| Chronic fatigue syndrome (CFS), also known as | | | | entity. In 1988 both the UK Department of |
| myalgic encephalomyelitis (ME), post-viral | | | | Health and Social Services and the British |
| fatigue syndrome (PVFS), and various other | | | | Medical Association officially recognized it |
| names, is a syndrome (or group of syndromes) | | | | as a legitimate and potentially distressing |
| of unknown and possibly multiple etiologies, | | | | disorder. Opponents of the term ME maintain |
| affecting the central nervous system (CNS), | | | | there is no inflammation, although there are |
| immune, and many other systems and organs. | | | | cases of CFS that present inflammation (see |
| There is no simple diagnostic test; CFS is a | | | | Sophia Mirza). United Kingdom and Canadian |
| diagnosis of exclusion, although recent | | | | researchers and patients generally use this |
| research indicates biological hallmarks of | | | | term in preference to CFS. |
| the syndrome, and a diagnostic test is | | | | |
| predicted soon. Most definitions (other than | | | | Chronic fatigue syndrome (CFS); this name was |
| the 1991 UK Oxford criteria[1]) require a | | | | introduced in 1988 by a group of United |
| number of features, the most common being | | | | States researchers based at the Centers for |
| severe mental and physical exhaustion or | | | | Disease Control and Prevention, and is used |
| depletion which is "unrelieved by rest" | | | | increasingly over other designations, |
| (according to the 1994 Fukuda definition),[2] | | | | particularly in the United States. |
| and is often worsened by even trivial | | | | |
| exertion (controversially, the Oxford and | | | | Chronic fatigue immune dysfunction syndrome |
| Fukuda criteria require this to be optional | | | | (CFIDS); many people, many patients and |
| only). CFS occurs more often, but not | | | | advocacy groups in the USA use the term CFIDS |
| exclusively, in women, possibly due to | | | | (pronounced [See-Fids]), originally an |
| immunological factors (women are overall more | | | | acronym for the above or "Chronic Fatigue & |
| susceptible to similar disorders). CFS is | | | | Immune Dysfunction Syndrome". This term was |
| most easily diagnosed when formerly active | | | | introduced by patients current with the |
| adults become ill, but it has been reported | | | | biomedical research in an attempt to reduce |
| in persons of all ages, including young | | | | the psychiatric stigma attached to "chronic |
| children and particularly teenagers. | | | | fatigue", as well as the public perception of |
| | | | CFS as a psychiatric syndrome. The term also |
| Patients with this diagnosis commonly report | | | | calls attention to the immune dysfunction in |
| many other symptoms which are far more | | | | patients for which evidence has been steadily |
| wide-ranging than these research diagnostic | | | | growing since the illness was first |
| criteria, including: pain, muscle weakness, | | | | identified, and which now appears to be an |
| loss of brain function, hypersensitivity, | | | | integral part of this illness. |
| orthostatic intolerance, digestive | | | | |
| disturbances, depression, immune system | | | | Post-viral [fatigue] syndrome (PVS or PVFS); |
| weakness, and cardiac and respiratory | | | | this is a related disorder. According to |
| problems. These symptoms, like the syndrome's | | | | original ME researcher Dr. Melvin Ramsay, |
| hallmark 'fatigue', range from mild to | | | | "The crucial differentiation between ME and |
| life-threateningly severe. Some cases resolve | | | | other forms of post-viral fatigue syndrome |
| or improve over time, and where available, | | | | lies in the striking variability of the |
| treatments bring a degree of improvement to | | | | symptoms not only in the course of a day but |
| many others. Most diagnostic criteria insist | | | | often within the hour. This variability of |
| that the symptoms must be present for at | | | | the intensity of the symptoms is not found in |
| least six months, and all insist on there | | | | post-viral fatigue states" (Ramsay 1989). |
| being no other cause for the fatigue: i.e. | | | | However, other researchers and advocates |
| the fatigue must be idiopathic, not caused by | | | | argue that other post-viral syndromes (such |
| conditions such as radiation treatment for | | | | as post-polio syndrome) do show similar |
| cancer, or diabetes. CFS remains a | | | | variability, and point to the striking |
