Chronic Fatigue Syndrome
What Is It?
Chronic fatigue Syndrome (CFS)
is a debilitating illness that is characterized by at
least six months of fatigue (feeling extremely tired or
exhausted), together with impaired concentration or
memory, and variable physical signs and symptoms. In
many patients with CFS, the disorder begins suddenly,
often following a flu-like infection or an episode of
physical or psychologic trauma (i.e., surgery, a
traumatic accident or the death of a loved). In other
cases, CFS develops gradually.
Many physicians look for the
fatigue to be severe enough to cause a greater than 50
percent reduction in usual activities. Currently, the
exact cause of chronic fatigue syndrome remains a
mystery. Although the illness sometimes occurs after an
infection with B. burgdorferi (Lyme disease bacteria) or
an episode of infectious mononucleosis, there is no
proof that these infections actually cause CFS. In a
similar way, efforts to link CFS to immune system
problems or to allergies have also been unsuccessful. So
far, the most promising theory describes CFS as a
multi-system disorder that disturbs the complex
relationship between the hypothalamus (a part of the
brain that regulates hormones and vital functions) and
the pituitary and adrenal glands. This theory is
supported by recent studies that link some people with
CFS to a form of neurally mediated hypotension
(abnormally low blood pressure caused by a brain/nerve
problem).
Worldwide, cases of CFS have
been reported in North America, Europe, Australia,
Russia, Africa and elsewhere. In the United States,
federal health authorities estimate that CFS currently
affects four to 10 of every 100,000 Americans older than
age 18, with women afflicted twice as often as men.
Although the illness is most common in people 25 to 45
years old, CFS can attack patients of all age groups,
including children.
In general, most cases of CFS
are sporadic, affecting isolated individuals; however,
at least 30 outbreaks of CFS have also been reported,
during which many patients suddenly developed the
illness at the same time. Again, despite the larger
numbers of patients involved in these outbreaks, health
experts have failed to identify one specific cause for
their CFS symptoms.
Symptoms
The most prominent symptom of
chronic fatigue syndrome is a persistent, unexplained
feeling of fatigue, which is not relieved by rest. This
fatigue must be severe enough to decrease the patient's
activity level at home, work or school.
Besides fatigue, patients with
CFS should have at least four more symptoms from the
following list, and these four symptoms must persist for
at least six months:
· Impaired
concentration or short-term memory. This impairment is
severe enough to affect routine activities at home,
work, school or social functions.
· Sore
throat.
· Enlarged
lymph nodes (swollen glands) in the neck or underarm
area.
· Muscle
pain.
· Pain
in several joints, with no redness or swelling.
· Headaches
which are "different" in some way. This may
mean a new type of headache pain, a new pattern of
headaches or headaches that are more severe than
before.
· Sleep
that doesn't refresh. On waking, the patient doesn't
feel rested.
· An
extreme reaction to exertion. After an episode of
exertion (exercise, strenuous activity at home or at
work), the patient feels sick for 24 hours or more.
Although patients with CFS can
have other symptoms that are not listed above, these
symptoms are not part of the official definition of CFS.
For example, 60 percent to 80 percent of patients with
CFS have symptoms of some type of psychiatric illness,
especially depression. Some investigators of chronic
fatigue syndrome do not use this term if there is any
active psychiatric illness, reserving CFS only for those
without symptoms of depression, anxiety or somatization
disorders. Others have symptoms of severe allergies,
allergic rhinitis or sinusitis.
What Your Doctor
Looks For
Your doctor will look for a
history of persistent, severe fatigue, together with the
CFS symptoms listed above. Your doctor also will ask
about symptoms of other illnesses that can be confused
with chronic fatigue syndrome, including:
hypothyroidism; adrenal insufficiency; cardiac
disorders; sleep apnea or narcolepsy; side effects of
medications; cancer; hepatitis B or C; certain
psychiatric illnesses, especially including major
depression, bipolar affective disorder, schizophrenia or
delusional disorders; dementia; the eating disorders,
anorexia nervosa or bulimia; drug abuse, including
alcohol abuse; and severe obesity.
Diagnosis
Currently, there is no
laboratory test or procedure to confirm the diagnosis of
CFS. Until a better way is found, doctors must diagnose
CFS by exclusion - by eliminating all other illnesses as
the cause of a patient's symptoms. Once all other
illnesses are excluded, the best possible explanation is
CFS.
As part of this process of
exclusion, your doctor will perform a physical
examination and a mental status examination. He or she
will also order some basic screening laboratory tests,
including: urinalysis; complete blood count, with
differential; erythrocyte sedimentation rate (ESR); and
blood chemistry tests to measure levels of glucose
(blood sugar), protein, albumin, globulin, calcium,
phosphorus, and other blood chemicals. In addition, your
doctor will order blood tests to measure liver enzymes
(to evaluate liver function and/or liver damage), as
well as thyroid tests. Additional, more specialized
testing may be ordered by the physician, including
tilt-table testing to look into whether neurally-mediated
hypotension exists.
Expected
Duration
By definition, symptoms of CFS
must persist for at least 6 months. In many patients,
symptoms persist for several years, but are worst in the
first one to two years.
Prevention
Since the cause of CFS remains
unknown, there is currently no way to prevent it.
Treatment
There is no specific treatment
regimen to treat CFS. In general, doctors use a
combination of the following:
· Lifestyle
changes - The patient is encouraged to slow down and
to avoid physical and psychologic stress. They learn
to save their energy for essential activities at home
or work and to cut back on less important activities.
· Resuming
exercise gradually but steadily with the help of a
physical therapist, the patient begins an exercise
program where physical activity is increased
gradually.
· Treating
existing psychiatric problems - Psychiatric problems
can be treated with medication, cognitive behavioral
therapy or a combination of the two. For patients with
depression, tricyclic antidepressants (amitriptyline,
desipramine, nortriptyline and others) or selective
serotonin reuptake inhibitors (the SSRIs) may help.
· Treating
existing pain - Aspirin, acetaminophen or nonsteroidal
anti-inflammatory drugs are used to treat headaches,
muscle pain and joint pain.
· Treating
existing allergy symptoms - Antihistamines and
decongestants are used to treat allergy symptoms.
· Experimental
therapies - Researchers who believe that CFS is caused
by neural hypotension have reported some success in
treating CFS with fludrocortisone, beta-adrenergic
blocking agents and other medications that prevent low
pulse and blood pressure.
When To Call Your
Doctor
Call your doctor if you have
symptoms of CFS, especially if extreme fatigue prevents
you from fully participating in activities at home, work
or school.
Prognosis
Patients with CFS usually
experience their most severe symptoms within the first
one to two years of illness. After that time, a small
number of patients recover totally, and a small number
become totally incapacitated. For most patients, there
is gradual improvement, although they usually do not
achieve their pre-illness level of activity.
Last updated December 28, 1999(Intelihealth-John's
Hopkins Health Information)
Additional Info
For more information about
chronic fatigue syndrome, you can contact:
National Institute of Allergy
and Infectious Disease
Office of Communications
Building 31, Room 7A-50
31 Center Drive MSC 2520 Bethesda, MD 20892-2520
www.niaid.nih.gov
Centers for Disease Control and
Prevention
1600 Clifton Rd., NE
Atlanta, GA 30333
Telephone: (404) 639-3311
www.cdc.gov
American Association for
Chronic Fatigue Syndrome
7 Van Buren Street
Albany, NY 12206
Telephone: (800) 232-8710
weber.u.washington.edu/~dedra/aacfs1.html
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