Chronic Fatigue Syndrome

Chronic Fatigue Syndrome

اسلاید 1: www.tabaye.ir

اسلاید 2: Chronic Fatigue Syndrome an integrated approachDr CannellMidway Surgery St AlbansRoyal London Homoeopathic HospitalMarch 2004

اسلاید 3: My Interest and BackgroundAim of this PresentationMy work as a GP and Homeopathic DoctorMy work for the PCT Cost to the country in 1998 £ 100M Landmark in 2000: ‘Chief Medical Officer’I recognise that CFS is a real entity. It is distressing, debilitating, and affects a very large number of people…NICE has just been asked to report on CFS

اسلاید 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 seriouslyNeeds positive helpFind professionals poorly understand itFind gap in service provision

اسلاید 5: Factors in developing CFS (RLHH Patient Survey)

اسلاید 6: Prevalence10,000 practice: 20 to 200 cases!!At Midway Emis audit about 35 codedAdults most commonly 20y - 40y Children 13 to 15y - can be as young as 5y.

اسلاید 7: Better Prognosis (50% adults feel recovered after five years- but only 6% adults completely recover)under 20y of agehave a definite history of mild viral or infectious illnesssymptoms less than 4 yearsno severe muscle pains or neurological symptoms

اسلاید 8: Worst Prognosis If previous psychological disorder If following a severe infection, meningitis, encephalitis, Hepatitis B vaccinationsif lack of social support, on going family or financial problemsIf treated by over-emphasising rest, too rapid a return to workIf does not treat psychological or sleep disturbancesPoor diet and nutrition

اسلاید 9: Chronic Fatigue Syndrome Intern.Definition Major Criteria..must have allSevere Fatigue present > than six monthsNo other medical explanationA reduced level of activityNew and definite onsetNot life-long nor due to on-going exertionNot substantially relieved by restVaries from day to day

اسلاید 10: Major ones plus 4 or more minor features– that must not pre-date illnessShort Term Memory impairmentPoor concentration ->reduction of activitiesPainful Muscles and JointsPost-exertional malaise (more than 24 hours)Sore throatsTender lymph nodesUnrefreshing sleepHeadaches – new type or more severe

اسلاید 11: CFS: other common symptoms‘Flu-like symptomsVisual disturbancesLight and Noise SensitivitiesAbdominal and digestive disorders Balance disturbanceChest pains, palpitations“thermostat problems” (night sweats)Low blood pressure

اسلاید 12: CFS: other common symptomsAtypical anxiety / depressionBut suicidal thoughts rareAlcohol, drug & “chemical” intolerances ?? fibromyalgia and chronic hyperventilation, Irritable bowel syndrome, hypoglycaemia

اسلاید 13: Differential diagnosis of CFSadrenal insufficiency, thyroid disease anaemia, (iron, B12, folate)chronic infections, immunodeficiency statescoeliac disease and food intolerances auto-immune malignancy, leukaemiasmyasthenia gravis, multiple sclerosis, mood disorders, depression, occasionally dementia, somatisation disorders, primary sleep disorders, rheumatic diseases, Exclude drug and substance abuse, organo-phosphates toxicity,

اسلاید 14: Theoretical MechanismsHypothalamic- Pituitary- adrenal axisAutonomic system, control of endocrine function and biological rhythms Modified immune responses“Cell Membrane” Ion channels – viruses & toxins effect?? synaptic sensitivity to neurotransmitters

اسلاید 15: KEYNOTE: Check these but usually normalSometimes ….LeucopeniaRaised ESRAbnormal RBC morphology (MCV) Abnormal LFTs (ALT, AST)Thyroid: lowish T4 & TSHThyroid & gliadin antibodies

اسلاید 16: Useful to checkFerritin and Urine!!!Other auto-antibodies ANAAnti-viral titres, EBV AB’s serology Hep A B C Absimmunological profiles

اسلاید 17: CFS: other research findingsMinor ECG & EEG changesCerebral & cardiac SPECT scans31P NMR oxidative metab. in muscle hypothalamic-pituitary-adrenal axisLow urinary free-cortisol (cf. depression)Blunted ACTH response to CRHIncreased Synacthen response

اسلاید 18: Evidence for Treatment of CFS BeneficialPacing / Graded ExerciseCognitive Behavioural Therapy (CBT)UnknownAntidepressants on their ownCorticosteroids / Thyroxine / HRTDietary supplements, Melatonin ?NADH?Homeopathy (recent promising trial)Acupuncture / osteopathy / massage

اسلاید 19: Homeopathy and CFSTwo interesting cases of mine Older woman in our PCT seen privatelyYoung violinist seen at RLHHSome preliminary evidence for homeopathic approach

اسلاید 20: CFS – A Team approachRLHH team led by Dr JenkinsClinician, Nurse specialistOccupational Therapist, Physiotherapist Dietitian….not yet ..Autogenic Trainer / Cognitive TherapistOur PCT Bid for a local team

اسلاید 21: Lifestyle Management (LSM) Role of the Nurse Specialist, based on CBT / Graded Exercise/ Pacing6 x 1hr appointments (approx. monthly)Pacing adviceActivity diaries and scheduling Energy conservation RelaxationManagement of sleep problemsLonger term target settingCoping with setbacks

اسلاید 22: Patient assessment of Treatment Strategies (RLHH small study of 20 patients)

اسلاید 23: Work & social adjustment Scale and CFS (RLHH)

اسلاید 24: CFS Quality Life Scores RLHH study Eurogol EQ -5D

اسلاید 25: Patients with CFS Nutritional assessmentLow intakes Ca, Fe, Zn, Vit. D lower RBC Mg, serum Zn, Vit B1 adequate Mg intakes with low RBC Mg

اسلاید 26: CFS: SupplementsZinc? Everybody probably lowMagnesium? No evidenceVit B12, folate? Poor evidenceVitamins B1, B2, B6? some evidenceEFA? Some evidenceAnti-oxidants? Some evidenceNADH? Little evidenceCo-Enzyme Q10 ??

اسلاید 27: CFS: Multi-interventions For supplements aloneOne positive RCTOne RCT negative study, positive trendFor RCT of multi-pronged of individualised Rx v placebos ..positive outcome on QoL scoresMixed group of CFS and fibromyalgiaHormones, multivitamins / minerals + MagnesiumTargeted extra supplementsAntidepressants, sedatives, herbal treatments

اسلاید 28: CFS OrganisationsWestcare UK Residential, 155 Whiteladies Road, clifton, Bristol. Tel 0117 923 9341ME Association 4 Corrington Rd, Stanford-le-hope Essex Tel 01375 642466Action for ME, PO Box 1302, Wells Somerset Tel 01749 670799National ME Centre Harold Wood Hospital Harold Wood Romford EssexAssociation of Youth for ME PO Box 605 Milton Keynes Tel 01908 373300Tymes 9 Patching Hall Lane Chelmsford Essex Tel 01245 263482

اسلاید 29: Information for PresentationTask force report on CFS / ME September 1998. A report of the CFS / ME working group. CMO Jan 2002Effective Health Care. Interventions for the management of CFS / ME University of York NHS Centre for reviews and disseminationProposal 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 2000Dr Weatherly-Jones PhD Randomised controlled triple blind study of efficacy of homeopathic treatment for C.F.S. (MRC Grant) proceedings of ISHTAC Conference 2001 PhiladelphiaAwdry R . Homeopathy may help ME. Int Journal Alternat Complement Med 1996. 14: 12 – 16