What to do for women with chronic fatigue. Chronic fatigue

The modern pace of life exhausts people. Numerous chores around the house and problems at work force you to give your best.

The body adapts to such conditions, but after a while it malfunctions - chronic fatigue syndrome occurs. How to get rid of it?

What is chronic fatigue syndrome

Chronic fatigue syndrome occurs more often in women of reproductive age

Chronic fatigue syndrome is a form of mental, physical and emotional fatigue that occurs in the absence of illness or other pathological condition.

Chronic fatigue syndrome is characterized by prolonged exposure to factors that lead to exhaustion of a person. Performance decreases, which is not restored even after a long rest. Problems with concentrating appear, and it becomes more difficult to cope with usual activities.

Fatigue refers to protective functions body. The presence of overwork indicates the need for rest to replenish strength and energy. The chronic nature of the pathology is long-lasting - this is the main danger. The patient’s quality of life deteriorates, and the usual life collapses.

People of all ages are at risk - chronic fatigue manifests itself in both adults and children. A person's lifestyle is of great importance. Long working hours, lack of adequate sleep, frequent stress - all this can lead to fatigue.

According to statistics, representatives of the female half of humanity suffer more often from chronic fatigue. Increased likelihood of the syndrome occurring in reproductive age(20–45 years old).

In addition, there are different trends in recovery: some patients recover in a few months, others take a year or more. The cyclical nature of the syndrome has also been discovered - pathological condition alternates between stages of exacerbation and attenuation.

People most susceptible to developing the syndrome are:

having chronic diseases;
living in large cities;
have undergone surgery;
living in unfavorable environmental and sanitary conditions.

In addition, the risk group includes entrepreneurs and those whose profession involves risk and stress (doctors, brokers, military personnel, airport dispatchers).

Status video

Reasons for development

Available internal reasons development of chronic fatigue. Prolonged stress affects the functioning of human organs and systems, so chronic fatigue often occurs against the background of a malfunction in the body. The following reasons are highlighted:

heart failure - the heart does not work at a normal pace;
hypothyroidism - decreased efficiency of the thyroid gland;
allergic reactions;
pathologies affecting the respiratory system - bronchitis, asthma;
autoimmune disorders;
infection with a virus (cytomegalovirus, enterovirus, retrovirus). Fatigue is often caused by Epstein-Barr virus- the most common type of herpes;
chronic diseases: diabetes, anemia, pathologies of the liver, kidneys, lungs;
recovery period after injuries and surgery;
poisoning with salts of heavy metals;
infectious diseases.

Factors leading to chronic fatigue are represented by the following:

prolonged stress and tension;
lack of sleep or poor sleep quality over a long period of time
acute experience of failures;
malnutrition;
long-term use of medications or their misuse(cold relievers, sleeping pills, antihypertensives, contraceptives, antihistamines);
sedentary lifestyle;
poor environmental situation;
bad habits (smoking, drinking alcohol);
loss of a loved one.

Chronic fatigue syndrome is a result of lifestyle and external influence. In some cases, the appearance of a problem indicates the development of mental, endocrine, cancer and immune diseases. You can’t hesitate, you should visit a doctor and get diagnosed.

Symptoms and signs

The syndrome does not occur suddenly; it is characterized by a gradual increase in symptoms. Initially, the patient mistakes the symptoms for flu or a cold, because:

there is a runny nose and sore throat;
headache appears;
body temperature rises;
lymph nodes enlarge.

After 2–3 days, symptoms intensify and new ones are added:

muscle pain;
muscle weakness;
painful sensations in the joints;
prolonged and severe fatigue after exercise.

The main symptom is prolonged fatigue that remains even after rest. Performance decreases, although diseases and causes that could lead to the condition are clearly absent.

Frequent and persistent fatigue is the main symptom of the syndrome

In addition to the above-mentioned manifestations, other signs also occur:

heartburn and disruption of the digestive system;
hair loss;
increased sensitivity to light and visual disturbances;
increased heart rate;
nervous tic;
hearing loss and ringing in the ears;
acne, acne;
decreased sexual desire;
deterioration mental abilities(decreased concentration, memory impairment).

The changes also affect psycho-emotional health patient, therefore the following symptoms appear:

sleep problems: insomnia or a strong desire to sleep during the day;
depression;
prolonged irritation;
emotional depression;
indifference to everything around;
lack or lack of motivation;
decreased self-esteem;
desire for loneliness.

Insomnia is a frequent guest in chronic fatigue syndrome

Diagnostics

There are no specific tests for detecting chronic fatigue syndrome. diagnostic techniques. However, criteria have been developed by which the patient's condition is assessed. The presence of several indicators indicates the development of the syndrome, these include:

muscle tension and pain;
painful palpation lymph nodes(axillary and cervical);
decreased concentration and memory impairment;
painful sensations in the joints (without symptoms of other pathologies);
poor quality of sleep (the body does not recover);
headache;
development of pharyngitis - inflammation of the lymph nodes and pharynx;
increased fatigue after exertion (mental or physical) that lasts more than 1 day.

The symptoms of the syndrome are similar to those of other diseases, so the following pathologies are excluded:

To exclude other diseases, the following measures are used:

analysis of biochemical parameters and samples: levels of calcium, potassium, sodium, glucose, protein, alkaline phosphatase, kidney and liver tests;
general urine analysis;
general blood test: determination of platelets, ESR, leukocyte formula;
analysis rheumatoid factor and C-reactive protein;
specific tests: examination for herpes viruses, viral hepatitis, candidiasis, chlamydia, syphilis, HIV, toxoplasmosis;
electrocardiography - study of heart rhythm;
diagnostics of hormonal levels;
polysomnography - diagnosis of sleep periods;
Magnetic resonance imaging of the brain - to exclude tumors and other disorders.

Which doctor should I contact - table

Doctor	How will it help?
Immunologist	If chronic fatigue syndrome is accompanied by frequent colds, exacerbations of chronic diseases or relapses of previously suffered diseases, then you should contact an immunologist who will help restore the body’s immunity and vitality.
Endocrinologist	Sometimes chronic fatigue can accompany a more serious disease of the endocrine system, so consulting an endocrinologist will help identify this disease in the early stages.
Neuropathologist	Chronic fatigue syndrome is directly related to overstrain of the nervous system, so specialists such as a neurologist or neuropathologist will be able to correctly diagnose and treat this disease.
Psychologist	If chronic fatigue syndrome is caused by frequent stress, anxiety, and is manifested mainly by insomnia, unreasonable fear or anxiety, then you should consult a psychologist or psychotherapist who will help you understand your feelings and overcome psycho-emotional stress.
Therapist	If it is difficult to understand the causes of the disease or distinguish chronic fatigue from other diseases, you can seek help from a therapist who will prescribe the appropriate treatment or refer you to the right specialist.

Treatment

Drug therapy

After completing the diagnosis, treatment begins. Drugs are prescribed depending on the symptoms and factors that caused the development of the syndrome. It is forbidden to use medications independently, without a doctor’s prescription. The following groups of drugs are used:

Immunomodulators (Likopid, Dibazol, Polyoxidonium, Interferon). They influence the patient’s immunity, strengthen it and prevent the development of viral and colds. Appointed when frequent relapses diseases.
Non-steroidal anti-inflammatory drugs (Diclofenac, Naproxen, Ibuprofen, Ketorolac). Used for pain in muscles and joints.
Nootropic drugs (Phenibut, Aminolon, Piracetam) and antidepressants (Befol, Imipramine, Toloxatone). Prescribed for prolonged stress and prolonged depression. Also used for unreasonable feelings of fear and nightmares.
Antiviral drugs (Kagocel, Arbidol, Tamiflu, Anaferon). Used during the development of a viral infection.
Vitamin complexes (Triovit, Univit, Vitrum, Centrum). To improve well-being, strengthen the immune system and correct metabolic processes, drugs from this group are prescribed.

Homeopathic medicines are used to improve well-being:

Gelsemium. More often prescribed to older people who are faced with manifestations of the syndrome (feelings of anxiety, severe stress, hand tremors, weakness, fear of crowds).
Quininum arsenicosum. The drug is used to treat adult patients who have symptoms such as: insomnia, heaviness in the body, eye sensitivity to light, brain fog.
Acidum phosphoricum. The medicine is developed for adolescent patients with the following symptoms: mental instability, headaches, decreased concentration and loss of visual vigilance.

Medicines in the photo

Centrum is a vitamin complex designed to improve well-being and strengthen the immune system

Diclofenac is used for pain in muscles and joints

Interferon is used for frequent relapses of colds and to strengthen the immune system.

Psychotherapy

Psychotherapy is a mandatory component of the treatment of the syndrome. The specialist’s task is to explain to the patient the essence of his problem, that it can be eliminated.

During psychotherapy, psychological blocks that interfere with the patient are removed. These can be fears, worries and other negative emotions that deplete the patient’s health. It is important for the specialist to find out the questions that interest the patient. This way the doctor will be able to better understand the situation and direct therapy in the right direction.

The duration of treatment depends on the patient’s condition and the severity of the problem - from 3 months to 1 year. Consultation alone will not solve all problems, as many people think. A person’s desire to cope with the difficulties that have arisen is of great importance, so the task of treatment is to make the patient believe in himself and his strength.

Normalization of lifestyle

Chronic fatigue syndrome occurs when problems and difficulties accumulate. This is largely due to lifestyle. Important task treatment - to eliminate factors that interfere with the patient’s daily life.

