ME: "Statue of the Tired Man" By User: Burrows - Own work. Licensed under Public Domain via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Statue_of_the_Tired_Man.JPG#/media/File:Statue_of_the_Tired_Man.JPG
- 1 CFS / ME, Chronic fatigue syndrome, Chronic fatigue syndrome ICD-10
- 2 Definition
- 3 Disease Cause
- 4 Symptoms
- 5 Diagnosis
- 6 Proposals for medical examination
- 7 Occurrence
- 8 Differential Diagnoses (a selection)
- 9 Treatment
- 10 Medical prognosis
- 11 Pregnancy by ME
- 12 Specialist in Health Region South East
- 13 Literature
CFS / ME, Chronic fatigue syndrome, Chronic fatigue syndrome ICD-10
Similar states: SFS / ME, Myalgic Encephalopathy (ME). Idiopathic Chronic Fatigue Syndrome (CFS), neurostasis.
ME is a disabling one exhaustion combined with a variety of other symptoms and duration for at least 4-6 months when other illness is excluded.
- The cause is unknown, but is not considered a systemic autoimmune connective tissue diseases or Vasculitis.
- The condition can be classified among MUPS (Medical Unexplained Physical Symptoms)
Discussed and not proven. One assumes that several factors are important:
- Vulnerability (Genetic, Environment)
- Triggers (infection, injury, mental strain)
- Maintenance factors
- Often rapid onset, in some cases after upper respiratory infection
- Disabeling fatigue
- Duration of at least 46 months
- Intense bothers at least half the time
- Striking exhaustion (more than expected) after physical or mental effort
- Sleep without being rested
- Feeling of fever, but without measurable abnormal temperature
- Impaired memory and concentration (Cognitive difficulty)
- Sore throat and sore lymph nodes
- Muscle- og joint pain
- Increased sensitivity to light, smell and sound
Diagnose based on symptoms and exclusion of other illnesses. Frequently, diagnostic criteria are used. There are several editions. Current (1994, Fukuda) criteria here
Prevalence: 0,2 - 0,4% of adults, equivalent to 10-20.000 people in Norway. Most women. Less common in children. Incidence (new cases annually per 100.000 residents) in Norway (The Norwegian Institute of Public Health) is estimated at 39,4 / 100.000 among women and 12,9 / 100.000 among men. The disease is most common in the age group 10-19 years and 30-39 years.
Differential Diagnoses (a selection)
Other conditions that can explain a similar kind of exhaustion must be excluded.
- Addison's disease
- Diabetes mellitus
- Insulin-like growth factor-related disease
- Myastenia gravis
- Drug Side Effects
- Overweight (significant)
- Sjögren's syndrome syndrom
- Eating Disorders
- Metabolism too low (hypothyroidism)
- Systemic lupus erythematosus (SLE)
- Sleep apnea
- Virus Infections
Early mobilization with custom, graduated activity management / graduated rehabilitation without overstimulation
- Resting all day is not recommended. Resting in bed for more than 4 weeks can cause immunological disorders
- If accompanying depression is present, it should be treated
- Cognitive behavioral therapy for mobilization and better quality of life is recommended
- Learning of coping strategies can be important
- Customized stretching for muscles and joints combined with careful exercise or activity program is useful
- The immunosuppressive biological drug rituximab (Rixathon / MabThera) did not show definite effect in a Norwegian study (preliminary results, 2017)
Good study data is missing.
- Among adults, it is stated that 20 - 50% will improve during 1-3 years.
- Among children, improvement is seen at 54 - 94% after 6 years (reference: Joyce J, 1997)
Pregnancy by ME
One study suggests that worsening, unchanged and improved condition are about as common during a pregnancy.
- There do not appear to be any more pregnancy-related complications than expected from the population otherwise (reference: Typical RS, 2004)
Specialist in Health Region South East
- Oslo University Hospital at the ME / CFS Center has an interdisciplinary offer for adults (over 18 years) with Myalgic Encephalopathy (ME) / Chronic Fatigue Syndrome (CFS). The outpatient service covers the Health Region South-East in Norway. The admission to the ward is nationwide.
- National Directorate of Health (2014) can be downloaded here
- Egeland T, 2015 (Journal Nor Legeforen, 2015) here
- Various guidelines for diagnosis here