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Chronic Fatigue Syndrome/Myalgic Encephalomyelopathy Christopher Chiu MRCP PhD Introduction Common condition – – – – 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 Causes Genetic – More common within families – More likely in identical twins Infectious – Many pathogens linked – Chronic or post-infective Endocrine Psychosocial 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 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 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 Diagnosis History Examination Urinalysis Blood tests – Liver & thyroid function tests – Glucose Radiology 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 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 Not recommended Most drugs Unstructured vigorous exercise Prolonged/complete daytime rest Rigid schedule of activity & rest 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