Lifestyle restoration occurs in the following areas:

They determine a person’s need for sleep, since the well-known 7–8 hours are advisory in nature, and they are not suitable for everyone. Some people need less time to recuperate, others need 10 hours of sleep or even more. The main condition is that after sleep a person must fully recover.
Bad habits. Addictions deplete the body, causing bouts of fatigue. We're not just talking about alcohol and smoking - addiction to coffee or energy drinks has a negative impact on a person's condition. The temporary increase in strength caused by such stimulants is replaced by decline, the body cannot work to its limits. The patient’s task is to get rid of such addictions.
Organization of rest. Knowing how to rest is a whole science; not everyone is able to recover properly: some people like TV, others prefer a computer. In both cases, the person does not rest, but only wants to think so. Doctors recommend walks in the park. Fresh air and atmosphere allow you to escape from everyday life. An interesting hobby is also a way out of the situation, since your favorite activity brings a lot of positive emotions.
Daily regime. It is easier for the body to work if it is accustomed to certain actions at a specific time: go to bed at 10 pm, wake up at 7 am. Leapfrogging between bedtimes and wake-ups is more debilitating than physical activity.

Healthy and adequate sleep is a necessary element for recuperation

Diet for chronic fatigue syndrome

Depression and bad mood are often associated with a lack of vitamins and nutrients in the body. The patient’s task is to compensate for the deficiency and balance the diet.

seaweed;
feijoa;
cottage cheese;
vegetable soups;
porridge: buckwheat, rice, pea, oatmeal;
kefir, yogurt, fermented baked milk;
greens: spinach, lettuce, parsley, celery;
honey with nuts;
salted fish (200 g per week);
shellfish and other seafood;
rabbit meat;
grape juice;
lean veal;
dark chocolate (but in small quantities).

What should you give up? The list of prohibited products is presented as follows:

coffee;
strong tea;
fatty food;
sweets: cakes, caramel;
smoked products;
cocoa;
alcoholic products;
carbonated drinks.

Prohibited products - photo gallery

Cocoa is excluded from the diet during treatment

Coffee has a stimulating effect, but its duration is short

Alcoholic drinks suppress the immune system, and deterioration of the immune system is one of the reasons for the development of the syndrome

Therapeutic exercise and massage

Therapeutic gymnastics has a complex effect. It activates all body systems, improves metabolism and helps remove harmful substances.

To perform the exercises, no special conditions are required, because you can do gymnastics in a chair without being distracted from the work process. Breathing is important - even and deep.

The initial stage is muscle relaxation. Then they begin to perform gymnastics:

Perform head turns to the right and left with fixation in the extreme position.
Lower your head forward all the way, fix the position for a few seconds and move your head back.
Pressing your chin to your chest, turn your head left and right (the chin should not come off your chest).
Pull your chin forward and pull your shoulders back.

A soothing massage is another way to relax. The technique eliminates muscle tension and soreness, improves blood circulation and tissue nutrition.

Folk remedies

To increase the body's resistance at home, you can use traditional medicine. You should consult a doctor and consult before using them to rule out an allergic reaction.

They have good efficiency water tinctures. A striking example- a remedy from St. John's wort. To prepare you need:

Add 1 tbsp to 100 ml of boiling water. l. dry herb St. John's wort.
Let the product sit for 30 minutes.
A glass of medicine is divided into 3 parts and consumed throughout the day 20 minutes before meals.

The common plantain also has a lot beneficial properties, the plant is also suitable for eliminating chronic fatigue. To prepare the composition you need:

Take 10 g of dry leaves and chop them, pour 300 ml of boiling water.
Set the composition for 30 minutes.
Take the product 3 times a day, 2 tbsp. l. Duration of treatment - 3 weeks. Take the medicine 30 minutes before meals.

Herbal remedies are effective for chronic fatigue syndrome. The recipe is simple:

Mix oats, prickly tartar leaves and dry peppermint leaves (2 tablespoons of each ingredient).
Pour the composition with 5 cups of boiling water.
Infuse the product for 60–90 minutes (the vessel is wrapped in a terry towel).
The duration of treatment is 15 days. Drink half a glass 3-4 times a day before meals.

Lingonberries and strawberries are rich in vitamins and have a general strengthening effect. It is not necessary to take berries; it is enough to use plant leaves. Prepare the medicine as follows:

Chopped plant leaves (1 tablespoon each) are mixed and poured with 500 ml of boiling water.
The medicine is infused in a thermos for 40 minutes. Take a teaspoon of tincture 3 times a day.

Clover remedy relieves fatigue and has a tonic effect. It is easy to prepare a decoction:

Place 1 liter of warm water on the fire, add 300 g of dried clover flowers into the water.
Boil the product for 20 minutes.
Remove the broth from the heat and cool, add 100 g of sugar to it, stir thoroughly.
Take the infusion 3-4 times a day, 150 ml. Can be used as tea, but in the specified dosage.

Ginger is used to boost immunity. The plant has a positive effect on the emotional background and also strengthens strength.

First recipe:

Grind 150 g of ginger root, add 800 ml of alcohol or vodka.
Infuse the composition for 1 week, consume 1 tsp. 1 per day.

Second recipe:

A piece of root (about the size of a fingernail) thumb hands) grate, pour 200 ml of boiling water.
Leave the product for 15 minutes. To improve the taste, you can add a little lemon juice or honey.
The drug is drunk throughout the day.

Healing plants in the photo

Plantain has a calming effect

Prevention measures

Outdoor recreation restores strength and allows you to escape from problems

diversify your diet;
do not experiment with diets and fasting - to lose weight you need to visit a doctor and consult with him;
relax as much as possible after work: take a bath, drink hot tea, have an aromatherapy session, do not take work home;
take vitamin complexes, especially in winter and spring;
take walks more often and be in the fresh air - walks relax and drive away bad thoughts, and fresh air tones up;
alternate loads correctly: every 2 hours you should be distracted and change the type of activity - with physical activity for mental work and vice versa;
When you spend a long time at your desk, exercise is useful - this good way relax and recover after tiring work;
during prolonged stress, bad mood and headaches, you can go to the cinema or get out into nature.

Chronic fatigue syndrome is far from a harmless condition. The lack of intervention leads to serious problems: immunity deteriorates, the body's resources are depleted, and the psyche changes. It is easier to prevent the development of a condition than to eliminate it, so maintaining physical and mental health is a priority for every person.

Chronic fatigue syndrome is a disease that occurs quite often in modern society. Probably everyone has experienced such a state when, after hard physical or mental work, severe fatigue sets in. Usually, it can be relieved with proper rest and sleep. But, if this condition persists for several weeks, then most likely you have chronic fatigue. And it is impossible to get rid of it with ordinary rest. Need help from a specialist.

The causes of the described disease are different. If the body is overtired for a long time, then the cause of this problem may be a serious illness. Often, attacks of chronic fatigue syndrome (CFS) occur after viral illnesses.

IMPORTANT: Unfortunately, modern medicine cannot clearly name the causes of CFS. But almost all researchers of this problem agree that there is a connection between chronic fatigue and the presence of viruses in the body. Another “obvious” cause of this problem is disturbances in the functioning of the nervous system caused by stress, excessive mental fatigue and so on.

Also among the causes of this disease, experts identify:

taking certain medications
diseases such as asthma, bronchitis and emphysema
disruptions in the functioning of the cardiovascular system
sleep disturbances and insufficient rest
poor nutrition
depression and negative emotional state

Chronic fatigue syndrome can strike a person at any age. But, as statistics show, women most often suffer from this disease.

Chronic fatigue symptoms and signs

Consequences of CFS

The symptoms of CFS vary, but most often appear in combination. Typically, experts include these signs:

Feeling tired for more than 3 weeks
Muscle discomfort similar in sensation to that which occurs after excessive physical activity
Noticeable memory loss and frequent occurrence of depression
Violations of the “wake-rest” regime: insomnia, increased sleepiness
Joint pain
Frequent headaches
Enlarged lymph nodes

If chronic fatigue is not treated in time, then all of the above symptoms may begin to progress. In this case, the presence of diseases accompanying these symptoms will be absent. Even laboratory tests will not be able to detect violations of the physiological norm.

Diagnosing chronic fatigue syndrome is quite difficult due to the fact that blood and urine tests will be normal. Ultrasound and x-rays of a patient with this problem will not show abnormalities. That is why, most often, people with CFS are diagnosed with vegetative-vascular dystonia or neurotic reaction. However, treatment of these diseases does not produce any results.

Mental Fatigue Test by Akiyoshi Kitaoka

As mentioned above, this problem has a viral and neuralgic pathology. Everything is clear with viruses; the body’s immune system spends a lot of energy to fight them, which leads to chronic fatigue. Concerning nervous exhaustion, then it is a common cause of such a disease.

Visual illusions of Akiyoshi Kitaoka

In order to determine chronic fatigue caused by a mental state, you can use Akioshi Kitaoka's tests. This famous Japanese psychology professor developed a method for studying a person’s mental state based on “visual illusions.”

Focus your gaze on one point in the picture:

If the drawings are motionless, then the mental state is normal. Professor Kitaoka believes that this is only possible in a rested, balanced person
If, when focusing the gaze, the picture continues to move, then the patient urgently needs rest, both psychological and physical. Adequate sleep is especially recommended for such a person.

The movement of “visual illusions” indicates physical fatigue, a person’s stressed state and a deterioration in his health. Akioshi Kitaoka developed this test to identify mental problems, but it can also be used to identify chronic fatigue syndrome.

