صفحه 1:
صفحه 2:
Chronic Fatigue Syndrome
" an integrated approach
Dr Cannell
Midway Surgery St Albans
Royal London Homoeopathic Hospital
March 2004
صفحه 3:
My Interest and Background
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صفحه 4:
The Doc and the CFS Patient
= The Doc
= ‘Its all in the mind’..
= A Heartsink? Not enough time?
= The Patient ...
= wants to be taken seriously
= Needs positive help
= Find professionals poorly understand it
= Find gap in service provision
صفحه 5:
Factors in developing CFS
(RLHH Patient Survey)
Fac No % Possibly %
Viral ‘tion 4.1 31.8
Definitely %
64.2
31.5
44.4
30.2
40.7
24.6
26.3
13.9
16.7
41.5
33.1
28.8
35.7
52.2
36.1
45.9
47.6
26.9
22.5
41
23.6
23.1
37.6
40.2
35.7
Continuing Infection
Work stress
Relationship stress
Emotional stress
Food Allergy
Major life event
Hormonal disorder
Other allergy
صفحه 6:
Better Prognosis
= (50% adults feel recovered after five
years- but only 6% adults completely
recover)
= under 20y of age
= have a definite history of mild viral or
infectious illness
= symptoms less than 4 years
= no severe muscle pains or neurological
symptoms
صفحه 7:
0 Prognosis
= If previous psychological disorder
= If following a severe infection, meningitis,
encephalitis, Hepatitis B vaccinations
= if lack of social support, on going family or
financial problems
= If treated by over-emphasising rest, too rapid
a return to work
= If does not treat psychological or sleep
disturbances
= Poor diet and nutrition
صفحه 8:
Chronic Fatigue Syndrome intern.Definition
4 Major Criteria..must have all
= Severe Fatigue present > than six
months
= No other medical explanation
= A reduced level of activity
= New and definite onset
= Not life-long nor due to on-going exertion
= Not substantially relieved by rest
= Varies from day to day
صفحه 9:
Major ones plus 4 or more minor
4 features- that must not pre-date illness
= Short Term Memory impairment
= Poor concentration ->reduction of activities
= Painful Muscles and Joints
= Post-exertional malaise (more than 24 hours)
= Sore throats
= Tender lymph nodes
= Unrefreshing sleep
= Headaches - new type or more severe
صفحه 10:
CFS: other common
symptoms
= ‘Flu-like symptoms
= Visual disturbances
= Light and Noise Sensitivities
= Abdominal and digestive disorders
= Balance disturbance
= Chest pains, palpitations
= “thermostat problems” (night sweats)
= Low blood pressure
صفحه 11:
CFS: other common
symptoms
= Atypical anxiety / depression
= But suicidal thoughts rare
= Alcohol, drug & “chemical”
intolerances
= ?? fibromyalgia and chronic
hyperventilation, Irritable bowel
syndrome, hypoglycaemia
صفحه 12:
Differential diagnosis of CFS
= adrenal insufficiency, thyroid disease
= anaemia, (iron, B12, folate)
= chronic infections, immunodeficiency states
= coeliac disease and food intolerances
= auto-immune
= malignancy, leukaemias
= myasthenia gravis, multiple sclerosis,
= mood disorders, depression, occasionally dementia, somatisation
disorders,
= primary sleep disorders,
= rheumatic diseases,
= Exclude drug and substance abuse, organo-phosphates toxicity,
صفحه 13:
Theoretical Mechanisms
= Hypothalamic- Pituitary- adrenal axis
= Autonomic system, control of endocrine
function and biological rhythms
= Modified immune responses
= “Cell Membrane” lon channels - viruses &
toxins effect
= ?? synaptic sensitivity to
neurotransmitters
صفحه 14:
KEYNOTE: Check these but usually
4 normal
Sometimes ....
= Leucopenia
=" Raised ESR
= Abnormal RBC morphology (MCV)
= Abnormal LFTs (ALT, AST)
= Thyroid: lowish T4 & TSH
= Thyroid & gliadin antibodies
صفحه 15:
Useful to check
= Ferritin and Urine!!!
