Clinical Practice: Chronic fatigue syndrome

Abstract

The diagnosis chronic fatigue syndrome (CFS) was conceptualized in the mid-1980s. It is a clinically defined condition characterized by severe and disabling new onset fatigue with at least four additional symptoms: impaired memory or concentration, sore throat, tender cervical or axillary lymph nodes, muscle pain, multi-joint pain, new headaches, unrefreshing sleep or post-exertion malaise. Chronic fatigue syndrome in adolescents is a rare condition compared to symptomatic fatigue. The estimated prevalence of adolescent CFS ranges between 0.11 and 1.29 % in Dutch, British, and US populations. Diagnosis of the chronic fatigue syndrome is established through exclusion of other medical and psychiatric causes of chronic fatiguing illness. Taking a full clinical history and a full physical examination are therefore vital. In adolescence, CFS is associated with considerable school absence with long-term detrimental effects on academic and social development. One of the most successful potential treatments for adolescents with CFS is cognitive behavioural therapy, which has been shown to be effective after 6 months in two thirds of the adolescents with CFS. This treatment effect sustains at 2-3-year follow-up. In conclusion, the diagnosis CFS should be considered in any adolescent patient with severe disabling long-lasting fatigue. Cognitive behavioural therapy is effective in 60-70 % of the patients. Prompt diagnosis favours the prognosis.

Chronic Fatigue Syndrome at Age 16 Years

“…The FAI is derived from responses to questions asked during pregnancy and when the child was 8 to 10 years old regarding the following 9 factors, comprising 14 items in total: (1) age of mother at first pregnancy; (2) housing, comprising adequacy, basic amenities, defects, damp, and infestation; (3) mother's and father's low educational attainment; (4) financial difficulties; (5) relationship with partner, comprising lack of affection, cruelty, and lack of support; (6) social network, comprising lack of emotional support and lack of practical support; (7) substance abuse; (8) being in trouble with the police; and (9) psychopathology of the mother (anxiety, depression, or suicide attempts). Each of the 14 items is assigned a value of 1 if an adversity is present and 0 if it is not present; hence, the FAI has a theoretical range of 0 to 14.…”

“…[1][2][3] CFS, also known as myalgic encephalomyelitis (ME) or, more recently, systemic exertion intolerance disease, 4 has been defined by using various diagnostic criteria. 5 Guidelines from the UK National Institute for Health and Care Excellence state that the diagnosis of CFS should be made after 3 months of persistent or recurrent fatigue that is not the result of ongoing exertion, not substantially alleviated by rest, has resulted in a substantial reduction in activities, and has no other known cause.…”

How is paediatric chronic fatigue syndrome/myalgic encephalomyelitis diagnosed and managed by paediatricians? An Australian Paediatric Research Network Study

“…Paediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a condition, characterised by profound, unexplained chronic fatigue together with a range of other sleep, pain, cognitive, autonomic, neuro‐endocrine and immune symptoms. It causes significant morbidity at a crucial time in a young person's development . In a paediatric setting, it typically occurs during mid to late adolescence, a time associated with significant changes in social, cognitive, physical and biological development .…”

“…It causes significant morbidity at a crucial time in a young person's development. 1,2 In a paediatric setting, it typically occurs during mid to late adolescence, a time associated with significant changes in social, cognitive, physical and biological development. 3 Disruption during this crucial development phase can lead to school absence, as well as long-term social, health, emotional, academic and vocational implications.…”

Improvement rates in adolescent patients with chronic fatigue syndrome after receiving cognitive behavioural therapy

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Werker et al [7] claim that several randomised controlled trials have demonstrated that cognitive-behavioural therapy (CBT) resulted in improvement and 'recovery' in 60-70 % of adolescent patients with chronic fatigue syndrome when assessed at 6 months [3,4,6], with 'comparable results at 2-3-year follow-up' [2,5]. However, I believe further data from the cited research studies would have been helpful to put the results in their full context.

The open-label FITNET trial [4,5] did indeed report a 63 % 'recovery' rate at 6 months.

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