Chronic fatigue syndrome, or CFS, is a debilitating and complex disorder characterized by profound fatigue that is not improved by bed rest and that may be worsened by physical or mental activity. Persons with CFS most often function at a substantially lower level of activity than they were capable of before the onset of illness.
In addition to these key defining characteristics, patients report various nonspecific symptoms, including weakness, muscle pain, impaired memory and/or mental concentration, insomnia, and post-exertional fatigue lasting more than 24 hours. In some cases, CFS can persist for years. The cause or causes of CFS have not been identified and no specific diagnostic tests are available.
Moreover, since many illnesses have incapacitating fatigue as a symptom, care must be taken to exclude other known and often treatable conditions before a diagnosis of CFS is made.
Chronic Fatigue Syndrome Defined
A great deal of debate has surrounded the issue of how best to define CFS.
Similar Medical Conditions
A number of illnesses have been described that have a similar spectrum of symptoms to CFS.
How Common Is CFS?
The study estimated that between 4.0 and 8.7 per 100,000 persons 18 years of age or older have CFS and are under medical care.
Who Gets CFS?
There is now evidence that CFS affects all racial and ethnic groups and both sexes.
Is CFS Contagious?
Contagious diseases typically occur in well-defined clusters, otherwise known as outbreaks or epidemics.
Clinical Course of CFS
This knowledge is required to facilitate communication between physicians and patients, to evaluate possible new treatments, and to address insurance and disability issues.
Infectious Agents
Due in part to its similarity to chronic mononucleosis, CFS was initially thought to be caused by a virus infection, most probably Epstein-Barr virus.
Immunology
It has been proposed that CFS may be caused by an immunologic dysfunction, for example inappropriate production of cytokines.
Hypothalamic-Pituitary Adrenal (HPA) Axis
Multiple laboratory studies have suggested that the central nervous system may have an important role in CFS.
Neurally Mediated Hypotension
Persons with NMH will develop lowered blood pressure under these conditions, as well as other characteristic symptoms, such as lightheadedness, visual dimming, or a slow response to verbal stimuli.
Nutritional Deficiency
Many patients do report intolerances for certain substances that may be found in foods or over-the-counter medications, such as alcohol or the artificial sweetener aspartame.
Diagnose CFS
If a patient has had 6 or more consecutive months of severe fatigue that is reported to be unrelieved by sufficient bed rest and that is accompanied by nonspecific symptoms, including flu-like symptoms, generalized pain, and memory problems, the physician should further investigate the possibility that the patient may have CFS.
Test for CFS
While the number and type of tests performed may vary from physician to physician, the following tests constitute a typical standard battery to exclude other causes of fatiguing illness.
Non-Pharmacologic Therapy
An appropriate amount of physical activity is required by everyone for physical and emotional well-being.
Pharmacologic Therapy
Pharmacologic therapy is directed toward the relief of specific symptoms experienced by the individual patient. Patients with CFS appear particularly sensitive to many medications, especially those that affect the central nervous system.
Prescription Medications
These drugs can be used to relieve pain in CFS patients. Some are available as over-the-counter medications.
Experimental Drugs and Treatments
Ampligen, Gamma Globulin, Corticosteroids, Dehydroepiandrosterone, High Colonic Enemas, Kutapressin, and Neurosurgery.
Dietary Supplements and Herbal Preparations
A variety of dietary supplements and herbal preparations are claimed to have potential benefits for CFS patients.
CFS Education
Learning about what CFS is and what it is not is a critical component of therapy. |
