May 12^th is international chronic fatigue syndrome awareness day. Which highlights the debilitating and complex condition characterized by persistent exhaustion, physical and mental fatigue, and a lack of energy that is not relieved by rest or sleep. Chronic fatigue syndrome, also called myalgic encephalomyelitis, is an illness that causes extreme fatigue that lasts for at least 6 months. A known cause has not been readily identified, and it is probable that it is due to multiple factors, especially because there are many other conditions with similar symptoms. The symptoms worsen with physical or mental activity but don't fully improve with rest.

What are the possible causes?

As stated above, there is no known well-defined and specific cause of CFS, however a number of possibilities have been proposed:

• Genetics - it appears to run in some families, so some people may be born with a higher likelihood of developing the condition.
• Infections - some people develop CFS symptoms after getting better from a viral or bacterial infection.
• Physical or emotional trauma - others report that they experienced an injury, surgery or significant emotional stress shortly before their symptoms began.

Since these mechanisms are so different, it for that reason that a multifactorial is considered unlikely, or the condition might be due to some other unknown undiscovered mechanism. It is also possible that CFS is not a distinct entity on its own, but rather lies on a spectrum of severity of some other known illness.

What are the typical symptoms?

The severity and type of symptoms can vary from person to person, and they can also change drastically from day to day. These include:

• Extreme exhaustion after physical or mental exercise, called post-exertional malaise.
• Problems with memory or thinking skills.
• Dizziness that worsens with moving from lying down or sitting to standing, orthostatic intolerance.
• Muscle or joint pain.
• Unrefreshing sleep.

People with the condition also may become extra sensitive to light, sound, smells, food and medicines.

What are the risk factors?

• Sex - women are diagnosed with CFS much more often than men, but it may be that women are simply more likely to report their symptoms to a doctor.
• Age - the illness can occur at any age, but it most commonly affects young to middle-aged adults.
• Other medical problems - people who have a history of other complex medical problems, such as fibromyalgia or postural orthostatic tachycardia syndrome, may be more likely to develop ME/CFS.

How is it diagnosed?

Diagnosis of chronic fatigue syndrome is made by excluding the many other conditions with similar symptoms. This means there is no single test to confirm the diagnosis, and there are no specific laboratory tests to confirm it. As a result, there is no consensus agreement amongst medical professionals as to how chronic fatigue syndrome may be definitively diagnosed. These other conditions include:

• Sleep disorders. Fatigue can be caused by sleep disorders. A sleep study can determine if your rest is being disturbed by disorders such as obstructive sleep apnoea, restless legs syndrome, or insomnia.
• Other medical problems. Fatigue is a common symptom in several medical conditions, such as anaemia, diabetes, and underactive thyroid. Lab tests can check your blood for evidence of some of the top suspects.
• Mental health issues. Fatigue is also a symptom of a variety of mental health problems, such as depression and anxiety. A therapist can help determine if one of these problems is causing your fatigue.

It is of course possible to have CFS and all these other conditions at the same time, which would naturally make it harder to diagnose. To assist with this challenge, diagnostic criteria have been proposed to help with the diagnosis. These specify that the fatigue must be so severe that it interferes with the ability to engage in pre-illness activities; that it is of new or definite onset; that is not substantially alleviated by rest; and that it is worsened by physical, mental or emotional exertion.

Furthermore, the person would also need to experience at least one of these two symptoms:

• Difficulties with memory, focus and concentration.
• Dizziness that worsens with moving from lying down or sitting to standing.

These symptoms must last for at least six months, and occur at least half the time at moderate, substantial, or severe intensity.

How is it treated?

There is no cure or specific treatment for chronic fatigue syndrome. Treatment focuses on symptom relief. The most disruptive or disabling symptoms should be addressed first. Pain is managed with analgesics and anti-inflammatories, and for those with depression the relevant therapies are instituted.

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