IMPORTANT: CFS can be diagnosed using another test, which was developed by Australian scientists from Griffith University. They found several biomarkers (single nucleotide polymorphisms) in the body that were present in 80% of subjects who had symptoms of chronic fatigue syndrome. Now, with the help of simple tests, you can not only identify the presence of such a problem, but also find out the effectiveness of its treatment.

Chronic fatigue syndrome Epstein Barr virus

Not long ago, Andrew Lloyd from the University of New South Wales in Australia found a connection between the Epstein-Barr virus and chronic fatigue syndrome. This virus belongs to the herpesvirus family and is the causative agent of mononucleosis. According to statistics, it is found in the body of almost every adult and every second child.

Epstein Barr virus

The scientist believes that the activity of the Epstein-Barr virus can temporarily “damage” the brain. Which can lead to chronic weakness and apathy. A team of specialists led by Andrew Lloyd tested people who complained of chronic fatigue syndrome. Most of them had traces of the virus in their blood.

But, the presence of the Epstein-Barr virus does not necessarily lead to CFS. Of the 39 people who suffered from mononucleosis, only 8 could not recover quickly. This difference, according to experts from the University of New South Wales, depends on the state of the patient's immune system. The stronger it is, the faster a person with chronic fatigue syndrome can recover.

How to improve performance?:

A decrease in performance can have a painful impact on the “pocket”, the psychological and physical state of the body. It happens that if you give yourself slack, then everything starts to fall apart, problems grow lumpy. But the opposite happens. When you seem to want to work productively, but something gets in the way. This may just be the notorious chronic fatigue syndrome.

If your vitality is at zero, then you cannot sharply force events. We need to find out the reason for this situation. If it is caused by fatigue, then you need to ensure yourself proper rest. If you ignore it, it can only make the situation worse.

Improving performance

Drinking liters of coffee is not an option. Firstly, this amount of caffeine has a negative effect on the nervous system. And if 1-2 mugs of coffee can invigorate the body, then all subsequent mugs of this drink will have a detrimental effect on well-being
Secondly, coffee is a diuretic. That is, it has a diuretic effect. Which can lead to dehydration and, as a result, fatigue. Therefore, if you need to improve your performance, you need to drink no more than two cups of coffee a day and ensure access to water in your body
A drug such as Deanol aceglumate helps improve performance. It can help boost your mood, improve brain function, and improve your well-being during depression. This drug is indicated for memorizing and reproducing large amounts of information, as well as for excessive physical activity.
Also, Phenotropil has proven itself to be effective in stimulating brain function and improving its blood supply. This drug in tablet form stimulates intracellular metabolism. What helps increase physical and mental performance
But, you cannot use these medications without consulting a doctor!

Which doctor should I go to?

Chronic fatigue syndrome is a problem that should only be treated under the guidance of a specialist. Unfortunately, it is not uncommon for CFS to be a symptom serious illness. And success in its treatment will depend only on the timely assistance of a qualified specialist. If you have symptoms of this disease, it is best to consult a therapist. He will be able to assess the patient’s condition and refer him to a specialist.

If chronic fatigue syndrome occurs as a result of frequent stress, anxiety state And causeless fear, then it is best to seek help from a psychotherapist or psychologist. This specialist will help you overcome psychological problems.

If CFS is caused by overstrain of the nervous system, it would be more advisable to consult a neurologist or neurologist. This specialist will help you choose the right treatment for this disease and help you get rid of this disease.

Sometimes chronic fatigue can cause disruptions in the endocrine or immune system. In this case, help should be obtained from specialists in these areas.

Chronic fatigue syndrome treatment with drugs

There are several medications that are used in the treatment of this disease. These include:

sleeping pills and sedatives
agents that activate serotonin production
psychotropic drugs
vitamins B1, B6, B12 and C
immunocorrectors with adaptogenic effect
anti-inflammatory drugs
other auxiliary agents (tranquilizers, enterosorbents, nootropic drugs, antihistamines in the presence of allergies)

Anti-staphylococcal vaccines Staphypan Berna and intravenous immunoglobulin. Also, recent studies have shown that some antidepressants have a good effect on the body with the problem described above.

The symptoms of this disease can be significantly reduced with the help of L-carnitine and magnesium. A special place in this list is given to drugs containing L-carnitine. This substance is responsible for transporting fatty acids. If they are deficient, the body's cells will receive less energy. If the lack of L-carnitine in the body drags on for a long time, it can lead to chronic fatigue.

As for magnesium, it is this macroelement that is responsible for the production and consumption of energy in the body. And its lack can also result in the disease described above. That is why, when diagnosing CFS, doctors often prescribe medications with magnesium and L-carnitine.

IMPORTANT: Chronic fatigue syndrome may be a consequence of a lack of iodine in the body. A lack of this element can lead to disturbances in the functioning of the thyroid gland. Such violations are very dangerous and can lead to various negative consequences. In particular, to loss of strength, lethargy and muscle weakness.

Non-drug treatment of chronic fatigue syndrome

You can restore your strength not only with the help of pills, mixtures and injections. The main factor for success with this disease is proper rest. And that is why it must be provided. Good sleep is especially important.

Another way non-drug treatment CFS is exercise. Moderate physical activity can increase the “capacity” of a person’s energy reserves. Regular fitness classes, running, swimming and other physical activities will help accumulate energy over time and improve the condition of the body.

Equally important for defeating chronic fatigue is proper nutrition. After all, it is through nutrition that a person can stock up on energy. Deficiency of some nutrients can lead to serious consequences. Fruits, vegetables, cereals and unground grains are the main sources of many useful nutrients that will not only help overcome fatigue, but also improve health.

You also need to keep a record of the liquid you drink. Two to three liters clean water per day will help get rid of toxins, improve metabolic processes in the body and, as a result, overcome the problem described above.

Chronic fatigue syndrome treatment with folk remedies

IN folk medicine There are also several recipes with which you can cheer up and overcome CFS:

Honey and vinegar. Mix 100 g of honey and 3 tablespoons of vinegar. The resulting mixture should be consumed one teaspoon per day. After 1.5 weeks there should be no trace of fatigue left

Based on this mixture, you can prepare a healthy energy drink. To do this, mix a teaspoon of vinegar, honey and iodine in a glass. The mixture must be poured with boiled water and stirred. You should drink this mixture only after meals, one glass per day.

Cinnamon tincture. Cinnamon helps to cope well with this disease. But simply adding it to baked goods is not enough. More effective means is a tincture of this spice. To prepare it, you need to pour a bag of cinnamon (50 g) into a container and pour vodka (0.5 l). This product should be infused in a dark room for three weeks. Cinnamon tincture is good for calming the nervous system and relaxing the body.
Ginger. Another natural immunostimulant is ginger root. This natural product has many beneficial qualities, and one of them is helping with chronic fatigue syndrome. Greatest effect can be achieved using ginger tincture. To do this, you need to grate 150 g of the root of this plant and mix it with 800 ml of vodka. This remedy should be infused for at least a week. You can also use ginger in tea. To do this, you need to divide the root into 6 parts and squeeze the juice from each. Then the juice should be poured with a glass of boiling water. You need to add honey and lemon to this drink.
Kefir and honey. Before going to bed, you can help your body relax and fall asleep faster with the help of kefir and honey. To do this, half a glass of kefir needs to be diluted with half a glass of boiled water. Then add honey to this drink and mix

Prevention of chronic fatigue syndrome

In order to prevent CFS, you need to change your daily routine. It is advisable to try to go to bed and get up earlier. This regime change days will pass beneficial not only in terms of preventing chronic fatigue syndrome, but also in terms of increasing productivity
It is also very important to devote at least 30 minutes a day to physical activity. And for this it doesn’t matter to go to the gym. There are sets of exercises that you can do at home or at work. Physical activity will not only help keep your body in good shape, but will also significantly reduce mental stress.
Bad habits such as smoking and excessive alcohol consumption can also cause CFS. That's why you need to get rid of them
Walking in the fresh air and vivid impressions help cope well with fatigue. Visit theater and cinema regularly. This will help get rid of the above-described illness associated with mental problems.

Nature is an excellent antidepressant. Therefore, at least once a year you need to get out to the sea or to the mountains. On vacation you need to relax not inside concrete walls, but where there is a lot clean air devoid of city dust. In addition, the air in such places is saturated useful substances capable of improving health.

Chronic fatigue syndrome is not a harmless disease. It can cause not only loss of performance, but also negatively affect the health of the body as a whole. In addition, treating this disease is very difficult and takes a long time. Therefore, it is easier to warn him. And the best way to do this is through proper rest, good sleep, physical activity and proper nutrition.

Sophia. I recently read somewhere that chronic fatigue syndrome is associated with disturbances in brain function. And in order to prevent such violations, it is necessary to consume foods rich in omega 3. After this article, I try to eat fish and nuts once a week.

Elizabeth. I am also susceptible to this type of fatigue. For me it is more of a moral plan. Sometimes everything gets boring: monotony, lack of joy in life, etc. Hands down. I don't want anything. I don’t know if it’s fatigue or something else. But I'm trying to please myself with something. I’ll go to the museum or cook some delicious dessert. And you see, life is getting better. And immediately performance increases and fatigue increases like never before.

Video: Disease of a city dweller. Great Race

Update: October 2018

Chronic fatigue syndrome is a disease when a person constantly feels “broken” mentally and physically for at least six months, and this does not go away even after a long rest. The main cause of the disease is considered to be infection with viruses, mainly of the herpes group ( main reason called Epstein-Barr virus), and the pathology itself is also called benign myalgic encephalomyelitis, which means “inflammation of the brain and spinal cord, occurring with muscle pain and having a benign (that is, not ending in life-threatening complications) course.”

