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London Criteria for ME/CFS (1990) (Dowsett, Goudsmit, Macintyre & Shepherd)

Dolphin

Senior Member
Messages
17,567
Just in case that website ever goes down, I'm going to point the info here:

London Criteria - Version one

THE ‘LONDON’ CRITERIA – DIAGNOSTIC CRITERIA FOR THE SELECTION OF SUBJECTS FOR RESEARCH INTO M.E./PVFS

adopted by M.E. Action (now Action For M.E..)

Major Criteria

These five major criteria must all be present for a diagnosis of M.E./PVFS to be made. The presence of minor criteria listed below lends further support to the diagnosis but if they occur in the absence of the major criteria then the volunteer research subject should not be used for the purpose of research into M.E./PVFS and an alternative diagnosis should be keenly sought.

    1. An identifiable viral illness immediately preceding the development of M.E./PVFS. This usually presents with upper respiratory symptoms and is usually attributed to ‘flu or glandular fever. Other prodromal (and/or concurrent) illnesses which have been reported are: gastro-intestinal infections, meningitis, myocarditis, thyroiditis, labyrinthitis, Bornholm’s disease, hand, foot & mouth disease.
    2. Exercise-induced fatigue precipitated by trivially small exertion – physical or mental – relative to the patient’s previous exercise tolerance. Pain and coarse fasciculations in exercised muscles is common. These symptoms may sometimes be immediate or delayed for a few hours and may persist for several days.
    3. Thus a previously accomplished athlete may liken the after-effects of climbing a single flight of stairs to those of running a marathon or a previously able-bodied housewife may find a normal day’s housework beyond her physical capacity.
    4. Impairment of short-term memory and loss of powers of concentration, usually coupled with other neurological and psychological disturbances such as emotional lability, nominal dysphasia, disturbed sleep patterns, vertigo or tinnitus.
    5. Fluctuation of symptoms, usually precipitated by either physical or mental exercise (see b) above.
These major symptoms should have been present for at least 6 months and should be ongoing.

Minor Criteria
These can be subdivided into the following two categories:

  1. Autonomic: Bouts of inappropriate night or day-time sweating; Raynaud’s phenomenon; postural hypotension; disturbances of bowel motility manifesting as recurrent diarrhoea or occasionally constipation (these symptoms are frequently indistinguishable from those of irritable bowel syndrome); photophobia; blurred vision due to disturbed accommodation; hyperacusis; frequency of micturition; nocturia.
  2. Immunological: Symptoms suggesting persistent viral infection, e.g. episodes of low-grade fever (i.e. not exceeding an oral temperature of 38.6C) combined with feeling feverish (i.e. a down-regulated ‘thermostat’); sore throat which may be persistent or recurrent (i.e. present for at least one week per month); arthralgia of a fixed or migratory nature.
This list is by no means exhaustive: headaches, nausea and bloating, for instance. are common symptoms in many patients but are not sufficiently discriminative because of their widespread occurrence in many other disorders.

The curious intolerance to alcohol and hypersensitivity to drugs are highly specific in this context. It should also be emphasised that the symptoms of ME tend to vary capriciously from hour to hour and day to day. Nevertheless it is absolutely characteristic that they tend to be exacerbated by physical or mental exertion and this association should always be sought whilst taking the history. We recommend the use of M.E. Action’s questionnaire for Research subjects Volunteers.
 

Dolphin

Senior Member
Messages
17,567
London Criteria - Version one

THE ‘LONDON’ CRITERIA – DIAGNOSTIC CRITERIA FOR THE SELECTION OF SUBJECTS FOR RESEARCH INTO M.E./PVFS

adopted by M.E. Action (now Action For M.E..)

[Important Note: The exclusion diagnoses and the physical examination findings omitted in publication have been added by Shoutout About ME.]

Three criteria must be present for a diagnosis of ME/PVFS to be made:

  1. Exercise-induced fatigue precipitated by trivially small exertion -physical or mental – relative to the patient’s previous exercise tolerance.
  2. Impairment of short-term memory and loss of powers of concentration, usually coupled with other neurological and psychological disturbances such as emotional lability (= being upset by things that would not normally cause distress), nominal dysphasia (= difficulty finding the right word), disturbed sleep patterns, dysequilibrium (= imbalance or unsteadiness rather than vertigo/spinning round) or tinnitus (= noises in the ear).
  3. Fluctuation of symptoms, usually precipitated by either physical or mental exercise (see above).
These symptoms should have been present for at least 6 months and should be ongoing.

