients had a mean EI 7.5, a median EI of

7, and a range between 6-10. Prior to therapy five out of ten

patients had chest pain. At the completion of the trial one out of

ten patients had chest pain. At the beginning of the trial, 9 out of

10 patients had light-headedness, unsteadiness, inability to think

well. At the completion of the trial, one of ten patients continued

to have these symptoms. At the beginning of the trial, five out of

ten patients had palpitations, while at the completion of the trial

three out of ten patients had palpitations.

Serologic Evidence. Serologic studies of the Epstein-Barr virus VCA

IgM titers were done on all patients before the beginning of the

trial. They were positive VCA, IgM titers in five out of ten. The

remainder of the EBV suspected CFS patients had elevated EBV EA

antibody titers. At the completion of the trial, two out of ten

continued to have VCA IgM positive titers. At the beginning of the

trial, seven out of ten had positive EA antibody titers (.gtoreq.10).

At the completion of the trial, eight out of ten continued to have

positive EA antibody titers. This population of ten patients was

characterized by little to no HCMV experience. None had a HCMV IgM

titer; eight out of ten had negative CMV IgG titers indicating no

experience with this virus. One patient had a titer CMV IgG which was

less than 200 and one had a titer greater than 200.

While the foregoing treatments involved administration of

valacyclovir or ganciclovir, the test results and the results of

treatment are entirely consistent with the postulate that chronic

fatigue syndrome is caused by a persistent herpes virus infection,

and therefore, treatment by other antiviral agents which demonstrate

anti-herpetic antiviral activity may be used for treatment of chronic

fatigue syndrome as well. Included among this group of antiviral

agents are acyclovir, ganciclovir, valacyclovir, farnciclovir,

cidofovir, pharmaceutically accepted derivatives and mixtures thereof

and other herpetic antiviral agents used in concentrations which

achieve adequate antiviral levels.

Example 3

HCMV-Isolated CFS Patients--Test of Antiviral Treatment. A study was

conducted to assess the possible efficacy of ganciclovir treatment on

a subset of CFS patients with (1) high HCMV IgG ELISA antibody

titers; (2) minimal/no serologic evidence of concurrent EBV

multiplication; and (3) oscillating ECG abnormalities at Holter

monitoring.

Patients. From March, 1993, through June, 1994, 3 men and 15 women

with the mean age of 39.7 plus or minus 7.7 years, with CFS (as

defined by the USA, Centers for Diseases Control criteria), were

recruited from a single infectious diseases referral center in

Birmingham, Mich. Approximately 50 patients with chronic fatigue

syndrome were screened for inclusion in this study. The 18 CFS

patients studied had a duration of overwhelming fatigue of more than

2 years and with oscillating or repetitively abnormal aberrant T-

waves at 24-hour ECG recordings using Holter monitoring. In these 18

CFS patients, baseline standard 12 lead ECG, 2-D echocardiogram, rest-

stress myocardial perfusion (thallium 201 or Tc-99 cardiolite) and

rest-stress multiple gaited acquisitions (MUGA) studies as well as

coronary angiography excluded coronary artery disease. HCMV ELISA and

HCMV ELISA IgG titers, as well as EBV capsid antigen (VCA), ELISA IgM

and EBV total early antigens (EA) immunofluorescent antibody titers

were assayed. Additionally, buffy coats, urine and myocardial

biopsies were tested for infectious HCMV. As a control of the

occurrence of HCMV and EBV virus antibodies in normal non-CFS

persons, residing in the same area, 20 random individuals were tested

for HCMV antibodies and for EBV antibodies. Holter monitoring, MUGA

studies and endomyocardial biopsies in these patients were done.

Holter monitors, MUGA studies and endomyocardial biopsies were read

blindly without knowledge of the patient. Also readings were repeated

by at least one, and often several, other physician readers. A

patient's 24-hour Holter monitor was considered positive if T-waves

became intermittently inverted or flat. Labile T-wave abnormalities

at Holter monitoring were present in each CFS patient. In addition to

the Holter monitoring, at each outpatient visit, a subjective

evaluation of the patient's functional status was recorded using the

energy index (EI) as previously described.

Infusions of Ganciclovir. After placement of a peripherally inserted

central catheter (PICC) or a groshong catheter, ganciclovir was given

intravenously in a dose of 5 mg. per kg. at 12-hour intervals for 30

days. Patients were seen once a week by the same physician and

complete blood counts, SMA values and urinalysis were conducted.

After 30 days, patients were seen at intervals of 4-6 weeks and

evaluated at each of these times. They were advised to avoid

exercise, fatigue and alcohol and engage in regular sleeping

patterns.

