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What is M.E./CFS?
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (M.E./CFS ) is an endemic disorder, associated with an initial viral infection, that occurs in both epidemic and sporadic forms.
M.E./CFS is an acquired brain dysfunction and results in a rapid and persistent exhaustion of both physical and cognitive abilities, an autonomic disregulation and a reduction of more than 50% of the individual's previous ability to carry out work, school or social activities. This Central Nervous System dysfunction can be exacerbated by levels of physical, sensory, cognitive, or emotional stress that would have been of no consequence in the same patient prior to the infectious or traumatic injury.
This neuroimmunological injury can usually be identified by studying SPECT or PET Scan Images of the patient's brain.
The following information is only a brief review of M.E./CFS originally compiled as a physician's guide. Interested physicians and patients are encouraged to order the comprehensive and authoritative text The Clinical and Scientific Basis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Patient's have found the book an "easy-to-read and understand" source of information on the various aspects of M.E./CFS.
A Myalgic Encephalomyelopathy
In its complete form, M.E./CFS can be characterized as a Myalgic Encephalomyelopathy.
Myalgic incorporates fibromyalgia, migratory and post-exertion muscle pain and spasm that is routinely observed in 70% of M.E./CFS patients.
Encephalopathy can be demonstrated by autopsy, SPECT, QEEG, and PET scan and sometimes MRI.
Myelopathy refers to spinal cord pathology as first noted by U.S. neurologist, Alberto Marinacci in California in the 1950's. Complaints of headaches, causalgia, neck and spinal pain are common.
A description of M.E./CFS in Adults
Acute onset M.E./CFS consists of a short prodromal illness, often described as starting with a "flu-like illness", but in reality occuring after any of several infectious insults, including encephalitis with severe headaches, an upper or lower respiratory infection, gastroenteritis, conjuctivitis, or Borneholme's disease with or without acute onset of peresis or pain syndromes. In children, Hand, Foot and Mouth-like rash is common. This is followed by the primary acute illness:
The following Dr. A.L. Wallis" 1955, Edinburgh Definition, with modifications by Dr. Melvin Ramsay, represents an accurate, clinical description of a full-blown case of M.E./CFS.
General Characteristics:
The systemic illness is accompanied by a relatively low fever or subnormal (and highly variable) temperatures and "an alarming tendency to become chronic". There is a marked variability and fluctuation of both symptoms and physical findings in the course of a day.
System Dysfunction:
There is a unique form of (marked) muscle, sensory and cognitive fatigability, whereby, even after a minor degree of physical (sensory, cognitive or emotional) effort, 3-5 days or longer elapse before adequate muscle (cognitive and emotional) powers are restored.
There are CNS changes, impairment of memory, changes in mood, sleep disorders and irritability or depression.
There may be significant involvement of the autonomic nervous system resulting in orthostatic tachycardia and hypotension, coldness of the extremities, episodes of sweating or profound pallor, sluggish pupils, bowel changes and micturition, possibly as a result of a lesion of the hypothalamus.
There is diffuse and variable involvement of the central nervous system, leading to ataxia, weakness and/or sensory changes in a limb, nerve root or peripheral nerve.
Myalgias and Cephalgias:
There may be muscular pain, tenderness and myalgia in up to 70% of these patients.
There are usually cephalgias, characterized in mild cases with retro-orbital and occipital headaches in the early stages of the disease process. In severe cases, the illness may debut with a severe incapacitating pancephalic pain that may persist for months. In addition, cervical and upper thoracic vertebrae pain, often with causalgia, is regularly encountered.
The Chronic Illness
If the illness persists for a period of more than one year, there is an alarming tendency for the disease process to become chronic.
Chronic illness represents an extension of the features of the acute illness. However, the symptoms tend to be less fulminant, less variable and compounded frequently by a financial and social poverty that occur as a direct result of the disabling features of the M.E./CFS illness.
Warning: Many treatable and some potentially progressive and life-threatening illnesses may also debut in this fashion. The patient should always be seen and investigated by a qualified physician to rule out these illnesses. Patients who persist in their illness for more than six months should be re-examined at least every six months and tested yearly, since some illnesses may declare themselves in an eratic and cyclical manner.
M.E./CFS in Children
Children become dyslexic, tearful, physically weak and exhibit exhaustion or profound mood changes. Previously active children shun physical activity. Those with previously good academic levels may start to fail their grades. Since development of this illness often occurs in grade 8, children changing school systems are out of view of the teachers who know them well. Unless there is parental intervention, they are sometimes moved to slow learners' classes. If the parent objects, they are often classified inappropriately as suffering from school phobia or having an interfering parent.
The younger the age, the more difficult it is for the children to verbalize the changes in their physical and mental state. Uninformed physicians frequently misdiagnose these children as simply depressed. Suicide is frequent.
Physicians should include M.E./CFS in the differential diagnosis of any child with a previously good academic and sports background who develops the following changes in personality, apparent intelligence and physical abilities after a viral infection.
Symptoms in Children
The following is a combined list from two separate publications, of A.L. Wallis and P.O. & W. Behan.
(1) Depression: This often occurred with weeping tendencies, and appeared early. Nearly all affected children are first diagnosed as hysterical, depression or "parental over-involvement".
(2) Loss of energy: This occurred in all but the mildest cases and frequently persisted.
(3) Retardation of thought processes: Work involving abstract thought was difficult to perform in all cases with protracted illness or recurrences. Serial seven test was poorly performed, often with errors, often starting the test well and then getting bogged down.
(4) Impairment of thought process: This was a common feature, and the contents of papers or magazines read only a few minutes earlier could not be recollected.
(5) Impairment of memory: Recent retention and recall - items of work to be done or purchases to be made - had to be listed as memorizing proved unreliable.
(6) Disorders of sleep: Inversion of sleep rhythm was common with nightmares in children, often with hallucinations on waking.
(7) Behaviour disorders: Temper tantrums were frequent in young children. In older children unsociability, lack of attention and effort on return to school was frequent. If behaviour was checked, children tended to weep. There is anxiety and clinging dependency, with a reluctance to attend school.
(8) Physical activities: There is a lack of interest in playing games with other children. When forced to attend school and take part in physical exercise, this has been followed by disastrous deterioration in the clinical condition, with overwhelming exhaustion and weakness supervening.
(9) Weight loss: A significant amount of body weight may be lost early in the disease process.
(10) Profound weakness: The weakness may be so severe that the child is confined to a wheel chair.
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