Patients are often referred to a psychiatrist, and this is the biggest misconception, because it was considered that we do not have an organic basis, but that there is a psychological problem. In this way, the patients' condition generally worsened. Everything often ended with resignations, divorces and disruptions in social relations - says prof. Dr. Branislav Milovanović
Chronic fatigue syndrome (
Chronic Fatigue Syndrome ) or myalgic encephalomyelitis (Myalgic Encephalomyelitis) is manifested by severe exhaustion, and in the most severe forms of the disease, patients are bedridden . This is a disease that occurs in young people, because of it marriages fall apart, they lose their jobs. Chronic fatigue syndrome under code R-53.8 is recognized as a disease by the World Health Organization.
Chronic fatigue syndrome is a devastating and multisystemic disease
The condition is often misdiagnosed, so patients are sometimes treated incorrectly or take therapy on their own for many years.
- Chronic fatigue syndrome is manifested by muscle pain, cognitive disorders. According to the opinion of most scientists, this is a disease that is on the same level as cancer or HIV infection, and in more severe stages, it is more serious. This is a devastating and multisystemic disease for which there was not enough understanding until now - says Prof. Dr. Branislav Milovanović , one of 23 experts at the level of the European Union who deals with the treatment of chronic fatigue syndrome.
How does the disease arise and how is it diagnosed?
Prof. Dr. Milovanović was the first in our country to start dealing with neurocardiology, he introduced a number of diagnostic methods, he is a member of the European Academy of Sciences and Arts, and he has been dealing with chronic fatigue syndrome for more than 20 years.
- It has been noticed that the disease occurs after some infection, when the patient does not recover after 15 or 20 days. Diagnostics does not find anything that could indicate the existence of a disease, because the main problem is at the level of the cells, at the level of the mitochondria organelles that produce energy. If we did a skin or muscle biopsy, we would detect the disease, but you can't biopsy everyone. The only way to prove this disease is to test the autonomic nervous system - says Prof. Milovanović.
Serious damage
The problem, however, is that there are few autonomic nervous system testing laboratories in the region. Laboratories exist in KBC "Bežanijska kosa", Klinik "Rebro" in Zagreb and KC Ljubljana and in Banja Luka. Prof. Dr. Milovanović explains that experts can test the autonomic nervous system and find serious damage.
- You find, for example, a complete disorder of blood pressure regulation. Accompanying symptoms are
pain in the muscles and joints , in 80 percent of cases there are problems with the gastrointestinal tract. Neurological outbursts, muscle spasms, tingling sensations, weakness in the arms and legs, tremors, usually trembling of the fingers are possible - says Dr. Milovanović.
Three basic symptoms
Over time, patients notice that they lack strength. The state of chronic fatigue disrupts everyday life. There is, however, a certain number of symptoms, symptomatology and conditions that must be met in order to establish a diagnosis.
- The first is fatigue that lasts longer than 6 months. Then a drop in energy during some physical effort, the third very important symptom is a sleep disorder. At the beginning of the infection, there is great drowsiness, and later there is a sleep disorder, so patients wake up during the night and cannot sleep - explains prof. Dr. Branislav Milovanović.
There are also side symptoms in the form of cognitive disorders, most often problems with memory, concentration, difficult speech. Disturbances in the function of the autonomic nervous system are also manifested in the form of loss of consciousness, some patients feel dizzy when standing up.
Heart palpitations , ringing in the ears, dizziness also occur .
The dead end of chronic fatigue syndrome
In almost 80 percent of patients, anxiety, phobia, and depression are also registered, and that is what, as pointed out by Prof. Dr. Branko Milovanović is actually a dead end.
- These are psychological disorders that some patients had earlier, and in some they appeared with the onset of this disease. Since diagnostics do not find anything, patients are then often referred to a psychiatrist, and this is the biggest misconception, because it was thought that we do not have an organic basis, but that there is a psychological problem. In this way, for the most part, the condition of the patients worsened, often ending in resignations, divorces and disruptions in social relations - says Dr. Milovanović.
Alarming data
Prof. Dr. Milovanović states that the problem is also in the education of doctors, who mostly could not learn about this disease during their basic studies. Dr. Milovanović says that, nevertheless, progress is being noticed and that there are young experts who want to devote themselves to the treatment of this disease. At prof. A student from Slovenia graduated from Milovanović on the topic of chronic fatigue syndrome, and the professor is the author of the chapter on chronic fatigue syndrome in the textbook from which students from Osijek will gain knowledge. When it comes to chronic fatigue syndrome, Dr. Milovanović says that all this is necessary, because the epidemiological data are alarming and very worrying.
- In the United States of America, about 2 million citizens already have this diagnosis, but it is considered to be only the tip of the iceberg. In Europe, 2 million people have this disease, and the seriousness of the problem is evidenced by the fact that the European Parliament passed a resolution to urgently establish funds, educate doctors and take action - warns prof. Dr. Branislav Milovanović.