Statistical Methods. Eighteen patients, 3 men and 15 women, all with

CFS, with a mean age of 39.7 ranging from 29 to 51 years, were

evaluated. Statistical significance between patients meeting the

criteria for the HCMV subset and other patients with CFS were

evaluated using tests of homogeneity of chi-square analysis and the

two-tailed Fisher's exact test for bivariate analysis of dichotomous

data.

Results. Of the 18 patients with CFS, 13 patients improved. These 13

patients are hereinafter referred to as " Group A " . The gender and

ages of CFS patients who improved and the 5 CFS patients that did not

improve, these 5 patients are hereinafter referred to as " Group B, "

were similar. Of the 13 CFS patients that improved, the mean age was

37; among the 5 patients that did not improve, the mean age was 41.

One patient in each of the two groups smoked, and a single patient in

Group A had an elevated cholesterol level.

The mean duration of fatigue prior to therapy was longer, 2.8 years,

in Group B patients versus Group A patients, having a mean duration

of 1.6 years. Prior to receiving intravenous ganciclovir, patients in

both CFS groups experienced marked worsening fatigue with exercise.

Prior to therapy, myalgia, lightheadedness and dull non-specific left-

sided chest aches not related to activities were noted in both CFS

groups. Other than the above symptoms, physical examinations in all

the patients were normal. Two patients in Group A had mitral valve

prolapse and another patient in Group A had an occasional mild

episode of bronchial asthma. Reactive depressions were more common in

Group A. Eight patients in Group A and two patients in Group B

complained of difficulty in their ability to concentrate.

Cardiac Studies. Twelve-lead ECG's were normal except for single lead

T-wave inversions in standard lead III among 7 patients in Group A

and 2 patients in Group B.

After treatment with ganciclovir, 3 patients in Group A with

previously abnormal myocardial dynamics reverted to normal and in 3

others, results of MUGA tests improved with lesser degrees of

tardokinesis, hypokinesis, or left ventricular dilatation. At follow

up 6 months after intravenous ganciclovir treatment, one patient in

Group B with an initial normal MUGA study, showed septal hypokinesis.

Myocardial perfusion rest-stress studies were normal in 13 of the 14

patients in whom the study was conducted. Right ventricular

endomyocardial biopsy showed varying degrees of cardiomyopathic

changes characterized by myofiber disarray, myofiber dissolution,

myofiber-drop out with fibrous replacement and occasioned myofiber-

hypertrophy were evident in 7 of the 14 patients.

HCMV and EBV Antibody Titers. Eight of the patients had high HCMV

ELISA IgG antibody titers with a mean of 322 u. Two patients had

positive IgM HCMV antibody titers. Ten of the 13 patients had little

to no evidence of EBV multiplication as tested by an elevated

antibody titer to EA.

Changes in Vitality after Intravenous Ganciclovir Treatment. At the

start of ganciclovir, the severity of fatigue based on the energy

index, in all patients was similar with a mean of 3 for Group A

versus a mean of 2 for Group B. Six months later, the energy indices

had increased. Mean indices were 7 and 4 for Groups A and B,

respectively. Before therapy with ganciclovir, none of the patients

were able to work or function normally. After the antiviral

treatment, the 13 patients in Group A, but none of the patients in

Group B, resumed their normal pre-CFS activity levels. In general,

our studies revealed that patients in Group A had greater improvement

than patients in Group B.

Toxicities in Intravenous Ganciclovir. In an initial test, a single

patient had a transient increase in serum creatinine, but upon

recalculation of dose based upon lean body mass in a repeated test,

the serum creatinine level reverted to normal. Similarly, there were

no adverse events or symptoms attributable to ganciclovir.

Case Study. A 51-year-old millwright who enjoyed excellent health and

whose only risk factor for coronary artery disease was cigarette

smoking suddenly experienced overwhelming, progressive fatigue

forcing him to stop work. As a result of this fatigue, he was

essentially bedridden and slight exertion further worsened his

fatigue. He suffered from lightheadedness, generalized muscle aches,

intermittent sore throat and an inability to think clearly. The

physical exam was normal, chest x-ray, HDL cholesterol levels and

urinalysis all were normal. At resting 12-lead ECG showed an inverted

T-wave in standard lead III, but was otherwise normal. An ELISA IgM

antibody titer to HCMV was positive, while Epstein-Barr virus

antibody tests were negative. Holter monitoring showed oscillating

abnormal flat or inverted T-waves appearing with the onset of sinus

tachycardias, and alternating with the reappearance of normal upright

T-waves when tachycardias resolved.

A myocardial sestamibi perfusion rest/stress test showed reversible

ischemia of the anterior, apical and inferior walls, but at cardiac

catheterization, the coronary arteries were patent. A stress MUGA

study revealed abnormal left ventricular function with a resting

ejection fraction of 40% (normal >50%).

