(Systemic exercise intolerance disease; SILK)
Chronic fatigue (CFS) is a syndrome of fatigue, which hinders the everyday stops> 6 months, unexplained and is accompanied by a number of associated symptoms. Treatment includes the review of the patient’s disability, the treatment of specific symptoms, cognitive behavioral therapy and a graded exercise program.
Although 25% of people report that they are chronically tired (fatigue), only about 0.5% meet the criteria for CFS. Although the term CFS was first used in 1988, the fault is well described at least since the mid-1700s, but under other names (eg. As Febricula, neurasthenia, chronic brucellosis, exercise-syndrome). CFS is most common in young women and middle-aged women, but is described in all other age groups, including children and in both sexes.
Chronic fatigue (CFS) is a syndrome of fatigue, which hinders the everyday stops> 6 months, unexplained and is accompanied by a number of associated symptoms. Treatment includes the review of the patient’s disability, the treatment of specific symptoms, cognitive behavioral therapy and a graded exercise program. Although 25% of people report that they are chronically tired (fatigue), only about 0.5% meet the criteria for CFS. Although the term CFS was first used in 1988, the fault is well described at least since the mid-1700s, but under other names (eg. As Febricula, neurasthenia, chronic brucellosis, exercise-syndrome). CFS is most common in young women and middle-aged women, but is described in all other age groups, including children and in both sexes. CFS is not a simulation (intentional feigning of symptoms). CFS are similar to those in fibromyalgia, such as sleep disorders, mental disorder, fatigue, pain and worsening of symptoms in activity many patterns. Etiology etiology is unknown. No infectious, hormonal, immunological or physiological mechanism is known. Among the many suspected infectious causes Epstein-Barr virus, Lyme disease, candidiasis and cytomegalovirus have been found to be the cause. Similarly, there are no allergic markers and no immunosuppression. It has been reported by various small immunological abnormalities These abnormalities include about low IgG levels, abnormal levels of IgG, decreased lymphocyte proliferation and low gamma-interferon levels in response to mitogens, low cytotoxicity of natural killer cells circulating antibodies and immune complexes, and many other immunological findings. However, there is no consistent or reliable reproducible pattern of immunologic abnormalities and none provides an adequate sensitivity or specificity to it to allow a definition of the syndrome. Relatives of CFS patients have an increased risk for the syndrome, suggesting a genetic component or frequent environmental exposure. Recent studies have some genetic markers that may predispose to CFS identified. Some researchers believe that the etiology will eventually prove to be multifactorial, including a corresponding genetic predisposition and exposure to microbes, toxins and other physical and / or emotional trauma. Symptoms and complaints before the start of the CFS, most patients are very active and successful. The onset is usually abrupt, and many patients report a first virus-like illness with swollen lymph nodes, extreme fatigue, fever and symptoms in the upper respiratory tract. The initial syndrome disappears, but seems to trigger protracted severe fatigue that impairs daily activities and many of the other features of the syndrome. In February 2015, the “Institute of Medicine” published (now “the Health and Medicine Division of The National Academies of Science, Engineering, and Medicine”) a comprehensive review of this disease called Beyond Myalgic Encephalomyelitis / Chronic Fatigue Syndrome: Redefining of illness. In this review, a new name was suggested that systemic stress intolerance disease ( “systemic exertion intolerance disease”, BE) and new diagnostic criteria to facilitate the diagnosis and emphasize the most consistent features (see table: Diagnostic criteria for chronic fatigue syndrome * ). In addition, the review emphasizes clearly the validity of this debilitating disease. The physical examination is unremarkable, and there are usually found no signs of muscle weakness, arthritis, neuropathy or organ enlargement. However, some patients have elevated temperature nichtexsudative pharyngitis and / or palpable (but not enlarged) or tender lymph nodes have. All abnormal physical findings must be evaluated and will be excluded alternative diagnoses that cause chronic fatigue, before the diagnosis of CFS can be made. Diagnostic criteria for chronic fatigue syndrome * Diagnosis requires that there are in the patient the three following symptoms: A significant reduction or impairment of the ability to build on stages of the disease in the training at work and in social or personal activities for more than 6 there are months and is accompanied by fatigue that is often leaden, of new or definite onset (not lifelong), is not the result of ongoing excessive effort and is not substantially alleviated by rest after load sleep without recovery At least one of the following manifestations are also required: Cognitive impairment Orthostatic intolerance * Diagnostic criteria Proposed by the Institute of Medicine (now the Health and Medicine Division of The National Academies of Science, Engineering, and Medicine) in February 2015. frequency and severity of symptoms should be assessed. The diagnosis of ME / CFS should be called into question if the patients do not moderate, significant or severe intensity of at least half the time these symptoms. Diagnosis Clinical Criteria laboratory examination to exclude CNS disorders The diagnosis is made by the characteristic history together with the results of a normal physical examination and normal laboratory tests. The case definition is sometimes useful, but is v. a. an epidemiological and research tool and should not be administered to individual patients. The investigation is aimed at all non-CFS causes that are suspected on the basis of objective clinical findings. If no base is evident or suspected to contain an appropriate laboratory assessment blood count and measurement of electrolytes, BUN, creatinine, TSH, and ESR. If indicated by clinical findings, a further check chest X-ray, sleep studies and testing for adrenal insufficiency in selected patients may contain. Serological tests for infection, antinuclear antibodies and neuroimaging are not without objective evidence of disease by examination (d not only subjective complaints h.) Or indicated by basic tests; in such cases, the pretest probability is low and the risk of false-positive results (and thus unnecessary treatment and / or confirmatory tests) high. Prognosis Most patients recover over time, although they do not necessarily return to their constitution against the disease. But this time typically involves years and an improvement is often done only partially. some data show that an earlier diagnosis and intervention improves prognosis. Treatment Confirmation of patient symptoms Cognitive behavioral therapy Gradual Training medicines for depression, sleep disorders or pain, indicated to treat if effectively, doctors must accept anerkenen and validity of patients’ symptoms. Whatever the underlying cause, these patients suffer and want very a return to their previous state of health. However, patients, rename expectations. They must accept their limitation and accept and concentrate on what they still can, instead of always complaining about what they no longer can. Cognitive behavioral therapy and gradual training programs are the only measures that have proved helpful. Depression should be treated with antidepressants and / or psychiatric training. Sleep disorders should be treated aggressively with relaxation techniques and improved sleep hygiene (see table: sleep hygiene). If these measures are ineffective, hypnotics and / or the transfer may be necessary to a sleep specialist. Patients with pain (usually as a component of fibromyalgia) can be treated using a number of drugs, such as pregabalin, duloxetine, amitriptyline or gabapentin. Body therapy is often helpful. Unproven or disproved treatments such as antiviral agents, immunosuppressants, elimination diets and amalgam extractions should be avoided. Important points that Chronic Fatigue Syndrome (CFS) is a fatigue, life-changing, stops> 6 months and typically affects previously healthy and active person; It is not a simulation. The etiology is unclear, but probably it comprises several factors, including genetic susceptibility, microbial exposure and environmental and psychological factors. Diagnose CFS based on characteristic symptoms in patients with a normal examination and normal basic laboratory findings; The criteria of the Institute of Medicine (now “the Health and Medicine Division of The National Academies of Science, Engineering, and Medicine) can be helpful, but are not limited to the individual patient use. Check the symptoms of patients, encourage them to accept their limitation and to accept and treat with cognitive behavioral therapy and gradual training. Use medication as needed to treat specific symptoms (eg. as pain, depression, insomnia).