Two Indian clinicians described how Chronic Fatigue Syndrome (CFS), also called myalgic encephalomyelitis, affects the brain and daily function and urged clinicians to focus on clinical assessment, symptom pacing and multidisciplinary follow-up.

“CFS affects the brain and nervous system through dysregulation of neurotransmitters, altered autonomic function, and impaired energy metabolism,” said consultant neurologist Dr A Santosh Sriram. He listed common problems as brain fog, poor concentration, sleep disturbances, headaches, increased pain sensitivity and a key feature: post-exertional malaise. Post-exertional malaise is a disproportionate worsening of symptoms after minimal physical or mental activity.

Consultant physician Dr Shraddha Sanghani framed CFS as persistent fatigue lasting more than six months that does not usually improve with rest. She named likely contributors as prior viral infection, immune dysregulation, hormonal imbalance and psychological stress, and stressed that CFS differs from routine tiredness because activity often makes symptoms worse.

Both clinicians noted there is no single diagnostic test. “Evaluation is primarily clinical,” Dr Santosh said. He recommended cognitive screening or formal neuropsychological testing where needed and sleep studies when a primary sleep disorder is suspected. He said blood tests should be used to exclude thyroid disease, anaemia, vitamin deficiencies, infections and metabolic or psychiatric causes that can mimic fatigue.

On management, Dr Shraddha recommended a structured routine that balances activity with rest, commonly called pacing. She advised avoiding overexertion, gradual introduction of gentle activity depending on tolerance, good sleep hygiene, hydration and a balanced diet. Dr Santosh added that care can include cognitive behavioural therapy, pain management, physiotherapy, treatment for anxiety or depression and medications when appropriate.

For long-term care they recommended regular follow-up using simple tools such as fatigue severity scales or activity logs, and referral to specialists if symptoms are severe or cognitive or mood problems worsen. Both clinicians emphasised multidisciplinary support as the usual route to improving daily function for people with CFS.

Photo credit: media.newindianexpress.com

Tags: Chronic fatigue syndrome, myalgic encephalomyelitis, post-exertional malaise, autonomic dysfunction, pacing

Topics: Stress, focus & mental clarity, Neuroscience & neuroplasticity, Sleep technology