ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Tuesday, October 1, 1996 TAG: 9610010020
SECTION: EXTRA PAGE: 4 EDITION: METRO
Q: What Is Chronic Fatigue Syndrome?
A: Chronic Fatigue Syndrome is also called Chronic Fatigue and Immune Dysfunction Syndrome, or CFIDS, and Myalgic Encephalomyelitis, or ME, elsewhere in the world. (It was once called chronic Epstein-Barr Virus, but the EB virus is no longer thought to cause it.) According to the federal Centers for Disease Control and Prevention, the following must be present in a case of CFS:
1. Clinically evaluated, unexplained, persistent or relapsing chronic fatigue that is of new or definite onset (has not been lifelong); is not the result of ongoing exertion; is not substantially alleviated by rest; and results in substantial reduction in previous levels of occupational, educational, social or personal activities.
2. The concurrent occurrence of four or more of the following symptoms, all of which must have persisted or recurred during six or more consecutive months of illness and must not have predated the fatigue: cognitive problems; sore throat; tender lymph nodes in the neck or armpit; muscle pain; joint pain without swelling or redness; headaches of a new type, pattern or severity; unrefreshing sleep; or post-exertional malaise lasting more than 24 hours.
(Widespread musculoskeletal pain and fatigue is thought by some to be a separate illness - fibromyalgia syndrome - which many CFS patients also have.)
Q: Are there other symptoms?
A: Those with CFS sometimes report other symptoms, including high or low body temperature, vision problems, rashes, dizziness, irritable bowel, hair loss, allergies and chemical sensitivity. Who gets CFS?
Children and adults of every race, social class and ethnicity can get CFS, but it earned the label ``yuppie flu'' in the 1980s because it seemed to be most prevalent among white, middle-class women. Others have argued that current studies underestimate the prevalence of CFS in low-income populations and have overstated the prevalence among women because women seek medical attention more frequently than men. CFS has been diagnosed around the world.
Q: Is CFS a new illness?
A: Many researchers believe CFS is a new name for an illness that goes way back. Neurasthenia, a popular diagnosis in the 19th century, may have been the same illness.
Q: What causes CFS?
A: The cause is unknown, though there are intriguing areas of research. Dr. Peter Rowe of Johns Hopkins University Medical School in Baltimore has been studying the relationship between CFS and Neurally Mediated Hypotension, or NMH - low blood pressure caused by mixed signals between the heart and brain that can cause fainting and dizziness when a person moves from reclining to standing.
NMH is not limited to CFS patients, but upward of 90 percent of the adolescents and adults with CFS evaluated by Rowe and his colleagues tested positive for NMH. Of these, one-third of those treated with blood pressure medication and diet and lifestyle changes not only overcame NMH but virtually recovered from their CFS symptoms. Another third had a marked improvement in CFS symptoms.
Rowe has begun a controlled, randomized study to see if low blood pressure causes some CFS cases. He acknowledges that NMH could be the result of a deeper, underlying cause.
Richard L. Bruno of the Kessler Institute for Rehabilitation in Saddle Brook, N.J., believes the low blood pressure condition is a symptom of something deeper - perhaps the effects of a poliolike virus that has not yet been identified. Bruno and his staff specialize in post-polio sequelae, a chronic fatigue problem that affects adults who survived polio as children.
He has found remarkable similarities between CFS patients and those suffering from post-polio syndrome. One shared trait is the presence of brain lesions in the white matter that connects the brain activation area in the brain stem (known to be damaged by polio) to the brain's cortex or supercomputer. There are also suggestions that outbreaks of a CFS-like illness that occurred before the polio epidemic of the 1950s left its victims immune to polio. Bruno wonders if a polio-like enterovirus is at work in CFS. His institute is beginning to recruit children with CFS and polio for a comparative study.
There are many other suspects: viruses, bacteria, environmental chemicals and other agents. Some kind of genetic predisposition also is likely. But Dr. Thomas J. Lane, who runs the CFS clinic at New Britain General Hospital in Connecticut, warns that CFS - which might be a bundle of illnesses under one label - could have more than one cause. And what triggers CFS may not be what keeps it going. Such a trigger could be a viral infection or a traumatic life event, Lane said. He suggests that the trigger may cause an imbalance and that the immune system may play a role.
Q: How is CFS treated?
A: CFS isn't treated; its symptoms are. There are a vast number of medicines used to treat troubled sleep, aching joints, headaches and other symptoms. Dr. Jacob Teitelbaum of Annapolis, Md., claims to have had good success using diet, supplements of vitamins, minerals and hormones. His program is set forth in ``From Fatigued to Fantastic!'' (Avery, $11.95). But, as Lane points out: ``Nothing has been shown in a well-controlled trial to do anything.''
Based on some promising British research, Lane's work has used a combination of cognitive-behavioral therapy and self-directed, graduated exercise with some success. Though not all researchers endorse this approach, many doctors encourage patients to be as active as possible.
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