= Other auto-antibodies ANA
= Anti-viral titres, EBV AB’s serology
=" Hep ABC Abs
= immunological profiles
صفحه 16:
CFS: other research findings
= Minor ECG & EEG changes
= Cerebral & cardiac SPECT scans
= 31P NMR oxidative metab. in muscle
= | hypothalamic-pituitary-adrenal axis
= Low urinary free-cortisol (cf. depression)
= Blunted ACTH response to CRH
= Increased Synacthen response
صفحه 17:
CVIGEHICe اناا TPeaGuiilerit OF
CFS
= Beneficial
= Pacing / Graded Exercise
= Cognitive Behavioural Therapy (CBT)
= Unknown
= Antidepressants on their own
= Corticosteroids / Thyroxine / HRT
= Dietary supplements, Melatonin ۵
= Homeopathy (recent promising trial)
= Acupuncture / osteopathy / massage
صفحه 18:
4 Homeopathy and CFS
= Two interesting cases of mine
= Older woman in our PCT seen privately
= Young violinist seen at RLHH
= Some preliminary evidence for
homeopathic approach
صفحه 19:
ot CFS - A Team approach
= RLHH team led by Dr Jenkins
= Clinician, Nurse specialist
= Occupational Therapist, Physiotherapist Dietitian
= ....not yet ..Autogenic Trainer / Cognitive Therapist
= Our PCT Bid for a local team
صفحه 20:
Lifestyle Management (LSM)
Role of the Nurse Specialist, based on CBT / Graded Exercise/ Pacing
= 6 x Lhr appointments (approx. monthly)
= Pacing advice
= Activity diaries and scheduling
= Energy conservation
= Relaxation
= Management of sleep problems
= Longer term target setting
= Coping with setbacks
صفحه 21:
Best
>>
9۷6
56.5
25
20
14.2
Patient assessment of
Treatment Strategies
oes nanan
%
34.8
35
25
14.2
sam
e
0
%
8.7
35
0
19
RLHH small study of 20 patients)
<
%
0
5
25
0 5
Worst
<<
%
0
Treatment
Lifestyle
Manage.
Homeopathy
Antidepressants
Exclusion diet
صفحه 22:
Work & social adjustment
۶۰ and CFS (RLHH)
36.
35.
34.
33 Base
32 Post LSM
@1 year
(.026) (.036)
صفحه 23:
Patients with CFS
Nutritional assessment
= Low intakes Ca, Fe, Zn, Vit. D
= lower RBC Mg, serum Zn, Vit 1
=" adequate Mg intakes with low RBC Mg
صفحه 24:
ot CFS: Supplements
Zinc? Everybody probably low
Magnesium? No evidence
Vit B12, folate? Poor evidence
Vitamins B1, B2, B6? some evidence
EFA? Some evidence
Anti-oxidants? Some evidence
NADH? Little evidence
Co-Enzyme Q10 ??
صفحه 25:
CFS: Multi-interventions
For supplements alone
= One positive RCT
= One RCT negative study, positive trend
For RCT of multi-pronged of individualised Rx v
placebos ..positive outcome on QoL scores
= Mixed group of CFS and fibromyalgia
= Hormones, multivitamins / minerals + Magnesium
= Targeted extra supplements
= Antidepressants, sedatives, herbal treatments
صفحه 26:
CFS Organisations
= Westcare UK Residential, 155 Whiteladies Road, clifton,
Bristol. Tel 0117 923 9341
= ME Association 4 Corrington Rd, Stanford-le-hope Essex
Tel 01375 642466
= Action for ME, PO Box 1302, Wells Somerset Tel 01749
670799
= National ME Centre Harold Wood Hospital Harold Wood
Romford Essex
= Association of Youth for ME PO Box 605 Milton Keynes
Tel 01908 373300
= Tymes 9 Patching Hall Lane Chelmsford Essex
Tel 01245 263482
صفحه 27:
Information for Presentation
Task force report on CFS / ME September 1998.
A report of the CFS / ME working group. CMO Jan 2002
tions for the management
of CFS / ME University of York NHS Centre for reviews
and dissemination
Proposal for a West Herts Adult CFS Service. (April 2002)
Guidance on the management of C.F.S / M.E. (for GPS)
Action for M.E. PO Box 1302, Wells, Somerset.
Chronic Fatigue Syndrome ..the facts Oxford university
Press 2000
Dr Weatherly-Jones PhD Randomised controlled triple
blind study of efficacy of homeopathic treatment for
C.F.S. (MRC Grant) proceedings of ISHTAC Conference
2001 Philadelphia
Awdry R . Homeopathy may help ve Int Journal Alternat
Complement Med 1996. 14: 12 -