Chronic Fatigue Syndrome (CFS)

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, chronic fatigue and immune dysfunction syndrome, and postviral fatigue syndrome. It was first recognized as a syndrome in the 1860s by Dr. George Beard, who called it neurasthenia. He believed it 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, manic-depression). 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 virus hypothesized in the mid-1980s has been discounted.

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. Counseling and peer support groups help some patients cope with the frustrating nature of the disease.

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