Chronic Fatigue Syndrome Department Of Medicin：慢性疲勞綜合征醫(yī)學系

1、a patient with chronic fatigue syndromekristin steffen, md2/22/06i have no financial disclosures.objectivesnidentify case definition for chronic fatigue syndrome (cfs)nrecognize similarities between cfs and fibromyalgiandescribe clinical presentation, prognosis of cfsnreview recommendations for diag

2、nosis nidentify 2 treatmentsnidentify useful referencesninformational presentation only (i am not soliciting referrals!)case of afnaf is a 35 yo f diagnosed with cfs in 1992 with abrupt onset of symptoms following urinextensive negative work up for alternative cause (14 physicians, every recommended

3、 test plus more than twice as many more)nextensive trials of experimental treatments (32+)non ssi total disability, appealing employer decision to revoke employer-based disability benefitnstable: neither improving nor worsening, currently taking no specific pharmacologic therapy 1994 cdc case defini

4、tion for cfsni. clinically evaluated, unexplained, persistent, or relapsing fatigue that is of new or definite onset; it is not the result of ongoing exertion; is not alleviated by rest; and results in substantial reduction in previous levels of occupational, educational, social, or personal activit

5、iesand1994 case definition of cfs, contnii. four or more of the following symptoms that persist or recur during six or more months of illness that do not predate fatigue:1994 case definition of cfs, contnii. four or more of the following symptoms that persist or recur during six or more months of il

6、lness that do not predate fatigue:conditions that exclude cfs dxnany active medical condition that may explain the presence of chronic fatiguenany previously diagnosed medical condition whose resolution has not been documented beyond reasonable doubtnany past or current diagnosis of specified psychi

7、atric disordersnalcohol or other substance abusensevere obesity (bmi 45)conditions that do not exclude cfs dxnany condition defined primarily by symptoms that cannot be confirmed by diagnostic laboratory testsnany condition under specific treatment to alleviate all symptoms related to that condition

8、 and for which adequacy of treatment has been documentednany condition, such as lyme disease or syphilis, that was treated with definitive therapy before the development of chronic symptomatic sequelae.conditions that do not exclude cfs dxnany isolated or unexplained pe finding or lab or imaging tes

9、t abnormality that is insufficient to strongly suggest the existence of an exclusionary conditionidiopathic chronic fatiguenclinically evaluated, unexplained chronic fatigue of greater than 6 months duration that does not meet criteria for cfs diagnosissimilarities between cfs and fibromyalgiancommo

10、n in women nmyalgias and fatigue in 90%nsymptoms in common: cognitive and mood, headache, nonrestorative sleepnno known causenclinical diagnosis (no specific diagnostic tests, except trigger points in fibromyalgia)nchronic symptoms, no highly effective treatmentfibromyalgia diagnostic criterianwides

11、pread body pain (left and right, above and below the waist) and axial skeletal pain (neck, chest wall, mid or low back)npresence in 11 of 18 tender point sites on digital palpation with “an approximate force of 4 kg”cause of cfsnunknownnpossible precipitants that have been studied but have not been

12、found to be causative:clinical presentation with cfsnvariablensudden onset of fatigue after urinafter uri, continued overwhelming fatigue plus addl sx (e.g. altered sleep, cognition)nsymptoms exacerbated by excessive physical activitynno prior hx of backache/chronic headacheclinical presentation, co

13、nt.ntypically in formerly high functioning individualsnonce inciting illness resolved, physical exam is normalnfeel feverish, but normal tempnachy joints, but no findings on examnmuscle fatigue, but normal biopsiesnfrequent sore lymph nodesndisabled by symptoms, but outwardly healthy appearingclinic

14、al presentation, cont.npatients may be accused of malingering by family, colleaguesn*cognitive dysfunction: no specific pattern of cerebral abnormalities uniquely characterize cfs patients; most prominent features may be slowed processing speed, impaired working memory, poor learningprognosisnsome r

15、ecover completely, some recover and are able to work but have flares, some never recovernof those who recover, most recover within 5 yearsnas illness progresses reports of muscle pain and forgetfulness increase, depression decreasesnpoorer prognosis when patient believes the illness is due to a (giv

16、en) physical causediagnosisnclinical, based on typical presentation, case definitionnno diagnostic exam or test findings existnpurpose of evaluation is to identify and treat any underlying contributing factorsdiagnosisrecommended evaluation:uhistory and physical examucbc with diff, esr, chemistries

17、(electrolytes, kidney tests, liver tests, glucose, total protein, iron), tshufurther tests if clinically indicated to exclude alternative diagnoses suspected on the basis of initial testinguspecial immunologic testing, brain imaging, etc. are not recommendeduno specific cognitive testing recommended

18、 treatment of cfsnonly two therapies have been shown beneficial in clinical trials:ucognitive behavioral therapyugraded exercisenno known “cure”ngoal: symptom management and reintegration into social and occupational networksineffective measuresnimmune serum globulinnacyclovirngalantaminencorticosteroidsnamantadinendoxycyclinenmagnesiumncolonic enemasnevening primrose oilnvitamin b12nampligennessential fatty acidsnliver extractndialyzable leukocyte extractninterferonnexclusion diet