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About 12 years ago, I was asked to do a domicillary visit to see a 10 year old girl who in the spring had taken her secondary school entrance examination; caught a heavy cold with a persistent sore throat, which was taking a long time to clear; had a perpetual headache; dizziness on standing; extreme tiredness, which became worse if she tried to do anything; paraesthesia of the hands and feet intermittently; and disturbed sleep. Her general practitioner suggested postural hypotension, but I could find little abnormal except for some unsteadiness when she tried to walk. Routine haematological and biochemical tests were normal, as was computed tomography of her head. The physiotherapist that I referred her to reported that their attempts to mobilise her were actually making her worse, and wondered if she had a neuromuscular disease.
Diagnosis
This illness, which I did not then recognise, has since been described in various publications,1-3 but the best summary was issued in 1996 by the US National Institute of Allergy and Infectious Diseases,4 using the International Centre for Disease Control criteria published by Fukuda et al, which gives a clear research definition.5 In children, the symptoms change little after three months, and I accept symptoms stable at three months as the time to apply these criteria as a working definition. Although there is a common pattern of symptoms in all age groups, there may be several subgroupings of the illness with either a predominant pattern of muscular pain and physical weakness for which treatment using cognitive behavioural therapy (CBT) may be less appropriate, or predominantly neurocognitive symptoms for which CBT may be helpful, but an early return to school inappropriate. Bell describes common complaints in children and adolescents of fatigue, headaches, sleep disturbance, and cognitive disturbance6; anorexia is …