CHRONIC FATIGUE SYNDROME

Definition:

Chronic Fatigue Syndrome (CFS) is a complex of medical conditions of unknown etiology characterized by intense, debilitating, and severe fatigue – both physical and mental – that lasts for six months or more. Its symptoms vary and do not show any specific origin. CFS interferes with daily activities, does not improve with rest, worsens with exercise, and produces widespread symptoms both physically and neuropsychologically.

Prevalence:

Data on the extent of Chronic Fatigue Syndrome vary depending on how each investigator defines the syndrome and by the investigator’s methodology, but it is clear that the primary symptom is very common among the general population. An estimated 5% to 20% of all patients seeking primary medical care have experienced fatigue lasting more than a month at some point in their lives.
CFS is predominant in females – between six and seven times more common in women than in men. Patients are generally young adults – most cases are between 25 and 45 years old – although many cases have been found in patients in their forties and fifties and others have been reported in children, adolescents, and the elderly.

Causes:

The specific cause of Chronic Fatigue Syndrome is unknown. Some theories suggest that it may be due to the Epstein-Barr virus (EBV) or human herpesvirus 6 (HHV-6). Even though there has been no specific virus identified as the cause, CFS is associated with an increased presence of certain fungi such as Candida spp. Another possible cause is inflammation of the nervous system due to a defective response of the immune system.
Other factors may also play a role in the development of Chronic Fatigue Syndrome include previous diseases, stress, genetic factors, environment, and occupation.

Symptoms:

Chronic Fatigue Syndrome is diagnosed by first ruling out all other psychological and medical conditions. CFS currently has no definitive symptomatology or diagnostic test.
The symptoms of CFS come and go, becoming more severe with physical or psychological stress, interfering with interactions with family, work, and socially – even, in some cases, preventing basic activities of daily living. The psychological impairment of CFS induces restlessness, anxiety, and depression. These symptoms can manifest themselves on a regular basis, at times even following the seasons, although each outbreak can be different from the previous and it is rare that the periods between outbreaks are completely without symptoms.
Among the symptoms there should be major and minor clues to the presence of CFS, among which:
• unexplained chronic fatigue, either persistent (lasting at least six months) or intermittent,
• that occurs for the first time or with a clear-cut onset,
• that is not the result of recent exertion, that does not go away with rest, and
• that causes a significant drop in the patient’s normal activities.
Other diseases that can cause chronic fatigue must then be excluded.
At the same time, there should also be at least four related symptoms, connected to one another, that have been persistent for at least six months and that have become present after the onset of fatigue:
• feeling very tired for more than 24 hours after exercise that would normally be easy
• not feeling rested after having slept enough
• lack of memory
• trouble concentrating
• confusion
• joint pain without swelling or redness
• headaches that feel different from those in the past
• irritability
• mild fever of 38.3°C (101°F) or less
• muscular pain and weakness, all over the body or in separate areas, with no apparent cause
• sensitivity in lymph nodes of the neck or armpit.

Types of Fatigue:

The body can experience three kinds of fatigue. The first, physiological or functional fatigue, is normal and occurs after performing any strenuous physical activity or at the end of the workday. This sort of fatigue disappears with an adequate period of repose, after which the person feels rested. There is also psychological fatigue that can occur when one has a boring task to do: this fatigue goes away once the task has been finished. The third kind is what we call chronic fatigue, the main characteristic of which is that it is constant. During a long period of time, the person wakes up tired and stays tired all day in spite of having taken what would normally be adequate rest.

Prevention:

The best way to prevent Chronic Fatigue Syndrome is by maintaining an optimal state of health, which involves many factors including nutrition, recreation, and occupation, as well as other factors that can’t be controlled completely – heredity, age, and sex – which may be moderated by how we conduct our daily activities.

Prognosis:

The long-term expectations for patients with Chronic Fatigue Syndrome vary. It is difficult to make predictions at the onset of symptoms. Some patients recover completely after six months to a year, others never come to feel that they will return to the way they were before their symptoms began. Studies suggest that patients are more likely to improve if they receive early treatment accompanied by a well-directed rehabilitation program.
We should take into account the risk of developing depression and the inability to participate in social and work activities, which can lead to alienation and a propensity to develop the side effects from medications or treatments.

Treatment:

At present, there is no cure for Chronic Fatigue Syndrome. The goal of treatment is to relieve its symptoms and to detect the presence or influence of other diseases early enough to render appropriate treatment.
Clinical studies of CFS carried out in both public and private centers have led to a better understanding of this health problem even though its specific cause has yet been to be determined. Emergent technologies have given medical doctors access to advanced treatments and promising results. Autologous stem cells stand out among these novel therapeutic options: their judicious application has already been shown to reduce the symptoms related to CFS and they are expected to provide an ultimate cure in the near future.

General Recommendations:

The person with CFS needs to consider their individual nutritional factors, especially deficiencies. The diet must be appropriate to the individual, be varied and balanced, and contain all the necessary nutrients. Regular exercise should be according to the patient’s constitution and age. It is equally important to eliminate habits harmful to one’s health, such as smoking, alcohol, and physical inactivity, and to include positive recreational habits.
People who suspect they might have CFS should visit their doctor for a complete evaluation that takes into account medical history, laboratory tests, physical examinations, and habits. Once the diagnosis is established, treatment options can be considered based on each specific case. Therapy with autologous stem cells obtained from bone marrow should be considered because of its effectiveness in strengthening the immune system and metabolism and because it is readily available, has low risk, and is minimally invasive.