The main number of cases are residents of large cities located in age group 25-45 years old (that is, the most able-bodied). This is explained by the fact that it is this category of the population, trying to provide for their family and achieve career growth, lead such an exhausting lifestyle that they do not pay attention to the symptoms of the disease they are developing or do not treat them and immediately go to work. Most often, signs of chronic fatigue syndrome can be found in people who are entrusted with great responsibility at work and must be extremely attentive: health workers, air traffic controllers, people associated with night transport (especially rail) transportation.

Causes of pathology

Chronic fatigue syndrome (CFS) is based on a disruption in the interaction between the “commander-in-chief” centers of the autonomic system, which impairs the production of substances necessary for the development of inhibition in the central nervous system. The disease is possible when infection occurs against the background of constant stress of the immune system. Typically, the development of CFS is caused by an infectious disease caused by one of those viruses that, upon penetrating the body, “settle” in certain of its cells (usually in the cells of the nervous system) for a very long period, becoming inaccessible to the medications introduced into the body. This:

Epstein-Barr virus;
cytomegalovirus;
enteroviruses, including Coxsackie viruses;
herpes virus type 6;
hepatitis C virus;
retroviruses.

The development of the disease is provoked by overload of the parts of the brain responsible for emotions and the intellectual sphere, while the areas that are “turned on” during active physical work remain unused.

The risk group includes:

residents of large cities. The larger the city, the higher the risk of developing the syndrome. 85-90% of cases are residents of megacities (most of them are registered in the USA and Australia);
people living in unfavorable hygienic conditions;
persons of those professions who bear great responsibility and work in shifts: medical workers, pilots, rescuers, dispatchers, railway operators;
entrepreneurs;
those who suffer from chronic diseases, especially: hypothyroidism, heart pathologies, autoimmune disorders;
those who often suffer from viral infections (viruses “like” to suppress the immune system);
teenagers actively preparing to enter universities;
people with nutritional disorders, when there is: consumption of low-quality products, insufficient amounts of micro- and macroelements in the diet;
persons experiencing mental disorders (depression, anxiety) and stress that exhausts a person;
people leading an unhealthy lifestyle: constantly lacking sleep, moving little, practically not going outside, wasting time uselessly;
those suffering from food allergies;
living in unfavorable environmental conditions;
having the following mental characteristics: perfectionism, constant feeling of stress, fear of losing a job or status, suspiciousness and conflict;
allergy sufferers;
working with salts of heavy metals;
constantly taking medications such as antihistamines, contraceptives, blood pressure lowerers, sleeping pills;
frequently taking alcohol or drugs.

The majority of the cases are women.

Various laboratory indicators indicate that chronic fatigue syndrome is not a mental pathology, but a somatic disease. Thus, the immunogram shows an increase in CD3 and CD4 lymphocytes, natural killer cells, interferon, interleukin-1, and tumor necrosis factor. During a serological test, antibodies to viruses of the herpes group or some others are detected in the blood. Using biochemical studies, a connection was established between CFS and the concentration of carnitine in the blood plasma: the less L-carnitine, the lower performance and feeling worse person.

Historical data

Scientists suggest that this disease appeared at the beginning of the 20th century - when the pace of life significantly accelerated and the amount of information that needed to be processed increased. So, in 1934 the symptoms of this disease were registered among a large number of people in Los Angeles, in 1948 - in Iceland, in 1955 - in London, in 1956 - in Florida. But only in 1984, after doctor Cheney characteristic symptoms were described immediately in 200 people in Incline Village (Nevada), and antibodies to herpetic group viruses were detected in their blood; the syndrome was described as a separate disease. Since 1988, chronic fatigue syndrome has been identified as a separate diagnosis.

How does the disease manifest itself?

The main symptoms of chronic fatigue syndrome are the following:

constant fatigue, a feeling of weakness that does not go away even after a long rest;
rapid fatigue - even after performing simple work;
pain throughout the body, especially in the muscles (all muscles can hurt) and joints - first one or the other joint hurts;
decreased concentration;
deterioration in the ability to analyze and reflect;
sleep disorders: a person cannot fall asleep for a long time, and, despite constant fatigue, sleeps superficially, often wakes up;
fears, worries, anxiety intensify at night;
frequent headaches, which are most often localized in the temples and have a pulsating nature;
bad mood, irritability, short temper;
tendency to depression, apathy;
phobias may develop;
dark thoughts;
a tendency to frequent colds, which occur mainly according to one scenario - with a sore throat;
more frequent exacerbations of chronic diseases.

Chronic fatigue syndrome is disguised as various somatic diseases. Thus, people suffering from this disease may notice weight loss, disturbances in digestive tract(for example, a tendency to constipation), causeless enlargement of lymph nodes and their soreness. With CFS, body temperature can remain elevated or decreased for a long time, which forces a person to undergo examination by various specialists.

If you have recently renovated your apartment/office, bought new furniture, replaced household appliances, etc. and notice chronic fatigue, perhaps this is how it manifests itself chronic poisoning vapors of formaldehyde, which is contained in all building materials, furniture, modern fabrics and household appliances (see).

How is the diagnosis made?

The diagnosis of CFS is not made based on the above symptoms. Only if all diseases accompanied by increased fatigue and weakness are excluded, and if doctors cannot find another cause, such a diagnosis is made.

This is especially true for stages 1-2 of oncology. Symptoms of cancer in the early stages, when it can still be completely cured, differ little from CFS. It is also necessary to exclude tuberculosis, which is almost asymptomatic. And other somatic diseases that occur in a sluggish, erased form. Eliminate helminthic infestations.

Diagnosis of chronic fatigue syndrome begins with the person undergoing a full examination. When specified symptoms must be submitted:

general blood and urine tests
biochemical tests
feces for helminth eggs (three times)
blood for determining antibodies to Giardia, Toxocara, Ascardia and other worms
perform an ultrasound of the abdomen
chest x-ray
it is also necessary to determine in the blood the titers of antibodies to the Epstein-Barr virus, cytomegalovirus, virus herpes simplex and enteroviruses
HIV infection is also excluded
diseases of endocrine organs
the fundus is examined
Doppler ultrasound of the vessels of the head and neck is performed; in some cases, the neurologist may prescribe an MRI or computed tomography of the brain.

If the data of all of the above tests are within normal limits, and the infectious disease specialist does not make a diagnosis or prescribe treatment based on the titer of antibodies to herpes viruses, a diagnosis of chronic fatigue syndrome is made.

The diagnosis is made based on a table of criteria when there is:

2 large criteria + 6 small ones,
if the first 3 minor criteria do not coincide with the person’s existing ones, or there is only 1 minor criterion out of the first three, a combination of 2 major + 8 minor criteria is needed to make a diagnosis.

Large criteria

Small criteria

Fatigue occurs for 6 months or longer. It can be called periodic or periodically increasing. After sleep or rest (even for a long time), the condition does not improve. Reduced daily activity by 2 times.
Somatic, infectious, endocrine and mental illness, as well as poisoning.

elevated body temperature – up to 38.5°C, not higher;
diagnosed with pharyngitis (sore throat);
an increase of up to 2 cm and tenderness of the cervical and axillary lymph nodes;
muscle pain;
the disease began suddenly;
severe headaches that were not there before;
weakness in all muscles;
a feeling of weakness, lasting more than a day, after those physical activities that were previously tolerated normally;
pain, aching in the joints, while the joints themselves look unchanged: there is no swelling or redness over them;
sleep disorders;
changes in the psycho-emotional sphere: depression, apathy, photophobia, deterioration of attention and memory.

Treatment

CFS syndrome must be treated comprehensively, necessarily including in the treatment program:

compulsory rest;
a full night's sleep (at least 8 hours);
adequate nutrition, periodic fasting days. It is not recommended to consume sweets in large quantities: such products sharply increase blood sugar levels, and then reduce them no less sharply, which can aggravate the patient’s condition;
mandatory inclusion of walking and physical therapy exercises in the daily routine;
massage – general or segmental;
taking a contrast shower;
mandatory treatment of those diseases that can cause a constant lack of oxygen in the body (chronic sinusitis, vasomotor rhinitis, bronchiectasis) or chronic poisoning (carious teeth, chronic tonsillitis and so on);
receiving positive emotions from a source that is individual for everyone (music, fishing, playing with children or pets).

The following drugs are prescribed for the treatment of chronic fatigue syndrome:

antidepressants, which not only eliminate symptoms of depression, but also significantly improve the immune status of such patients by activating the activity of NK cells. For the treatment of CFS, Azafen, Zoloft, Sirlift, Prozac, and Fluoxetine are prescribed;
daytime tranquilizers. These are drugs that eliminate anxiety and restlessness without causing drowsiness;
L-carnitine, which in the mitochondria of cells is involved in the production of ATP obtained from the oxidation of fatty acids. Its prescription is justified, because with CFS there is a decrease in the concentration of this amino acid in the blood;
magnesium preparations. When prescribing them, it is based on the fact that loss of strength and fatigue can be caused by a deficiency of magnesium, 80-90% of which is located intracellularly. It is the combination of this electrolyte with ATP that allows energy to be transferred and stored in cells;
B vitamins providing improved communication between the nervous system and the muscle;
non-steroidal anti-inflammatory drugs. They are prescribed to eliminate pain in muscles and joints;
immunomodulators. With frequent colds, chronic bronchitis, bronchial asthma. These can be broad-spectrum drugs (for example, Polyoxidonium, Levamisole, Thymalin or Sodium Nucleinate) or only antiviral drugs (interferons);
antiviral drugs and immunoglobulins. They are prescribed by an infectious disease doctor when elevated titers of antibodies to viruses are detected in the blood or the DNA of these viruses is determined in the blood;
nootropics, increasing the adaptive abilities of the brain and stimulating its work. These are “Glycine”, “Semax”, “Aminalon”.

