Chronic Fatigue Syndrome/Myalgic Encephalomyelopathy

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Chronic Fatigue Syndrome/Myalgic
Encephalomyelopathy

• Christopher Chiu MRCP PhD

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Introduction

• Common condition
• 1 in 250 sufferers
• 80 undiagnosed
• More common in women middle-aged/elderly
• Cause unclear despite gt3000 research papers
• Causes
• Definitions
• Other causes of fatigue
• Treatments

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Causes

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

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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

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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

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Other causes of fatigue

• 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

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Diagnosis

• History
• Examination
• Urinalysis
• Blood tests
• Liver thyroid function tests
• Glucose
• Radiology

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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

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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