Anthony Komaroff—Medical care of ME/CFS patients

An overview of management of patients with this illness was presented. Age range is 5 – 65 years. 65% patients are female. It affects all socio-economic groups, but is more common in Afro-Americans and Latinos. 50% patients are "shut-in" or bedridden much of the time. Average duration of illness is 14 years (4-36 year range). Post-exertional malaise (PEM) is characteristic and not seen in any other illness. Cognitive impairment is common. The SF-36 shows low scores in all areas. 10% patients achieve full remission, 23% end up with an alternative diagnosis.

This is not depression, as SSRIs do not fix it. There are abnormalities in the HPA, and neurological and immunological abnormalities are not seen in depression. However with psychological assessment, 50% patients have a diagnosis of depression after onset. Prolactin is often elevated in CFS, and decreased in depression.

Abnormalities found include: neuro-endocrine dysfunction, cognitive deficit, autonomic dysfunction, abnormalities on MRI,Spect and EEG, lactate abnormalities in the CSF, striking differences in immune system. There is evidence of abnormal energy metabolism. Infectious agents implicated include HHV6 in 90-95% patients (the receptor is the complement receptor).

Treatment options discussed:

• CBT helps patients cope with the illness and reduces symptoms.
• Gradual exercise plan which should be gentle to avoid PEM
• Trazadone for sleep
• Rituximab—as possible autoimmune disease

Final words were that case definitions may encompass several different subsets or other illnesses.