ABSTRACT
Almost all chronic fatigue syndrome treatment is in an experimental stage, and some physicians are reluctant to engage in treatment protocols that have not had rigorous experimental trials. CFS patients are difficult to manage, since they present long lists of symptoms, extensive histories, and may require extended follow-up. Various other problems include limit-setting for therapy, insurance difficulties, and applying treatments which are based on anecdotal clinical success shared through professional networking. When viewing CFS as a multicausal limbic encephalopathy in a dysregulated neuroimmune network, the physician can apply a number of therapeutic interventions: anti-infective, immunomodulatory, neuroendocrine, neuropharmacologic, neurobehavioral, symp-tom-oriented, and “other.” Several viruses have been detected by the Polymerase Chain Reaction (PCR): CMV, Epstein-Barr, and HHV-6 have all been detected in CFS patients in this manner. Therapeutic interventions used for subsets of CFS include antibiotics, anti-virais, immunomodulatory agents, interferon, H-2 blockers, intravenous immunoglobulin (IVIG), kutapressin, oral alpha interferon, NSAIDS, and many psychotropic medications. The latter include benzodiazepines, tricyclic antidepressants, monoamine oxidase inhibitors, and fluoxetine. The recent discovery of nitric oxide as a neurotransmitter, as well as a vasodilator, has broken new treatment ground in CFS, and using nitroglycerin as a source of nitric oxide produced symptom relief when other medications have failed. In addition, a large number of patients have already tried alternative medications with the cooperation of their contacts in the AIDS underground.
