Article introduction:
BACKGROUND: Chronic fatigue is a frequently occurring problem in both the primary and specialist health services. The Department of Neurology at Haukeland University Hospital has established a standard assessment for patients referred with suspected CFS/ME. This study reports diagnoses and findings upon assessment, and considers the benefit of supplementary examinations.
MATERIAL AND METHOD: Diagnoses and findings from examinations of 365 patients assessed for suspected CFS/ME are retrospectively reported.
RESULTS: A total of 48 patients (13.2 %) were diagnosed with CFS/ME, while a further 18 patients (4.9 %) were diagnosed with post-infectious fatigue. Mental and behavioural disorders were diagnosed in 169 patients (46.3 %), and these represented by far the largest group. Serious, but unrecognised somatic illness was discovered in two patients, while changes of uncertain significance were identified by MRI and lumbar puncture in a few patients.
INTERPRETATION: Fatigue is a frequently occurring symptom in the population. Thorough somatic and psychiatric investigation is necessary before referral to the specialist health services. Mental disorders and reactions to life crises are common and important differential diagnoses for CFS/ME. Long waiting times in the specialist health services may result in delayed diagnosis for these patients.
The reported prevalence of CFS/ME is 0.2 – 3 % (7 – 9). In the period from 2008 – 12, 5 809 persons in Norway received the ICD-10 diagnosis
G93.3 (10). This figure will include patients with CFS/ME, but it is not known whether all these fulfil the established criteria for this condition. The absence of biomarkers represents a challenge in terms of diagnosis, as does the need to exercise clinical discretion with regard to the significance of other explanations for the symptom complex. According to the Norwegian Directorate of Health guidelines (11), the diagnoses neurasthenia and burn-out will also be relevant for this patient group.
The core symptom of CFS/ME is persistent fatigue (> 6 months) that is unrelated to exertion. Rest does not help, and other conditions cannot explain the fatigue. Several sets of criteria for the condition are available (12).
The Norwegian Directorate of Health (11) recommends the Canadian criteria (13) or the Fukuda criteria (14). In 2015, the American Institute of Medicine published a report (15) in which they reviewed the criteria and scientific evidence base for the condition. They concluded by presenting new criteria, and the term Systemic Exertion Intolerance Disease (SEID) was proposed. These criteria have met with criticism (16) and are neither validated nor used in scientific publications.
On 1 February 2012, the Department of Neurology at Haukeland University Hospital established a standardised assessment for patients referred with suspected CFS/ME. In this study we summarise findings and diagnoses in the first 365 patients who were assessed. Our aim was to report the final diagnosis for these patients and to evaluate the benefit of comprehensive medical assessment.
Investigation of suspected chronic fatigue syndrome/myalgic encephalopathy, by J F Owe H Næss, I O Gjerde, J E Bødtker, O-B Tysnes in Tidsskr Nor Legeforen 2016; 136:227 – 32, no.3-9 Feb 2016