Although ME/PVFS typically follows an infection, usually a viral illness (which may be subclinical) in a previously fit and active person, it has also been observed to be triggered by other factors such as immunisations, life traumas and exposure to chemicals. Furthermore, in a minority of patients, ME/PVFS has a gradual onset with no apparent triggering factor. For these reasons proof of a preceding viral illness is not a prerequisite for diagnosis.

OTHER SYMPTOMS SOMETIMES EXPERIENCED BY PEOPLE WITH M.E./PVFS
Many symptoms are experienced by people suffering from M.E./PVFS and in the right symptomatic context they contribute to the validity of the diagnosis. Nevertheless, not all people suffering from M.E./PVFS experience all these symptoms and their absence does not exclude the condition.

These can be subdivided into the following two categories:

  • Autonomic:
    • bouts of inappropriate night or day-time sweating;
    • Raynaud’s phenomenon (= cold extremities);
    • postural hypotension (= lowered blood pressure on standing);
    • disturbance of bowel motility manifesting as recurrent diarrhoea or occasionally constipation (these symptoms are frequently indistinguishable from those of irritable bowel syndrome);
    • photophobia (= sensitivity to bright light); vision due to disturbed accommodation;
    • hyperacusis (= sensitivity to loud noise);
    • frequency of micturition (= passing urine more often than normal); nocturia (= passing urine at night).
  • Immunological (Symptoms suggesting persistent viral infection):
    • episodes of low-grade fever (not exceeding an oral temperature of 38.6C) combined with feeling feverish, (i.e. a down-regulated ‘thermostat’);
    • sore throat which may be persistent or recurrent (i.e. present for at least one week per month);
    • arthralgia (fixed or migratory).


This list is by no means exhaustive; headaches, nausea and bloating, for instance, are common symptoms in many patients but are not sufficiently discriminative because of their widespread occurrence in many other disorders. The curious intolerance to alcohol and hypersensitivity to drugs are highly specific in this context. It should also be emphasised that the symptoms of M.E. tend to vary capriciously from hour to hour and day to day. Nevertheless it is absolutely characteristic that they tend to be exacerbated by physical or mental exertion and this association should always be sought whilst taking the history.

PHYSICAL SIGNS
Sometimes evident in people suffering from M.E. / PVFS

Characteristic physical signs are seen in M.E./PVFS and in the right symptomatic context they contribute to the validity of the diagnosis. Nevertheless their absence does not exclude the condition, and they are as follows:

  • Pharyngitis which is either persistent or recurrent (present for at least one week every month) with or without tonsillar enlargement. This is nearly always non-exudative and when present may be accompanied by the low-grade fever mentioned under immunological symptoms.
  • Tender and possible enlargement of lymph nodes, particularly of the cervical groups; these also may accompany the fever and they may decrease in size during the afebrile periods.
  • Muscle tenderness with a particular predilection for the neck and shoulder girdle and the major muscles of locomotion. Points of exquisite tenderness are occasionally found by palpating the affected muscles with the tip of a finger.
  • A positive Romberg test.


A VIRAL TRIGGER?
Although M.E./PVFS typically follows an infection, usually a viral illness (which may be subclinical) in a previously fit and active person, it has also been observed to be triggered by other factors such as immunisations, traumas and exposure to chemicals. Furthermore, in a minority of patients, M.E./PVFS has a gradual onset with: no apparent triggering factor. For these reasons proof of a preceding viral illness is not a prerequisite for diagnosis or inclusion in a study group.

ASSESSMENT, INVESTIGATION AND DIAGNOSlS
When diagnosing M.E. for research purposes, particular attention must be paid to two factors:

  • many of the symptoms and signs evident in people suffering from M.E./PVFS could be due to a large number of other important diseases/conditions.
  • M.E. may run in parallel with other diseases having similar symptoms and signs.


