Ronnie's CFS Page with info on Chronic Fatigue Syndrome also known as Myalgic Encephalomyelitis
by Anthony L. Komaroff, MD.

Often, when people hear that there is no known test or cause for Chronic Fatigue Syndrome CFS), the immeditately understand that to mean that the illness is not real. This is incorrect.

Over the past 15 years, scientists have identified numerous biological abnormalities that provide evidence for the reality and seriousness of CFS, even though the cause of CFS and diagnostic tests for it are sill unknown. 1) These biological abnormalities have given researchers clues tot he cause of the illness. In particular, they have provided evidence that the illness involves both the brain and the immune system.

There are no diagnostic tests yet for CFS because none of the biological abnormalities clearly distinguishes patients with CFS from other individuals. In reality there is no perfect biological tests ...for any illness.. When a test gets close enought to perfect, clinicians use it to help confirm or refute their clinical judgment. Testing in CFS has primarily been used to rule out other illnessess that also can cause Chronic Fatigue.

What is the cause of CFS?
The leading model of CFS pathogenesis is rooted in scientifically identified abnormalities in the brain (Central Nervous System) and the immune system, which influence and alter the function of the other in a reciprocal cycle (fig 1. http://www.best.com/~cfids/k/fig1.jpg Low levels of circulating cortisol, identified in several CFS research studies (2,#) can increase immune activation, which is also a key feature of CFS.

This system activatation could theoretically result in brain dysfunction: when the immune sytem is activated, it makes chemical messages. Brain cells as well as other immune cells can receive these messages. This could lead to fatigue, cognitive dysfuntion, enhanced sense of pain, hormonal dysregulation and other features of CFS (4)

POST VIRAL ONSET
Many cases of CFs begin with symptoms suggesting an infection, like a common viral illness. Doctors do not usually perform tests to confirm common viral infections, since they typically quickly resolve. For that reason, there is no documentation of the infection that seems to start CFS in many patients.
However, some of the most intersting research in recent years involves studies that did document an infection at athe start of the illness. For example, CFS has been reported following acute mono, a viral infection. (5/6)

Lyme disease, (7/9) ( a bacterial infection.) and Q fever (10) and infection with a different kind of infectious agent. These studies prove that cfs can indeed follow inthe wake of a well - documented infection.

This research inidcates that no single infectious agent is likely to be the cause of CFS. Instead CFS is likely to be caused by some abnormality in the body's response to any of several different infectious agents. The sudies of infectious agents in CFS are complicated.

One reason is that the symptoms of CFS surely arise in the brain, yet it is very hard for scientists to study yet it is very hard for scientists to study infectious agents in the human brain: that requires taking brain tissue (biopsies) a potentially dangerous test.

Another reason is that some infectious agents permantly live int a dormant state inside our bodies. There is evidence that some of these infections, like nfection with virus HHV-6(11/14) get reawakened in patients with CFS. The unanswered question is whether the reawakened virus is the cause of bodily damage, and resulting symptoms, or whether it is the result of illness.

IMMUNE SYTEM ABNORMALITIES.
several immune system pataerns are seen more often in patients with CFS. The identified abnormalities mimic the immune pattern of a body fighting a virus, even though no virus has been identified as the cause fo CFS.

Specific findings include:


The most intriguing immonological finding in CFS is the discovery of a novel, low molecular weight protein in an anitviral pathway called the RNase-L pathway (24/27) This novel protein is found much more often in CFS patients than in healthy people or than found in peoplw with other conditions that can cause fatigue; depression or fibromyalgia (27)

Neurological findings
There is considerable evidence that the brain and central nervous systedm are involved in CFS. Soft evidence includes patient-reported symptoms such as; cognitive dysfuntion, sensitivities to stimuli such as bright lights, noise and odors, numbness, and tingling in the extremities; and fragamented sleep.

HARD EVIDENCE includes:

EPIDEMIOLOGY
Recent epidemiological data has helped to establish the revelance and importance of CFS as a serious public health issue. Data from private investigators and from the Centers for disease Control and Prevention ( CDC ) indicate that more than 200 of ever 10,000 Americans have CFS. (38-40) Depending of demographic factors-such as age, sex and ethnicity-the prevalence can range from 200 to 800 cases per 100,000 (38) this makes CFS more common than well-known illnesses such as multiple sclerosis (41) and systemic lupus erthyematosus (42) which like cfs predominantly affects females.

CFS is Real

Taken together, these and other findings provide important evidence that CFS is not all in the head or an imagined illness. While there is not yet a test, scientists are moving closer to developing tools to assist clinicians int he diagnosis of CFS. In the interim, scientists have provided clues to the biology of CFS andhave given clinicians scientists and patients critical data that shows that CFS is a real and serious illness.

This article can be found in full on co-cure archives june 2000 week 1 #2 or roger burns site..http://www.cfs-news.org/

please excuse errors if any, i have cfs! ronnie :)

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