When the question is how to cope with chronic fatigue syndrome, physiotherapeutic methods also come to the rescue:

Water procedures. They relax, relieve muscle tension and pain.
Magnetotherapy. The effect of the magnetic field has a relaxing effect on muscles, has an analgesic effect, and restores the functioning of the endocrine and immune systems.
Laser irradiation of blood helps activate self-regulation mechanisms, stimulates the functioning of the nervous system.
Acupuncture. The specialist’s influence on biologically active points leads to any desired effect, including relieving tension from spasming muscles, improving the functioning of the nervous system, and normalizing the nutrition of muscles, joints and internal organs.
Massage, which relaxes “tight” muscles, improving nutrition in them.

Treatment at home includes not only taking pills, but also doing autogenic training. This is a method of psychotherapy that a person can perform independently. It involves deep relaxation, against the background of which a person instills in himself certain thoughts, for example, indifference to an irritating factor or stimulation of his own protective forces and positive qualities. The first auto-training sessions are best conducted with the participation of a psychotherapist.

You can also use aromatherapy at home. It is recommended to use lavender, jasmine, sandalwood, chamomile, bergamot, and ylang-ylang oils.

Mix 100 g honey and 3 tsp. apple cider vinegar, take 1 tsp. every day;
Dissolve 1 tsp in a glass of water. honey and apple cider vinegar, add 1 drop of iodine. Drink a glass of this drink throughout the day.
Pick a few dandelions with leaves and a few nettle stems, take 100 g of these ingredients (with flowers and leaves), chop, mix with 1 tbsp. wormwood and calamus. Next, this mixture needs to be poured with 0.5 liters of vodka and left for 10-12 days. Take 1 tsp/day, first dissolving it in 50-100 ml of water.
Brew 1 tbsp in 200 ml of water. St. John's wort, leave for an hour, take 1/3 cup before each meal.
Drink ginger tea. To do this, cut off a small piece of ginger root, grate it on a fine grater (or crush it with a knife to release the juice), pour boiling water over it, and add honey and lemon to slightly cooled tea.

Forecast

The disease is not considered life-threatening and may go away even without treatment. True, there is a risk that with more severe stress or as a result of any physical disease, CFS will develop again, leading to disruption of the immune system.

It is possible to predict a protracted course of the disease, without the onset of full recovery, in people over 40 years of age, or if its development has caused depression. If during the first two years the symptoms regress, this gives hope for a complete cure.

Prevention

To avoid the development of chronic fatigue syndrome, you need to devote time and attention to observing the following rules:

take breaks after every 1-1.5 hours of work;
move more;
periodically relax in complete silence, go out into nature;
give up bad habits;
engage in any feasible sport;
do not eat fast food, but include at least 800 grams of vegetables, fruits or berries in your diet.

Chronic fatigue syndrome (CFS) causes loss of energy, constant exhaustion, affecting the quality of life and does not go away with sleep or rest.

This condition previously had other names, for example, myalgic encephalomyelitis (ME), myalgic encephalopathy, nervous asthenia and others.

Chronic fatigue syndrome is a condition that results in long-term disability that can worsen over time. According to statistics, only 17-64% of patients experience a gradual improvement in well-being; in 10-20% of cases, on the contrary, the loss of strength and energy progresses. Full recovery possible in approximately 10% of cases, more often in children and adolescents.

Anyone can develop CFS, although it is more common in women. As a rule, the disease manifests itself at the age of 20-45 years. CFS also occurs in children, usually aged 13–15 years.

In most cases, symptoms are mild or moderate, but about 25% of people have severe CFS symptoms. There are the following criteria for the severity of the disease:

Mild symptoms: a person is able to take care of himself, but sometimes he needs to take a day off to rest.
Moderate symptoms: the ability to move may be limited, and there may also be various symptoms. Sleep patterns may be disrupted, sometimes a person has to sleep in the afternoon.
Severe symptoms: the person is able to do minimal tasks, such as brushing their teeth, but their ability to move is severely limited. There may also be problems concentrating.

The causes of chronic fatigue are not completely clear. There are several theories of its origin:

viral infection;
hormonal imbalance;
psychological disturbances, such as stress or emotional trauma.

It is believed that some people have a genetic predisposition to this disease, as it is more common in some families. To treat chronic fatigue syndrome, there are several methods that are usually used in combination. This includes drug therapy, psychotherapy, physiotherapy and lifestyle correction.

Chronic fatigue (CFS): symptoms

Symptoms of chronic fatigue syndrome vary from person to person, and the course of the disease often consists of alternating periods of exacerbation and improvement. For some time, symptoms may subside, and the person returns to the usual rhythm of life. Then fatigue, drowsiness and loss of strength overcome with renewed vigor, affecting the quality of life.

Constant physical and mental fatigue- the main symptom of CFS, which does not go away after sleep or rest and prevents a person from performing daily activities. Most people with CFS describe this fatigue as overwhelming and say it is different from the fatigue they have previously experienced.

Exercise may worsen symptoms. Sometimes this does not appear immediately: fatigue may appear several hours or the next day after playing sports. In severe cases of CFS, a person is unable to do anything on their own or is only able to perform simple tasks, such as brushing their teeth. Sometimes people spend all their time in bed and cannot even leave the house.

There are other common symptoms besides fatigue and lack of energy, but most people only experience a few of them. These symptoms include the following:

muscle pain, joint pain, or severe headache;
poor short-term memory, impaired concentration, difficulty trying to concentrate, finding the right word, “head in a fog”;
soreness of the lymph nodes;
abdominal pain and other symptoms similar to irritable bowel syndrome, such as bloating, constipation, diarrhea and nausea;
a sore throat;
sleep disturbance, such as insomnia or feeling tired after waking up;
sensitivity or intolerance to light, loud noises, alcohol and certain foods;
psychological disorders, such as depression, irritability and panic attacks;
less common symptoms such as dizziness, sweating, fluctuations in body temperature.

Causes of fatigue

The exact cause of chronic fatigue syndrome (CFS) is not known, but there are several theories about it. Some experts believe that CFS can be triggered by a viral infection, such as mononucleosis. Weakness after a viral infection is normal, but this does not explain why the symptoms of CFS do not go away over time and gradually become more severe.

Other possible causes of fatigue:

dysfunction of the immune system;
hormonal imbalance;
psychiatric disorders - in some cases the disease is associated with emotional exhaustion, stress, depression and psychological trauma;
heredity - some people may inherit a predisposition to chronic fatigue syndrome, as this disease sometimes runs in families;
any physical injury- in some cases the disease developed after a previous surgery or a serious accident.

Perhaps the cause of fatigue in CFS is a combination various factors, these questions are currently being studied.

Diagnosis of chronic fatigue syndrome

There is no specific test or examination for chronic fatigue syndrome, but diagnosing the syndrome can take a long time, as it will first require ruling out other diseases that have similar symptoms. Most often, the diagnosis and treatment of CFS is carried out by a neurologist or general specialists: therapist, pediatrician (for children), family doctor.

When you see a doctor with symptoms of severe, constant fatigue, you will need to explain how the disease appeared and developed, what worsens the symptoms or brings relief. After this, the doctor will conduct an examination.

To exclude other diseases that cause a feeling of constant fatigue and drowsiness, for example, anemia, hypothyroidism, hepatitis or kidney disease, blood tests, urine tests and other studies are prescribed.

If the examination rules out other causes of fatigue, your doctor should evaluate your condition using specific criteria that have been adopted by the International Chronic Fatigue Syndrome Study Group. According to these criteria, CFS is possible if fatigue and loss of energy continue for 6 months or more, do not improve with rest, and significantly limit daily activities. In addition, the person must have at least 4 of the following symptoms:

memory impairment and problems concentrating;
sore throat (pharyngitis);
soreness of the lymph nodes in the neck and armpits;
muscle pain or stiffness;
joint pain without signs of inflammation (no swelling or redness);
the appearance of headache and changes in its type and severity;
sleep problems;
worsening of symptoms after physical or mental exertion.

Treatment of chronic fatigue syndrome

Doesn't exist yet specific treatment, allowing you to definitely get rid of chronic fatigue syndrome. However, there are ways you can make it easier. Treatment in each case is selected individually, based on existing complaints and diseases. Early diagnosis, medications to relieve symptoms, and lifestyle changes can all help.

Treatment is aimed at:

maintaining and, if possible, developing the patient’s mental and physical abilities;
control over symptoms of the disease.

There are various treatments for CFS, described below, but it is important to remember that the effect of treatment varies from person to person. During treatment, repeated adjustments to treatment approaches may be required, including if therapy does not work within a few days and symptoms worsen.

Cognitive behavioral therapy for CFS

Cognitive behavioral therapy helps relieve fatigue - a type of psychotherapy that allows you to change a person’s attitude towards the manifestations of the disease. The goal of cognitive behavioral therapy is to relieve symptoms and control their impact on the psyche. To do this, the problems pressing on a person are broken down into smaller ones, and the cycle of interconnected negative thoughts, feelings, physical sensations and actions.

