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Chronic Fatigue Syndrome/Myalgic Encephalomyelopathy

Chronic Fatigue Syndrome/Myalgic Encephalomyelopathy. Christopher Chiu MRCP PhD. Introduction. Common condition 1 in 250 sufferers 80% undiagnosed More common in women & middle-aged/elderly Cause unclear despite >3000 research papers Causes Definitions Other causes of fatigue Treatments.

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Chronic Fatigue Syndrome/Myalgic Encephalomyelopathy

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  1. Chronic Fatigue Syndrome/Myalgic Encephalomyelopathy Christopher Chiu MRCP PhD

  2. Introduction • Common condition • 1 in 250 sufferers • 80% undiagnosed • More common in women & middle-aged/elderly • Cause unclear despite >3000 research papers • Causes • Definitions • Other causes of fatigue • Treatments

  3. Causes • Genetic • More common within families • More likely in identical twins • Infectious • Many pathogens linked • Chronic or post-infective • Endocrine • Psychosocial

  4. Definitions • Center for Disease Control • Unexplained, persistent fatigue not due to ongoing exertion, not substantially relieved by rest, of new onset and resulting in significant reduction in previous levels of activity AND • Four or more for 6 months or more • Impaired memory/concentration • Postexertional malaise • Unrefreshing sleep • Muscle pain • Multijoint pain without swelling/redness • Headaches of new type/severity • Sore throat • Tender lymph nodes

  5. NICE guidelines 2007 • Additional symptoms • Dizziness • Nausea • Palpitations • Symptoms fluctuate & change over time • Signs of other serious conditions • Neurological signs • Inflammation of joints • Heart/lung disease • Weight loss • Enlarged lymph nodes

  6. Infectious EBV, CMV, HHV-6, HIV, Influenza Lyme disease, TB Toxoplasmosis Endocrine Hypothyroidism Diabetes Adrenal disease Vitamin deficiency B12, folate, D, iron Haematologic Anaemia Occult malignancy Autoimmune Psychiatric Other causes of fatigue

  7. Diagnosis • History • Examination • Urinalysis • Blood tests • Liver & thyroid function tests • Glucose • Radiology

  8. Management • Acknowledgement of the condition • Shared decision-making • No known pharmacological treatment • Symptom relief if necessary • Sleep management • Rest periods & relaxation techniques • Diet • Attempt to maintain work/education • Graded Exercise Therapy

  9. Cognitive Behavioural Therapy • Individualised programme • Psychological therapy • Used widely in other settings including cardiac rehab & diabetes management • Addresses situations can cause thoughts, actions & feelings that perpetuate problems

  10. Not recommended • Most drugs • Unstructured vigorous exercise • Prolonged/complete daytime rest • Rigid schedule of activity & rest

  11. Conclusion • CFS/ME is difficult to diagnose & treat • Underlying causes are not known • Important to rule out other severe conditions • May have prolonged course with relapses • Most improve over time & return to work

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