This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Neurology  • Musculoskeletal Syndromes (Chronic Fatigue, Gulf War)  • Alert me on articles by topic

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: While the study by Dr Blacker and colleagues¹ demonstrates that galantamine is not an effective treatment for persons with chronic fatigue syndrome (CFS), I do not believe that this negative outcome represents an appropriate test of the cholinergic hypothesis in the pathogenesis of CFS.

Soreq and Seidman² and Brenner et al³ have demonstrated in animal models of posttraumatic stress disorder and in Gulf War syndrome (a possible syndromic relative of CFS) that cholinergic neurons produce sustained and excessive amounts of AChE-R, an altered soluble variant of acetylcholinesterase. There is evidence that the sustained production of AChE-R derails the cholinergic neurons from performing their normal "signal-to-noise ratio" determination role in healthy brain function.⁴ If there is a cholinergic contribution to the pathogenesis of CFS, it would likely be the dysregulated production of AChE-R. The failure of galantamine to favorably influence the outcome of this syndrome could then . . . [Full Text of this Article]

Peter V. Madill, MD
pmadill@cds1.net
Sebastopol, Calif