| controversial diagnosis, and even its | | | | similarity between post-viral fatigue |
| terminology and classification are | | | | syndrome and CFS symptoms, noting that many |
| controversial. Recently, genetics and stress | | | | CFS cases are triggered by a viral illness. |
| have been found to be factors in the | | | | |
| development of CFS. | | | | Chronic Epstein-Barr virus (CEBV) or Chronic |
| | | | Mononucleosis; the term CEBV was introduced |
| Originally studied in the late 1930s as an | | | | by virologists Dr. Stephen Straus and Dr. Jim |
| immunological neurological disorder under the | | | | Jones in the United States. The Epstein-Barr |
| medical term "myalgic encephalomyelitis" | | | | virus, a neurotropic virus that more commonly |
| (ME), CFS has been classified by the World | | | | causes infectious mononucleosis, was thought |
| Health Organization (WHO) as a disease of the | | | | by Straus and Jones to be the cause of CFS. |
| central nervous system since 1969. In 1992 | | | | Subsequent discovery of the closely related |
| and early 1993 the terms "post-viral fatigue | | | | human herpesvirus 6 shifted the direction of |
| syndrome" (PVFS) and "chronic fatigue | | | | biomedical studies, although a vastly |
| syndrome" (CFS) were added to ME under the | | | | expanded and substantial body of published |
| exclusive ICD-10 designation of G93.3. | | | | research continues to show active viral |
| | | | infection or reinfection of CFS patients by |
| Lacking a diagnostic test of any kind, CFS | | | | these two viruses. These viruses are also |
| has historically been mis-diagnosed, for | | | | found in healthy controls, lying dormant. |
| example in patients presenting CFS symptoms | | | | |
| with similar biological conditions or | | | | Low Natural Killer cell disease; this name is |
| infections (such as Lyme or Epstein-Barr) | | | | used widely in Japan. It reflects research |
| (the latter of which is often the cause of | | | | showing a reduction in the number of natural |
| glandular fever, or infectious | | | | killer cells in many CFS patients. More |
| mononucleosis), or psychological conditions | | | | significantly, the activity of the remaining |
| (ranging from depression to hypochondria). A | | | | natural killer cells is reduced, often by as |
| lack of information and awareness has led to | | | | much as two thirds. |
| many patients being stigmatized as | | | | |
| hypochondriac or lazy. The Centers for | | | | Yuppie Flu; this was a factually inaccurate |
| Disease Control & Prevention (CDC) have now | | | | nickname for CFS, first published in a |
| recognized CFS as a serious illness and have | | | | November 1990 Newsweek article. It reflects |
| recently launched a campaign to raise public | | | | an assumption that CFS mainly affects the |
| and medical awareness about it. | | | | affluent ("yuppies"), and implies that it is |
| | | | a form of malingering or burnout. CFS, |
| There are a number of different terms which | | | | however, affects people of all races, |
| have been identified at various times with | | | | genders, and social standings, and this |
| this disorder. | | | | nickname is inaccurate and considered |
| | | | offensive by patients. It is likely that this |
| Myalgic encephalomyelitis (pronounced | | | | article contributed to the damaging public |
| [my-al'jik en-sef'a-lo-my'e-ly'tis]) or M.E, | | | | (and even medical) perception of CFS as a |
| "inflammation of the brain and spinal cord | | | | psychiatric or even psychosomatic condition. |
| with muscle pain", as a disease entity has | | | | |
| been recognized and described in the medical | | | | Uncommonly used terms include Akureyri |
| literature since 1938, with the seminal paper | | | | Disease, Iceland disease (in Iceland), Royal |
| being that by Wallis in 1957; Sir Donald | | | | Free disease (after the location of an |
| Acheson's (a former Chief Medical Officer) | | | | outbreak), atypical poliomyelitis, epidemic |
| major review of ME was published in 1959;[3] | | | | vasculitis, raphe nucleus encephalopathy, and |
| in 1962 the distinguished neurologist Lord | | | | Tapanui flu (after the New Zealand town |
| Brain included ME in his textbook of | | | | Tapanui where the first doctor in the country |
| neurology, and in 1978 the Royal Society of | | | | to investigate the disease, Dr Peter Snow, |
| Medicine accepted ME as a distinct clinical | | | | lived). |