Chronic fatigue syndrome

CFS: description

Physicians call chronic Chronic Fatigue Syndrome (CFS) a serious and multifaceted neuroimmunological disorder (neuroimmunological = affecting the nervous and immune system). Main symptoms are debilitating mental and physical fatigue and tiredness that can not be explained by a known physical cause or specific mental disorder. In addition, those affected still have a variety of other complaints.

Typically, CFS symptoms increase after a small amount of physical or mental effort. Protection or rest bring no lasting improvement. The performance and quality of life of patients are often severely compromised for years. Many sufferers can no longer work and are bedridden. Some rely on comprehensive care. The suffering of this disease is also often high, because sometimes it is not recognized, or is not taken seriously by the person’s environment.

In the past, CFS was often considered a mental illness. But this is disproven – CFS is now considered a multi-system disease that affects, inter alia, the immune system and energy metabolism.

Controversy about the right term

There are different definitions and classification criteria for CFS. The naming of the disease is (internationally) also not uniform and partly controversial:

For example, Chronic Fatigue Syndrome (CFS) is often referred to as Myalgic Encephalomyelitis (ME), especially in the UK and Scandinavia, where extensive inflammation of the central nervous system (encephalitismyelitis) with muscle involvement (myalgic) is considered the cause of the disease , Other experts prefer to use the combined term ME / CFS.

In Germany one often speaks of chronic fatigue syndrome, sometimes also of chronic fatigue syndrome. However, many experts and sufferers have dismissed these names as downplaying – the persistent weakness or fatigue of CFS patients has nothing to do with simple exhaustion or fatigue. In addition, sufferers suffer from many other complaints, not only morbid fatigue.

In addition, CFS must not be confused with the fatigue that often occurs with cancer or other serious, chronic illnesses. Although this causes similar complaints, but has another cause. There are also similarities with the symptoms of other diseases such as fibromyalgia, which is one of the rheumatic diseases.

frequency

It can not be said exactly how often a chronic fatigue syndrome occurs in Germany or other countries – the data varies considerably, possibly because there are no uniform diagnostic criteria and the condition is often not recognized. According to the Federal Association for Chronic Fatigue Syndrome, approximately 300,000 people in this country have a chronic fatigue syndrome. This estimate is obtained by translating appropriate American CFS frequency studies to Germany. Worldwide, approximately 17 million people are said to have CFS.

Women are significantly more affected than men. CFS can occur at any age. Very often people with disease outbreak are between 29 and 35 years old (mean age of onset).

CFS: symptoms

Chronic fatigue syndrome (CFS) is a complex disease that usually develops abruptly, often after a viral infection. But there are also those affected, in which CFS has evolved creeping over a long time.

Experts use different criteria catalogs for the diagnosis of chronic fatigue syndrome. Frequently used, for example, the “Canadian Consensus Criteria” (CCC) and the International Consensus Criteria (ICC):

Canadian CFS criteria

According to the Canadian Consensus Criteria (CCC), Chronic Fatigue Syndrome has all the following symptoms:

• Fatigue: new onset, inexplicable, persistent or recurrent physical or mental fatigue that significantly reduces the patient’s level of activity
• Post-exertional malaise and / or fatigue: After exercise, you experience unusual fatigue, increased malaise, pain and / or other symptoms. The patient needs more than 24 hours to recover.
• Sleep disorders: e.g. not restful sleep, disturbed day-night rhythm
• Pain: e.g. Muscle and / or joint pain, novel headache

Additionally need at least two neurological or cognitive manifestations For example, confusion, impaired concentration and short-term memory, word finding disorders, impaired locomotor coordination (ataxia).

Another condition for the diagnosis is according to the Canadian criteria that at least one symptom in at least two of the following categories occurs:

• Autonomous manifestations: e.g. extreme paleness, dizziness, nausea and irritable bowel syndrome, bladder disorders, palpitations with or without cardiac arrhythmias
• Neuroendocrine manifestations: e.g. often low body temperature, perspiration, intolerance to heat and cold, loss of appetite or appetite, marked weight change, aggravation of stress symptoms
• Immunological manifestations: e.g. Sensitive lymph nodes, recurrent sore throat, recurrent flu-like symptoms, recent hypersensitivity to food, medicines and / or chemicals

Last but not least, the Complaints for at least six months exist (in children for three months), so that the diagnosis “chronic fatigue syndrome” can be made.

International CFS criteria

According to the International Consensus Criteria (ICC), the diagnosis of “Chronic Fatigue Syndrome” is not a condition that the symptoms persist for at least six months. The doctor can also attest to an affected CFS earlier if the following criteria are met:

• Postexertional neuroimmune exhaustion (PENE), i. e. After physical or mental exertion, there is a disproportionate worsening of the symptoms (physical and mental fatigue, muscle aches, cardiac arrhythmia, etc.), which may last for hours to days. Neither sleep nor rest help against it. PENE is considered a cardinal symptom, which must be given in any case in a chronic fatigue syndrome.
• at least 1 symptom from the category neurological impairment, e.g. Pain, sleep disorders, memory and concentration disorders, muscle weakness, impaired locomotor coordination, sensitivity to odors, noise, light or touch
• at least 1 symptom from the category immunological, gastrointestinal and urogenital impairments, e.g. chronic respiratory infections, increased susceptibility to infections, food intolerances, irritable bowel, disorders of urination
• at least 1 symptom from the category of energy production and ion transport disruption, e.g. Cardiac arrhythmia, palpitations, low blood pressure, dizziness, inability to adapt the circulation to an upright body position (orthostatic intolerance), sweating, shortness of breath, intolerance to heat / cold and severe temperature changes

CFS: causes and risk factors

What exactly causes a chronic fatigue syndrome has not yet been conclusively clarified. According to recent studies, it seems to be an autoimmune disease (dysregulation of the immune system) and a serious disturbance of the energy metabolism in the mitochondria (“power plants” of the cells). This is suggested by several studies in recent years. In addition, various factors are discussed that may predispose, induce, or sustain CFS.

