Chronisch Vermoeidheidssyndroom: diagnose, behandeling en ...

KCE Reports 88 Chronic Fatigue Syndrome 23
o acute viral infections, such as infectious mononucleosis (anti-
Epstein Barr antibodies).
Before more research will be available to give evidence on their utility and their ability
to discriminate CFS patients from controls, do not do the following tests routinely:
• the head-up tilt test
• auditory brainstem responses
• electrodermal conductivity
• polysomnographic assessment of sleep (awaiting confirmation of the
recent data from Reeves et al. (2006) 47 in larger population studies),
except if the anamnesis suggested a primary sleep disorder. In this
latter case, a clinical assessment by a sleep physician is critical to
decide on the usefulness of a polysomnography.
Reconsider the diagnosis if the person has none of the following symptoms:
• post-exertional fatigue or malaise
• cognitive difficulties
• sleep disturbance
• chronic pain.
Tests should not be repeated as is often the case in current practice due to e.g. medical
shopping.
Key points
• The diagnosis is a clinical one. No discriminating diagnostic tests are
currently available, for adults or for children and young people;
• Before making the diagnosis, it is important to exclude alternative and
common diagnoses, such as endocrine diseases or mood disorders;
• To exclude alternative diagnoses, a battery of tests is recommended (see
Standard tests to perform) whereas a lot of diagnostic procedures should be
avoided (see Tests that should be avoided) according to the absence of
evidence about their ability to discriminate CFS patients from non-CFS
patients;
• Using strict definition for CFS based on Fukuda criteria is advocated;
• NICE recommended making diagnosis of CFS when symptoms have
persisted for 4 months. As no scientific evidence is endorsing this criterion,
this recommendation should not be implemented in Belgium before a
validation against current definitions;
• Tests should not be repeated as is often the case in current practice due to
e.g. medical shopping;
• It can be recommended to refer children and young people to a
paediatrician for assessment to exclude other diagnoses within 6 weeks of
suggestive symptoms (RCPCH recommendations);
• A child who is referred with debilitating fatigue for assessment should be
given an option of “generalised fatigue”;
• Though it has been suggested to make the diagnosis in children as soon as
after 3 months of debilitating fatigue, a better scientific underpinning of this
criterion is absolutely recommended before adopting it in a new definition.
2.4 EPIDEMIOLOGICAL DATA ABOUT CFS
Epidemiological studies and their findings are likely to differ according to the setting in
which they were conducted, whether fatigue as a symptom, chronic fatigue or CFS was
studied, the definition of CFS used and the rigorousness of the efforts made to rule out
alternative medical explanations. 48 Comparisons between studies having studied
prevalence of CFS are summarized in Table 1.