Chronic fatigue syndrome

July 21, 2010 5:10:02 PM PDT
Chronic fatigue syndrome. Find out about this debilitating disease that affects millions.

About Chronic Fatigue Syndrome Information provided by the Centers for Disease Control and Prevention

Chronic fatigue syndrome, or CFS, is a debilitating and complex disorder characterized by profound fatigue that is not improved by bed rest and that may be worsened by physical or mental activity. Persons with CFS most often function at a substantially lower level of activity than they were capable of before the onset of illness.

In addition to these key defining characteristics, patients report various nonspecific symptoms, including weakness, muscle pain, impaired memory and/or mental concentration, insomnia, and post-exertional fatigue lasting more than 24 hours. In some cases, CFS can persist for years.

The cause or causes of CFS have not been identified and no specific diagnostic tests are available. Moreover, since many illnesses have incapacitating fatigue as a symptom, care must be taken to exclude other known and often treatable conditions before a diagnosis of CFS is made.

Risk Factors for CFS:

  • People of every age, gender, ethnicity and socioeconomic group can have CFS.

  • CFS affects women at four times the rate of men.

  • Research indicates that CFS is most common in people in their 40s and 50s.

  • Although CFS is much less common in children than in adults, children can develop the illness, particularly during the teen years.
Defining CFS Symptoms:
  • CFS is marked by extreme fatigue that has lasted at least six months; is not the result of ongoing effort; is not substantially relieved by rest; and causes a substantial reduction in daily activities.

  • In addition to fatigue, CFS includes eight characteristic symptoms: postexertional malaise (relapse of symptoms after physical or mental exertion); unrefreshing sleep; substantial impairment in memory/concentration; muscle pain; pain in multiple joints; headaches of a new type, pattern or severity; sore throat; and tender neck or armpit lymph nodes.

  • Symptoms and their consequences can be severe. CFS can be as disabling as multiple sclerosis, lupus, rheumatoid arthritis, congestive heart failure and similar chronic conditions. Symptom severity varies from patient to patient and may vary over time for an individual patient.
Treatment of CFS:
  • Since there is no known cure for CFS, treatment is aimed at symptom relief and improved function. A combination of drug and nondrug therapies is usually recommended.

  • No single therapy exists that helps all CFS patients.

  • Lifestyle changes, including prevention of overexertion, reduced stress, dietary restrictions, gentle stretching and nutritional supplementation, are frequently recommended in addition to drug therapies used to treat sleep, pain and other specific symptoms.

  • Carefully supervised physical therapy may also be part of treatment for CFS. However, symptoms can be exacerbated by overly ambitious physical activity. A very moderate approach to exercise and activity management is recommended to avoid overactivity and to prevent deconditioning.

  • Although health care professionals may hesitate to give patients a diagnosis of CFS for various reasons, it's important to receive an appropriate and accurate diagnosis to guide treatment and further evaluation.

  • Delays in diagnosis and treatment are thought to be associated with poorer long-term outcomes. For example, CDC's research has shown that those who have CFS for two years or less were more likely to improve. It's not known if early intervention is responsible for this more favorable outcome; however, the longer a person is ill before diagnosis, the more complicated the course of the illness appears to be.
Recovery from CFS:
  • CFS affects each individual differently. Some people with CFS remain homebound and others improve to the point that they can resume work and other activities, even though they continue to experience symptoms.

  • Recovery rates for CFS are unclear. Improvement rates varied from 8 percent to 63 percent in a 2005 review of published studies, with a median of 40 percent of patients improving during follow-up. However, full recovery from CFS may be rare, with an average of only 5 percent to 10 percent sustaining total remission.
Possible Causes of CFS:
  • Despite an intensive, nearly 20-year search, the cause of CFS remains unknown. Many different infectious agents and physiologic and psychological causes have been considered, and the search continues.

  • Much of the ongoing research into a cause has centered on the roles of the immune, endocrine and nervous systems may play in CFS. More recently, interactions among these factors are under evaluation.

  • Genetic and environmental factors may play a role in developing and/or prolonging the illness, although more research is needed to confirm this. CDC is applying cutting-edge genomic and proteomic tools to understand the origins and pathogenesis of CFS.

  • CFS is not caused by depression, although the two illnesses often coexist, and many patients with CFS have no psychiatric disorder.
About the Open Medicine Institute:

The Open Medicine Institute is a collaborative, community-based translational research institute dedicated to personalized medicine with a human touch while using the latest advances in medicine, informatics, genomics, and biotechnology. The Institute works closely with the Open Medicine Clinic and other clinics to conduct research and apply new knowledge back into clinical practice.

Dr. Andreas M. Kogelnik, is the Director. Dr. Kogelnik received his M.D. from Emory University School of Medicine in Atlanta and his Ph.D. in bioengineering from the Georgia Institute of Technology. Subsequently, he completed is residency in Internal Medicine and a Fellowship in Infectious Diseases at Stanford University and its affiliated hospitals.

Following his clinical training, he remained at Stanford with NIH funding for his post-doctoral research in microbiology, immunology and bioinformatics with Dr. Ellen Jo Baron and Dr. Stanley Falkow, where he explored host-response profiles in severely ill patients.

During this time working with Dr. Jos? Montoya, he was instrumental in the conception, design, and execution of the EVOLVE study. EVOLVE was a placebo-controlled, double-blind study of a subset of chronic fatigue syndrome patients with evidence of viral infection.

Finally, Dr. Kogelnik worked with Dr. Atul Butte in translational informatics to determine patterns that indicated a high risk for adverse events in pediatric patients at Lucille Packard Children's Hospital.

For more information, go to www.openmedicineinstitute.org


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