What is chronic fatigue syndrome?

What are the symptoms of chronic fatigue syndrome and how is it diagnosed?

Chronic fatigue syndrome (CFS), also referred to as CFS/ME, is a poorly understood condition about which we know very little.

Even though chronic fatigue syndrome is recognised by the WHO and the NHS, many doctors are still not familiar with it and often leave patients unaware of the syndrome, believing that their symptoms are the consequences of a depressive disorder. 

There are no biological markers for making the diagnosis. To date, only a set of symptoms can determine whether or not the patient is affected by CFS. 

In order to make a CFS diagnosis, the following 3 symptoms must be present:

• Severe fatigue that has lasted for at least 6 months, is intense and new, with a more or less definite onset, and is not the result of continuous overexertion that is not improved with rest. This fatigue results in a substantial reduction or impairment in personal, professional, or social activities previously performed. 
• Post-exertional malaise, meaning that, if a patient engages in an activity that requires slightly more effort than usual, he or she will be required to rest within 48 hours of the exertion. 
• Non-restorative sleep, meaning the patient sometimes wakes up exhausted despite having slept a perfectly adequate number of hours. 

As well as at least one of the following two symptoms:

• Cognitive impairment (especially in the early stages of the illness, with memory loss or concentration problems).
• Dizziness

In addition, medical teams initially seek to eliminate other conditions from the diagnosis that also involve the symptoms described above. Patients will then undergo numerous medical tests to rule out the following conditions: fibromyalgia, hypotension, mononucleosis, hypothyroidism, irritable bowel syndrome, certain cancers, and many inflammatory and autoimmune diseases.  

Once all these conditions have been ruled out, chronic fatigue syndrome can be considered. 

What are the causes and course of chronic fatigue syndrome?

Causes of chronic fatigue syndrome

CFS is classified as a neurological disease, but current pathology studies suggest that CFS is primarily immunological and that infectious sites that patients can sometimes develop (such as tooth decay, for example) can make their fatigue a lot worse.

Lifestyle is not implicated in CFS, unlike burn out, for example, where exhaustion is caused by a combination of work and family stress. 

Scientists are also looking into the fact that chronic fatigue syndrome could be the consequence of a microbial or viral infection. However, evidence of this has not been found in biological markers. 

Progression of chronic fatigue syndrome

The progression of CFS varies from person to person. The most acute manifestations usually last for 2 years and may return in a cyclical fashion as flare-ups. These symptoms tend to diminish over time.  

Not all patients recover completely, but the vast majority gradually regain their abilities.  

Doctors estimate that fatigue usually disappears, on average, after 5 years.  

How is chronic fatigue syndrome treated?

There is no specific treatment for chronic fatigue syndrome. However, a number of things can be done, such as

• Cognitive behavioural therapy (CBT): CBT is usually a fairly brief course of psychotherapy aimed at redirecting discouraging thoughts that might inhibit a positive outlook which promotes recovery.
• Gradual physical activity: Physical activity can be very important in CFS, as prolonged periods of rest can lead to deconditioning and thus worsen CFS symptoms. It is therefore necessary to gradually introduce some regular aerobic exercise such as walking, swimming, cycling, or running under close medical supervision. 
• Medication and alternative treatments: Some specific symptoms such as pain, depression and sleeping difficulties can be treated. However, it is difficult for doctors and patients alike to say which treatments work because symptoms differ from patient to patient and because symptoms can appear and disappear spontaneously. 

Who should you consult if you think you have chronic fatigue syndrome?

The lack of knowledge among doctors about CFS and the fact that there are no biological markers make it difficult to know where to turn. The doctors best able to diagnose the disease today are doctors of internal medicine or internists.

However, according to Robert Schenk, president of the French Association of Chronic Fatigue Syndrome (ASFC), some internists consider that these symptoms are psychological in nature. Patients therefore often end up going to so a mental health professional and, if the specialist considers that the patient is in a depressive state, then he or she will unfortunately be excluded from any later recognition of chronic fatigue syndrome. 

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