|
Back to Top
Back to Top
Back to Top
Back to Top
Back to Top |
Chronic Fatigue Syndrome is an illness defined by its clinical parameters and includes
both patient symptoms and physical exam findings. A working definition based primarily on
the findings in adults is being tested nationally at several levels. These studies are
evaluating both the accuracy of the definition and the number of patients who fulfill it.
Other studies are searching for laboratory and physiologic markers of the syndrome.
When evaluating patients with chronic fatigue of unknown origin,
physicians can use the following definition of CFS as a guide. This detailed definition
was developed for research use under the leadership of the Centers for Disease Control and
Prevention. It was published in the ANNALS OF INTERNAL MEDICINE in March
1988. Because the disease is still poorly understood, however, the outlined criteria
should be considered provisional. The definition is as follows:
| I. |
Clinically evaluated,
unexplained, persistent or relapsing chronic fatigue that is of new or definite onset (has
not been lifelong); is not the result of ongoing exertion; is not substantially alleviated
by rest; and results in substantial reduction in previous levels of occupational,
educational, social, or personal activities; |
| II. |
The concurrent
occurrence of four or more of the following symptoms, all of which must have persisted or
recurred during six or more consecutive months of illness and must not have predated the
fatigue: |
| |
1. |
Impaired memory or concentration |
| |
2. |
Sore throat |
| |
3. |
Tender cervical or axillary lymph
nodes |
| |
4. |
Muscle pain |
| |
5. |
Multi-joint pain |
| |
6. |
New headaches |
| |
7. |
Unrefreshing sleep |
| |
8. |
Post-exertion malaise |
As suggested by the
above statements the origins and boundaries of the syndrome are still unclear. Illnesses
that are consistent with CFS definitely occur in adults and adolescents. Whether or not
the syndrome occurs as a readily recognizable illness in younger children is still an open
question.
Fatigue is a nebulous concept. It can be considered good or bad.
Good fatigue follows successful work or play and resolves within a finite period of time.
Bad fatigue may or may not have a predisposing event, and it may persist for unexpected
periods of time. If it lasts for excessive periods, it might be considered as being
chronic. If the chronic fatigue prevents the person from normal work or play, it becomes a
liability and medical advice may be sought. The health care provider then attempts to
identify a specific or more frequently a generic reason for the patient's complaint(s).
Since fatigue is present in a wide variety of diseases, the health care giver tries to
shorten the list by asking questions that may lead to a diagnosis or to the performance of
confirmatory laboratory tests. More often than not, the answers to the questions or the
description of the patient's other complaints are the key factors in establishing a
diagnosis.
This latter statement is critical when it comes to the concept of
the Chronic Fatigue Syndrome. It is much more than at least six months of fatigue and a
decrease of substantial activity. The syndrome or pattern of symptoms and signs (findings
on physical exam) includes much more. The other complaints include those that are typical
of infectious or inflammatory illnesses, such as: impaired memory or concentration, sore
throat, tender lymph nodes, muscle pain, multi-joint pain, new headaches, unrefreshing
sleep and post-exertion malaise. Physicians exposed to such complaints, if supported by
fever, cough or diarrhea and abnormal laboratory findings, usually have no trouble in
reaching a diagnosis. If the symptom list is more lengthy (or perhaps somewhat vague) and
the physical and laboratory examinations are normal, the caregiver may then consider CFS
as a diagnosis. Although not required as a component of the working definition, a typical
case frequently begins following a "flu-like" illness or mononucleosis. Even
more frequently, the exact origin of the episode is unknown. The course of the acute
illness may be as expected, but the child or adolescent doesn't regain his or her usual
pre-illness level of activity. CFS, at this time, however, should never be considered as a
primary diagnosis, especially in younger children, since there are many reasons for such a
course.
Ages 6-12
Chronic or
persistent illnesses obviously occur in children in this age group, but the pattern of
signs and symptoms that constitute CFS, is very rare. The syndrome should only be
considered if a prudent, yet thorough evaluation has been performed. Adherence to the
working definition may be impossible because of the style of communication used by young
children in particular. Published experience in this age group is meager at best. Some of
the reports follow widely reported "epidemics" of the syndrome. Since the
syndrome remains to be precisely defined, such epidemics need to be considered as unique
events at this time. Even if considered, CFS in this age group should only be an interim
diagnosis, and not a definitive diagnosis until research clearly defines the role of CFS
in children. The great risk of doing the latter is failure to recognize a condition that
responds to specific treatment. The syndrome may be synonymous with the post-infection
fatigue syndrome if it follows an acute infection and the return to normal activity
follows a week or more of extra rest. If school absenteeism is prolonged for months and
the child doesn't participate in usual activities even on weekends, potential causes
should not be overlooked. This statement doesn't mean performing all tests known to
mankind nor visiting a large number of varied health care givers; it means prudently
working with the care givers who either know the family best or who listen to the child's
problems and provide supportive care while pursuing the origin of the problem.
Ages 12-18
Adolescents are
more like adults in terms of symptoms and consequences of the symptom complex than are the
younger children. This statement should come as no surprise to most readers. The challenge
to caregivers (health professionals and parents) is to differentiate CFS from illnesses
that simply occur during this time from those that virtually only occur at this time of
great change in the life. The latter may be considered to include school avoidance, stress
due to peer or personal pressure, depression and living within a dysfunctional family.
Studies of CFS or similar clinical illnesses such as Fibromyalgia, suggest that resolution
of symptoms is to be expected. The time of resolution, however, is not readily predicted.
As in the younger child, CFS should continue to be only a working diagnosis, and
intervention should be directed at resumption of as "normal" a life as possible.
Involvement of the school and patient's peers is often necessary. Acquisition of coping
skills for independent living is particularly important in the older teenagers.
In any age group, treatment is restricted to education,
continuing a reasonable search for underlying illness, medication for symptom relief,
attainment of coping skills and low levels of exercise. Information and coping skills are
required for the family, friends and the school as much as for the patient.
Brochure authored by Michelle L.
Banks, M.S., ed.
Material for this brochure compiled by the
National Chronic Fatigue Syndrome and Fibromyalgia Association
* Brochure information may be reproduced provided sources are credited * |
