Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
In Reply: My colleagues and I were not proposing
that our study was an exhaustive test of cholinergic mechanisms. However,
anticholinesterases are now being used increasingly widely to treat other
neurocognitive disorders such as traumatic brain injury and Parkinson disease.
This, coupled with other observations in CFS, such as marked sensitivity to
the anticholinergic adverse effects of tricyclic antidepressants, findings
of cognitive impairment, and previous positive (and negative) trials involving
both bethanechol and galantamine, led to a hypothesis that our many coinvestigators
found persuasive. Our finding that these patients had measurable cognitive
impairment that did not show a response to an anticholinesterase is an invitation
for further research; we await a trial such as that recommended by Dr Madill.
Blacker CVR. Chronic Fatigue Syndrome and the Cholinergic Hypothesis—Reply. JAMA. 2004;292(22):2723. doi:10.1001/jama.292.22.2723-b