chronic fatigue syndrome

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chronic fatigue syndrome

(CFS), collection of persistent, debilitating symptoms, the most notable of which is severe, lasting fatigue. In other countries it is known variously as myalgic encephalomyelitis (ME), chronic fatigue and immune dysfunction syndrome, and postviral fatigue syndrome. It may have been first recognized as a syndrome in the 1860s by George Beard, who used the term neurasthenianeurasthenia
, condition characterized by general lassitude, irritability, lack of concentration, worry, and hypochondria. The term was introduced into psychiatry in 1869 by George M. Beard, an American neurologist; he believed it to be a neurosis with a fatigue component.
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 to described what he believed to be a neurosis with a fatigue component. Definitions and theories of its cause have changed over the years; many cases have been misdiagnosed as imaginary because doctors could find no cause. In the mid-1980s it came to the public's attention, as affluent women in their thirties began to seek treatment. (For unknown reasons, more women than men seek treatment for the disease.)

Symptoms and Identification

As currently defined, chronic fatigue syndrome is the presence of severe, disabling fatigue lasting for six or more consecutive months. The fatigue is persistent or relapsing, and is new (i.e., not lifelong), not relieved by rest, not the result of ongoing exertion, and interferes with normal work, social, educational, or personal activities. Diagnosis also requires at least four of the following symptoms, each persistent or recurring and not present before the fatigue: impairment of short-term memory or concentration, sore throat, tender lymph nodes in the neck or axillary region, muscle pain, joint pain, headaches peculiar to the syndrome, unrefreshing sleep, and malaise of more than one day's duration following exertion. Chronic fatigue that does not meet all these criteria is termed "idiopathic fatigue."

The course of the disease varies. Many people first experience symptoms after a cold or bout of the flu. Most people reach a plateau early on; the symptoms come and go with varying severity afterward. Some experience complete remission; others have their symptoms indefinitely.

There are no specific diagnostic tests. Diagnosis must first rule out known causes of fatigue such as hypothyroidism, cancer, multiple sclerosis, and major depression with psychotic or melancholic features (e.g., schizophrenia, bipolar disorder). Chronic fatigue syndrome and nonpsychotic, nonmelancholic depression, however, are not mutually exclusive. Substance abuse and side effects of prescribed medications must also be eliminated as possible causes.

Cause and Treatment

There is no known single cause of CFS. Some authorities believe it is a condition shared by many different underlying diseases rather than an entity unto itself; others believe it is caused by a defect of the immune system. Hormonal deficits, low blood pressure, and viral infections have been studied as possible causes or contributors. The postulated causal link with Epstein-Barr virusEpstein-Barr virus
(EBV), herpesvirus that is the major cause of infectious mononucleosis and is associated with a number of cancers, particularly lymphomas in immunosuppressed persons, including persons with AIDS.
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 hypothesized in the mid-1980s has been discounted. In 2009 researchers announced that they had found xenotropic murine-leukemia-virus-related virus (XMRV) in many patients with CFS, but the study did not show that XMRV was linked to CFS. Other studies failed to replicate its findings, and the paper was later retracted.

There is no definitive treatment for CFS, although success has been reported anecdotally with antidepressants, antianxiety medications, antivirals, and immune boosters. Symptomatic treatment for the muscle and joint pains is helpful in some cases, as are psychological and physical therapies. Counseling and peer support groups may help some patients cope with the frustrating nature of the disease. A British study reported in 2012 that cognitive behavioral therapy and graded exercise therapy were the most successful and cost-effective treatments, but other have asserted that that assessment significantly overstating the results of the study.

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The major and minor criteria follow with the point scores indicated in parentheses.
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2,6-8,10) A positive diagnosis can be reached when patients have either (1) 2 major criteria, (2) 1 major and 2 minor criteria, or (3) 4 minor criteria.
Minor criteria Predisposing heart condition (known or found on echocardiograph) Fever, temperature >38[degrees]C Vascular phenomena, major arterial emboli, septic pulmonary infarcts, mycotic aneurysm (see at PET scan), intracranial hemorrhage, conjunctival hemorrhages, and Janeway lesions Immunologic phenomena: glomerulonephritis, Osle nodes, Roth spots, or rheumatoid factor Serologic evidence: IgG I antibodies [greater than or equal to] 800 <6,400 Diagnosis definite 1.
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