Chronic fatigue syndrome - Dr Mike Tenterborn

What is it?

Features
Unexplained fatigue for > 3 / 4 months.
General Malaise/flu like symptoms.
Boom/Bust Pattern.
Muscle pain and tenderness.
Headaches -?migraine or tension headaches.
Painful lymph nodes / sore throat.
Dizziness &/or Nausea.
Sleep Disturbance - with non-restful sleep.
Determination to achieve (previous high achievers).

Cognitive impairment/ Brain Fog.
Evidence of a prior viral infection in some.
?Secondary affective disorders.
Can be familial.
Three Grades of Severity.
Overlap with Fibromyalgia.
Temporo-mandibular joint pain.
Conditions to exclude
Neurological disorder.
Autoimmune Diseases.
Cardio-respiratory Disease. - Sleep apnoea.
Nutritional Disorders and or Malabsorptions.
Malignancies.
Investigations
Full History & Examination including weight & height.
FBC, ESR & CRP.
Thyroid Function.
Blood Sugar.
Liver, Bone and Renal Function.
Ferritin in children.
Creatinine Kinase.
Coeliac Screen.
MSU.

Non-routine investigations
Other as indicated by history - ie. EB virus, Borrelia (Lyme Disease) and  other serology, Toxic Metals (Hg), Immunoglobulins.
MRI Scans??
Studies on Mitochondrial Function - ATP production.
??? Head up tilt test, auditory brain stem responses.

Controversies
Royal Free Disease - ?Mass Hysteria. (Los Angeles Atypical Poliomyelitis).
?Purely Psychological.
CMO's report.
NICE Guidelines - still not accepted by some pressure groups.
Diagnostic Criteria.
Appropriate Treatment.
School/Workplace attitude.
Highest cause of Lost School Days.
Incidence 1-2%?

Management
Sleep Hygiene - ?Melatonin / Tricyclics.
Pacing - Avoidance of Boom/Bust - Diary.
Cognitive Behaviour Therapy?
Graded Exercise Theory?
Emotional/Psychological Support.
Liaison with Schools/Colleges/Employers.
Lightning Process?


Pain Control - Paracetamol, Ibuprofen, Gabapentin.
Anti-depressants.
Vitamin and Mineral Supplements ?Magnesium, Essential Fatty Acids, Nicotinamide Adenine Dinucleotide, Carnitine.
Diets - ?Allergy Tests.
Anti-fungal therapy? ?Probiotics.
Snake Oil. (10m. hits).