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.
