Myalgic Encephalitis / Chronic Fatigue Syndrome are now more widely recognized due to the similarities to Long Covid and because of the sheer number of people being affected. Conventional medicine, however, does not currently have the capacity or approach to be able to deal with it, which is why so many people are told it is a mental health rather than a physical health problem. In functional medicine, we do not accept this overly-simplistic view because while there are certainly mental health aspects to it (as there is with any long term or chronic illness) there are most definitely physical and neurological anomalies. Western medicine has a reductionist view of the body rather than wholistic, but CFS is a ‘whole body’ condition which is why I believe treatment options are so very limited according to their approach.
The reason it is so incredibly important to address chronic fatigue syndrome right away is that if we look historically at what happened following the Spanish Flu pandemic of 1918, there was an exceptionally steep rise in the number of patients suffering from a condition called Encephalitis Lethargica (EL), which bears an uncanny resemblance to Long Covid and chronic fatigue syndrome.
What is Encaphalitis Lethargica?
Encephalitis lethargica is a neurological disorder that first came to the fore in the winter of 1916-17 when it originated in Europe then spread across the world. It is believed that around 1 million people globally were affected, although not all cases were reported and because it was not a recognized illness there were differences in reporting. Around 30% of victims died, 30% survived without further symptoms but the final 30% or so were left ‘akinetic’ or motionless and with serious neurological sequalae akin to Parkinsons disease.
There is no known cause of encephalitis lethargica but the two main hypotheses are that is is a) related to environmental toxins and/or b) that it is related to the influenzas virus. A more recent third theory is that it could be an autoimmune disease. All of these explain the wide range of symptoms experienced by patients meaning that it could be a cluster of conditions rather than one entity, but because the disease has not recurred for 100 years, there is no opportunity to conduct further research.
Symptoms of Encephalitis Lethargica vs Chronic Fatigue
EL is divided into an acute phase and a chronic phase. The acute phase begins with non-descript flu-like symptoms such as low-grade fever, pharyngitis, shivering, headache, vertigo, and vomiting. Because of the range of following symptoms, it was broken down into 3 categories of patient. The first were dazed, confused and often had double-vision or strange eye movements. The second group went through manic phases of jerky movements and vocali
zations, followed by phases of restlessness, extreme fatigue and weakness that persisted for days. The final group were rigid, immobile, lacking emotion or facial expression yet could be moved around easily by a doctor exerting minimal pressure. It was also evident that this final group were completely mentally aware of their surroundings but were not engaging with it on either a physical or an emotional level.
The chronic phase could come about very rapidly and comprise of any neurological disturbances, but particularly excessive sleepiness, being dazed and confused, abnormal eye movements, double vision, high fever and general difficulties with movement. Most notably, shifts in symptoms would cause hourly or daily changes in the presentation of symptoms.
The acute phase often blended into the chronic phase months or even years later and typically involved Parkinsons-like symptoms including tremors, delayed physical and mental response and even behavioural changes including psychosis
People with chronic fatigue syndrome or long covid experience many of the same neurological symptoms and are met with the same amount of bewilderment by the medical establishment. There are very noticeable differences, of course, but the striking similarity in both aetiology and pathology make it hard to ignore the parallels.
Treatment for chronic fatigue and encephalitis lethargica.
There have been very, very few instances of EL over the last 100 years, but when it does arise conventional treatment is based on tackling symptoms and typically anti-Parkinsons drugs are used due to the high incidence of post-encephalitic Parkinsons disease.
During the Encephalitis Lethargica pandemic (officially 1917 – 1928, but continued well into the 1930s) although some people were immediately symptomatic, many others did not display symptoms for 1-5 years later and some even ten years later.
100 years ago it was noted that instances were worse in cities and built up areas, which has also been seen during the 2020 SARS CoV-2 pandemic. 100 years ago, likely causes were environmental toxins, which are far worse now, or an influenza-type virus, which is what SARS CoV-2 is. We already have a huge wave of ‘long covid’ patients suffering from excruciating debility echoing many of the symptoms noted in Encephalitis Lethergica patients. Whilst I am not aware of any parallels being drawn officially and I am writing purely based on my own clinical observations, I think it is too important an issue to ignore.
I think there is every reason to treat Long Covid, ME, Chronic Fatigue Syndrome as a potentially serious condition that could cause far more long term problems than the horrifying acute phase of the SARS CoV-2 virus that we have seen over the last two years. We have a society whose immune systems are weakened by poor diet, environmental pollutants and chronic stress. This pandemic must be our wake-up call to tackle chronic health problems in a very different way to what conventional medicine has offered for the last 100 years. It is truly time for Functional Medicine and Lifestyle Medicine to come to the fore.