Because it is vital that the M.E. study groups we use in research are as ‘pure’ as possible, the existence of a parallel disease would be grounds for disqualification. The most common alternative diagnoses/parallel. diseases to be borne in mind before referring a research subject volunteer to an M.E. study group can be considered under the following headings:

  • Chronic infections: toxoplasmosis, Lyme disease, HIV infection, chronic active hepatitis, schistosomiasis, brucellosis, occult sepsis, tuberculosis, giardia.
  • Endocrine disorders: hypothyroidism, thyrotoxicosis, Addison’s disease, Cushing’s syndrome, diabetes mellitus, hyperparathyroidism.
  • Neuromuscular disorders: myasthenia gravis, multiple sclerosis, mitochondrial myopathy, Parkinson’s disease.
  • Cardiovascular disorders: cardiac ischaemia.
    Metabolic disorders: sleep apnoea syndrome, chronic renal failure.
  • Malignant disease: occult tumours such as undiagnosed lymphomas, retroperitoneal sarcomas; renal and liver tumours; frontal lobe tumours.
  • Auto-immune disease: rheumatoid arthritis, systemic lupus erythematosus, thyroiditis, Sjogrens syndrome.
  • Haematological disorders: leukaemias and anaemias of varying origin
  • Miscellaneous: heavy metal poisoning, chronic intoxications due to prolonged exposure to chemicals such as petrol, benzene, organo-phosphorous compounds and methylene chloride; drug side effects such as those due to beta-blockers, and long-term benzodiazepine usage; chronic alcoholism; coeliac disease.
  • Psychiatric: primary depressive illness, anxiety neurosis.


Of particular importance is to eliminate chronic fatigue primarily associated with psychological factors. If there are signs of persistent anhedonia, apathy, low self-esteem, feelings of worthlessness and guilt, the possibility: of primary depressive illness should be actively considered and, if there is any doubt whatsoever, the subject eliminated from the research study.

If the subject has had any other diseases or conditions in the last three months they should be excluded from, research into M.E.

If the subject has taken any treatments – orthodox, complementary or nutritional – in the last three months they may have to be excluded from certain research projects.
 

Dolphin

Senior Member
Messages
17,567
London Definition Criteria (Modified Version 1 – used in the PACE Trial)

THE ‘LONDON’ CRITERIA

Criteria 1 to 4 must be present for a diagnosis of ME to be made.

  1. Exercise-induced fatigue precipitated by trivially small exertion (physical or mental) relative to the patient’s/participant’s previous exercise tolerance.
  2. Impairment of short-term memory and loss of powers of concentration,usually coupled with other [neurological and psychological]disturbances such as:
    [NB These should be asked for as symptoms, not tests, and do not have to be total or persistent for the whole period. These symptoms (in a-e) should be recorded but are not necessary, in order to make the diagnosis.]
  1. emotional lability [feeling easily upset by things that would not normally upset the participant, but the upset is brief and has usually gone within a few hours, and certainly by the next day]
  2. nominal dysphasia [difficulty finding the right word]
  3. disturbed sleep patterns [of any sort]
  4. disequilibrium [a feeling of imbalance]
  5. tinnitus [ringing in the ears]
  • Fluctuation of symptoms
    [The usual precipitation by physical or mental exercise, should be recorded, but is not necessary to meet the criteria.]
    – usually precipitated by either physical or mental exercise.
  • These symptoms should have been present for at least 6 months and should be
    ongoing.
  • There is no primary depressive illness present and no anxiety/neurosis.
    [N.B. This means that if any depressive or anxiety disorder are present, the London criteria are not met.]
 

Chrisb

Senior Member
Messages
1,051
But does it say anywhere who funded it? I have for some time been fascinated by the reference on the paper relating to the Oxford criteria as to the source of the funding for that conference and wondered what would constitute normal practice for the funding of such occasions. I know its probably off subject. One can see what the interest might be in shifting attention away from these criteria.
 

Dolphin

Senior Member
Messages
17,567
But does it say anywhere who funded it? I have for some time been fascinated by the reference on the paper relating to the Oxford criteria as to the source of the funding for that conference and wondered what would constitute normal practice for the funding of such occasions. I know its probably off subject. One can see what the interest might be in shifting attention away from these criteria.
Would there necessarily need to be funding for four individuals coming up with criteria.