Chronic fatigue syndrome definition

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Definitions, Guidelines, and Summaries

In 1938, Gilliam reported an epidemic of the illness giving a detailed description that added up to a twenty-point definition. His report came to be recognized as the first useful description of ME, but official acknowledgment of its existence was delayed by concerned US authorities for four years.[1]

Competing definitions, guidelines, and summary descriptions have accrued since then. Among them, some of the most notable are

  • The Ramsay definition (1986) [2]
  • The Holmes et al (1988) scoring system,[3] sometimes called "CDC 1988"
  • The Oxford criteria (1991)[4]
  • The "Fukada" CDC definition (1994),[5] or "CDC 1994"
  • The Carruthers et al (2003) Canadian Case definition for ME/CFS[6]

Case definitions in CFS have largely been established to define patients for research study purposes, and have certain limitations when used for general practitioner purposes. Several studies have found that using different case definitions ( eg broad vs conservative[8] ) has major influence on the types of patients selected and have also supported the distinction between specific subgroups of CFS to be identified and/or for the case definition to be further clarified with emphasis on using empirical studies: An international CFS study group for the CDC found in 2003 that ambiguities in the CDC 1994 CFS research case definition contribute to inconsistent case identification.[9]

At this time, there is no accepted conclusive test or series of tests for ME/CFS. According to the CDC, the main purpose of performing diagnostic tests of any sort at this point in time, is to rule out other causes for fatigue and other symptoms of CFS.[5] A review published in 2006 found that the accurate diagnosis of CFS is low[10]

Clinical practice guidelines, with the aim of improving diagnosis, several countries have now produced these, which are generally based on case descriptions but these documents have the aim of guiding decisions and criteria regarding diagnosis, management, and treatment. Modern medical guidelines are based on an examination of current evidence within the paradigm of evidence-based medicine and they usually include summarized consensus statements. Guidelines are usually produced at national or international levels by medical associations or governmental bodies.

References

  1. Byron M. Hyde (1992). The Clinical and scientific basis of myalgic encephalomyelitis/chronic fatigue syndrome. Ogdensburg, N.Y: Nightingale Research Foundation. ISBN 0-9695662-0-4.
  2. Ramsay MA (1986), "Postviral Fatigue Syndrome. The saga of Royal Free disease", Londen, ISBN 0-906923-96-4
  3. Holmes G, Kaplan J, Gantz N, Komaroff A, Schonberger L, Straus S, Jones J, Dubois R, Cunningham-Rundles C, Pahwa S (1988). "Chronic fatigue syndrome: a working case definition,". Ann Intern Med. 108 (3): 387–9. PMID 2829679. Details
  4. Sharpe M, Archard L, Banatvala J, Borysiewicz L, Clare A, David A, Edwards R, Hawton K, Lambert H, Lane R (1991). "A report--chronic fatigue syndrome: guidelines for research". J R Soc Med. 84 (2): 118–21. PMID 1999813. PMC 1293107 Synopsis by Template:GPnotebook)
  5. 5.0 5.1 Fukuda K, Straus S, Hickie I, Sharpe M, Dobbins J, Komaroff A (1994). "The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group". Ann Intern Med. 121 (12): 953–9. PMID 7978722.
  6. Carruthers BM, Jain AK, De Meirleir KL, Peterson DL, Klimas MD, Lerner AM, Bested AC, Flor-Henry P, Joshi P, Powles ACP, Sherkey JA, van de Sande MI (2003). "Myalgic encephalomyalitis/chronic fatigue syndrome: Clinical working definition, diagnostic and treatment protocols" (PDF). Journal of Chronic Fatigue Syndrome. 11 (1): 7–36. doi:10.1300/J092v11n01_02.
  7. National Institute for Health and Clinical Excellence. Guideline 53: Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy). London, 2007. ISBN 1846294533. NICE CG53 page.
  8. Jason LA, Corradi K, Torres-Harding S, Taylor RR, King C (2005). "Chronic fatigue syndrome: the need for subtypes". Neuropsychol Rev. 15 (1): 29–58. doi:10.1007/s11065-005-3588-2. PMID 15929497.
  9. Reeves WC, Lloyd A, Vernon SD, Klimas N, Jason LA, Bleijenberg G, Evengard B, White PD, Nisenbaum R, Unger ER (2003). "Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution". BMC Health Serv Res. 3 (1): 25. doi:10.1186/1472-6963-3-25. PMID 14702202.
  10. Maoz D, Shoenfeld Y (2006). "Chronic fatigue syndrome". Harefuah. 145 (4): 272–5, 319, 318. PMID 16642629.

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