Date sent: Fri, 12 Jan 2001 ORIGINAL RESEARCH Vegetative-Vascular Dystonia and Osteoalgetic Syndrome or Chronic Fatigue Syndrome as a Characteristic After-Effect of Radioecological Disaster: The Chernobyl Accident Experience Journal of Chronic Fatigue Syndrome, Vol. 7(3) 2000, pp. 3-16 Konstantin N. Loganovsky, MD, PhD (Cand. Med. Sci.) Konstantin N. Loganovsky is Leading Scientist, Neurology Department, Institute of Clinical Radiology, Scientific Center for Radiation Medicine, Academy of Medical Sciences of Ukraine, WHO Collaborating Center for Radiation Accident Management, 53 Melnikov Street, 04050, Kiev-50, Ukraine (E-mail: kosti@morion.kiev.ua). The author expresses cordial thanks for creative advice and the support of Professor Pierre Flor-Henry (Canada). ABSTRACT. The aim of this study was to determine whether the Chronic Fatigue Syndrome (CFS) definition could be applicable to the assessment of the medical aftermath of radioecological disasters and to investigate a possible psychophysiological basis of fatigue in Chernobyl accident survivors. One hundred randomly selected clean-up workers of the Chernobyl accident who presented with complaints of fatigue were examined neuropsychiatrically using MMPI profiles, Quantitative Electroencephalography (QEEG) and Somatosensory evoked potentials (SSEP). Twenty-six percent of them met the CFS diagnostic criteria. Their absorbed radiation doses were less than 0.3 Sv, an exposure level that is not expected to produce a clear deterministic radiation effect. Clinical symptomatology included persistent fatigue, odd skin sensations, bizarre feelings in bones, muscles and joints, irritability, headache, vertigo, pain in the chest area, emotional lability, irritability, lack of concentration and memory, cognitive deterioration, depression signs and sleep disorders. Liquidators with CFS had the characteristic MMPI profile with increased hypochondria, depression, clear hypochondria, schizophrenia, hysteria, psychasthenia, and bizarre sensory perception scales. Spectral analysis of QEEG showed lateralised (left-sided) increase of O-power (P < 0.001) and lateralised (left-sided) decrease of alpha-power (P < 0.001) and lateralised (left-sided) increase of beta-power (P < 0.01). SSEP were characterized by increased latencies and decreased amplitudes. SSEP significantly differed by topographic abnormalities in the left temporoparietal area in liquidators with CFS. Associations between schizophrenia-like, hypochondriac and psychasthenic psychopathology and an increase of latency of SSEP P300 and N400 in liquidators with CFS were revealed. Thus, “Vegetative-Vascular Dystonia” and “Osteoalgetic Syndrome” cases following exposure to ionizing radiation as a result of the Chernobyl accident can be classified as CFS cases. The psychophysiological basis of fatigue in liquidators consists of dysfunction of the cortico-limbical structures of the left, dominating, hemisphere. CFS is one of the most important consequences of radio-ecological disaster, which results from an interaction of different hazardous environmental factors. KEYWORDS. Chronic Fatigue Syndrome, Vegetative-Vascular Dystonia, Osteoalgetic Syndrome, ionizing radiation, Chernobyl accident, radloecological disaster INTRODUCTION Health after-effects of exposure to ionizing radiation, especially by ;mall doses (those that do not provoke radiation sickness), in the former USSR were conceptualized as “Vegetative-Vascular Dystonia” (Autonomous Nervous System Dysfunction) and “Osteoalgetic syndrome” (if chronic exposure with osteotropic radionuclides incorporation occurs) on the basis of studies of the medical aftermath of ~radioecological disasters in the radiochemical industry. Fatigue, headache, palpitations, osthealgia, myalgia, arthralgia, difficulty concentrating, dizziness, heat/cold intolerance, mood swings, diaphoresis, depression, anxiety, seizures were among the characteristic symptoms for these disorders (1-3). Fatigue, physical anergia, headache, lumbago, neuralgia, myalgia, arthralgia are also typical for Atomic bomb survivors in Hiroshima and Nagasaki. These symptoms