by Hans-Michael Sobetzko (1998)
"... CFS is to have to live in a paralyzing fog of a thousand complaints, pain and exhaustion of this absurd to have every day for years! "
an affected
many names - a condition
exists for the disease a variety of different names. In carving out literature mainly following terms are used:- Chronic Fatigue Syndrome (CFS) / USA
- Chronic Fatigue / Immune Dysfunction Syndrome (CFIDS) / USA
- Myalgic Encephalomyelitis (ME) / include UK, Australia, Canada, New Zealand
- Chronic Fatigue Syndrome (CFS) / Germany
organic brain disorders:
- Post Viral Fatigue Syndrome (PVFS)
- Benign Myalgic Encephalomyelitis "(BeMe)
complaints
The onset is usually flu-like and abrupt, in some cases, creep. Characteristic are neck, head, lymph nodes, muscle and joint pain, constant dizziness and serious disturbances of concentration and short-term memory. Weakness and dizziness, blurred vision, different sensations throughout the body, even in the face, moderate fever and feeling of fever, nausea and sleep problems are described. Often arises in the following years a bewildering variety of other symptoms. The extreme, often lasting for years, crippling fatigue and exhaustion from least effort have the disease its name.cause and origin
causes and mechanisms of disease CFS is still unclear, there is no single characteristic objective findings and not demonstrative result combination. The CFS definition from 1994 is based on a concept in which a so-called syndrome with possibly different causes is detected. It could thus act both to a single disease and a group of diseases or poisonings with similar symptoms and common final pathway.viruses, including EBV, HHV6, enteroviruses, Borna virus, retroviruses, Borrelia, fungi, malfunction of the endocrine, neurological disorders, persistent congestion in advance of the disease and a host of environmental toxins, particularly nerve-damaging substances, as Triggers and cofactors of CFS considered without this been a scientifically compelling evidence could be presented. [1,2,8,9]
Although CFS occurs in some cases by psychiatric disorders, there is no evidence that CFS itself A breakdown of this group. Moreover, it is debatable whether it is observed abnormalities is not primarily about the consequences of extremely stressful chronic illness. The definition of depression and somatization presents serious difficulties. [7.11]
due to decreased levels of the hormone "cortisol" was in some patients a disturbance of the hypothalamic-pituitary- Adrenal axis (HPA axis), the great importance for the reaction of the organism has to stress, are discussed. An administration of "cortisol" in low doses proved to be in a large-scale study to be largely ineffective [13].
Like other synonyms "Chronic Fatigue Immune Dysfunction Syndrome, CFIDS" suggests, are with the disease often associated abnormalities of the immune system, which in the past but were always detectable uncharacteristic and not in all cases. Increasingly, interest is focused on the central defense against viral 2,5 A synthetase / RNase L path, which has in CFS in many cases, an unexpectedly high activity. In July 1997 was the first time CFS-specific changes of the enzyme RNase L (L ow M olecular W eight RNase-L) have been reported [12]. Whether the laboratory evidence as definitive proof of this ribonuclease CFS diagnosis is the subject is currently under investigation.
also conceivable combination and mutual interaction of several factors that may be involved in the development and severity of CFS ("Biopsychosocial model of disease").
classification of fatigue
A group of experts Centers for Disease Control and Prevention, CDC in Atlanta / USA, the International Chronic Fatigue Syndrome Study Group, struck 1994, the following classification for detection of fatigue before [2]:Prolonged Fatigue:
continuous exhaustion, the 1 month or longer lasting
Chronic Fatigue:
fatigue, the continuous or recurrent lasts at least 6 months
Idiopathic Chronic Fatigue:
condition clinically evaluated, unexplained chronic fatigue that does not meet the definition criteria of CFS
Chronic Fatigue Syndrome:
clinically evaluated, unexplained chronic fatigue condition, the proposed definition of the criteria met
clarification
Since the observed symptoms are all nonspecific and occur with different disorders may, at first a careful investigation is necessary. The International Chronic Fatigue Syndrome Study Group the steps recommended in the differential diagnosis of chronic fatigue [2].Most of the listed studies have been carried out in view of the distressing symptoms even before reaching the six-month limit.
