AHMF: 98 Conference: Regland

One-Carbon Metabolism and CFS

B. Regland [1], M. Andersson [2], L. Abrahamsson [3], J. Bagby [2], L.E Dyrehag [2] T Germgard [4],
A.C Koch-Schmidt [4], and C.G.Gottfries

1 Institute of Clinical Neuroscience, Goteborg University
2 Pain Unit, Kungalv Hospital,
3 Department of Clinical Chemistry, Uddevalla Hospital,
4 Department of Natural Sciences, Kalmar University, Sweden

One-carbon metabolism is a chain of biochemical reactions that include the synthesis and successive transfer of methyl groups for the remethylation of homocysteine, and which is dependent on the availability of the vitamins cobalamin (B12) and folate.

Twelve outpatients, all women, who fulfilled the criteria for both chronic fatigue syndrome and fibromyalgia were rated on 15 items of the Comprehensive Psychopathological Rating Scale (CPRS-15). These items were selected to constitute a proper neurasthenic subscale.

Blood laboratory levels were generally normal. The most obvious finding was that, in all the patients, the homocysteine levels were increased in the cerebrospinal fluid. There was a significant positive correlation between homocysteine levels and fatiguability, and the levels of B12 in the cerebrospinal fluid correlated significantly with the item of fatiguability and with CPRS-15.

The correlations between vitamin B12 and clinical variables of the CPRS-scale in this study indicate that low B12 values in the cerebrospinal fluid are of clinical importance.

As a follow up open trial, 10 of the patients accepted injective therapy with 1 mg hydroxocobalamin each week for at least three months. The treatment effect was significantly more beneficial if the patient did not carry the thermolabile allele of the polymorphic gene methylenetetrahydrofolate reductase (MTHFR).

In the investigated group of patients, we conclude that vitamin B12 deficiency is probably contributing to the increased homocysteine levels and that the effect of vitamin B12 supplementation is dependent on whether or not the available methyl groups are further deprived by the existence of thermolabile MTHFR.