were integrated in “Genbaku Bura Bura Disease—Atomic Bomb Chronic Disease” of radiation, and are not psychogenic in origin (4-5). It should be noted that even now the terminology Vegetative-Vascular Dystonia is commonly used in the countries of the former USSR. This diagnosis refers to etiologically heterogeneous abnormalities of the diencephalic-limbic-reticular complex, which manifest with lability of heart rate and blood pressure, diaphoresis, headache, chest pain, back pain, pain in limbs, vertigo, fatigue, weakness, irritability, affective lability, anxiety, memory and concentration deterioration, sleep disorders, and meteotropia. Vegetative-Vascular Dystonia was the first typical diagnosis seen among Chernobyl accident survivors (6). Experts of the International Chernobyl Project (IAEA, 1992) stressed the differences between diagnoses of mental and nervous system disorders in the USSR and Western countries. In this respect, terms, such as 'Vegetative-Vascular Dystonia,' are not accepted in the West, where such disorders are usually classified as post-traumatic stress disorder (PTSD), anxiety, depression or somatoform disorders. According to the opinion of the IAEA experts, USSR medical doctors are physiologically- and neurologically-oriented in their diagnosis of mental disorders whereas medical practitioners of other countries aim to classify symptoms on empirical and pragmatic base (7). However, the latter interpretation results in an underestimation of the health effects of ionizing radiation and an overestimation of the role of psychogenic traumatization following nuclear accidents. The Russian conception of 'Vegetative-Vascular Dystoni' in irradiated patients is closer to Penfield’s 'Diencephalic Autonomic Epilepsy,' with a paroxysmal activity focus at the hypothalamus, and to the etiologically heterogeneous radiation-psychogenic 'Diencephalosis,' which was described in Atomic bomb survivors who developed Acute Radiation Sickness (8-10). The incidence and prevalence rate of Vegetative-Vascular Dystonia among radiation-exposure survivors is significantly higher than those of the general population. Moreover, Vegetative-Vascular Dystonia among survivors is associated with endocrine and immune disorders. However, such disorders are underestimated and misinterpreted by a majority of Western experts as somatoform disorders resulting from psychological stress only. To bridge the gap between East and West, we proposed, at the International Conference 'The Effects of Low and Very Low Doses of Ionizing Radiation on Human Health,' June 16-18, 1999, University of Versailles, World Council of Nuclear Workers (ii), that Chronic Fatigue Syndrome (CFS) is one of the most important health problems among Chernobyl accident survivors, a malady which could be triggered by low and very low doses of ionizing radiation together with psychoemotional stress. The data of this study was also kindly preliminary presented by Prof. Pierre Flor-Henry (Alberta Hospital Edmonton, Canada) as a poster at the 10th World Congress of the International Organization of Psychophysiology (lOP), Sydney, Australia, 8-13 February, 2000 (12). CFS is characterized by unexplained persistent fatigue, myalgia, headache, cognitive, emotional and other disorders. The diagnosis of CFS is based on a number of clinical criteria and the exclusion of other diseases (13-15). CFS is a systemic disease with dysfunction of the main regulatory systems, nervous, endocrine and immune and a predominance of cortico-limbic and hypothalamic-pituitary-adrenal axis abnormalities. Dysfunction of the hypothalamic-pituitary-adrenal axis and of the sympathetic component of the autonomic nervous system provide a reaction to stress, are the keypoints for understanding CFS symptomatology. The aim of this study was to determine whether the CFS definition could be applicable to the medical aftermath symptomatology seen after radioecological disasters and to investigate the possible psychophysiological basis of fatigue among Chernobyl accident survivors. ____________________ © 2000 by The Haworth Press, Inc. All rights reserved.