A few weeks ago, a European Union round table was organized for the countries of the Balkans. A working group was formed at the meeting attended by the Assistant Minister of Health Dr. Jelena Janković on behalf of the Ministry of Health of the Republic of Serbia.
Post-covid syndrome that turns into chronic fatigue syndrome
The European EMEA network of patients and doctors believes that in Serbia, about 30,000 people have chronic fatigue syndrome, which was presented at the round table of the Balkan patient associations a few weeks ago.
- The post-covid syndrome that is now appearing and turning into chronic fatigue syndrome is worrying. Based on European data, 10 to 30 percent of patients who have post-covid syndrome enter chronic fatigue syndrome. Then the question arises, is it the same disease? For the autonomic nervous system it is the same, we did not find any differences. But, if 10 to 30 percent of post-covid patients enter chronic fatigue syndrome, that means you get a minimum of 30,000 more new patients. These are serious numbers and our clinics are flooded with
patients who have passed covid 19 - says Prof. Dr. Branislav Milovanović.
The doctor explains that among post-covid patients, there are those with a diagnosis of complications of an acute infection.
- These are patients who have had a heart attack, stroke, thrombosis, have pulmonary fibrosis. When you perform diagnostics, you see the presence of inflammation of the heart muscle, arrhythmia. With the largest number of post-covid patients, however, you do not find anything and that is the group that is the largest, and those are the patients who enter chronic fatigue syndrome - emphasizes prof. Milovanović.
Dormant viruses and stress
Viruses are one of the main causes of this disease, it is assumed that
Epstein - at least a virus is the cause of this disease. Prof. Milovanović, however, based on his decades of experience, believes that herpes viruses are behind everything. As he explains, these are mostly dormant viruses, the appearance of which provokes some stress, which is also a trigger for the appearance of the disease.
- Science has not yet determined exactly why the disease develops in some people and not in others. There are patients who have congenital mitochondrial damage, which is inherited from the mother, so the disease usually develops during puberty in female children. This disorder of cells at the level of mitochondria is congenital, and there is also an acquired disorder where the peak occurs after puberty or after the age of 30 - explains prof. Dr. Milovanović.
Who are the most difficult patients?
Due to chronic fatigue syndrome, young people become disabled. Prof. Dr. Branislav Milovanović says that there are four stages of the disease.
- In the fourth degree, a person is bedridden, literally unable to get up, young people are unable to take a shower for six months, these are the most difficult patients. The third degree is when the patient is unable to work and has to leave work. There are also two milder forms when the functionality is disturbed - emphasized Dr. Milovanović.
Why is it important to detect the disease as soon as possible and start treatment?
European countries are conducting numerous studies on the topic of chronic fatigue syndrome. In Norway, patients diagnosed with this disease are allowed reduced working hours. When it comes to healing, Doctor Milovanović says that the data are, unfortunately, disappointing.
- Only 5 to 10 percent of patients are cured, and these are mostly younger people who are treated immediately. If the patient has had the disease for 5 or 10 years, then the cure is very difficult. About 64 percent of patients can return to a functional state, but feel discomfort. It is important, however, to fight so that the disease does not develop further. According to my experience, depending on how long the disease lasts, it takes a minimum of three months to two years to return to a functional state - says Prof. Milovanović.
Multidisciplinary treatment
The treatment is multidisciplinary, it is necessary to know how much physical effort the patient can be exposed to, in order to preserve his capacities. Prof. Milovanović says that the degree of damage to the autonomic nervous system is first tested.
- After testing, I have to see in which direction I can go. It is necessary to determine which infection is behind the disease. The patient has a
mineral and vitamin deficiency , so supplementation must be applied . Depending on the degree of the disease, antiviral and antibacterial therapy is sometimes used. If necessary, antibiotics are given. Amino acids, peptides, antioxidants are sometimes used, but the main treatment is mitochondria, coenzyme Q 10 is one of the main drugs used to improve energy production in mitochondria - says prof. Dr. Branislav Milovanović.
Prof. Dr. Branislav Milovanović was the first to introduce the new scientific discipline of neurocardiology in the Republic of Serbia, for which reason he became a member of the European Academy of Sciences and Arts at the suggestion of President Felix Unger. An international congress on neurocardiology is held in Serbia every year, and prof. In 2019, Milovanović also organized the World Congress on Non-Invasive Cardiology, making Serbia one of the leading centers in the world for this issue. Dr. Milovanović is the founder and first president of the Section for the Autonomic Nervous System of the
Serbian Medical Society . Since May 2005, the section has been a member of the European Federation for the Autonomic Nervous System as the first national association outside the European Union.
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