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By the way, doctor: Any help on the horizon for chronic fatigue syndrome?

By the way, doctor

Any help on the horizon for chronic fatigue syndrome?

Q. I would be most grateful for information concerning chronic fatigue syndrome, a disorder from which I have suffered for the past 10 years. Do you see any help on the horizon?

A. Chronic fatigue syndrome is a complex illness that is defined entirely by its symptoms. Profound fatigue is the main one, but the official diagnosis also includes others (muscle pain, sleep that doesn't refresh, feeling especially tired after exertion, to name a few). We don't yet have a way to make the diagnosis by a physical examination or with a lab test. Since anyone can say they have a symptom, some doctors suspect that the syndrome is not a real biological disorder but mainly psychological.

But in my view, since the early 1990s, researchers have found good evidence that chronic fatigue syndrome involves abnormalities of the brain and the autonomic nervous system, which controls functions like body temperature, heart rate, and blood pressure. They've also found that the immune system may get stuck in the "on" position, as if it were engaged in a long-term, low-grade war against some foreign invader.

Laboratories around the world are working on the disease. In the United States, the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health are supporting much of the research. Results from an interesting CDC-sponsored study were published in April 2006. Four teams of researchers compared genetic and other test results from 58 people with chronic fatigue syndrome with those from "nonfatigued" controls. The researchers found that certain genes important in brain function, immune activation, and energy metabolism were unusually active in people with chronic fatigue syndrome.

We're still a long way from identifying a cause or definitive test for chronic fatigue syndrome, let alone a reliable treatment. But we've made progress in understanding the biological basis of the illness. And that's the first, essential step in fixing any medical condition.

— Anthony L. Komaroff, M.D. Harvard Health Letter Editor in Chief

Last updated:	September 05, 2008