This patient was given daily intravenous ganciclovir treatments at 5

mg. per kg. every 12 hours, for 30 days. Five months later, the

stress MUGA test was repeated and, at this time, the resting ejection

fraction had increased 14%, from 40% to 54%, a normal level. Five

months later, the patient's maximal cardiac ejection fraction

increased from 54% to 68%. At this time, repeat myocardial perfusion

studies during exercise were normal. Left ventricular dysfunction was

no longer present and the patient's fatigue had disappeared.

Subsequently, the patient resumed work as a millwright and after a

21/2 year follow-up, remains well with normal left ventricular

function.

Conclusion. Based upon these research results, it is understood that

CFS patients with a significant ELISA IgG HCMV antibody titer,

greater than 120 units, with or without the presence of an IgM HCMV

ELISA antibody titer plus an absence of EBV VCA IgM antibody titer

along with an EBV EA antibody titer less than 40 describes a group of

CFS patients that are understood to derive benefit from ganciclovir

treatment. Our research showed a significant and persistent

improvement in the patient's energy levels as measured by the energy

index. The use of a single thirty-day course of intravenous

ganciclovir is arbitrary. Likewise while the above treatments

involved ganciclovir, any of the other antiviral agents mentioned

herein may be suitable. Further suppressive antiviral therapy with

drugs such as an oral preparation of ganciclovir (e.g., cytovene) or

oral valacyclovir for EBV CFS patients may be necessary to maintain

clinical improvement.

Example 4

HCMV Patients. Results of Copalis.RTM. Assays Specificity: The serum

of 17 patients were studied who had no cytomegalovirus IgG or IgM

antibody to structural viral proteins as measured by the classical

ELISA method. In these 17 patients there were no antibodies by the

Copalis.RTM. method using light scattering technique to either viral

protein (VP), CM.sub.2 or p52. Therefore, no false-positives by the

Copalis.RTM. method were seen.

The serum from the 121 separate patients were similarly tested. These

patients were positive by the ELISA classical technique for

structural cytomegalovirus IgG antibody. They were negative for

cytomegalovirus IgM antibody. All 121 of these patients positive for

cytomegalovirus IgG antibody were positive for viral protein

(Copalis.RTM.). The antigen for the cytomegalovirus ELISA technique

is nonpurified, human fiberblast tissue culture suspension of tissue-

culture-grown-cytomegalovirus. In every one of these 121 cases which

were positive for cytomegalovirus IgG by both Copalis.RTM. and ELISA

methods, they were negative by Copalis.RTM. method for antibodies to

p52 and CM.sub.2. None of these patients had the chronic fatigue

syndrome. There was one patient who was positive in very low titer to

cytomegalovirus IgG by the Copalis.RTM. method which was negative for

IgG antibody to cytomegalovirus by the ELISA method. These data

indicate that Copalis.RTM. light scatter antibodies do not occur with

nonstructural proteins CM.sub.2 or p52 in patients with past

cytomegalovirus infection. Seventy-six sera were analyzed which were

positive for viral capsid antigen IgM to Epstein-Barr virus and/or EA

antibody to Epstein-Barr virus. These cases had no cytomegalovirus

ELISA IgM or IgG. The obtained serum in 76 cases was uniformly

negative by Copalis.RTM. tests to human cytomegalovirus IgG and IgM.

The IgM includes both nonstructural antibodies CM.sub.2 and p52.

Therefore Epstein-Barr virus did not cause false-positive

Copalis.RTM. results. The tests by the Copalis.RTM. method are

greater than 99 percent specific; false-negatives are extraordinarily

rare.

Results of Copalis.RTM. antibody testing in patients with the U.S.

CDC-Chronic Fatigue Syndrome and various other patients with severe

onset of explained fatigue. Group 1) Eight patients were studied with

the chronic fatigue syndrome. They are six women and eight men with

ages ranging from 32 through 48. They had IgG antibodies to human

cytomegalovirus. They had no IgM antibodies to human cytomegalovirus

by the ELISA technique. They would be evaluated as having past

infection. These eight patients had high titer positive antibodies to

nonstructural gene products p52 and CM.sub.2. They were treated with

intravenous ganciclovir and followed by oral ganciclovir. These

nonstructural antibodies became markedly lower and disappeared.

Moreover, the fatigue in these patients was remarkably lessened. The

use of the Copalis.RTM. antibody titer in these patients depicted

incomplete virus multiplication and the reversal of this immune

status associated with the improvement of the patient with specific

anti-viral therapy. Two other patients, two women, a 27 year old

woman and a 48 year old woman had similar evidence of chronic fatigue

syndrome and high antibody titers to the nonstructural gene products

of human cytomegalovirus p52 and CM.sub.2. These patients could not

be treated with anti-viral agent, ganciclovir. Nevertheless, their

initial diagnosis was secured by the presence of the antibodies to

p52 and CM.sub.2.

