Chronic Fatigue Syndrome

Definition

CFS is a clinical chart which combines, since at least six months :

• a sensation of intense tiredness, of infectious kind, (with, sometimes, a feeling of a little fever or swollen ganglions), carrying with it a significant reduction (at least 50 %) of daily activity;
• memory, concentration, and mood disorders, which can remind of a depressive or generalized anxiety chart;
• functional disorders concerning several systems (locomotor, digestive, cardio-respiratory, etc...) that can remind of "somatization" symptoms (hypocondria, hysteria...).
• Sleep disorders are constant but often ignored by the sick person and his/her doctor. They show in an insidious manner :
  • - first, like a chart of hyper-sleepiness : "I have been sleeping a lot lately";
  • - then of clinophilia :"yes, Doctor, I do sleep, but at 6 PM, I have to rest because I’m exhausted !";
  • and in the end, insomnia, when the subject wakes up more tired than the evening before, and starts to want to sleep.

Hypersomnia or clinophilia?

Diagnosis

The diagnosis relies on the absence of underlying pathologies that could explain the chart. A complete (biological, clinical, radiological, and psychological) checkup must be carried out at least once. It allows to leave out the infectious (HIV, hepatitis) or autoimmune (multiple sclerosis, polyarthritis, lupus) diseases, the metabolic diseases (diabetes, thyroid disease) or psychiatric disorders (depression, addictive behaviours, depersonalization, conversion...).

Sometimes, the onset of the disease coincides with an infectious episode, so that the first descriptions mentioned the implication of a virus infection (Epstein Barr, mononucleosis, "yuppie flu"...)
But none of these hypotheses explains the persistence of the disease beyond six months in the absence of any clearly significant clinical or biological disturbance.

In front of the absence of objective signs, an intense stress is mentioned, or a situation of excessive overwork, and, often, a depression.

In some traditional cultures, "devils" or black magic are mentioned when people face the failure of western medicine (in the Western Indies, for example, people call "blesse" a similar chart caused by "the moving of the liver, the womb..." rooted in magic or trauma and expressing through numerous functional disorders (weakness, "gas", pain...) which remain medically unexplained.

Note : The clinical similarity of CFS and the Gulf War Syndrome (which, again, looks very much like the Balkan Syndrome - look for it on a search engine) is striking. A parallel can probably be established between them and "Karoushi" (an expression of overwork in Japan) or burnout.
(See "Burnout and Karoushi").

The roots (or even the reality) of the disease) remain discussed, but the recent Congresses of Rheumatology publish a lot of articles about objective disturbances of some sleep and pain neurotransmitters.

In our hypothesis, CFS is one of the clinical forms of the "hypo-sleep syndrome" and presents narrow links with "spasmophilia" (or tetany) and fibromyalgia.

Wake up more tired than the day before

Clinical description

• General signs of infectious kind.
  
  The complaint is sometimes centered on feverish sensations (never higher thab 38/38.2 °C), low bloodpressure that come with tiredness. Sore throats or swollen ganglions are frequent but not very specific, and polymorph headaches which remind of a "chronic sinusitis".
  Nb. That minor disorder of thermoregulation is sometimes the cause of shivers and sweating (sometimes strong) mostly in the evening and during the night.
  
  The appetite is disturbed, anorexia or excessive eating (with beliefs involving food at the root of sometimes too rigid diets).
• Psychological problems mostly consist of memory and concentration troubles. The subject has trouble finding the accurate words, forgets "everything", meets difficulties with reading or work.
  He/she readily mentions his/her age and the neuronal aging (fear of Alzheimer Disease).
  If he/she is young, the subject says he/she feels "like an old man/woman".
• Functional disorders concern the entire organism. Listing them can not be exclusive because all alarm circuits are implicated. Their symptomatology is always polymorph, of variable location and intensity, and combined with a component of disability («I’m sick and tired»), worrying («I’m afraid it’s bad, this time»).
• Sleep disorders are brought to light through a relevant interview only. The patient should not be asked if he/she sleeps well (during a famine, people are starving but appetite is maintained!) but rather how he/she feels when he/she wakes up ?

Therapeutic caretaking

The management of tiredness sometimes relies on cognitive and behavioral therapies, but the prevention of the attacks requires a perfect knowledge of the rules of sleep hygiene.

In fact, recent studies tend to establish a parallel between the Chronic Fatigue Syndrome and Fibromyalgia, and many authors think that both troubles might simply be two clinical forms of one chart (others distinguish subgroups according to the type of symptoms but we think that the initial disturbance of sleep in the common denominator of the different forms of expression of tiredness).

The main differences between the "two illnesses" might come, above all, from the specialty of the consulted doctor :
- The rheumatologist, the specialist of pain, or the somnologist will mention fibromyalgia;
- The neurologist knows the Chronic Fatigue Syndrome better;
- The psychiatrist will name neurasthenia or anxiodepressive disorders;

- In the same way, for emergency physicians, «spasmophilia» (or tetany) (which is the most frequent cause of calling in emergency) is generally considered to be "psychological".
In practice the patients often resent that doctor’s attitude which seems little satisfactory to them : they are delivered a sedative ("a quarter of a lexo") and comforting words...
Sometimes, out of a mutual wish to understand, one of the two or both will prefer to mention a plausible explanation which will allow the prescription of a treatment of which, at best, a placebo effect can be expected.
Magnesium offers, in this context, very interesting range possibilities (sic).

That type of sick persons do not easily accept the diagnosis of "imaginary" (Cf. the True-False sick person), turn towards other medicines, rightly called "alternative".
Like for the other symptoms caused by an unefficient sleep, a life event can happen that changes the conditions of sleep and everything goes back into shape!
The sick people who do not find a better sleep balance are sometimes so handicapped that they fall into a “chronic illness” statute and have to stop work completely.

The long term evolution is, in spite of all, very good!
(Cf. "Alarm systems:
"In contrast with the set of other degenerative diseases (diabetes, artériosclerosis, polyarthritis...) which become more and more disabling with age, in contrast with psychiatric disorders which sometimes evolve very badly...
As time goes by...., « arthrosis », colopathy, dizzy spells, lumbago, migraine and tinnitus... all these symptoms, though so disabling in the past, disappear gradually.
Like for fibromyalgia which has the reputation of having no cure, the chronic fatigue syndrome is of good prognosis and vanishes on the long term.
It all looks as if the sick person, who has become very old, finally stopped fighting against him/herself because he/she has become too weak for it.
Because the body is so old that it has just enough energy to keep on living despite the real fatigue, caused by time...