CHRONIC FATIG

UE

SYNDROME

BY H

EBA ESSAW

Y

CFS : DEFINITION• Persistent fatigue accompanied

by other specific symptoms for a minimum of six months.

• not due to ongoing exertion.• not substantially relieved by rest.• not caused by other medical

conditions.

CFS : DEFINITION• Chronic fatigue syndrome is

disorder without a known cause.• May be related to a previous

infection.• CFS for six months .• Accompanied by cognitive

difficulties : ---problems with short-term memory. --- - Concentration.

WHY THIS GUIDELINE MATTERS

- Prevalence of CFS : 0.2–0.4% -Age: Occur at any age, but it most

commonly affects people in their 40s and 50s.

- sex: Women more than men- Live style : overweight and inactive .- Stress appears to be a factor.

FIVE SYMPTOM CATEGORIES1- Post-exertional malaise with loss of physical or mental

stamina, rapid muscle or cognitive fatigability. 2. Unrefreshing sleep; disturbance of quantity and/or rhythm3. Myofascial pain, joint pain, abdominal and/or head pain4. Two or more neurocognitive manifestations5. At least one symptom from two of three subcategories: Autonomic manifestationsNeuroendocrine manifestationsImmune manifestations

ADOLESCENT CFS 1. Unexplained, persistent or relapsing chronic fatigue. - Over the past 3 months that was not the result of ongoing exertion and was not substantially alleviated by rest.

2. Substantial reduction in previous levels of social, educational, and personal activities.

3. Specific symptoms within the five classic symptom categories, which have persisted or recurred during the past 3 months of illness, but may predate the reported onset of fatigue

ONSET OF CFS

• Start suddenly, by a "flu-like illness“

• After infection by viral and non-viral pathogens.

SYMPTOMS1.A new onset of unexplained, persistent fatigue unrelated to exertion and

not substantially relieved by rest, that causes a significant reduction in previous activity levels.

2.Four or more of the following symptoms that last six months or longer: Impaired memory or concentrationPost-exertional malaise, where physical or mental exertions bring on

"extreme, prolonged exhaustion and sickness"Unrefreshing sleepMuscle pain (myalgia)Pain in multiple joints (arthralgia)Headaches of a new kind or greater severitySore throat, frequent or recurringTender lymph nodes (cervical or axillary)

OTHER COMMON SYMPTOMS 1. Irritable bowel, abdominal pain, nausea, diarrhea or bloating2. Chills and night sweats3. Brain fog4. Chest pain5. Shortness of breath6. Chronic cough7. Visual disturbances (blurring, sensitivity to light, eye pain or dry eyes)8. Allergies or sensitivities to foods, alcohol, odors, chemicals,

medications or noise9. Difficulty maintaining upright position (orthostatic instability, irregular

heartbeat, dizziness, balance problems or fainting)10. Psychological problems (depression, irritability, mood swings, anxiety,

panic attacks)

COGNITIVE FUNCTIONING • Decreased attention, memory, and reaction time.• Attention deficit was in the range of 0.5 to 1.0

SD below expected and were judged likely to affect day-to-day activities.

• Simple and complex information processing speed and working memory were moderately to extensively impaired.

• Perceptual abilities, motor speed, language, reasoning, and intelligence did not appear to be significantly altered

PATHOPHYSIOLOGY1. Unknown including oxidative stress, 2. Genetic predisposition,3. Infection by viruses as Epstein-Barr,

human herpesvirus 6 and mouse leukemia viruses.

4. Hypothalamic-pituitary-adrenal axis 5. Immune dysfunction as well as

psychological and psychosocial factors.

DIAGNOSIS AND MANAGEMENT: ADULTS

-Initial assessment - Take a full history - Examine the person - Assess for psychological

state

DIAGNOSIS OF CFS: ADULTS– Difficulty with sleeping, such as insomnia, hypersomnia, unrefreshing sleep, a disturbed sleep–wake cycle– muscle and/or joint pain without evidence of inflammation– headaches– painful lymph nodes without pathological enlargement– sore throat– cognitive dysfunction, such as difficulty thinking, inability to concentrate, impairment of short-term memory, and difficulties with word-finding, planning/organising thoughts and information processing– physical or mental exertion makes symptoms worse– general malaise or ‘flu-like’ symptoms– dizziness and/or nausea– palpitations in the absence of identified cardiac pathology.

COMORBIDITY

• In particular, investigate these ‘red flag’ features:• localizing/focal neurological signs• signs and symptoms of inflammatory arthritis or connective

tissue disease• signs and symptoms of cardiorespiratory disease• significant weight loss• sleep apnea• clinically significant lymphadenopathy.

GRADING OF CFS: MILD CFS• Mobile, can care for themselves

and do light domestic tasks with difficulty

• May still be in work or education but has probably stopped all leisure and social pursuits

• Often takes days off or uses the weekend to cope with the rest of the week

GRADING OF CFS: MODERATE CFS

• Reduced mobility and is restricted in all activities of daily living

• Has probably stopped work, school or college and needs rest periods

• Sleep is generally poor quality and disturbed

GRADING OF CFS: SEVERE CFS• Unable to do any activity, or minimal

daily tasks only• Severe cognitive difficulties. • Depends on a wheelchair for mobility.• Barely able to leave the house. • May spend most of their time in bed.• Often extremely sensitive to light and

noise.

INITIAL MANAGEMENT Manage symptoms early – do not wait for

diagnosis Advise about: -Fitness for work and education - Adjustments or adaptations -Liaise with: - employers -education providers - support services

SPECIALIST CFS CARE Refer to specialist CFS care depend on: - Person’s needs - Symptoms (type, duration, complexity,

severity) - Comorbidities - Referral within 6 months if CFS is mild,

3-4 months if moderate and immediately if severe

SPECIALIST CFS CARE

Management options including : - Cognitive behavioural therapy - Graded exercise therapy -Activity management - Sleep management - Rest and relaxation - Diet

TREATMENT OF CFS

Antidepressants : low dose antidepressants

improve sleep and relieve pain.

Sleeping pills

THERAPY OF CFS

Combination of psychological counseling with a gentle exercise program.

Graded exercise : Inactive people often begin with range-of-motion and stretching exercises for just a few minutes a day.

Psychological counseling: To figure out options to work around some of the limitations.

Feeling more in control of life can improve CFS dramatically.

ALTERNATIVE MEDICINE

Pain associated with chronic fatigue syndrome may be helped by:

AcupunctureMassageYoga or tai chi

Thank You

DIAGNOSTIC CRITERIA

To meet the diagnostic criteria of chronic fatigue syndrome, you must have unexplained, persistent fatigue for six months or more, along with at least four of the following signs and symptoms:

Loss of memory or concentrationSore throatEnlarged lymph nodes in your neck or armpitsUnexplained muscle painPain that moves from one joint to another without swelling or rednessHeadache of a new type, pattern or severityUnrefreshing sleepExtreme exhaustion lasting more than 24 hours after physical or mental

exercise