FIG. 4 is a table depicting the antibody titer levels of one of the

patients, a 47-year old male, before and after antiviral therapy.

This patient had IgG antibodies to HCMV but no IgM antibodies by the

ELISA technique. As shown, this patient had high titer positive

antibodies to nonstructural gene products p52 and CM.sub.2. After

antiviral treatment, these nonstructural antibodies became markedly

lower.

Three other patients with the chronic fatigue syndrome are of

interest. In two of these patients, the patient had, of course, IgG

ELISA antibodies to human cytomegalovirus and no IgM antibodies to

the ELISA testing. They would be ordinarily read as having past

infection. They had, however, markedly high antibody titers to

CM.sub.2. They had no elevated antibody titers to p52. They were

treated with intravenous ganciclovir followed by oral ganciclovir.

The CM.sub.2 antibodies lessened or disappeared and they improved.

The third patient, a 39 year old woman, with chronic fatigue syndrome

was diagnosed positive only by the p52 Copalis.RTM. method. This

patient was similarly treated with intravenous ganciclovir followed

by oral ganciclovir and improved remarkably. Therefore, the

decreasing response to antibodies to HCMV nonstructural gene products

(CM.sub.2) after specific antiviral administration defines human

cytomegalovirus chronic fatigue syndrome and define three kinds of

gene product response. 1) A response to both CM.sub.2 and p52; and 2)

A response to CM.sub.2 only but not p52; 3) A response to p52 but not

CM.sub.2. Several other patients who had the sudden onset of ongoing,

unexplained fatigue also have been studied and found to have

antibodies to the p52 and CM.sub.2. One of these was an 83 year old

woman with congestive heart failure and diabetes mellitus. Her

cardiac function improved after intravenous ganciclovir. A second

patient is a 75 year old woman with fatigue. Both of these older

women had antibody responses to both CM.sub.2 and p52. A 60 year old

man with morbid obesity and diabetes mellitus suddenly became

fatigued with sustained fatigue. He also was identified as having

incomplete cytomegalovirus infection by the presence of high titers

of the two nonstructural antibodies. Finally, an 82 year old woman

had ongoing fatigue of unknown cause. She had antibodies only to the

p52 epitopes.

For illustrative purposes, FIG. 3 depicts a 39-year old female

patient diagnosed with variable HCMV-EBV CFS co-infection, having

incomplete virus multiplication. As depicted in FIG. 3, the

administration of antiviral therapy, specifically both ganciclovir

and valacyclovir, remarkably reduced the presence of high antibody

titers to both HCMV and EBV.

Conclusion: This invention provides an exact means of diagnosing a

subset of patients with cytomegalovirus chronic fatigue syndrome. The

decrease in these antibody titers has been identified and the use of

specific anti-viral therapy has resulted in significant patient

improvement, accompanied by a decrease or disappearance of the

fatigue.

While embodiments of the invention have been illustrated and

described, it is not intended that these embodiments illustrate and

describe all possible forms of the invention. Rather, the words used

in the specification are words of description rather than limitation,

and it is understood that various changes may be made without

departing from the spirit and scope of the invention.

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Hi All,

I use magnesium and at times taurine. Taurine is supposed to

be good

for the heart and brain. I find it a natural calmative for me. I think

things like coenzyme Q-10 and L-Carnitine can be good. Research them

out.

Mike

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Hi All,

I have a friend that had a major problem with tachycardia.

She was

on all kinds of medications. I think that she was able to wean herself

down

a bit from a lot of them. I think that her doctor told her that she

might have

had a virus.

Mike

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hi all -

more than one doc has told me that tachycardia can be due to ANS

dysfunction, which a lot of us have, and can be (in my case at least)

easily controlled by small doses of beta blockers as needed.

Judith

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I had the same thing and magnesium orotate really reduced it.

Donna

Tachycardia

I have had CFS for about 5 years now and I have recently developed some form

of tachycardia. My heart rate just goes up to about 200 beats a minute for no

reason and I almost black out and get real shaky. My doctors can't determine if

it is sinus tachycardia or some form of supraventricular tachycardia. They say

it isn't reltated to CFS but I am still wondering. I am on a beta blocker for

now because without it I couldnt' get out of bed without my heart rate

skyrocketing. I am 25 years old, too young for these heart problems. I was

just wondering if any of you had experienced anything like this. It has been

going for over a month now and I cant take these beta blockers...the side

effects are awful. If anyone has any info I appreciate it. One more note, I

have been treating the stealth virus, HHV6b, and Nanobacteria over the past few

months, wonder if a virus or bacteria could cause this........??

Thanks for any help,

Suzanne

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suzanne

two other things.

1) lyme is known to irritate the heart and cause heart related

problems.

