Transcript Chronic Fatigue Syndrome in Conventional Medicine

Chronic Fatigue
Syndrome/Myalgic
Encephalomyelopathy
Christopher Chiu MRCP PhD
Introduction
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Common condition
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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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Causes
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Genetic
– More common within families
– More likely in identical twins
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Infectious
– Many pathogens linked
– Chronic or post-infective
Endocrine
 Psychosocial
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Definitions
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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
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Impaired memory/concentration
Postexertional malaise
Unrefreshing sleep
Muscle pain
Multijoint pain without swelling/redness
Headaches of new type/severity
Sore throat
Tender lymph nodes
NICE guidelines 2007
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Additional symptoms
– Dizziness
– Nausea
– Palpitations
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Symptoms fluctuate & change over time
Signs of other serious conditions
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Neurological signs
Inflammation of joints
Heart/lung disease
Weight loss
Enlarged lymph nodes
Other causes of fatigue
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Infectious
– EBV, CMV, HHV-6, HIV,
Influenza
– Lyme disease, TB
– Toxoplasmosis
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Endocrine
– Hypothyroidism
– Diabetes
– Adrenal disease
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Vitamin deficiency
– B12, folate, D, iron
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Haematologic
– Anaemia
– Occult malignancy
Autoimmune
 Psychiatric
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Diagnosis
History
 Examination
 Urinalysis
 Blood tests
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– Liver & thyroid function tests
– Glucose
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Radiology
Management
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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
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
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Not recommended
Most drugs
 Unstructured vigorous exercise
 Prolonged/complete daytime rest
 Rigid schedule of activity & rest
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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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