The Oxford criterea and the world health organisation

[gerwyn morris]

The diagnostic tool used in the Imperial college study was based on the work of Sharpe et al 1991-This established a diagnosis of cfs according to the Oxford criterea.This is clearly referenced in the study for those who haven't read it in any detail and aren't a geek like me!

Patients who fulfill the Oxford criterea are classified in the international classification of disease of the World Health Organisation as ICD10:48.0 as "MENTAL AND BEHAVIOURAL DISORDERS":subtitled "OTHER NEUROTIC DISORDERS"

Therefore according to the WHO the patients in the Imperial College study suffered from mental and behavioural disorders-A definitive view One would not expect to find XMRV in patients of this kind !

 

[DysautonomiaXMRV]

Hi, you raise a good point here.

The Oxford Criteria states there need not be any 'specific symptoms' to qualify for a diagnosis of CFS.
Although the Fukuda Criteria are very weak, they do require at least, 4 symptoms.

Now why is this important regarding the recent 'failed' UK XMRV study?

Recently, I read a response from Dr Anthony Cleare on the PLOS One website
in a reply to crticism of the Imperial College Study. Link

And I found this quite remarkable comment that you may be interested in.

''In addition, we also exclude patients with chronic somatisation disorder as defined by DSM-IV, which is not required by the Fukuda criteria.''

So Dr Cleare is making 'clear' that people with CFS Fukuda criteria diagnosis may not be organically ill when studied for XMRV.
This problem of selecting the wrong people to study, is in stark contrast to the WPI folk, who selected people very much organically ill, which was aided by using
Canadian Criteria CFS that is the most 'strict' out there for CFS. (Hence it was logical the WPI seleced it, if trying to search for a
retroviral cause for overwhelming chronic exhastion).

If Fukuda criteria CFS 'allows' people with no organic disease to be studied for XMRV infection who are suffering from somatization disorder, not CFS (According
to Dr Cleare). Then it's imperetive than studies on XMRV, (or even any other study) not use Fukuda Criteria ever again.

If this is a risk, then when using Oxford '91 criteria that has no symptoms that need to be specific to be told one has CFS, then Oxford '91 criteria
should never be used to 'search' for biological diseases, especially in a cohort of patients who are having blood tests done for a newly discovered retrovirus!

The good news is (after all the damage it's done) the Imperial College Study has been shown to have holes in it too deep
to be a valid study. Yes the media have jumped all over it, but real Scientists understand it's not a 'like for like' study.

After all if I pan for gold in the hills of Detroit in 1850 and claim there is no gold, it's different than panning for gold in the hills of California.

Unfortunately for patients, the general public and even many doctors, don't own a medical atlas with historical fault lines....
and additionally XMRV is never going to be found by researchers (due to selection bias) in patients whose CFS symptoms are described as 'learned helplessness'. (Butler et al, 1991).

 

[gerwyn morris]

Thank you I also note with interest British psychiatrists are obliged to use ICD10 not DSM-IV

 

[DysautonomiaXMRV]

Hi, that's interesting and would explain why Professor Peter White (British Psychiatrist) is so against ICD-10.

I have a video recording somewhere I found on an ME forum, of him stating that hopefully CFS and ICD-10 criteria will be ended, 'God Willing'.

Now it makes sense from what you say, why Professor White would feel so negatively towards ICD-10 inclusion of CFS.

 

[Mithriel]

I made a copy of this, can't remember where I got it though.

Oxford Definition of Chronic fatigue syndrome

a) A syndrome characterized by fatigue as the principal symptom.

b) A syndrome of definite onset that is not life long.

c) The fatigue is severe, disabling, and affects physical and mental
functioning.

d) The symptom of fatigue should have been present for a minimum of 6 months during which it was present for more than 50% of the time.

e) Other symptoms may be present, particularly myalgia, mood and sleep disturbance.

f) Certain patients should be excluded from the definition. They include:
~ Patients with established medical conditions known to produce chronic fatigue (eg severe anaemia). Such patients should be excluded whether the medical condition is diagnosed at presentation or only subsequently. All patients should have a history and physical examination performed by a competent physician.

i)Also excluded are patients with a current diagnosis of schizophrenia, manic depressive illness, substance abuse, eating disorder or proven organic brain disease.

Other psychiatric disorders (including depressive illness, anxiety disorders, and hyperventilation syndrome) are not necessarily reasons for exclusion.

Excluding proven organic brain disease means that any one with a positive neurological sing is excluded. Since ME is a neurological disease there are often positive tests such as the Romberg. It is interesting that the CDC patients were excluded if they had a positive Romberg sign (falling over if you have your eyes shut).

This sign is so common there was talk of it being included in the definition.

Mithriel

 

[thefreeprisoner]

I have a failing Romberg test. I fail it whether I have my eyes closed or open. (Thankfully a neurologist at hospital had enough insight to try one on me. I had previously been examined by 3 doctors who administered the basic muscle strength tests and reflexes but all of them forgot the Romberg.)

The interesting thing is that patients sent to Kings don't have a thorough neurological examination. It is claimed they do, but they don't (as evidenced by the patients themselves; see the comments on the PLosOne study by a patient). They are only asked a list of questions.

 

[thefreeprisoner]

Oh, and you WOULD expect to find XMRV in a cohort of patients whatever their illness, but at a rate of between 1 - 4%. Yet Imperial failed to find a single one.

That's what makes me think that the testing was wrong in the Imperial study, and we should focus on that, not necessarily on the cohort.