Ideally, the therapist conducting the therapy sessions should have experience treating chronic fatigue, and the sessions should be one-on-one. Treatment is selected individually and may include the following elements:

assistance in accepting a diagnosis;
struggling with thoughts that interfere with symptom relief;
attempts to increase a person's sense of control over their symptoms.

Therapeutic exercise for chronic fatigue

A specially selected step-by-step training plan is aimed at gradually increasing the time during which a person can perform physical work. Typically, your workout schedule includes aerobic exercise (which gets your heart rate up), such as swimming or walking. The plan is drawn up individually, taking into account the level of physical fitness.

Training is carried out strictly under the supervision of a physical therapy doctor with experience in treating CFS. It is advisable that classes take place individually. Having determined the basic level of load (comfortable for a person before starting training), the doctor will gradually increase the duration of training and its intensity.

The doctor will also set goals for the person, such as walking to the store or working in the garden. It may take weeks, months or even years to achieve these goals, but under no circumstances should you exceed your target load level prematurely.

Medicines to relieve fatigue

There are no medications specifically designed to treat chronic fatigue syndrome, but various drugs may help relieve symptoms of the disease. For example, pain in various parts the body can be relieved with painkillers.

For pain, fatigue and sleep disturbances, antidepressants may be prescribed, for example, amitriptyline, a weak tricyclic antidepressant. It has contraindications, for example, it should not be taken if you have heart disease. It may also cause side effects such as dry mouth, blurred vision, dizziness, and drowsiness.

If chronic fatigue syndrome is accompanied by severe nausea, antiemetics may be prescribed.

In addition to treatment from specialists, you can relieve fatigue with simple tips on lifestyle changes. For example, try to regulate physical activity, balancing periods of sleep and wakefulness, do not overload yourself and do not try to do more than you can do. Otherwise, this may negatively affect the prognosis of CFS. Over time, periods of activity can be increased.

By properly managing your available resources, you will be able to do more things. To do this, you need to properly plan your schedule for the day and even a week in advance. By properly distributing things - instead of rushing to do as much as possible in a short period of time - you can achieve sustainable progress.

The following rules may also help:

avoid stressful situations;
abstain from alcohol, caffeine, sugar and sweeteners;
avoid any foods and drinks that cause a negative reaction in the body;
eat small, regular meals to relieve nausea;
get plenty of rest;
Try not to sleep for long periods of time, as sleeping too much can worsen symptoms.

Despite treatment and lifestyle changes, relapses sometimes occur. This is a period of time when all the symptoms of chronic fatigue syndrome intensify, and the person is unable to perform usual activities. Relapses from CFS occur frequently and can be caused by a number of factors, such as an infectious disease or overwork. Sometimes obvious reason No.

To alleviate the condition during this period, it is recommended to rest more. The doctor may prescribe a set of therapeutic procedures during a relapse in order to more quickly alleviate its manifestations. With time and treatment, many people with chronic fatigue syndrome get better.

Alternative Treatments and Nutritional Supplements

Some people with CFS note that alternative treatment methods help them: relaxation techniques, yoga, kinesitherapy, massage, taking vitamins or dietary supplements, etc. Despite the fact that there is no scientific evidence of their effectiveness yet, you can use these methods in addition to traditional treatment.

Which doctor should I consult for chronic fatigue?

Typically, chronic fatigue syndrome is treated by a neurologist. However, other diseases may have similar symptoms, so a therapist can help you with the diagnosis. You can find these specialists using the NaPopravka service by following the links. A whole team of doctors will deal with complex treatment of symptoms; to find out which specialist you need, use the section

Chronic fatigue syndrome is a disease characterized by excessive, disabling fatigue that persists for at least 6 months and is accompanied by numerous joint, infectious and neuropsychiatric symptoms.

Chronic fatigue syndrome is defined as prolonged, severe, disabling fatigue without obvious muscle weakness. There are no associated disorders that could explain the fatigue. There are typically no depression, anxiety or other psychological diagnoses. Treatment is rest and psychological support; often with the use of antidepressants.

ICD-10 code

G93.3 Fatigue syndrome after a viral illness

Epidemiology

This definition of chronic fatigue syndrome (CFS) has several variations, and the heterogeneity of patients who meet the criteria for this definition is significant. Prevalence cannot be accurately determined; it varies from 7 to 38/100,000 people. Prevalence may vary due to differences in diagnostic evaluation, physician-patient relationships, social acceptability, risk of exposure to an infectious or toxic substance, or case identification and definition. Chronic fatigue syndrome is more common in women. Office-based studies have shown that the incidence is higher among people with white skin color. However, reviews of various communities indicate a higher prevalence among people of color, Hispanics, Latin Americans, and American Indians.

Approximately every fifth patient (10-25%) seeking medical care, complains of prolonged fatigue. Usually feeling tired - transient symptom, disappearing spontaneously or with treatment of the underlying disease. However, in some patients this complaint begins to persist and has Negative influence on general state health. When fatigue cannot be explained by any disease, it is assumed that it is associated with chronic fatigue syndrome, the diagnosis of which can only be made after excluding other somatic and mental disorders.

The prevalence of chronic fatigue syndrome in the adult population, according to some data, can reach 3%. Approximately 80% of all cases of chronic fatigue syndrome remain undiagnosed. Children and adolescents develop chronic fatigue syndrome much less frequently than adults. The peak incidence of chronic fatigue syndrome occurs in active age (40-59 years). Women in all age categories are more susceptible to chronic fatigue syndrome (60-85% of all cases).

Causes of chronic fatigue syndrome

Initially, they were inclined to the infectious theory of the development of chronic fatigue syndrome (viral infection), but further research revealed a wide variety of changes in many areas, including the structure and function of the brain, neuroendocrine response, sleep structure, immune system, and psychological profile. Currently, the most common stress-dependent model of the pathogenesis of chronic fatigue syndrome, although it cannot explain all the pathological changes characteristic of this syndrome. Based on this, most researchers postulate that chronic fatigue syndrome is a heterogeneous syndrome, which is based on various pathophysiological abnormalities. Some of them may predispose to the development of chronic fatigue syndrome, others directly cause the development of the disease, and still others determine its progression. Risk factors for chronic fatigue syndrome include female gender, genetic predisposition, certain personality traits or behavioral style, etc.

Stress-dependent hypothesis

The premorbid history of patients with chronic fatigue syndrome, as a rule, contains indications of a large number of stressful life events, previous infectious diseases and surgical interventions. Manifestation or exacerbation of chronic fatigue syndrome and its comorbid conditions in adults is often associated with stress or conflict situations.
Mental trauma in childhood (child abuse, abuse, neglect, etc.) is considered an important risk factor for the development of chronic fatigue syndrome. High reactivity to unfavorable psychosocial factors is characteristic of the entire spectrum of disorders associated with mental trauma in childhood. Stress in early period life during a critical period of increased brain plasticity continuously affects brain regions involved in cognitive-emotional processes and regulating the endocrine, autonomic and immune systems. There is experimental and clinical evidence that traumatic events experienced at a young age lead to long-term disruption of the hypothalamic-pituitary-adrenal system and a more pronounced reaction to stress. However, not all patients with chronic fatigue syndrome have a history of childhood psychological trauma. Probably, this mechanism may play a leading role in the pathogenesis of only a certain group of patients with chronic fatigue syndrome.
Comprehensive studies of neuroendocrine status in chronic fatigue syndrome have revealed significant changes in the activity of the hypothalamic-pituitary-adrenal system, which confirms a violation of the physiological response to stress. One third of patients with chronic fatigue syndrome have hypocortisolism, which is likely to be of central origin. Also worthy of attention is the discovery in families of patients with chronic fatigue syndrome of a mutation that disrupts the production of a protein necessary for the transport of cortisol in the blood. Women (but not men) with chronic fatigue syndrome have a reduced morning cortisol peak compared to healthy women. These sex differences in the circadian rhythm of cortisol production may explain more high risk development of chronic fatigue syndrome in women. Low cortisol levels lead to disinhibition of immune mediators and determine the response to stress of the suprasegmental parts of the autonomic nervous system, which in turn causes fatigue, pain phenomena, cognitive impairment and affective symptoms. Taking serotonin agonists in patients with chronic fatigue syndrome leads to greater increase plasma prolactin levels compared with healthy individuals. In patients suffering from major depression, the pattern of neuroendocrine disorders is reversed (hypercortisolism, serotonin-mediated suppression of prolactin). In contrast, depletion of morning cortisol levels has been observed in individuals suffering from chronic pain and various emotional disorders. Currently, dysfunction of the hypothalamic-pituitary-adrenal axis, the hormonal response to stress, and the neurotransmitter effects of serotonin are the most reproducible changes found in patients with chronic fatigue syndrome.
Patients with chronic fatigue syndrome are characterized by a distorted perception of natural bodily sensations as painful symptoms. It is also typical for them increased sensitivity to physical activity ( low threshold changes in heart rate, blood pressure, etc.) A similar pattern of impaired perception can be observed in relation to stress-related bodily sensations. It is believed that perceptual disturbances, regardless of the etiology of chronic fatigue syndrome, are the basis for the appearance and persistence of symptoms and their painful interpretation.

Central nervous system disorders. Some symptoms of chronic fatigue syndrome (fatigue, impaired concentration and memory, headache) suggest the pathogenetic possibility of central nervous system dysfunction. In some cases, MRI reveals nonspecific changes in the subcortical white matter of the brain, which, however, are not associated with cognitive impairment. Regional abnormalities in cerebral perfusion (usually hypoperfusion) on SPECT scans are typical. In general, all changes identified to date are not clinically significant.

