What is chronic fatigue syndrome ( CFS )?
Chronic fatigue syndrome (CFS) is a syndrome diagnosis in late 1980 was introduced by the United States Centers for Disease Control and Prevention (CDC) following two disease outbreaks in the United States. It is suspected that these two outbreaks of the disease were myalgic encephalomyelitis.
In a portion of the medical literature, the ME and CVS diagnoses were then used interchangeably. Later appeared new definitions of CFS and gradually shifted its meaning. In ICD-10-CM CVS now under unexplained fatigue and malaise, which (among others) ME is excluded.
According to the CDC, the main feature of chronic fatigue exercise intolerance: a relatively small effort already leads to exhaustion, while moreover the recovery takes longer than 24 hours.
Although CVS originally only meant for scientific research, the diagnosis is now also used in clinical practice. Because CFS is just a description of symptoms, further medical examination always desired.
Chronic Fatigue Syndrome Symptoms ( CFS Symptoms )
The symptoms of CFS are several times in the scientific literature developed into criteria. The definitions differ greatly from each other.
The best known criteria, and most used, the CDC 1994 criteria. These are summarized as follows:
-Main criterion: clinically evaluated chronic fatigue that:
*unexplainable;
*continuous present, or returns repeatedly
*new, or a clear beginning, (not the whole life already present);
*not the result of constant load;
*not clearly less is by rest;
*a significant decrease in the former activity level in the field of work, study, social or personal activities as a result.
Secondary criteria: at the same time preventing at least four of the following symptoms. These symptoms all need a period of at least six consecutive months during this period persist or return again and again. They may not already have existed for the fatigue began.
*the patient indicates that he or she is a deterioration of the short-term memory or concentration that is so severe that it will experience a significant reduction in the former activity level in the field of work, study, social or personal activities result;
*sore throat;
*sensitive cervical or axillary lymph nodes;
*muscle pain;
*headache that is new in terms of form, pattern and severity;
*sleep where the patient does not equip's;
*after exercise malaise feeling that persists for more than 24 hours;
*pain in various joints without swelling or redness.
Exclusion criteria: a diagnosis of CFS can not be made when fatigue can be caused by:
*a known condition that fatigue due (must be examined);
*severe depression with psychotic or melancholic features;
*drugs with fatigue as a side effect;
*eating disorders (anorexia, bulimia or severe obesity);
*abuse of alcohol or other substances.
According to a comparative study of ME patients would not make up more than half of all individuals who meet these criteria. The authors consider neglected the importance of exercise intolerance.
History
The diagnosis of myalgic encephalomyelitis dates back to 1956 when took place shortly after another several outbreaks of the disease were observed in some autopsies inflammation in brains and spinal cord. Before that time as diagnosis (epidemic) neuromyasthenia usual. Canadian scientist Byron Hyde gives as some earlier diagnoses that describe more or less the same syndrome Atypical poliomyelitis and muscular rheumatism (Sydenham, 1681). Descriptions of the disease go, says Hyde, back to papyrus fragments of 1900 and 1400 BC.
Was diagnosed with ME - the usually omitted addition benign (noncancerous) - recorded in 1969 in the disease classification of the World Health Organization, where today it is ranked among post-viral fatigue syndrome in the chapter 'other brain disorders. In the Netherlands is used by, among others UWV of the WHO classification derived CAS code where ME is listed with the code N690 as a disease of the nervous system.
In Japan the disease is known under the name "Low natural killer cell syndrome", to a common abnormality.
After the CDC in 1994 to handle a relatively simple set of criteria for the working diagnosis "chronic fatigue syndrome" had introduced the diagnosis hit ME in scientific research into disuse; virtually all the research on this area took place since then place in people who meet these criteria for CFS. An exception to this is the work of the Nightingale Research Foundation. Since 2007 the IACFS/ME international specialists organization, echoing many patient organisations, in favour of the use of the combined designation ME/CFS.
