Chronic fatigue syndrome

Nicholas Farber (Mr. Farber of the University of Pittsburgh has no relevant financial relationships to disclose.)
Jennifer Miller (Ms. Miller of Pennsylvania State University has no relevant financial relationships to disclose.)
Frank S Lieberman MD (Dr. Lieberman of the University of Pittsburgh has received consulting fees and honorariums from Schering-Plough for serving as a consultant and speaker. He has also received consulting fees from Merck for serving as a consultant.)
Deric M Park MD (Dr. Park of the National Cancer Institute has no relevant financial relationships to disclose.)
Anthony T Reder MD, editor. (Dr. Reder of the University of Chicago served on advisory boards and as a consultant for Bayer, Biogen Idec, Caremark Rx, Genentech, Genzyme, Novartis, Questcor/Malinkrodt, Serono, and Teva-Marion.)
Originally released May 13, 1996; last updated August 12, 2008; expires August 12, 2011
Notice: This article has expired and is therefore not available for CME credit.

This article includes discussion of chronic fatigue syndrome, postviral chronic fatigue syndrome, chronic mononucleosis syndrome, Tahoe flu, myalgic encephalomyelitis, neurasthenia, chronic fatigue and immune dysfunction syndrome, AIDS minor, yuppie flu, bored housewife syndrome, and effort syndromes. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Chronic fatigue syndrome, also known as myalgic encephalomyelitis or chronic fatigue immune dysfunction syndrome, is a debilitating illness diagnosed by means of exclusion. The illness is often controversial; the proposed etiology, preferred method of treatment, and even the nomenclature varies widely from source to source. The symptoms are also diverse and fluctuating, making uniform studies and research difficult. Even diagnosing chronic fatigue syndrome is a challenge, as reliable diagnostic tests and biological markers remain elusive. Little is certain about this illness, but this manuscript summarizes most of the current and widely accepted information about the subject.

Key points

Historical note and terminology

There is considerable belief that the history of chronic fatigue syndrome, termed myalgic encephalomyelitis in Great Britain, dates back to the 1800s. In 1869, American neurologist George Beard described a disease known as neurasthenia, an organic illness that caused disabling fatigue of the mind and body. Neurasthenia, which included around 70 symptoms, became a popular and often overused diagnosis in the late 1800s, but fell out of favor around 1918 when it became perceived as primarily psychological and was abandoned by neurologists.

By World War I, neurasthenia was rarely diagnosed. The fatigue illnesses affecting World War I soldiers, called effort syndromes, gained national attention, but subsequent studies by distinguished cardiologist Paul Wood concluded that psychological factors were again the primary trigger, and the conditions were placed instead in the realm of psychiatry (Moss-Morris and Petrie 2001). During this time, psychiatry became more sophisticated, and neurasthenia was seen as psychiatric rather than a neurologic condition (Friedberg 1998).

Nonetheless, worldwide incidences of fatigue syndromes have been reported in medical publications for centuries. Notable epidemics occurred at the Los Angeles County Hospital in 1934 and at the Royal Free Hospital in London in 1955. The symptoms were primarily neuromuscular (such as muscle weakness, headache, profound fatigue, and confusion), and an infective agent was thought to be rooted in the epidemics. The terms myalgic encephalomyelitis and neuromyasthenia developed as a result of the transmissible hypothesis, though many suggested mass hysteria was the true origin.

The disorder was officially termed “chronic fatigue syndrome” in late 1988 by the Centers for Disease Control. In 1994, the Centers for Disease Control began recognizing a definition of chronic fatigue syndrome based on the research of an international panel of chronic fatigue syndrome investigators. More than 100 years after the proposed neurasthenia diagnosis, medical disagreements returned to the nature of the disorder. Although chronic fatigue syndrome is a clinically defined medical condition, there is a long history of debate regarding its etiology (Englebienne and De Meirleir 2002).

The content you are trying to view is available only to logged in, current MedLink Neurology subscribers.

If you are a subscriber, please log in.

If you are a former subscriber or have registered before, please log in first and then click select a Service Plan or contact Subscriber Services. Site license users, click the Site License Acces link on the Homepage at an authorized computer.

If you have never registered before, click Learn More about MedLink Neurology  or view available Service Plans.