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Fortschr Neurol Psychiatr 2017; 85(02): 79-85
DOI: 10.1055/s-0042-121259
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Das chronische Müdigkeitssyndrom – ein kritischer Diskurs

Chronic Fatigue Syndrome: A Critical Review
Jens D. Rollnik
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Publication History

Publication Date:
24 February 2017 (online)

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Zusammenfassung

Das Chronic Fatigue Syndrome (CFS), auch als Myalgische Enzephalomyelitis (ME) bezeichnet, stellt Ärzte vor erhebliche Herausforderungen. Die Prävalenz des CFS kann mit unter 1 % angegeben werden. Überzeugende Modelle zur Ätiologie und Pathogenese einer eigenständigen CFS-Erkrankung liegen nicht vor. Zur Diagnose stehen keine einheitlichen diagnostischen Kriterien zur Verfügung. Differenzialdiagnostisch kann eine Chronische-Fatigue-Symptomatik durch eine Vielzahl somatischer (z. B. schwere, chronische Infektionskrankheiten, Enzephalomyelitis disseminata, endokrinologische Störungen) und psychiatrischer bzw. psychosomatischer Erkrankungen ausgelöst werden. Sind somatische Ursachen ausgeschlossen, gibt es große Überlappungen mit der Major Depression und somatoformen Störungen. In der Behandlung haben Bewegungstherapie, Antidepressiva und Psychotherapie ihren Stellenwert. Bis zu einem überzeugenden Beleg für eine neuroinflammatorische Genese sollte auf aggressive Immuntherapien, z. B. mit Rituximab, verzichtet werden. In der Summe gibt es bisher keine belastbare Evidenz für die Existenz des CFS als eigenständiges Krankheitsbild.

Abstract

Chronic fatigue syndrome (CFS), also called myalgic encephalomyelitis (ME), is a challenge to physicians. CFS prevalence is below 1 % in a general population. There are no convincing models that might explain etiology and pathogenesis of CFS as an independent, unique disease. No consistent diagnostic criteria are available. In the differential diagnosis of chronic fatigue, a variety of somatic (e. g. chronic infectious diseases, multiple sclerosis, endocrinological disorders) and psychiatric/psychosomatic diseases should be considered. After exclusion of somatic causes, there is a significant overlap with major depression and somatoform disorders. Exercise therapy, antidepressants and psychotherapy are useful treatment options. Unless there is enough evidence for neuroinflammation, aggressive immunotherapies like rituximab should not be considered. In sum, there is not enough evidence to assume that CFS is an independent, unique disease.

Schlüsselwörter

Chronic Fatigue Syndrome - CFS - Myalgische Enzephalomyelitis - ME - Ätiologie - Differenzialdiagnostik - Therapie

Key words

chronic fatigue syndrome - CFS - myalgic encephalomyelitis - ME - etiology - differential diagnosis - therapy
 

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