2) thyroid dysfunction is another big problem with the heart. you

might want to have the full thyroid function analyzed (TSH, T4, T3,

FreeT4). most DR's only check TSH.

here is a web site with a thorough breakdown of thyroid disorders.

http://www.drrind.com/default.asp

click on the section devoted to thyroid and adrenal function.

thanks

bill

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  • 3 weeks later...

> I have had CFS for about 5 years now and I have recently developed some form

of tachycardia. My heart rate just goes up to about 200 beats a minute for no

reason and I almost black out and get real shaky. My doctors can't determine if

it is sinus tachycardia or some form of supraventricular tachycardia. They say

it isn't reltated to CFS but I am still wondering.

I don't know what doctors you are seeing but most are clueless about CFS and

don't know diddly, so I wouldn't take what they say as gospel.

I've had heart palpitations on and off with my CFS, which I have had since 1987,

and it gets worse when I have a CFS relapse. I have just recently had an acute

CFS relapse, and while it's getting better, all of a sudden I'm having these

awful heart palpitations and tachycardia again. (Which is why I just signed on

to this mailing list, to get some tips about stopping it.)

Many years ago, I had an EKG done, along with an ultrasound for heart murmur and

they found nothing. What did help me at the time was taking potassium and

magnesium supplements, as recommended by my holistic MD , and they

worked like a charm! Like an idiot, with the absence of symptoms I got lazy and

stopped taking them. So guess what we're picking up at the store later this

evening?

You'll also find a list of alternative remedies here:

http://www.project-aware.org/Managing/Alt/heart.shtml

This site is for menopausal women but the remedies themselves apply to anyone

experiencing these symptoms.

Also, from what I just researched, sleep disorders can contribute to

palpitations/tachycardia, as well as caffeine and anxiety. So I would stop

drinking any caffeine, and try to regulate your sleep as much as possible

(though this can be hard as insomnia also is a frequent CFS symptom). I've

personally been having awful insomnia lately, which has coincided with my

palpitations returning (and they happen when I am trying to sleep at night). I

am also starting to wonder if sugar doesn't also contribute, since I had eaten a

sugary snack prior to going to bed last night, when I had the worst symptoms.

Duh. I should know better.

So, to summarise:

Get Potassium/Magnesium supplements.

Regulate your sleep.

Eliminate all caffeine from your diet.

Cut down on your sugar.

Herbal remedies such as Valerian root can help calm the heart.

I don't know if that helps, but it's a place to start. Keep me posted on what

you find, since I'm looking for more information as well.

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hi folks -

Brail wrote:

>>I've had heart palpitations on and off with my CFS, which I have had

since 1987, and it gets worse when I have a CFS relapse. I have just

recently had an acute CFS relapse, and while it's getting better, all of

a sudden I'm having these awful heart palpitations and tachycardia

again. (Which is why I just signed on to this mailing list, to get some

tips about stopping it.) <<

I'm not sure what you mean by " palpitations " since all that means is

that you are aware of your heart beating (it has some significance in

Chinese medicine, but not western), its not synonymous with tachycardia.

If the supplements you listed don't stop the tachycardia, tiny doses of

beta blockers such an Tenormin (prescription needed) have worked for me

w/o side effects. I got a referral to a cardiologist about this and had

a 24 hr. Holter monitor test done (which will show more than an EKG,

also to check out Lerner's theory

about inverted T-waves which he claims are common with PWCs and cause

some of our problems, see the list archives) and got a

surprisingly clean bill of cardiac health. Tachycardia can also be a

system of ANS dysfunction which many, many PWCs have. I think *any*

cardiac problems ought to be checked out with a specialist - this is one

time when its worth checking out with a doc rather than a mailing list!

Judith G

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Hi -

Symptoms are also similar to what I have read on hyperthyroidism. I have hypo

(Hasimotos) and get palpitations and feeling of a racing heart when the

antibodies are acting up. The only difference is that although it feels racing,

my heartbeat is actually my normal 60 beats per minute. It's wierd.

Kathy

Re: Tachycardia

> I have had CFS for about 5 years now and I have recently developed some form

of tachycardia. My heart rate just goes up to about 200 beats a minute for no

reason and I almost black out and get real shaky. My doctors can't determine if

it is sinus tachycardia or some form of supraventricular tachycardia. They say

it isn't reltated to CFS but I am still wondering.

I don't know what doctors you are seeing but most are clueless about CFS and

don't know diddly, so I wouldn't take what they say as gospel.

I've had heart palpitations on and off with my CFS, which I have had since

1987, and it gets worse when I have a CFS relapse. I have just recently had an

acute CFS relapse, and while it's getting better, all of a sudden I'm having

these awful heart palpitations and tachycardia again. (Which is why I just

signed on to this mailing list, to get some tips about stopping it.)