based diagnosis in all suspected cases
- detailed medical history, physical examination
- thorough investigation of the intellectual and spiritual Constitution (mental status)
- laboratory screening: complete blood count, ESR, ALT, total protein, albumin, globulin, alkaline phosphatase, calcium, phosphate, glucose, urea, electrolytes, creatinine, TSH, urine analysis
over the proposed level beyond basic research has to statement by the Centers for Disease Control and Prevention at the current state of knowledge no apparent value for the CFS diagnosis. Immunological, hormonal and virological investigations can at best hints. With EEG, CCT, SPECT, PET, MRI or similar techniques, the diagnosis of "CFS" to secure nor refute. An excessive diagnosis does not apparent advantages [2, 13].
diagnostic procedures in individual cases
- targeted exclusion of other diagnoses strictly to the cardinal symptoms and abnormal findings of the case focused further investigations
exclusions
Following that diagnosis must be excluded:- any active interference that may cause chronic fatigue , such as untreated hypothyroidism, sleep apnea, narcolepsy, and iatrogenic factors, such as drug side effects
- any previously diagnosed disorder whose treatment is not documented beyond reasonable doubt and that further activity of chronic fatigue could explain, for example, pre-cancers and non-healed cases of hepatitis B or C
- any past or current diagnosis of major depression with psychotic or melancholic parts, bipolar affective disorders, schizophrenia of any type, and all forms of paranoid disorders; any form of dementia, anorexia nervosa ; bulimia
- alcohol or drug abuse within the last two years before the chronic fatigue or any time thereafter
- morbid obesity with a body mass index of 45 or more
body mass index = body weight in kilograms / (body height in meters) ²
not exclusive conditions In contrast, provide the following circumstances alone does not sufficiently explain chronic fatigue. They can in terms of a concurrent disease coexist with a CFS, a case close to the diagnosis Chronic Fatigue Syndrome but not sufficient:
- any interference with a specific therapy that is likely to alleviate all the symptoms and their correct application is documented . These include hypothyroidism for which found an adequate hormone replacement with normal TSH levels, or asthma, for which the suitability of the therapy by pulmonary function tests and other studies show, is a.
- any health disorder such as Lyme disease or syphilis, which was finally treated with the prescribed therapy before development of CFS symptoms
- each isolated and unexplained physical examination findings, laboratory test or any isolated and unexplained findings of imaging techniques, which is not sufficient to prove the existence of a negative condition . This includes an increased antinuclear antibody titer that is inadequate, without additional clinical abnormalities or laboratory findings to indicate a discrete connective tissue disease.
- any medical condition that is defined primarily by symptoms and are not verified by laboratory tests can, including fibromyalgia, anxiety disorders, functional disorders, nonpsychotic and nichtmelancholische depression, neurasthenia and MCS (Multiple Chemical Sensitivity)
criteria of chronic fatigue syndrome
for the diagnosis Chronic Fatigue Syndrome, CFS has a case the following criteria for Fatigue and accompanying symptoms satisfy [2]:exhaustion criteria:
Chronic fatigue that
- secured clinically it is still unclear.
- new and with time determinable beginning occurred (not been lifelong).
- are not appreciably improved by rest.
- not due to congestion is still ongoing.
- resulting in a substantial reduction * of previous activities in education and employment and in social and personal life.
4 or more of the following listed eight symptoms that occurred earlier than the commencement date of exhaustion may be, must have coexisted for a period of at least 6 consecutive months of illness persistent or recurrent:
- self-reported limitations of short-term memory or concentration, which are difficult enough, a substantial * reduction in previous levels of activities in education and employment and social and create personal area
- neck pain
- sensitive neck and armpit lymph nodes, muscle pain
- pain of multiple joints without swelling and redness
- headaches of a new type, pattern or severity
- no recovery through sleep
- deterioration for more than 24 hours after efforts
* The magnitude of a substantial reduction was in the first definition of CFS in 1988 with at least 50 percent of the level given before disease onset [1,6]. If
meets all criteria and exhaustion is a symptomless in the required combination, there is a prior Chronic Fatigue Syndrome, CFS . If the necessary criteria for fatigue and symptoms are not met, a case as idiopathic chronic fatigue is classified. This term is not a new entity, but is intended as a category to facilitate comparative studies.
figures
Usable statistical figures for CFS are in the area of the Federal Republic does not, as results of studies are missing in large collectives. Only individual hospitals and clinics have published their data, but they were hardly raised under similar conditions and with different strategies. Also must be considered when comparatively small number of cases the risk of statistical bias by the composition or selection of the patient population (selectional bias).data from the Anglo-American world:
- varied information on the incidence of the syndrome in the past, very strongly. reported after a U.S. study published in 1995 [4] between about 2 and 6 percent of respondents to be chronically exhausted for at least 6 months. In contrast, filled only about 1 to a maximum of 3 per thousand, the criteria of CFS. Measured by the symptom "chronic fatigue" is the "chronic fatigue syndrome" very rare and must be clearly delineated.