Autonomic dysfunction. D.H. Streeten, G.H. Anderson (1992) suggested that one cause of chronic fatigue may be failure to maintain blood pressure in an upright position. It is possible that a separate subgroup of patients with chronic fatigue syndrome has orthostatic intolerance [the latter refers to symptoms of cerebral hypoperfusion, such as weakness, lipothymia, blurred vision, occurring in an upright position and associated with sympathetic activation (tachycardia, nausea, tremors) and an objective increase in heart rate more than 30 per minute]. Postural tachycardia associated with orthostatic intolerance is quite often observed in individuals with chronic fatigue syndrome. Symptoms characteristic of postural tachycardia (dizziness, palpitations, pulsations, impaired tolerance to physical and mental stress, lipothymia, chest pain, gastrointestinal symptoms, anxiety disorders, etc.) are also noted in many patients with chronic fatigue syndrome. The pathogenesis of postural tachycardia syndrome remains unclear; the role of baroreceptor dysfunction, increased sensitivity of alpha and beta adrenergic receptors, and pathological changes in venous system, disorders of norepinephrine metabolism, etc. In general, in some patients, chronic fatigue syndrome may indeed be pathogenetically caused by autonomic dysfunction, manifesting orthostatic intolerance.

Infections. Epstein-Barr virus, herpes virus type 6, Coxsackie virus group B, T-cell lymphotropic virus type II, hepatitis C virus, enteroviruses, retroviruses, etc. were previously considered as possible etiological agents of chronic fatigue syndrome. evidence of the infectious nature of chronic fatigue syndrome has not been obtained. In addition, therapy aimed at suppressing viral infection does not improve the course of the disease. Nevertheless, a heterogeneous group of infectious agents continues to be considered as a factor contributing to the manifestation or chronic course chronic fatigue syndrome.

Immune system disorders. Despite numerous studies, only minor abnormalities in the immune status have been identified in patients with chronic fatigue syndrome. First of all, they relate to increasing the expression of active markers on the surface of T-lymphocytes, as well as increasing the concentration of various autoimmune antibodies. Summarizing these results, it can be stated that mild activation of the immune system is typical for patients with chronic fatigue syndrome, but it remains unknown whether these changes have any pathogenetic significance.

Mental disorders. Since there is no convincing evidence of a somatic cause of chronic fatigue syndrome, many researchers postulate that it is a primary mental illness. Others believe that chronic fatigue syndrome is one of the manifestations of other mental illnesses, in particular somatization disorder, hypochondria, major or atypical depression. Indeed, in patients with chronic fatigue syndrome, the incidence of mood disorders is higher than in the general population or among people with chronic somatic diseases. In most cases, mood disorders or anxiety precede the onset of chronic fatigue syndrome. On the other hand, the high prevalence of affective disorders in chronic fatigue syndrome may be a consequence of an emotional response to disabling fatigue, immune changes, and central nervous system disorders. There are other objections to the identification of chronic fatigue syndrome with mental illness. Firstly, although some manifestations of chronic fatigue syndrome are close to nonspecific mental symptoms, but many others, such as pharyngitis, lymphadenopathy, arthalgia, are not at all typical for mental disorders. Secondly, anxiety-depressive disorders are associated with central activation of the hypothalamic-pituitary-adrenal system (moderate hypercortisolism), on the contrary, with chronic fatigue syndrome, central inhibition of this system is more often observed.

Symptoms of chronic fatigue syndrome

Subjectively, patients can formulate the main complaint differently (“I feel completely exhausted”, “I constantly lack energy”, “I am completely exhausted”, “I am exhausted”, “regular exercise makes me exhausted”, etc. .). When actively questioning, it is important to differentiate increased fatigue from muscle weakness or feelings of despondency.

Most patients evaluate their premorbid physical state as excellent or good. Feelings of extreme fatigue come on suddenly and are usually accompanied by flu-like symptoms. The disease may be preceded by respiratory infections, such as bronchitis or vaccination. Less commonly, the disease has a gradual onset, and sometimes begins gradually over many months. After the onset of the disease, patients notice that physical or mental effort leads to worsening feelings of fatigue. Many patients find that even minimal physical effort leads to significant fatigue and an increase in other symptoms. Prolonged rest or avoidance of physical activity can reduce the severity of many symptoms of the disease.

Frequently seen pain syndrome characterized by diffuseness, uncertainty, tendency to migrate pain. In addition to pain in muscles and joints, patients complain of headache, sore throat, tenderness of the lymph nodes, and abdominal pain (often associated with a comorbid condition - irritable bowel syndrome). Pain in chest is also typical for this category of patients, some of them complain of “painful” tachycardia. Some patients complain of pain in unusual places [eyes, bones, skin(pain at the slightest touch to the skin), perineum and genitals].

Changes in the immune system include tender lymph nodes, repeated episodes of sore throat, recurrent flu-like symptoms, general malaise, and hypersensitivity to foods and/or medications that were previously tolerated normally.

In addition to the 8 core symptoms that qualify as diagnostic criteria, patients may present with a variety of other disorders, the frequency of which varies widely. Most often, patients with chronic fatigue syndrome note a decrease in appetite up to anorexia or its increase, fluctuations in body weight, nausea, sweating, dizziness, poor tolerance to alcohol and medications that affect the central nervous system. The prevalence of autonomic dysfunction in patients with chronic fatigue syndrome has not been studied, however, autonomic disorders have been described both in individual clinical observations and in epidemiological studies. More often than others, orthostatic hypotension and tachycardia, episodes of sweating, pallor, sluggish pupillary reactions, constipation, frequent urination, respiratory disorders (feeling of lack of air, obstruction in the airways or pain when breathing) are observed.

Approximately 85% of patients complain of impaired concentration and weakened memory, but routine neuropsychological examination usually does not reveal disorders of mnestic function. However, upon in-depth study, minor but undoubted impairments in memory and assimilation of information are often discovered. In general, patients with chronic fatigue syndrome have normal cognitive and intellectual abilities.

Sleep disorders are represented by difficulty falling asleep, interrupted night sleep, daytime sleepiness, while the results of polysomnography are very variable. The most often described is “alpha intrusion” (imposition) during slow-wave sleep and a decrease in the duration of stage IV sleep. However, these findings are unstable and do not have diagnostic value; in addition, sleep disturbances do not correlate with the severity of the disease. In general, fatigue should be clinically distinguished from drowsiness and take into account that drowsiness can either accompany chronic fatigue syndrome or be a symptom of other diseases that exclude the diagnosis of chronic fatigue (for example, sleep apnea syndrome).

Almost all patients with chronic fatigue syndrome develop social maladjustment. Approximately a third of patients are unable to work and another third prefer part-time professional employment. The average duration of the disease is 5-7 years, but symptoms can persist for more than 20 years. Often the disease proceeds in waves, periods of exacerbation (deterioration) alternate with periods of relatively wellness. Most patients experience partial or complete remissions, but the disease often recurs.

Additional symptoms identified in patients with chronic fatigue syndrome

Irritable bowel syndrome (abdominal pain, nausea, diarrhea, or bloating).
Chills and sweats at night.
Feeling of fog, emptiness in the head.
Chest pain.
Labored breathing.
Chronic cough.
Visual disturbances (blurred vision, intolerance to bright light, eye pain, dry eyes).
Food allergies, hypersensitivity to alcohol, odors, chemicals, medications, noise.
Difficulty maintaining an upright position (orthostatic instability, irregular heartbeat, dizziness, unsteadiness, fainting).
Psychological problems(depression, irritability, mood swings, anxiety, panic attacks).
Pain in the lower half of the face.
Increase or decrease in body weight

The feeling of excessive fatigue, as well as chronic fatigue syndrome itself, is comorbid with many functional diseases, such as fibromyalgia, irritable bowel syndrome, post-traumatic stress disorder, dysfunction mandibular joint, chronic pelvic pain, etc.

Diagnostic criteria

Chronic fatigue syndrome has been described many times under various names; searching for a term that most fully reflects the essence of the disease. continue to this day. The following terms were most often used in the literature: “benign myalgic encephalomyelitis” (1956), “myalgic encephalopathy”, “chronic mononucleosis” (chronic infection with the Epstein-Barr virus) (1985), “chronic fatigue syndrome” (1988), “post-viral syndrome fatigue." ICD-9 (1975) did not mention chronic fatigue syndrome, but did include the term “benign myalgic encephalomyelitis” (323.9). ICD-10 (1992) introduced a new category - post-viral fatigue syndrome (G93).

The term and definition of chronic fatigue syndrome were first introduced by US scientists in 1988, who suggested a viral etiology of the syndrome. The Epstein-Barr virus was considered as the main pathogen. In 1994, a revision of the definition of chronic fatigue syndrome was carried out and in an updated version it acquired international status. According to the 1994 definition, the diagnosis requires persistence (or remittance) of unexplained fatigue that is not relieved by rest and significantly limits daily activities for at least 6 months. In addition, 4 or more of the following 8 symptoms must be present.

Problems with memory or concentration.
Pharyngitis.
Pain on palpation of the cervical or axillary lymph nodes.
Muscle soreness or stiffness.
Joint tenderness (no redness or swelling).
New headache or change in its characteristics (type, severity).
A dream that does not bring a feeling of restoration (freshness, vigor).
Worsening fatigue to the point of exhaustion after physical or mental effort, lasting more than 24 hours.

In 2003, the International Group on Chronic Fatigue Syndrome recommended the use of standardized scales to assess the main symptoms of chronic fatigue syndrome (impaired daily activities, fatigue and accompanying symptom complex).

