Chronic Fatigue Syndrome: The First Real Evidence of an Illusive Disease

Words like ’fatigue’ and ‘pain’ are some of the most complex concepts in all of medicine. They are tough to define and are incredibly subjective. There are many external factors which affect them. More importantly, the impact of the patients’ internal environment and perception of pain adds to these factors. Some cultures react more openly and with more enthusiasm to pain while others are of stoic nature. In some societies, fatigue is a way of life while in others the slightest bit of fatigue is something that needs to be avoided and dealt with immediately.

A disease or group of disorders, which cause crushing, unremitting fatigue that persists for six months or longer, have taken the name of Chronic Fatigue Syndrome (CFS) over the last few decades in the clinical world. Acceptance, that this issue may be a real diagnosable disease or disease group, has been slow. The demographic spread of patients suffering from this problem has been all over the map. The symptoms have been vague and almost indefinable because those two nasty words “pain’ and “fatigue” are also pretty indefinable. The causes or root pathologies that lead to the malady have been difficult to define, to say the least. 

So far, from researching treatments for CFS, most of the research has been focused on finding out whether this thing is real or if the clinical world should just stop using the term CFS and try and redefine the whole issue.

The first evidence that CFS may indeed be real was recently published by the Stanford press. The research included a small study that compared the brain magnetic resonance imaging scans (MRI scans) of patients with CFS (according to the definition given above) and normal people. The results were astonishing. The white matter in the brains of these CFS patients was shown to be less dense than the white matter of normal patients. That is real, calculable evidence! It can be seen and quantified and may be a total paradigm shift in our understanding of CFS and fatigue issues in general.

The white matter of the brain (distinct from the grey matter) consists of billions of long filaments called axons arising from the grey matter which consists of the bodies of neurons. These axons form trillions of connections with other neurons in other parts of the brain and the rest of the body. The white matter is much like the network cabling that connects all the computers of the world together to form the internet. Without that kind of networking, communication is impossible. To force the metaphor with network cabling a little further, these axons are covered by an ‘insulating’ material called myelin. Problems with myelin are known to cause diseases like multiple sclerosis (MS). It looks like changes in the density of the matter and quality of the insulation and networking in general may have something to do with CFS. That is what is important to know as it gives researchers a starting point to work from, when developing further studies on the causes and workings of a brain with CFS.

However, this is only the first step. Years of research will be needed to answer crucial questions like:
What causes change in the density of white matter?
How do these changes actually affect the brain and give rise to symptoms?
Are the changes the cause of CFS or an effect of CFS?

New research will give rise to new questions and eventually when a critical mass of knowledge is reached, clinically sound management strategies for the management of CFS will be developed.

For now, we know it is real.