Chronic Fatigue Syndrome Causes ( CFS Causes )
CFS is a syndrome diagnosis and thus indicates no cause. Although the diagnosis is designed to be distinguished from patients suffering from chronic fatigue syndrome, can not be ruled out that also other meet the necessary criteria. Especially if the broad CDC criteria of 1994, it is therefore not surprising that research into CFS found a deviation always occurs in only a portion of the patients studied. In a study where the Canadian stricter criteria are applied abnormally low efficiency of ATP production is measured.
Because not been systematically investigated the extent that the same patients, abnormalities can not be automatically attributed to the illness ME. A comprehensive biomedical explanation is necessary.
arise
Myalgic encephalomyelitis occurs in many cases after an acute infection, although some patients experience a slow, insidious onset. Also, blood transfusions and vaccinations have been associated with the onset of the disorder.
There is evidence for a relationship with certain common viruses, including herpes viruses such as Epstein-Barr virus, as well as enteroviruses Coxsackie B and polio viruses. In a study in 2007, 82% of the patients studied according to CFS criteria enteroviruses in gastric biopsies. Almost all patients mild chronic inflammation was detected.
Physical and mental stress can worsen the condition.
Susceptibility, treatment and prognosis
The number of persons diagnosed with CFS applies, strongly depends on the chosen definition. ME / CFS Foundation Netherlands cites extent of its audience numbers from 60,000 to 150,000 patients. Compared to ME there is a higher percentage of young people diagnosed with CFS.
There is no known cure; treatments aimed at various symptoms help some patients. Therefore, the treatment consists mainly of symptoms. In addition, there have been experiments, inter alia, with high doses of vitamin B or carnitine. Because CFS is a complex syndrome, the risk that all complaints of the patient has been attributed allowing additional diseases are missed.
It seems that those who are diagnosed early, and take plenty of rest in the acute phase of the disease and in relapse restore the most. Excessive exercise may worsen the symptoms. In a retrospective, non-comparative, unblinded study on the effect of azithromycin, an antibiotic, was indicated by 58 of 99 patients reduced their symptoms. The level of the substance acetylcarnitine in this group was also lower. The mechanism of this effect, which should be confirmed in further research, it is still not fully understood; Also, the authors give their hypotheses in response to this finding does not indicate that they expect that this effect would come by a bacterial infection. Retrospective studies in medicine only very limited evidence.
The course is variable and unpredictable. After the initial phase, the disease exhibits these in most cases, over the years, a pattern of deterioration and improvement. Most are gradually better, a significant minority remains seriously affected.
In a subgroup of patients who have an inefficient ATP production is an increase in production of these effectively. Average ATP production was improved by 44% and the clinical symptoms improved comparable. The treatment consists of raising of the substances that are involved in the ATP production and reduction of substances that impair the production.
In England, Belgium and the Netherlands have tried to treat patients with a combination of cognitive behavioral therapy and gradual activation. The assumption is that people sometimes do not know what the physical cause of the symptoms. That does not mean that the symptoms are so psychologically. Since the cause is not clear therefore, that can not be treated with cognitive-behavioral therapy. Can be handled by the negative impact of CFS. Negative consequences of fear, anger, the failure to work or school and avoid movement or just over-activity. By working on these negative effects an improvement of the symptoms can be achieved. This philosophy will include espoused by the Nijmegen Research Chronic Fatigue, which based on a biopsychosocial model works with cognitive behavioral therapy. According to an evaluation Belgian study, this approach leads to a negative effect on the operation. Another study finds positive effects on some symptoms (fatigue, mood and physical fitness) in some CFS / ME patients but did not lead to an improvement in cognitive function or quality of life. The Nijmegen model proved to be a useful screening for mental fatigue, but not CFS.
Cognitive behavior therapy (with a very different perspective) also used to facilitate learning to cope with a chronic disease and thus improve the quality of life. In CFS are some concerns, however, that better results are reported on methods such as pacing (alternation of activity and rest) and envelope (building reserve). There is no scientific research done.