Treatment

The various symptoms of CFS can be treated with different medications. However, none of these symptomatic treatments are usually curative.

Antidepressants, sleeping medications, anti-inflammatory drugs, analgesics (pain medications), stimulants (amphetamine class or others), muscle relaxants, GABA inhibitors, NADH, DHEA, colloidal silver, Guaifenesin, Coenzyme Q10, Noni juice, high dose vitamins and herbs are commonly taken by patients but the benefits can be variable.

Biofeedback and cognitive conditioning may be helpful. Physical therapy may help intense muscle pain and debility. Rest is important. Graded exercise can be tried, as tolerated, but the results are not as promising as reported by the British investigators.

A good balanced diet is recommended but drastic changes are not necessary. It is possible to have the onset of celiac sprue (sensitivity to gluten in grains, bread etc) after the viral infection.

Although the effect is transient, intravenous immunoglobulin (purified, concentrated antibody preparation from pooled donor blood) may alleviate severe myalgia and fatigue in about 30% of the ME/CFS patients. The preparation is extremely expensive (thousands of dollars per infusion) but safe since 1994. The optimal dosing of this drug has not been clearly defined.

Low-dose cortisone may be helpful according to a small study but this is yet to be confirmed. High-dose cortisone should be avoided. Patients are often worse after cortisone given for other reasons (asthma, surgery, etc.).

Specific treatment for infections should be potentially effective but not necessarily curative, if the offending pathogen can be found. Antibiotics active against C. pneumoniae can produce dramatic results in appropriate patients. The safety of prolonged antibiotic suppression therapy of this type of infection is unclear. However, repeated exposure to certain antibiotics could increase the breast cancer rate according to one unconfirmed study.

Specific antiviral drug may be beneficial in patients with chronic reactivation of chickenpox virus or other herpes viruses. Initial controlled trial of intravenous acyclovir in 1988 did not show a difference in response of the antiviral-treated and the placebo-treated groups. Other reports of using Valtrex (the oral equivalent of intravenous acyclovir) have shown only mild benefit in some patients. The preliminary results of a controlled trial of Valcyte, a drug active against CMV and HHV-6, showed mildly improved cognitive function but no improvement of physical symptoms, as compared to placebo-treated patients (presented at the International HHV-6 conference, Baltimore, June 2008).

Currently, there is no FDA-approved antiviral drug against enteroviruses. We will continue to attract the interest of Pharmaceutical Companies to begin the development process.