- The majority of those affected is in the middle age (30-50 years).
- According to almost all studies, more women than men [7].
- the patients were found in the UK on average number of medical professionals and teachers [7].
- There is strong evidence for the existence of different and sometimes inappropriate survey methods to significant Distortions in the statistical assessment conducted. [2]
course and prognosis
missing for a definitive statement on the conduct reliable medical data, moreover, the individual medical records often differ greatly. Deaths as a direct result of CFS are not known. There is no reliable scientific evidence for the transition of the CFS in front of sequelae or permanent organ defects. [5]usually follows the abrupt onset is usually a phase of maximum power constraints, and most pronounced symptoms. During this time the patient already suffering in silence and in all efforts have severe symptoms, can often do not leave the house, are largely confined to bed and get on the scale to Bell often have a range between 0 and 30 points.
For years, there is often a slow improvement with relapse and recovery phases. Some patients recover completely. Some sufferers report a slow, continuous degradation of cyclic or gradients.
The UK ME Association [11] assumes that
- 35% of those affected recover slowly but steadily,
- 40% of cases have a checkered history, remain
- reduced 20% serious, do
- 5%, a continuous deterioration .
loads and loads
relapses, even those that were once tolerated without problems often lead to a worsening of the condition, which uses characteristically often after one or two days [5]. Relapses among others by infections, stress situations, excessive physical demand, and not least caused by too high doses of drugs such as antidepressants.It is very important to distinguish between a real increase in symptoms and relapse: a reasonably normal life for most sufferers is only possible if they will accept for a certain amount of discomfort. The patient itself must control this process consciously and control. Many chronic sufferers have similar problems.
contrast, is "no return" for a serious, sustained symptom deterioration, which is out of control and significantly reduces in each phase of the disease usual level of activity for long periods.
CFS and environment is a disease rarely been assessed so differently. Concerned they will feel as years of continuous hell in which even the smallest efforts to torture. In addition to direct disease-related symptoms worsen drastic restrictions on family life, in dealing with friends and acquaintances at work and the situation of the Sick.
From Environmental CFS is due to a dismissed even in worst phases usually relatively stable external impression is often shown to be exaggerated, emotionally justified Befindlichkeitssstörung.
CFS almost inevitably means a collision with social performance standards based on long time no longer be met. A vicious circle of direct complaints and growing professional problems, social isolation and increasing steadily decreasing self-esteem. Neither himself nor others can explain the person's condition or whose generally accepted health disorder as "justification".
In this situation, you should a possible suicide risk very seriously [3], especially if the diagnosis is "CFS" not yet made.
even if arising from the "labeling" of an overwhelming appeal in many ways complex currently no causal therapies that opens up the possibility of individual, to develop the disease appropriate coping strategies. In addition, make inappropriate, often onerous additional therapies that are often prescribed on the basis of alternative diagnoses avoided.
treatment
whether drugs can help the recovery process is very controversial. There is no generally accepted pharmacological therapy is currently not available. Often therefore only possible conservative side effects for symptomatic treatment of symptoms is recommended [5]. The almost always increased sensitivity of the Sick to drugs of any kind must necessarily be taken into account here. In many cases this means that drugs prescribed at doses significantly below the usual minimum dosage .Documented deficiencies in vitamin and mineral balance should be balanced and a balanced diet should be sought. When secured allergies and sensitivities, an appropriate diet can help.
Although CFS is often associated with a marked mental symptoms, it is with great Probably not a psychogenic illness. Moreover, it seems extremely difficult to distinguish primary and in response to a serious chronic disease resulting secondary disorders. This is especially true if the history has no mental illness. Often unaware of CFS-specific features used psychotherapy process, the situation of patients with no identifiable benefits have an additional burden.
