George
waitin' fer rabbits
- Messages
- 853
- Location
- South Texas
This case definition was put together in 2003 by the following Doctors and Clinicians
Bruce M. Carruthers, MD, CM, FRCP(C)
Anil Kumar Jain, BSc, MD
Kenny L. De Meirleir, MD, PhD
Daniel L. Peterson, MD
Nancy G. Klimas, MD
A. Martin Lerner, MD, PC, MACP
Alison C. Bested, MD, FRCP(C)
Pierre Flor-Henry, MB, ChB, MD, Acad DPM, FRC, CSPQ
Pradip Joshi, BM, MD, FRCP(C)
A. C. Peter Powles, MRACP, FRACP, FRCP(C), ABSM
Jeffrey A. Sherkey, MD, CCFP(C)
Marjorie I. van de Sande, BEd, Grad Dip Ed
An allstar cast to say the least. This esteemed group has been trying to get the CCC for CFS/ME established for years now. They are up against the CDC. (roll eyes) Maybe we can help them by starting a writing campaign that points out that the WPI used the CCC in their science study. Other studies have not used this criteria and have not found XMRV in CFS/ME patients. The leak (rumor mill) says that both the Dr. Alter (NIH) paper and Dr. Lo (FDA) paper used this criteria. Who know's but now's as good a time as any to get a criteria established.
A patient with ME/CFS will meet the criteria for fatigue, post-exertionalmalaise 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,
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 andhypersensitivity to oise …and/or emotional overload, which maylead to 1)crash 2) periods and/or anxiety. (Carruthers et al. (11)
6. At Least One Symptom from Two of the Following Categories:
a. Autonomic Manifestations: orthostatic intolerance…neurally mediated
hypotenstion (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.
To be included, the symptoms must have begun or have been significantly
altered after the onset of this illness.
It is unlikely that a patient will suffer from all symptoms in criteria 5 and 6. The disturbances tend
to form symptom clusters that may fluctuate and change over time. Children often have numerous prominent symptoms but their order of severity tends to vary from day to day.
*There is a small number of patients who have no pain or sleep dysfunction, but no other diagnosis fits except ME/CFS. A diagnosis of ME/CFS can be entertained when this group has an infectious illness type onset.
**Some patients have been unhealthy for other reasons prior to the onset of ME/CFS and lack detectable triggers at onset and/or have more gradual or insidious onset.
Exclusions: Exclude active disease processes that explain most of the
major symptoms of fatigue, sleep disturbance, pain, and cognitive
dysfunction. It is essential to exclude certain diseases, which would be
tragic to miss: Addison's disease, Cushing's Syndrome, hypothyroidism,
hyperthyroidism, iron deficiency, other treatable forms of anemia,
iron overload syndrome, diabetes mellitus, and cancer. It is also
essential to exclude treatable sleep disorders such as upper airway resistance
syndrome and obstructive or central sleep apnea; rheumatological
disorders such as rheumatoid arthritis, lupus, polymyositis
and polymyalgia rheumatica; immune disorders such as AIDS; neurological
disorders such as multiple sclerosis (MS), Parkinsonism,
myasthenia gravis and B12 deficiency; infectious diseases such as tuberculosis,
chronic hepatitis, Lyme disease, etc.; primary psychiatric
disorders and substance abuse. Exclusion of other diagnoses, which
cannot be reasonably excluded by the patient's history and physical
examination, is achieved by laboratory testing and imaging. If a
potentially confounding medical condition is under control, then the
diagnosis of ME/CFS can be entertained if patients meet the criteria
otherwise.
Co-Morbid Entities: Fibromyalgia Syndrome (FMS), Myofascial Pain
Syndrome (MPS), Temporomandibular Joint Syndrome (TMJ), Irritable
Bowel Syndrome (IBS), Interstitial Cystitis, Irritable Bladder
Syndrome, Raynaud's Phenomenon, Prolapsed Mitral Valve, Depression,
Migraine, Allergies, Multiple Chemical Sensitivities (MCS),
Hashimoto's thyroiditis, Sicca Syndrome, etc.
Such co-morbid entities may occur in the setting of ME/CFS. Others such as IBS may precede
the development of ME/CFS by many years, but then become
associated with it. The same holds true for migraines and depression.
Their association is thus looser than between the symptoms within the
syndrome. ME/CFS and FMS often closely connect and should be
considered to be overlap syndromes.
Idiopathic Chronic Fatigue: If the patient has unexplained prolonged
fatigue (6 months or more) but has insufficient symptoms to meet the
criteria for ME/CFS, it should be classified as idiopathic chronic fatigue.
General Considerations in Applying the Clinical Case Definition
to the Individual Patient
1. Assess Patient's Total Illness: The diagnosis of ME/CFS is not arrived
at by simply fitting a patient to a template but rather by observing
and obtaining a complete description of their symptoms and
interactions, as well as the total illness burden of the patient.