Preliminary (predisposing) factors

A chronic fatigue syndrome is usually preceded by an infection. This infection often falls into a phase characterized by stress or high physical activity.

In addition, some experts suspect that some people have a genetic susceptibility (genetic predisposition) for CFS. This is suggested by twin studies. So far, however, no specific risk genes for the chronic fatigue syndrome could be detected.

Triggering factors

Most patients call an infection the trigger of chronic fatigue syndrome. For example, there have been cases of CFS following infection with Epstein-Barr virus (infectious mononucleosis) or enteroviruses (e.g., influenza), dengue fever, Q fever, or Lyme disease.

In addition to such infections sometimes severe injuries, surgery, pregnancies or childbirth give the impetus for a chronic fatigue syndrome. Stressful events such as the death of a loved one or unemployment may also trigger CFS.

Maintaining factors

Overwork and mental stress can increase the symptoms of a chronic fatigue syndrome. Even though patients can no longer work due to CFS, receive little social support and / or become depressed, this can make the disease worse. The same applies if those affected by their environment (family, friends, colleagues, doctors, etc.) are not taken seriously.

Surgery and accidents can also lead to an acute increase in complaints. Also problematic is the increased susceptibility to infection, which is often associated with CFS: Many patients suffer after infection for weeks increasingly to the symptoms of chronic fatigue syndrome. Likewise, allergies and food intolerance can negatively affect the condition of CFS sufferers.

CFS: examinations and diagnosis

Chronic fatigue syndrome is difficult to diagnose and in many cases is not recognized. There are no special laboratory examinations or examinations with the help of devices which ensure the diagnosis of CFS. In addition to the exact collection of medical history (history) with all emerging symptoms, it is therefore important to exclude other diseases that can cause similar symptoms such as a chronic fatigue syndrome. These include, for example:

• Thyroid, heart and liver diseases
• Anemia, due to iron deficiency
• Diabetes (diabetes mellitus)
• neurological disorders such as multiple sclerosis (MS)
• rheumatologic diseases (such as rheumatoid arthritis)
• Infectious diseases such as chronic hepatitis or Lyme disease
• tumor diseases
• severe mental illnesses (such as depression)
• Alcohol, drug or drug abuse
• pronounced obesity (severe obesity)

In order to rule out such factors, various examinations may be necessary, such as a physical examination, ultrasound and blood tests. Once this is done, the doctor can use a set of criteria (see “Symptoms” above) to check whether the patient has the required features of chronic fatigue syndrome. If so, the diagnosis CFS can be made.

CFS: treatment

There is still no agreement among experts on how best to treat a chronic fatigue syndrome. One thing is certain: the CFS therapy should be adjusted individually. It addresses the most distressing symptoms (eg sleep disorders, pain) and concomitant diseases and should include both drug and non-drug treatments.

drugs Painkillers, for example, can be used for joint and headaches. If depression accompanies depression, treatment with antidepressants may also be required. If the patient has a (chronic) infection, this should be treated specifically, for example with antibiotics in the case of a bacterial infection. If a deficiency of certain vitamins or minerals (such as vitamin D, zinc, iron) is detectable, it may be useful to compensate for the deficit with appropriate preparations.

Note: So far, no targeted drugs against CFS are available. However, scientists are currently researching the efficacy of drugs that regulate the immune system.

In general, CFS becomes one predetermined daily routine recommended. From Overwork is strongly discouragedbecause it can aggravate the symptoms. For the same reason, sufferers should if possible too avoid emotional stress.

To be helpful often relaxation techniques like autogenic training or other stress reduction methods. For example, you can help CFS patients with sleep disorders. In addition, sometimes also seem one dietary changes (sufficient vitamins and minerals, high in protein, sufficient unsaturated fatty acids) and the Avoiding and eliminating pollutants to reduce the discomfort of CFS in some cases.

CFS: disease course and prognosis

It is difficult to predict how chronic fatigue syndrome (CFS) progresses on a case-by-case basis.

In most cases, the disease begins suddenly, often as a result of an infection: the ongoing fatigue and poor performance may be so pronounced that those affected hardly ever leave the house. After months to years, a chronic fatigue syndrome can improve again – whether spontaneous or due to a certain treatment is usually not say. However, the regained efficiency often does not last long: the chronic fatigue syndrome has a high relapse rate; Especially after infections, physical stress and stress periods, the debilitating and persistent exhaustion can set in again. Some of those affected by CFS are permanently restricted in their everyday lives due to the disease (including disability).

In rarer cases, a chronic fatigue syndrome does not occur suddenly but creepingly. Over time, the complaints become stronger. Accepts chronic fatigue syndrome This course, the chances of recovery are significantly worse.