(excerpts)
Chronic fatigue syndrome is a true mystery. Some experts feel the affliction has always been with us, but it first came to the attention of medical science midway through the 20th century as a bizarre, debilitating condition sparked by an initial flu-like illness. Preliminary investigations suggested the fatigue was linked to inflammation in the brain and spinal cord, and the condition was dubbed "myalgic encephalomyelitis" (ME), as it is still known in England.
But no symptoms were visible. All that seemed to unite its victims was their exhaustion. (Even now, there is no diagnostic test for it.) So, in 1970 two psychiatrists writing in the British Medical Journal dismissed the condition as mere hysteria, an assessment that stuck for decades. Young doctors were taught that CFS was "hysterical nonsense, a non-disease," says Charles Shepherd, medical adviser to the ME Association in Britain. "So it became something that few people were willing to investigate," and retained its "psychosomatic" status through the 1980s when it was derided as the "yuppie flu" suffered by self-obsessed hypochondriacs.
"But now the research shows that this is undoubtedly not a psychological problem," Dr. Shepherd says.
CFS researcher Anthony Komaroff, a professor of medicine at Harvard Medical School, agrees, pointing to clear evidence of "objective, biological differences" between chronic-fatigue sufferers and the rest of the population.
"The central nervous system and the immune system are measurably different," Dr. Komaroff says. People with CFS have less grey matter in their brains and abnormal functioning of the hypothalamus, as well as elevated levels of cytokines (proteins released by the immune system), impaired white blood cells and lower adrenalin levels. And now researchers have found genetic differences, which may lead to a gene-based diagnostic test.
CFS is now taken so seriously that Statistics Canada estimates as many as 1.3 per cent of Canadians suffer from it and the U.S. Centers for Disease Control and Prevention has launched a public-awareness campaign to dispel the "psychosomatic" stigma.
Still, there is no "cure." The few drugs commonly prescribed can only address the symptoms, such as pain and sleep deprivation. And few of the many alternative remedies available offer much relief.
Most sufferers hope that by looking after themselves and pacing their activity, they can manage the illness. But for some that simply isn't enough.
What makes a person prone to chronic fatigue syndrome?
The answer is written in our genes, researcher Anthony Komaroff says.
"The disease is a consequence of some biological vulnerability that patients are born with," explains Dr. Komaroff, a professor of medicine at Harvard Medical School, "and then something in their environment exposes that vulnerability."
Scientists now believe the sequence is something like this: First, a viral infection leads to a flu-like illness - for example, studies have linked CFS to a number of viruses (including those for Type 6 herpes and its cousin Epstein-Barr, a common cause of another exhausting illness, mononucleosis). Although in most cases, the immune system responds and the people recover, for an unfortunate few, the illness persists, and the immune response never shuts down.
It appears that the fatigue becomes chronic because of malfunctions that occur in a number of cranial control centres, but there remains a great deal that doctors don't know.
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