2. Variability and Coherence of Symptoms: Patients are expected to exhibit
symptoms from within the symptom group as indicated, however
a given patient will suffer from a cluster of symptoms often
unique to him/her. The widely distributed symptoms are connected
as a coherent entity through the temporal and causal relationships revealed
in the history. If this coherence of symptoms is absent, the diagnosis
is in doubt. (Carruthers et al. (13)
Bruce M. Carruthers, MD, CM, FRCP(C)
Anil Kumar Jain, BSc, MD
Kenny L. De Meirleir, MD, PhD
Daniel L. Peterson, MD
Nancy G. Klimas, MD
A. Martin Lerner, MD, PC, MACP
Alison C. Bested, MD, FRCP(C)
Pierre Flor-Henry, MB, ChB, MD, Acad DPM, FRC, CSPQ
Pradip Joshi, BM, MD, FRCP(C)
A. C. Peter Powles, MRACP, FRACP, FRCP(C), ABSM
Jeffrey A. Sherkey, MD, CCFP(C)
Marjorie I. van de Sande, BEd, Grad Dip Ed
An allstar cast to say the least. This esteemed group has been trying to get the CCC for CFS/ME established for years now. They are up against the CDC. (roll eyes) Maybe we can help them by starting a writing campaign that points out that the WPI used the CCC in their science study. Other studies have not used this criteria and have not found XMRV in CFS/ME patients. The leak (rumor mill) says that both the Dr. Alter (NIH) paper and Dr. Lo (FDA) paper used this criteria. Who know's but now's as good a time as any to get a criteria established.
A patient with ME/CFS will meet the criteria for fatigue, post-exertionalmalaise 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,
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 andhypersensitivity to oise …and/or emotional overload, which maylead to 1)crash 2) periods and/or anxiety. (Carruthers et al. (11)
6. At Least One Symptom from Two of the Following Categories:
a. Autonomic Manifestations: orthostatic intolerance…neurally mediated
hypotenstion (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.
To be included, the symptoms must have begun or have been significantly
altered after the onset of this illness.
It is unlikely that a patient will suffer from all symptoms in criteria 5 and 6. The disturbances tend
to form symptom clusters that may fluctuate and change over time. Children often have numerous prominent symptoms but their order of severity tends to vary from day to day.
*There is a small number of patients who have no pain or sleep dysfunction, but no other diagnosis fits except ME/CFS. A diagnosis of ME/CFS can be entertained when this group has an infectious illness type onset.
**Some patients have been unhealthy for other reasons prior to the onset of ME/CFS and lack detectable triggers at onset and/or have more gradual or insidious onset.
Exclusions: Exclude active disease processes that explain most of the
major symptoms of fatigue, sleep disturbance, pain, and cognitive
dysfunction. It is essential to exclude certain diseases, which would be
tragic to miss: Addison's disease, Cushing's Syndrome, hypothyroidism,
hyperthyroidism, iron deficiency, other treatable forms of anemia,
iron overload syndrome, diabetes mellitus, and cancer. It is also
essential to exclude treatable sleep disorders such as upper airway resistance
syndrome and obstructive or central sleep apnea; rheumatological
disorders such as rheumatoid arthritis, lupus, polymyositis
and polymyalgia rheumatica; immune disorders such as AIDS; neurological
disorders such as multiple sclerosis (MS), Parkinsonism,
myasthenia gravis and B12 deficiency; infectious diseases such as tuberculosis,
chronic hepatitis, Lyme disease, etc.; primary psychiatric
disorders and substance abuse. Exclusion of other diagnoses, which
cannot be reasonably excluded by the patient's history and physical
examination, is achieved by laboratory testing and imaging. If a
potentially confounding medical condition is under control, then the
diagnosis of ME/CFS can be entertained if patients meet the criteria
otherwise.
Co-Morbid Entities: Fibromyalgia Syndrome (FMS), Myofascial Pain
Syndrome (MPS), Temporomandibular Joint Syndrome (TMJ), Irritable
Bowel Syndrome (IBS), Interstitial Cystitis, Irritable Bladder
Syndrome, Raynaud's Phenomenon, Prolapsed Mitral Valve, Depression,
Migraine, Allergies, Multiple Chemical Sensitivities (MCS),
Hashimoto's thyroiditis, Sicca Syndrome, etc.
Such co-morbid entities may occur in the setting of ME/CFS. Others such as IBS may precede
the development of ME/CFS by many years, but then become
associated with it. The same holds true for migraines and depression.
Their association is thus looser than between the symptoms within the
syndrome. ME/CFS and FMS often closely connect and should be
considered to be overlap syndromes.
Idiopathic Chronic Fatigue: If the patient has unexplained prolonged
fatigue (6 months or more) but has insufficient symptoms to meet the
criteria for ME/CFS, it should be classified as idiopathic chronic fatigue.
General Considerations in Applying the Clinical Case Definition
to the Individual Patient
1. Assess Patient's Total Illness: The diagnosis of ME/CFS is not arrived
at by simply fitting a patient to a template but rather by observing
and obtaining a complete description of their symptoms and
interactions, as well as the total illness burden of the patient.
2. Variability and Coherence of Symptoms: Patients are expected to exhibit
symptoms from within the symptom group as indicated, however
a given patient will suffer from a cluster of symptoms often
unique to him/her. The widely distributed symptoms are connected
as a coherent entity through the temporal and causal relationships revealed
in the history. If this coherence of symptoms is absent, the diagnosis
is in doubt. (Carruthers et al. (13)