Many years ago, I had an EKG done, along with an ultrasound for heart murmur

and they found nothing. What did help me at the time was taking potassium and

magnesium supplements, as recommended by my holistic MD , and they

worked like a charm! Like an idiot, with the absence of symptoms I got lazy and

stopped taking them. So guess what we're picking up at the store later this

evening?

You'll also find a list of alternative remedies here:

http://www.project-aware.org/Managing/Alt/heart.shtml

This site is for menopausal women but the remedies themselves apply to anyone

experiencing these symptoms.

Also, from what I just researched, sleep disorders can contribute to

palpitations/tachycardia, as well as caffeine and anxiety. So I would stop

drinking any caffeine, and try to regulate your sleep as much as possible

(though this can be hard as insomnia also is a frequent CFS symptom). I've

personally been having awful insomnia lately, which has coincided with my

palpitations returning (and they happen when I am trying to sleep at night). I

am also starting to wonder if sugar doesn't also contribute, since I had eaten a

sugary snack prior to going to bed last night, when I had the worst symptoms.

Duh. I should know better.

So, to summarise:

Get Potassium/Magnesium supplements.

Regulate your sleep.

Eliminate all caffeine from your diet.

Cut down on your sugar.

Herbal remedies such as Valerian root can help calm the heart.

I don't know if that helps, but it's a place to start. Keep me posted on what

you find, since I'm looking for more information as well.

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Hi Judith, you made some very good points in your message below which

I snipped. However, I have never heard of anyone with 'CFS' who

had secondary heart problems, being helped by seeing a cardiologist.

While your advice is the right road to take, I don't want folks to

think they will get some treatment or pill from a cardiologist that

will help them (forget about curing). I think the heart symptoms

are related to the overall viral condition, and once the immune

system gets better so will the heart symptoms (i've been there).

In no way am I disputing anything you wrote, I just think one can

spend a lot of money on heart testing and get nothing for it.

Mike C.

.. I think *any*

> cardiac problems ought to be checked out with a specialist - this

is one

> time when its worth checking out with a doc rather than a mailing

list!

>

> Judith G

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hi Mike and all -

>>you made some very good points in your message below which

I snipped. However, I have never heard of anyone with 'CFS' who

had secondary heart problems, being helped by seeing a cardiologist.

While your advice is the right road to take, I don't want folks to

think they will get some treatment or pill from a cardiologist that

will help them (forget about curing). I think the heart symptoms

are related to the overall viral condition, and once the immune

system gets better so will the heart symptoms (i've been there).

In no way am I disputing anything you wrote, I just think one can

spend a lot of money on heart testing and get nothing for it.>>

I agree with you but I guess I didn't make my point clear enough.

Sometimes problems can be *primary* and not connected to CFIDS (and how

can you tell the difference? sometimes you can't) - I have one doc who

watches out for things just like that and over the years he's caught a

couple serious things that I would've brushed off as being CFS related

and not treatable, when in fact they were, and would've become worse

without treatment. Also, when anything as deadly serious as your heart

is concerned, its worth making sure nothing is wrong no matter what the

cause. And as I pointed out, though my tachycardia is undoubtedly due

to my CFIDS its still treatable with medication.

regards,

Judith

.. I think *any*

> cardiac problems ought to be checked out with a specialist - this

is one

> time when its worth checking out with a doc rather than a mailing

list!

>

> Judith G

This list is intended for patients to share personal experiences with

each other, not to give medical advice. If you are interested in any

treatment discussed here, please consult your doctor.

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Hi :

Is it possible you could have mitral valve prolapse which has many strange

symptoms such as migraine, chest pain and fainting? I have mitral valve prolapse

(the leaflets of my valve when it opens flap back too far and allow leakage into

the left ventricle (which is the main pumping chamber of your heart). I have had

two echocardiograms - one showed the mitral valve prolapse and the other did

not...so you see it can not always be seen. It is supposed to be very common in

the population. Also there is a condition called dysautonomia where your nervous

system doesn't function right. I am not sure how to explain it except that it

can go along with mitral valve prolapse. If you suspect this is your problem

and you haven't had an echocardiogram in a while, I would suggest one. I know it

is kind of scary to have your heard thumping away but if it is from this, there

is not much to be afraid of. I take beta blockers for migraines but it is also

good for this condition. Good Luck!

Teena

Re: Tachycardia

> I have had CFS for about 5 years now and I have recently developed some form

of tachycardia. My heart rate just goes up to about 200 beats a minute for no

reason and I almost black out and get real shaky. My doctors can't determine if

it is sinus tachycardia or some form of supraventricular tachycardia. They say

it isn't reltated to CFS but I am still wondering.

I don't know what doctors you are seeing but most are clueless about CFS and

don't know diddly, so I wouldn't take what they say as gospel.

