What is Chronic Fatigue Syndrome?
Chronic Fatigue Syndrome (CFS), which is also sometimes referred to as Chronic
Fatigue Immune Dysfunction Syndrome (CFIDS) or Myalgic Encephalomyelitis (M.E.),
is a condition characterized by the primary symptom of a prolonged, persistent
debilitating fatigue not relieved by rest and not directly caused by other
conditions. In general, a diagnosis for CFS requires that the tiredness is
severe enough for at least a 50% decrease in the patient’s ability to
participate in ordinary activities. The Centers for Disease Control (CDC)
describes CFS as a distinct disorder with specific symptoms and physical signs,
based on the exclusion of other possible causes.
What causes CFS?
The exact cause of CFS is unknown. A distinct or direct cause has not been
positively identified.
Some studies have shown that Chronic Fatigue Syndrome may be caused by
inflamed nervous system pathways, Mycoplasma bacterial infection, or viral
illness (such as Epstein-Barr) complicated by an inadequate or dysfunctional
immune response. For some, the condition can occur following an injury,
infection preceding or following surgery (e.g., peritonitis), or other traumatic
body events that weakens or adversely affects the immune system. Age,
environment, genetic disposition, prior illness, or stress may also be factors.
Like most autoimmune illnesses, CFS most commonly occurs in women, usually ages
30 to 50.
Symptoms of CFS
What are the symptoms of CFS?
Many of the symptoms of CFS are similar to those associated with the flu
(muscle aches, headache, and fatigue). However, unlike the flu, while with CFS
these symptoms may ebb and flow, they never go away. (Imagine dealing with flu
symptoms on a daily basis and you know how someone with CFS feels on a good
day.)
What are the primary symptoms of CFS?
Primary symptoms include:
- New onset fatigue or tiredness that lasts for at least 6 months and is
not relieved by normal rest
- Full-body fatigue serious enough to restrict normal activity that
develops from far less exertion than was possible before the illness
What other symptoms are sometimes present?
Additional symptoms include:
What is the difference between CFS and "chronic fatigue"?
Chronic Fatigue Syndrome (ICD10-CM or WHO ICD-10 G93.3) has a different
medical diagnostic code than idiopathic Chronic Fatigue (WHO F48.O).
There are different symptom requirements used to diagnose these different
entities.
Chronic Fatigue Syndrome and chronic fatigue are sometimes incorrectly used
as synonymous, when in actuality they are two entirely different diagnoses.
Chronic fatigue is often a symptom of other conditions, such as Chronic Fatigue
Syndrome, depression, and so forth.
Patients can sometimes get relief from the chronic fatigue that accompanies
other conditions. As the condition causing the chronic fatigue improves, the
chronic fatigue lessens.
At present, there is no cure (complete relief) from Chronic Fatigue Syndrome.
CFS Tests
Everybody gets tired! How is the fatigue of CFS different?
The fatigue of CFS is all-encompassing. It involves not only the feeling of
having gone without rest (even after getting a full night’s sleep, for those
that fortunate; disrupted or irregular sleep patterns is often another side
effect of CFS), the fatigue includes muscle weakness, cognitive impairment, and
ongoing headaches of varying degrees.
Tests have shown that many CFS victims already start off with a
lower-than-normal oxygen level in the brain, and exercise, instead of increasing
it, actually makes it go lower. In addition, studies such as those noted in a
2004 article Muscle Metabolism with blood flow restriction in Chronic Fatigue
Syndrome in the Journal of Applied Physiology have shown that blood
flow to the muscles is also altered.
Melissa Kaplan
describes this by saying that “the body reacts to even mild exercise, like a
short walk, as if it has run a marathon on top of working an 80-hour week:
extreme pain, fatigue, cognitive dysfunction...and it lasts for 36-48 hours.”
What are some of the tests for CFS?
Physical examination is usually conducted to confirm the fever, lymph node
tenderness, lymph node swelling, or other symptoms, but often examination alone
is not considered conclusive.
A health care provider can deduce a diagnosis of CFS only after ruling out
all other known possible causes of fatigue, such as:
- Drug dependence
- Endocrine diseases (such as hypothyroidism)
- Infections
- Muscle or nerve diseases (such as multiple sclerosis)
- Other illnesses (such as heart, kidney, liver diseases)
- Other immune or autoimmune disorders
- Psychiatric or psychological illnesses, particularly depression (because
the severe fatigue of CFS itself may bring about depression, a diagnosis of
depression does not rule out CFS; however, fatigue related to depression
alone must be ruled out in order for CFS to be diagnosed)
- Tumors
What symptoms must be present for a CFS diagnosis?
A diagnosis of CFS must include:
- Absence of other causes of chronic fatigue (excluding depression when
other symptoms are present)
- At least 4 of the other symptoms listed
- Extreme, prolonged fatigue
There are no specific tests to confirm the diagnosis of CFS; however, a
variety of tests are usually conducted in order to exclude other possible causes
of the symptoms.
Note: In order to rule out muscle or nerve diseases and/or psychiatric or
psychological illnesses, a complete neuro-psych exam may be a part of the
diagnosis process.
Some typical findings on tests that, while not specific enough to diagnose
CFS, are seen consistently in people who are eventually diagnosed with the
disorder. These include:
- Brain MRI that shows evidence of swelling in the brain or destruction of
some of the nerve cells (demyelination)
- Higher levels of specific CD4 T white blood cells compared to other
types of white blood cells (e.g., CD8 T cells)
- Specific white blood cells (lymphocytes) containing active forms of EBV
or HHV-6
What treatment is available for CFS?
At present, no treatment has been proven to be effective as a way to cure CFS.
Rather than hope for a cure, the symptoms are treated instead. Many people with
CFS experience depression and other psychological problems that may improve with
treatment.
Some of the proposed treatments include:
- Antianxiety drugs to treat anxiety
- Antidepressant drugs to treat depression
- Antiviral drugs, such as acyclovir
- Drugs to fight "hidden" yeast infections, such as nystatin
- Medications to reduce pain, discomfort, and fever
Unfortunately, for many with CFS, medications can cause adverse reactions or
side effects that are worse than the original symptoms of Chronic Fatigue
Syndrome.
While patients with CFS are encouraged to maintain active social lives, and
mild physical exercise may also be helpful, for many this isn’t possible.
What long-term effects should somebody with CFS expect? (In other words:
What is the prognosis?)
The long-term outlook for patients with CFS is difficult to predict at the
initial onset. Some patients have been reported to completely recover after six
months to a year. Others may take longer for a complete recovery. Some never
recover or return to pre-illness energy and wellness levels.
What are the complications of CFS?
CFS causes what might be considered lifestyle restrictions. For people for
whom the fatigue is so severe or unpredictable that they are essentially
disabled and homebound during much of the course of the illness, this leads to
social isolation and an inability to maintain steady employment.
What should I do if I suspect I have CFS?
Call for an appointment with your health care provider if you experience
persistent, severe fatigue, with or without other symptoms of CFS. Remember:
There are other serious disorders that can cause similar symptoms; those need to
be excluded.
Note:
Canadian CFS Diagnostic Code
Because of the efforts of
The Myalgic Encephalomyelitis Association of Ontario, Dr. Alison Bested, and
others, Chronic Fatigue Syndrome (CFS) now has an official diagnostic code (OHIP
Diagnostic Code 795) by the Ontario Medical Association as a Neurological
Illness. According to information on the
The National ME/FM Action Network, the association had hoped to get "Myalgic
Encephalomyelitis (ME)" included in the diagnostic code definition, but they're
celebrating the success all the same.
Copyright © 2004-2006 Pamela Rice Hahn
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