Book Review

Post-Viral Fatigue Syndrome

Chronic Fatigue Syndrome

N Engl J Med 1994; 330:73January 6, 1994

Article

Post-Viral Fatigue Syndrome
Edited by Rachel Jenkins and James Mowbray. 463 pp. New York, John Wiley, 1993. $137.50. ISBN: 0-471-92846-1

Chronic Fatigue Syndrome
Edited by David M. Dawson and Thomas D. Sabin. 218 pp., illustrated. Boston, Little, Brown, 1993. $65. ISBN: 0-316-17748-2

In 1988, the Centers for Disease Control described chronic fatigue syndrome and proposed a research case definition for it. This move classified an interrelated but heterogeneous array of debilitating symptoms under a new name. There has now been sufficient opportunity to apply this case definition and to accumulate abundant clinical and research data and anecdotal experiences with which to formulate hypotheses regarding the pathogenesis of this entity. Two very different scholarly books have emerged from the large lay and professional literature reporting on that experience.

Jenkins, a psychiatrist, and Mowbray, an immunopathologist, have assembled an ambitious book consisting of 29 chapters by 35 contributors whose expertise extends well beyond the disciplines linked most strongly with chronic fatigue syndrome -- namely, virology, immunology, epidemiology, and neuropsychology. This book is best suited to readers who want an intensive survey of the field, circa 1990. Its unique strengths include contributions from workers in both the United Kingdom and North America, who have had long-standing differences of opinion about chronic fatigue syndrome and related disorders, and several fine chapters summarizing the evaluation of fatigue in children, athletes, and workers. There is an excellent and balanced discussion by Ray of the relation of affective disorders to chronic fatigue syndrome.

As the name of the book -- Post-Viral Fatigue Syndrome -- implies, the editors and some of the contributors are attached to the belief that most cases of chronic fatigue syndrome are triggered by an acute viral infection and that the symptoms persist because the infection remains active for years. These beliefs are central to two related weaknesses of the book. First, many contributors fail to distinguish the subgroup of patients with a putative viral infection from patients with other precipitants of severe fatigue. Second and more important, the book's focus on the poorly substantiated notion that enteroviruses in particular underlie the bulk of cases of the syndrome precludes more than passing acknowledgment of other hypotheses in much of the book.

Dawson and Sabin, in Chronic Fatigue Syndrome, offer a more moderate and balanced review by 22 contributors in 15 concise chapters. Clinicians interested in the practical realities of the syndrome and its management will prefer this textbook. Many of the chapters, such as those on the neuroradiologic features of the syndrome, mitochondrial studies, and fatigue in neurodegenerative disorders and multiple sclerosis, reflect the interest the authors have in their own specialties -- namely, neurology and psychiatry. As a result, the book is not comprehensive enough for all clinicians. Its strength derives ironically from the fact that the editors themselves have not been prominent researchers in the field. Rather, they are thoughtful clinicians who seem relatively free of biases that can stem from an energetic pursuit of a single hypothesis. As Dawson and Sabin state in their preface, “Clearly, speculation about [chronic fatigue syndrome] will continue. Disabled patients continue to need care.” The openness and clarity of this book will help such patients while the debate rages elsewhere.

Stephen E. Straus, M.D.
National Institutes of Health, Bethesda, MD 20892