I've had heart palpitations on and off with my CFS, which I have had since

1987, and it gets worse when I have a CFS relapse. I have just recently had an

acute CFS relapse, and while it's getting better, all of a sudden I'm having

these awful heart palpitations and tachycardia again. (Which is why I just

signed on to this mailing list, to get some tips about stopping it.)

Many years ago, I had an EKG done, along with an ultrasound for heart murmur

and they found nothing. What did help me at the time was taking potassium and

magnesium supplements, as recommended by my holistic MD , and they

worked like a charm! Like an idiot, with the absence of symptoms I got lazy and

stopped taking them. So guess what we're picking up at the store later this

evening?

You'll also find a list of alternative remedies here:

http://www.project-aware.org/Managing/Alt/heart.shtml

This site is for menopausal women but the remedies themselves apply to anyone

experiencing these symptoms.

Also, from what I just researched, sleep disorders can contribute to

palpitations/tachycardia, as well as caffeine and anxiety. So I would stop

drinking any caffeine, and try to regulate your sleep as much as possible

(though this can be hard as insomnia also is a frequent CFS symptom). I've

personally been having awful insomnia lately, which has coincided with my

palpitations returning (and they happen when I am trying to sleep at night). I

am also starting to wonder if sugar doesn't also contribute, since I had eaten a

sugary snack prior to going to bed last night, when I had the worst symptoms.

Duh. I should know better.

So, to summarise:

Get Potassium/Magnesium supplements.

Regulate your sleep.

Eliminate all caffeine from your diet.

Cut down on your sugar.

Herbal remedies such as Valerian root can help calm the heart.

I don't know if that helps, but it's a place to start. Keep me posted on what

you find, since I'm looking for more information as well.

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> Hi -

>

> Symptoms are also similar to what I have read on hyperthyroidism. I have hypo

(Hasimotos) and get palpitations and feeling of a racing heart when the

antibodies are acting up. The only difference is that although it feels racing,

my heartbeat is actually my normal 60 beats per minute. It's wierd.

Strange!! Well, my heart was definitely racing...when I was tested initially,

they tested me for EVERYTHING. I was finally diagnosed by a holistic doctor (an

MD) and she was the only one with enough sense to tell me I was probably

suffering from a mineral deficiency. When I took the supplements, it went away.

Of course, I felt fine and after a while stopped taking them out of laziness.

So...I went out and got my supplements the other night as I said I would,

including potassium, magnesium, calcium, and iron (among some others). Feel a

zillion times better and haven't had a problem since (though granted I've only

had a day or so using them, the difference I feel is significant).

Best to try supplements because they can't hurt (unless you OD on them) and many

of those specialty doctors don't think about the obvious.

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> I'm not sure what you mean by " palpitations " since all that means is

> that you are aware of your heart beating (it has some significance in

> Chinese medicine, but not western), its not synonymous with tachycardia.

I think the common definition of palpitation is that of a feeling of a skipped

or extra beat. I had that in addition to tachycardia.

> If the supplements you listed don't stop the tachycardia, tiny doses of

> beta blockers such an Tenormin (prescription needed) have worked for me

> w/o side effects.

Thanks...my supplements did the trick. Should have kept using them in the first

place, but I hadn't used them for a few years so I had forgotten...

> I think *any*

> cardiac problems ought to be checked out with a specialist - this is one

> time when its worth checking out with a doc rather than a mailing list!

Sure...but just know that most of them don't even think to look at nutritional

deficiency first. You can go through all that rigamarole with the EKG and an

ultrasound when a $6 bottle of potassium may fix the problem.

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  • 4 years later...

These studies find that a complex that inhibits PAHX-AP1 is reduced

in DS. When PAHX-AP1 is overexpressed in the heart it predisposes to

tachycarida. Trisomy 21 may be associated with fetal tachycardia.

Proc Natl Acad Sci U S A. 2006 Aug 29;103(35):13074-9. Epub 2006 Aug

21.

A repressor complex, AP4 transcription factor and geminin, negatively

regulates expression of target genes in nonneuronal cells.

Kim MY, Jeong BC, Lee JH, Kee HJ, Kook H, Kim NS, Kim YH, Kim JK, Ahn

KY,

Kim KK.

Department of Obstetrics and Gynecology, Research Institute of

Medical Sciences and Medical Research Center for Gene Regulation,

Chonnam National University Medical School, Kwangju 501-190, South

Korea.

The transcription of neuron-specific genes must be repressed in

nonneuronal cells. REST/NRSF is a transcription factor that restricts

the expression of many neuronal genes through interaction with the

neuron-restrictive silencer element at the promoter level. PAHX-AP1

is a neuronal gene that is developmentally up-regulated in the adult

mouse brain but that has no functional NRSE motif in its 5' upstream

sequence. Here, we report that the transcription factor AP4 and the

corepressor geminin form a functional complex in which SMRT and

histone deacetylase 3 are recruited. The functional complex represses

PAHX-AP1 expression in nonneuronal cells and participates in

regulating the developmental expression of PAHX-AP1 in the brain.

