Chronic fatigue syndrome (CFS) is defined as a set of symptoms of intense and almost permanent exhaustion that appear for no apparent reason or underlying pathology. The patient becomes tired to the point of not being able to perform the simplest daily tasks such as showering or grocery shopping. When the disorder is severe, the patient cannot maintain a socio-professional life and sometimes loses autonomy.

This syndrome has known a multitude of names over time: neurasthenia, post-viral fatigue syndrome, chronic mononucleosis, yuppie disease, Lake Tahoe syndrome or myalgic encephalomyelitis. It was recognized as a serious neurological disease by the WHO in 1992.

A mysterious disease, the origin of which has not yet been precisely defined, and the management of which raises serious difficulties, chronic fatigue syndrome profoundly affects the quality of life — personal, family, professional and social — of those who are affected.

Causes

Contrary to popular belief, chronic fatigue syndrome is not a disease of neurological origin, although many of the symptoms are neurological. To date, four main assumptions have been made:

The immune track

According to some scientists, chronic fatigue syndrome is linked to a change in the patient’s immune status. A study carried out in 2008 identified a higher level of the inflammatory response in the event of exposure to stress or infection in chronically tired people. According to the researchers, this pronounced inflammatory state from the slightest disturbance would be at the origin of the symptoms of chronic fatigue syndrome: asthenia, flu-like condition, pain, breathing difficulties. Thus, it would seem that the only way to reduce the symptoms would therefore be to avoid anything that could trigger a modulation of immunity: infection, intense physical activity, stress, etc.

In fact, CFS often appears after a bacterial or viral infection. Once the disease is cured, the fatigue persists. In particular, doctors point the finger at viral infections with the herpes virus and the Epstein-Barr virus (responsible for infectious mononucleosis). Brucellosis and mycoplasmas (bacteria) have also been implicated.

The muscle track

Doctor Yves Jammes, professor of the Faculty of Medicine and cardiologist at the European Hospital of Marseille (France), has carried out a large number of studies on chronic fatigue syndrome. He compared the muscular response to physical exertion in a sick patient and in a healthy patient. He observed in the individual affected by CFS: a reduction in muscle excitability measured during physical exertion, an increase in oxidative stress and damage to the muscle membrane, an insufficient response of the protective proteins of stress oxidative induced by physical effort, and low levels of CD26 (molecule playing an anti-inflammatory role). The decrease in protective proteins could also affect brain tissue.

Therefore, it seems that chronic fatigue syndrome is also linked to significant degradation of muscle and brain cells due to oxidative stress (that is to say the aggression of cells by free radicals). Oxidative stress is caused by various attacks (intense physical activity, emotional stress, infections, bad eating habits, smoking, etc.).

The hormonal track

In people with this condition, certain hormones are present in amounts slightly less than normal. These include growth hormone and cortisol (called the “stress hormone” because it helps the body cope with periods of physical or psychological stress). However, we do not know if this hormonal abnormality is the cause or one of the consequences of CFS.

It should be noted that it has often been observed, in people with CFS, a high frequency of events with a strong emotional impact in the three months preceding the onset of the disease.

The toxicological track

Exposure to certain pesticides or insecticides sometimes causes symptoms similar to those of CFS and could be involved in some cases.

Symptoms

As the name suggests, this syndrome is primarily characterized by extreme fatigue, which rest does not reduce. However, a fifth of the population complains of fatigue, sometimes bordering on exhaustion. Other criteria must therefore be taken into account in establishing chronic fatigue syndrome.

• Fatigue is unexplained: it is not linked to an established organic or psychological cause.
• Fatigue is chronic and disabling: it has lasted for at least six months, and significantly disrupts professional, family, social, school activities, etc.
• Discomfort occurs following physical or psychological effort and persists for more than twenty-four hours.
• Sleep does not allow you to recover.
• Patients suffer from muscle, joint and abdominal pain, and headaches.
• They present frequent and recurring sore throats, recurring flu-like symptoms, allergies, food intolerances, etc.
• Neurological or cognitive problems are highlighted: confusion, loss of short-term memory, difficulty concentrating, disorientation, dizziness when changing from sitting to standing.
• Nausea, palpitations, alcohol intolerance, pallor or feeling feverish are other signs.
• Depression can accompany and further complicate chronic fatigue syndrome.

In fact, the picture can vary considerably from one patient to another, although all share the main constants. The most acute manifestations of CFS usually last two years and occur cyclically.

Diagnosis

Diagnosis of chronic fatigue syndrome occurs both by cross-checking the symptoms, and by exclusion. A complete assessment will make it possible to search for clues that could link the syndrome to an underlying disease, of which it would be the manifestation. The approach will therefore be multidisciplinary, with initial treatment by an internal medicine specialist, who approaches the patient as a whole in order to eliminate the pathologies that could be at the origin of the symptoms. A psychiatrist will be responsible for detecting any psychological problems.

The tests will also aim to rule out fibromyalgia, which has many similarities to chronic fatigue syndrome. After that, if the diagnosis of CFS is confirmed, the patient can be referred to a specialist.

Treatment

The patient is usually integrated into a rehabilitation program, which lasts for several months. Doctors, psychologists, rehabilitation specialists, social workers: a range of specialists will work together to provide care.

This is based on a double line of action: exercise training (aerobics, stretching, exercises in water) and the psychological approach, so that the patient learns to live with his disease. Because it is more about rehabilitation — that is, functional improvements — than healing.

Relieve Symptoms

There is no specific and universal treatment for chronic fatigue syndrome, with clearly and formally demonstrated effectiveness. It is therefore necessary to focus on relieving symptoms, strengthening autonomy, and maximizing the patient’s abilities while respecting their limitations. Relaxation techniques can have real benefits, as can those that improve the quality of sleep.

Ensure a balanced diet, practice — moderately and under medical supervision — physical activity, use additional methods (aromatherapy, light therapy, herbal medicine, etc.), anything that can put the patient in confidence, help them to live better in their body, to better identify and manage their capacities, is of interest.

In fact, people with Chronic Fatigue Syndrome, unlike patients suffering from depression, aspire to fully savor the pleasures of existence, but due to their exhaustion, life slows down, which generates significant frustration.

Prevention

Since the causes are unknown, it is not possible to institute a prevention regimen for chronic fatigue syndrome. This does not, however, prevent some advice from being offered.

The first is that heavy, persistent, and unexplained fatigue should prompt you to see a doctor. This symptom could indeed reflect the development of a serious disease, maybe chronic fatigue syndrome, maybe some other condition, physical or psychiatric. In any case, the consultation will make it possible, if necessary, to implement early and appropriate therapeutic care. You must not let things drag on, on the pretext that things will get better soon.

• Avoid psychological stressors and fight against it by different methods: psychotherapy, relaxation, meditation, relaxing yoga, etc.
• Avoid strenuous sports activities.
• Avoid overwork.
• Maintain a healthy lifestyle: sufficient sleep, balanced diet (rich in fiber and nutrients and low in saturated fatty acids and rapid sugars). However, physical activity should be kept moderate as it is often the cause of symptoms. Despite this, patients must fight against a sedentary lifestyle.
• Avoid alcohol, tobacco, and caffeine.
• Obtain psychological support through associations or support groups.
• Protect yourself from bacterial and viral infections (by maintaining good hand and tooth hygiene, avoiding too close contact with those around you, wearing a mask, favoring protected sex, etc.).
• Eliminate allergens or treat allergies as soon as possible.