Cognitive behavior therapy has been found in CFS in certain limits as helpful affected learn to use the remaining space optimally in their attitude and lifestyle to adjust the current limits, without them as long-term to accept unchangeable. The disease requires a dynamic process with constantly alters be a flexible disease management framework that can be supported with this approach and improved [10].
for all forms of treatment is the result of the unclear cause of CFS is a rigorous assessment of the effort, the risks and potential benefits of demand.
Living with CFS: Disease Management
great importance to CFS has an adapted lifestyle with avoidance of stress and overload, and a possible economic use of the remaining energy and skills. As a basis for effective management of the disease is the clear structure a regulated daily routine with a basic program of activities that is manageable even on a bad day, be strongly discouraged. The frequently observed diurnal rhythm of the symptoms should be borne in mind when planning, because heavier tasks to do in the asymptomatic phase poorer labor-saving.
One of the lower performance range adequate physical activity (eg walking, cycling, swimming) has almost always positive and should be an integral part of a treatment concept to prevent a further weakening due to inactivity. The load limits must always determine the patient himself. For seriously ill person may adequately physical activity at the beginning there already is to be maintained for a few moments to sit in bed.
are asked life and survival strategies as a most effective disease management. The ultimate goal here is less to be the complete freedom from symptoms. Rather, an individual must compromise between family, social and professional needs on the one hand and the desire for a relatively tolerable symptoms on the other hand, found.
-end
literature
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2. Fukuda K, Strauss SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff AL and the International Chronic Fatigue Syndrome Study Group: The Chronic Fatigue Syndrome: A Comprehensive Approach to Its Definition and Study. Annals of Internal Medicine 1994; 121: 953-959
3. Bell DS: The Doctor's Guide to Chronic Fatigue Syndrome. Addison-Wesley Publishing Company 1994 4. Buchwald D, Umali P, Umali J, Kith P, Pearlman T, Komaroff A: Prevalence of Chronic Fatigue and Chronic Fatigue Syndrome in the Community. Ann.Intern.Med. 1995; 123:81-88
5. CDC (Centers for Disease Control and Prevention ): The Facts About Chronic Fatigue Syndrome. 1994 6. Fock RRE, Krüger GRF: Chronic Fatigue Syndrome - CFS - Chronisches Erschöpfungssyndrom/ Eine Standortbestimmung. Deutsches Ärzteblatt 1994; 43: 1872-1876
7. National Task Force on Chronic Fatigue Syndrome (CFS), Postviral Fatigue Syndrome (PVFS), Myalgic Encephalomyelitis (ME): Report from the National Task Force on Chronic Fatigue Syndrome (CFS), Postviral Fatigue Syndrome (PVFS), Myalgic Encephalomyelitis (ME), Westcare 1994
8. Schönfeld B: Das Chronic Fatigue Syndrome - eine neue Krankheit?; Bundesgesundheitsblatt 1993; 12: 499-505
9. Schönfeld, B: Das Chronische Müdigkeitssyndrom ( Chronic Fatigue Syndrome ), historische und epidemiologische Aspekte; Bundesgesundheitsblatt 1993; 12: 505-510
10. Sharpe M, Hawton K, Simkin S, Surawy C, Hackmann A, Klimes I, Peto T, Warrell D, Seagroatt V: Cognitive behaviour therapy for the chronic fatigue syndrome: A randomised controlled trial; British-Medical-Journal. 312/7022 (22-26) 1996
11. Shepherd C: Myalgic Encephalomyelitis: Post-Viral Fatigue Syndrome - Guidelines for the Care of Patients, second edition. 1995
12. Suhadolnik RJ, Peterson DL, O'Brien K, Cheney PR, Herst CV, Reichenbach NL, Kon N, Horvath SE, Iacono KT, Adelson ME, Meirleir KD, Becker PD, Charubala R, Pfleiderer WJ Biochemical evidence for a novel low molecular weight 2-5A-dependent RNase L in chronic fatigue syndrome. Interferon Cytokine Res 1997 Jul; 17 (7) :377-385
13th Homepage of the CDC, the "Chronic Fatigue Syndrome, download 2 / 1998
Copyright H.-M. Sobetzko 3 / 1998
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