This complex also serves as a transcriptional repressor of DYRK1A, a

candidate gene for Down's syndrome. Furthermore, compared with that

in normal fetal brain, the expression of AP4 and geminin is reduced

in Down's syndrome fetal brain at 20 weeks of gestation age, at which

time premature overexpression of dual-specificity tyrosine-

phosphorylated and regulated kinase 1A (DYRK1A) is observed. Our

findings indicate that AP4 and geminin act as a previously

undescribed repressor complex distinct from REST/NRSF to negatively

regulate the expression of target genes in nonneuronal cells and

suggest that the AP4-geminin complex may contribute to suppressing

the precocious expression of target genes in fetal brain.

PMID: 16924111 [PubMed - indexed for MEDLINE]

Biochem Biophys Res Commun. 2001 Sep 7;286(5):1107-16.

Cardiac Characteristics of Transgenic Mice Overexpressing Refsum

Disease Gene-Associated Protein within the Heart.

Koh JT, Choi HH, Ahn KY, Kim JU, Kim JH, Chun JY, Baik YH, Kim KK.

Dental Science Research Institute, Chonnam National University,

Kwangju, 501-190, South Korea.

Arrhythmia is a common cardiac symptom of Refsum disease. Recently,

we identified a novel neuron-specific PAHX-associated protein (PAHX-

AP1), which binds to the Refsum disease gene (PAHX). In this report,

we developed heart-targeted transgenic (TG) mice under the control of

alpha-myosin heavy chain promoter to determine whether cardiac

overexpression of PAHX-AP1 provokes cardiac involvement symptoms.

Northern and in situ hybridization analyses revealed PAHX-AP1

transcript was overexpressed in TG atrium, especially in the

sinoatrial node. TG mice showed tachycardia, and tachyarrhythmia was

observed in 20% of TG mice. Isolated TG atria showed higher frequency

beating and were more sensitive to aconitine-induced tachyarrhythmia

than the wild-type, and 40% of the TG atria showed irregular beating.

Action potential duration in TG atrial fiber was shortened much more

than the wild-type. Systemic administration of arrhythmogenic agents

induced arrhythmia in TG mice, while no arrhythmia with the same dose

in nonTG mice. Our results indicate that the chronic atrial

tachycardia by overexpressed neuron-specific PAHX-AP1 transgene in

atrium may be responsible for the increased susceptibility to

arrhythmia. Copyright 2001 Academic Press.

PMID: 11527414 [PubMed - indexed for MEDLINE]

Ultrasound Obstet Gynecol. 2000 Dec;16(7):610-3.

Fetal heart rate in chromosomally abnormal fetuses.

Liao AW, Snijders R, Geerts L, Spencer K, Nicolaides KH.

Birthright Research Centre for Fetal Medicine, King's College

Hospital Medical School, Denmark Hill, London SE5 8RX, UK.

OBJECTIVES: To determine the effects of chromosomal defects on fetal

heart rate at 10-14 weeks of gestation. METHODS: Fetal heart rate at

10-14 weeks of gestation in 1061 chromosomally abnormal fetuses was

compared to that from 25,000 normal pregnancies. The chromosomally

abnormal group included 554 cases of trisomy 21, 219 cases of trisomy

18, 95 of trisomy 13, 50 of triploidy, 115 of syndrome and 28

of sex chromosome abnormalities other than syndrome. RESULTS:

In the normal group, fetal heart rate decreased from a mean value of

170 beats per minute (bpm) at 35 mm of crown-rump length to 155 bpm

at 84 mm crown-rump length. In trisomy 21, trisomy 13 and

syndrome fetal heart rate was significantly higher, in trisomy 18 and

triploidy the heart rate was lower and in other sex chromosome

defects it was not significantly different from normal. Fetal heart

rate was above the 95th centile of the normal range in 10%, 67% and

52% of fetuses with trisomy 21, trisomy 13 and syndrome,

respectively. The fetal heart rate was below the 5th centile in 30%

of fetuses with triploidy and 19% of those with trisomy 18.

CONCLUSIONS: Trisomy 21, trisomy 13 and syndrome are

associated with fetal tachycardia, whereas in trisomy 18 and

triploidy there is fetal bradycardia. Inclusion of fetal heart rate

in a first-trimester screening program for trisomy 21 by a

combination of maternal age and fetal nuchal translucency thickness

is unlikely to provide useful improvement in sensitivity.

PMID: 11169365 [PubMed - indexed for MEDLINE]

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