Biology of chronic fatigue gains focus

The Boston Globe: "By Judy Foreman | September 5, 2005

For years, many doctors and others dismissed people with Chronic Fatigue Syndrome as depressed, lazy, or just plain whiny.
Now, a slew of research -- more than 2,000 scientific papers by some counts -- is suggesting that chronic fatigue is not a psychiatric illness, but a nasty mix of immunological, neurological, and hormonal abnormalities.

Several types of brain scans, for instance, have found different patterns of blood flow to certain regions of the brain in patients with chronic fatigue, and other studies have shown that patients have difficulty in thinking and processing information, and are unable to do several mental tasks at once.

''There are objective brain abnormalities in many patients with CFS that are consistent with the symptoms patients describe,' said Dr. Anthony Komaroff, a chronic fatigue expert and editor-in-chief of Harvard's Health Publications, a division of Harvard Medical School.

Chronic fatigue, which has no known cure, is more than feeling tired all the time. Definitions vary, but the one the federal government uses says it is characterized by persistent, unexplained fatigue lasting at least six months, as well as four of the following: sore throat, tender lymph nodes, muscle pain, multi-joint pain, headaches, un-refreshing sleep, malaise after exercise, and impaired memory or concentration.

The syndrome -- which can come on after an acute infection, a head injury, a major life stress, or from no obvious triggers at all -- now affects 800,000 to 2.5 million Americans, most of them women, said Dr. William Reeves, chief of CFS research at the federal Centers for Disease Control and Prevention.

But the ailment is tricky to diagnose because its symptoms overlap with those of other conditions such as depression, Gulf War Syndrome and fibromyalgia. A federal study now underway is designed to measure the activity of thousands of genes in 190 people, some with CFS, some without, to find a distinctive genetic fingerprint for chronic fatigue.

The goal, said Reeves, is a blood test for chronic fatigue.

''This illness is a nightmare that is extraordinary," said Dr. David Bell, a specialist in Lyndonville, N.Y.

''If you're lucky, you get over CFS in a couple of years. If you're not, it stays with you for the rest of your life.""