Conditions that exclude the diagnosis of chronic fatigue syndrome are the following:

The presence of any current somatic diseases that may explain the persistence of chronic fatigue, such as severe anemia, hypothyroidism, sleep apnea syndrome, narcolepsy, oncological diseases» chronic hepatitis B or C, uncontrolled diabetes mellitus, heart failure and other severe cardiovascular diseases, chronic renal failure, inflammatory and dysimmune diseases, diseases of the nervous system, severe obesity, etc., as well as taking medications, the side effects of which include a feeling of general weakness.
Mental illness (including history).
- Major depression with psychotic or melancholic symptoms.
- Bipolar affective disorder.
- Psychotic states (schizophrenia).
- Dementia.
- Anorexia nervosa or bulimia.
Abuse of drugs or alcohol for 2 years before the onset of fatigue and for some time after.
Severe obesity (body mass index 45 or more).

The new definition also includes diseases and conditions that do not exclude the diagnosis of chronic fatigue syndrome:

Disease conditions that are diagnosed based on clinical criteria only and that cannot be confirmed by laboratory tests.
- Fibromyalgia.
- Anxiety disorders.
- Somatoform disorders.
- Non-melancholic depression.
- Neurasthenia.
Diseases associated with chronic fatigue, but successful treatment which led to an improvement in all symptoms (the adequacy of therapy must be verified). For example, success replacement therapy hypothyroidism must be verified normal level thyroid hormones, adequacy of treatment of bronchial asthma - assessment of respiratory function, etc.
Diseases associated with chronic fatigue and caused by a specific pathogen, such as Lyme disease, syphilis, if adequate treatment was carried out before the onset of symptoms of chronic fatigue.
Isolated and unexplained paraclinical abnormalities (changes in laboratory parameters, neuroimaging findings), which are not sufficient to strictly confirm or exclude any disease. For example, these findings may include elevated antinuclear antibody titers in the absence of additional laboratory or clinical evidence to reliably diagnose a connective tissue disorder.

Unexplained chronic fatigue that is not completely satisfying diagnostic criteria, can be regarded as idiopathic chronic fatigue.

In 2007, the UK's National Institute of Health (NICE) published less stringent criteria for chronic fatigue syndrome, recommended for use by various specialists.

The presence of new, persistent or recurrent fatigue (over 4 months in adults and 3 months in children), which:
- cannot be explained by any other disease;
- significantly limits activity level;
- characterized by malaise or worsening fatigue after any effort (physical or mental), followed by extremely slow recovery (over at least 24 hours, but usually within a few days).
The presence of one or more symptoms from the following list: sleep disturbance, muscle or joint pain of polysegmental localization without signs of inflammation, headache, tenderness of the lymph nodes without pathological enlargement, pharyngitis, cognitive dysfunction, worsening of symptoms with physical or mental stress, general malaise, dizziness and/or nausea, palpitations in the absence organic pathology hearts.

The NICE criteria for chronic fatigue syndrome have received considerable criticism from experts, which is why most researchers and clinicians continue to use the 1994 international criteria.

Along with chronic fatigue syndrome, secondary forms of this syndrome are also identified in a number of cases. neurological diseases. Chronic fatigue is observed with multiple sclerosis, Parkinson's disease, motor neuron diseases, chronic cerebral ischemia, strokes, post-polio syndrome, etc. The basis of secondary forms chronic fatigue lies direct damage to the central nervous system and the impact of other factors indirectly related to the underlying disease, for example, depression that arose as a reaction to a neurological disease.

Diagnosis of chronic fatigue syndrome

There are no specific paraclinical tests to confirm the clinical diagnosis of chronic fatigue syndrome. At the same time, a mandatory examination is carried out to exclude diseases, one of the manifestations of which may be chronic fatigue. Clinical evaluation of patients with the leading complaint of chronic fatigue includes the following measures.

Detailed medical history, including medications used by the patient that may be causing fatigue.
Exhaustive examination of the patient’s somatic and neurological status. Superficial palpation of somatic muscles in 70% of patients with chronic fatigue syndrome with gentle pressure reveals painful points localized in various muscles, often their location corresponds to that of fibromyalgia.
Screening study of cognitive and mental status.
Carrying out a set of screening laboratory tests:
- general blood test (including leukocyte count and ESR determination);
- biochemical analysis blood (calcium and other electrolytes, glucose, protein, albumin, globulin, creatinine, ALT and AST, alkaline phosphatase);
- assessment of thyroid function (thyroid hormones);
- urine analysis (protein, glucose, cellular composition).

Additional studies usually include determination of C-reactive protein (a marker of inflammation), rheumatoid factor, and CPK (muscle enzyme) activity. Determination of ferritin is useful in children and adolescents, as well as in adults if other tests confirm iron deficiency. Specific tests confirming infectious diseases (Lyme disease, viral hepatitis, HIV, mononucleosis, toxoplasmosis, cytomegalovirus infection), as well as a serological panel of tests for Epstein-Barr viruses, enteroviruses, retroviruses, herpes viruses type 6 and Candida albicans carried out only if there is a history of indications of an infectious disease. On the contrary, MRI of the brain and examination of the cardiovascular system are considered routine methods when chronic fatigue syndrome is suspected. To exclude sleep apnea, polysomnography should be performed.

In addition, it is advisable to use special questionnaires to help assess the severity of the disease and monitor its course. The most commonly used are the following.

The Multidimensional Fatigue Inventory-MFI assesses general fatigue, physical fatigue, mental fatigue, reduction in motivation and activity. Fatigue is defined as severe if the score on the general fatigue scale is 13 points or more (or on the activity reduction scale - 10 points or more).
Quality of life questionnaire SF-36 (Medical outcomes survey short form-36) to assess impairment of functional activity in 8 categories (limitation of physical activity, limitation of usual role activities due to health problems, limitation of usual role activities due to emotional problems, physical pain, general health assessment, vitality assessment, social functioning and general mental health). The ideal norm is 100 points. Patients with chronic fatigue syndrome are characterized by a decrease in functional activity (70 points or less), social functioning (75 points or less) and a decrease in the emotional scale (65 points or less).

Drug treatment of chronic fatigue syndrome

There are isolated studies indicating some positive effect of intravenous immunoglobulin (compared to placebo), but the effectiveness of this method of therapy cannot yet be considered proven. Most other drugs (glucocorticoids, interferons, antivirals, etc.) turned out to be ineffective against both the feeling of fatigue itself and other symptoms of chronic fatigue syndrome.

IN clinical practice Antidepressants are widely used to successfully relieve some symptoms of chronic fatigue syndrome (they improve sleep and reduce pain, have a positive effect on comorbid conditions, in particular fibromyalgia). Some open studies have shown a beneficial effect of reversible MAO inhibitors, especially in patients with clinically significant autonomic symptoms. However, it should be borne in mind that most patients with chronic fatigue syndrome do not tolerate medications that act on the central nervous system well, so therapy should be started with low doses. Preference should be given to antidepressants with a favorable spectrum of tolerability. In addition, official herbal preparations with significantly lower amounts side effects may be considered as an alternative therapy in individuals who have had negative experiences with antidepressants. The basis of most official complex herbal remedies is valerian. Controlled randomized trials demonstrate that the effects of valerian on sleep include improving sleep quality, prolonging sleep time, and decreasing the time it takes to fall asleep. The hypnotic effect of valerian on sleep is more evident in individuals suffering from insomnia than in healthy individuals. These properties allow the use of valerian in persons with chronic fatigue syndrome, core clinical picture of which are dissomnic manifestations. More often, not a simple valerian extract is used, but complex herbal preparations (novopassit), in which a harmonious combination of extracts medicinal plants provides a complex psychotropic (sedative, tranquilizing, mild antidepressant) and “organotropic” (spasmolytic, analgesic, antiallergic, vegetostabilizing) effect.

There is evidence that some patients have obtained a positive effect when prescribed amphetamine and its analogues, as well as modafinil.

In addition, paracetamol or other NSAIDs are used, which are especially indicated for patients with musculoskeletal disorders (muscle soreness or stiffness).

Sleep disorders may sometimes require the use of sleeping pills. As a rule, you should start with an antihistamine (doxylamine) and only if there is no effect, use prescription sleeping pills in minimal doses.

Some patients use alternative treatment- vitamins B large doses, herbal medicine, special diets, etc. The effectiveness of these measures has not been proven.

Non-drug treatment of chronic fatigue syndrome

Cognitive behavioral therapy is widely used to eliminate pathological perception and distorted interpretation of bodily sensations (i.e. factors that play a significant role in maintaining the symptoms of chronic fatigue syndrome). Cognitive behavioral therapy may also be useful in teaching the patient more effective coping strategies, which in turn may lead to increased adaptive capacity. Controlled studies have found that 70% of patients report a positive effect. A combination of stepwise programs may be helpful. physical exercise with cognitive behavioral therapy.

Deep breathing techniques, muscle relaxation techniques, massage, kinesiotherapy, and yoga are considered as additional interventions (mainly to eliminate comorbid anxiety).

Forecast

With long-term observation of patients with chronic fatigue syndrome, it was found that improvement occurs in approximately 17-64% of cases, deterioration in 10-20%. The probability of a complete cure does not exceed 10%. 8-30% of sick people return to their previous professional activities in full. Elderly age, long duration of the disease, severe fatigue, comorbid mental illnesses are risk factors poor prognosis. On the contrary, complete recovery is more often observed in children and adolescents.