The subgrouping results in the PACE Trial are a shabby sop.
Additional information on the London Criteria:
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.
OTHER REASONS FOR EXCLUSION FROM RESEARCH INTO M.E.
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.
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.
OTHER REASONS FOR EXCLUSION FROM RESEARCH INTO M.E.
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.
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.]
a) 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]
b) nominal dysphasia [difficulty finding the right word]
c) disturbed sleep patterns [of any sort]
d) disequilibrium [a feeling of imbalance]
e) tinnitus [ringing in the ears]
3. 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.
4. These symptoms should have been present for at least 6 months and should be ongoing.
5. 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.]
Version 2, 26.11.2004
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.]
a) 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]
b) nominal dysphasia [difficulty finding the right word]
c) disturbed sleep patterns [of any sort]
d) disequilibrium [a feeling of imbalance]
e) tinnitus [ringing in the ears]
3. 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.
4. These symptoms should have been present for at least 6 months and should be ongoing.
5. 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.]
Version 2, 26.11.2004