@Hip @Valentijn this is my question. I'm looking at the clinical criteria as the basis of closing in on a diagnosis. Then, I look at the various other manifestations that come in to play due to comorbidities, genetics, lifestyle, etc, If the main criteria isn't met, do we miss the forest for looking at trees?
CLINICAL WORKING CASE DEFINITION OF ME/CFS
A patient with ME/CFS will meet the criteria for fatigue, post-exertional malaise and/or fatigue, sleep dysfunction, and pain; have two or more neurological/cognitive manifestations and one or more symptoms from two of the categories of autonomic, neuroendocrine, and immune manifestations; and adhere to item 7.
__ 1. Fatigue: The patient must have a significant degree of new onset, unexplained, persistent, or recurrent physical and mental fatigue that substantially reduces activity level.
__ 2. Post-Exertional Malaise and/or Fatigue: There is an inappropriate loss of physical and mental stamina, rapid muscular and cognitive fatigability, post exertional malaise and/or fatigue and/or pain and a tendency for other associated symptoms within the patient’s cluster of symptoms to worsen. There is a pathologically slow recovery period - usually 24 hours or longer.
__ 3. Sleep Dysfunction:* There is unrefreshed sleep or sleep quantity or rhythm disturbances such as reversed or chaotic diurnal sleep rhythms.
__ 4. Pain:* There is a significant degree of myalgia. Pain can be experienced in the muscles, and/or joints, and is often widespread and migratory in nature. Often there are significant headaches of new type, pattern or severity.
__ 5. Neurological/Cognitive Manifestations: Two or more of the following difficulties should be present: confusion, impairment of concentration and short-term memory consolidation, disorientation, difficulty with information processing, categorizing and word retrieval, and perceptual and sensory disturbances – e.g. spatial instability and disorientation and inability to focus vision. Ataxia, muscle weakness and fasciculations are common. There may be overload1 phenomena: cognitive, sensory – e.g. photophobia and hypersensitivity to noise - and/or emotional overload, which may lead to “crash”2 periods and/or anxiety.
__ 6. At Least One Symptom from Two of the Following Categories:
__ a. Autonomic Manifestations: orthostatic intolerance - neurally mediated hypotension (NMH), postural orthostatic tachycardia syndrome (POTS), delayed postural hypotension; light-headedness; extreme pallor; nausea and irritable bowel syndrome; urinary frequency and bladder dysfunction; palpitations with or without cardiac arrhythmias; exertional
dyspnea.__ b. Neuroendocrine Manifestations: loss of thermostatic stability – subnormal body
temperature and marked diurnal fluctuation, sweating episodes, recurrent feelings of feverishness and cold extremities; intolerance of extremes of heat and cold; marked weight change - anorexia or abnormal appetite; loss of adaptability and worsening of symptoms with stress.
__ c. Immune Manifestations: tender lymph nodes, recurrent sore throat, recurrent flu- like symptoms, general malaise, new sensitivities to food, medications and/or chemicals.
__ 7. The illness persists for at least six months: It usually has a distinct onset, **although it may be gradual. Preliminary diagnosis may be possible earlier. Three months is appropriate for children.
Also, there may be some secondary and event-related anxiety due to the overwhelming symptoms but this tends to abate and does not fit a clinical diagnosis of GAD.
I also, was under the impression that although not 100% consistent, NK cell function was most often low. Nowhere in the CCC does it say NK cell function is normal as a factual consistent finding for persons with ME/CFS.
Neither is there mention of visual deterioration.
[Other symptoms: Visual accommodation and focusing difficulties, blurred or double vision and dry eyes are common. Tinnitus may occur. ] Or, chronic upper respiratory tract infections and nasal congestion. I was under the impression a person feels flu-like but there was very little objective medical evidence. If I had obvious infections, I think docs would be thrilled to drown me in antibiotics.
Just my thoughts.