Chronic Fatigue Syndrome profoma

Question 1

Define Chronic Fatigue Syndrome

Answer 1

Neurological illness

diagnosed after at least 4 months of disabling fatigue affecting physical & mental function

No specific diagnostic test

Main aim of treatment= manage symptoms
- Treatment individualised, based on the most severe complaint.

Question 2

Epidemiology of Chronic Fatigue Syndrome

Answer 2

x 2-3 more prevalent among women than men.

Peak ages between 30 & 50 years.

1 study found prevalence among Pakistani ancestry of 3.5%, compared to 0.8% in white people.

Question 3

Aetiology of Chronic Fatigue Syndrome

Answer 3

Actual cause is UNKNOWN

Triggers include:
- Viral & bacterial infections e.g. Epstein- Barr virus, Mycoplasma pneumonia, Giardia duodenalis.
- Immunological - IgG subclass deficiency.
- Neuroendocrine
- Genetic
- Gastrointestinal
- Psychological factors

Question 4

Pathophysiology of Chronic Fatigue Syndrome

Answer 4

Not entirely understood.

Hypothesis:
- Alteration in nervous system.
- Leading to changes in cell-mediated immunity.
- Activation of oxidative pathways.
- Alterations in the function of Natural Killer cells

Question 5

Clinical presentation of Chronic Fatigue Syndrome

Answer 5

3 main defining symptoms:
- Symptoms last at least 6 months- this is what distinguishes CFS from fatigue.
- Fatigue is not related to other medical or psychiatric conditions
-Symptoms do not improve w/ sleep or rest

Fatigue described as:
- Fast, abrupt onset of the fatigue
- Associated w/ viral infection e.g. mononucleosis, influenza or hepatitis.
- Post-exertional Malaise (PEM) - excessive fatigue after minimal physical or mental exertion.
- Sleep disturbance - not refreshing.
- Daytime hyper-somnolence & night time insomnia

Other general symptoms:
- Myalgia - muscle aches.
- Poor concentration
- Tender lymph nodes that are not enlarged.
- Stiffness & pain (w/out joint swelling). No specific locations.
- Chills
- Feverish
- Severe headaches

Question 6

Investigations for Chronic Fatigue Syndrome

Answer 6

DePaul symptom questionnaire - frequency and severity of CFS/ME.

FBC w/ WBC- to exclude active infection.

ESR & CRP - to exclude active infection.

TSH test - to exclude hypothyroidism.

HIV antibody test - to HIV infection.

Question 7

Management for Chronic Fatigue Syndrome: Conservative

Answer 7

Tailored to individuals symptoms, making lifestyle changes & taking medication to control certain symptoms.

Counselling therapies e.g. CBT

Graded exercise therapy (GET) is good to stop deconditioning of muscles in mild CFS but not good in severe because it might cause PEM.

Avoid alcohol, tobacco or caffeine.

Question 8

Management for Chronic Fatigue Syndrome: Pharmacological

Answer 8

Pain- COX-2 inhibitors; opioids only used for very severe cases, shortest possible duration.

Tricyclic Antidepressants: varying success in improving sleep, pain levels, severity of fatigue.

SSRI and SNRI: no direct action on the underlying pathology, provides neuropathic pain relief & antidepressant effect.

Question 9

Prognosis for chronic fatigue syndrome

Answer 9

• Longitudinal studies indicate that 17-64% patients improve with treatment
• Less than 10% meet criteria for full recovery
• 20% of patients may worsen over time

Question 10

Comparison of Chronic Fatigue Syndrome & Fibromyalgia

Answer 10

Table on notes!

https://www.notion.so/Chronic-fatigue-syndrome-ME-7bbf6942cb574262b5343793353e67bc