The chronic fatigue syndrome (CFS) was formally defined in
1988 to describe a syndrome of severe and disabling fatigue of
uncertain aetiology associated with a variable number of
somatic and/or psychological symptoms. CFS has been reported
in most industrialised countries and is most prevalent in
women aged between 20 and 50 years. Despite occasional claims
to the contrary, the aetiology of CFS remains elusive.
Although abnormalities in tests of immune function and
cerebral imaging have been described in variable numbers of
CFS patients, such findings have been inconsistent and cannot
be relied upon, either to establish or exclude the diagnosis.
Thus, diagnosis rests on fulfillment of the Centers for
Disease Control case definition which was revised in 1992.
This case definition remains somewhat controversial, largely
due to its subjectiveness. The mainstay of treatment is
establishing the diagnosis and educating the patient about the
illness. An empathetic clinician can stop further
consultations elsewhere (‘doctor shopping’) and subsequent
excessive investigations, which frequently occur in such
patients. Most patients should undertake a trial of
antidepressant therapy, even if major depression is not
present. The choice of antidepressant drug should tailor the
tolerability profile to relief of particular CFS symptoms,
such as insomnia or hypersomnia. Failure to improve within 12
weeks warrants an alternative antidepressant agent of another
class. Many other drugs have been reported anecdotally to be
beneficial, but no therapy has been demonstrated to be
reproducibly useful in double-blind, placebo-controlled
clinical trials with an adequate duration of follow-up.
Blondel-Hill E, Shafran SD