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'''Myalgic encephalomyelitis''' (ME) is a [[neurology|neurological]] disorder of the [[central nervous system]] (CNS), classified as a [[post-viral fatigue syndrome]] ([[ICD10]] code: G93.3) by the [[World Health Organization]] (WHO). The name indicates [[inflammation]] of the [[brain]] and/or [[spinal cord]] accompanied by [[myalgia]] (muscle pain). The disease affects multiple bodily systems, including the [[immune system|immune]], [[circulatory system|cardiovascular]], [[neuroendocrine]] and [[metabolism|metabolic]].<ref name="Hyde1992">Hyde BM (ed.) (1992), "The Clinical and Scientific Basis of Myalgic Encephalomyelitis / Chronic Fatigue Syndrome", Nightingale Research Foundation, Ottawa, Canada with editorial and conceptual advice from Levine P and Goldstein J., 724+23p, ISBN 0-9695662-0-4</ref> | '''Myalgic encephalomyelitis''' (ME) is a [[neurology|neurological]] disorder of the [[central nervous system]] (CNS), classified as a [[post-viral fatigue syndrome]] ([[ICD10]] code: G93.3) by the [[World Health Organization]] (WHO). The name indicates [[inflammation]] of the [[brain]] and/or [[spinal cord]] accompanied by [[myalgia]] (muscle pain). The disease affects multiple bodily systems, including the [[immune system|immune]], [[circulatory system|cardiovascular]], [[neuroendocrine]] and [[metabolism|metabolic]].<ref name="Hyde1992">Hyde BM (ed.) ([[1992]]), "The Clinical and Scientific Basis of Myalgic Encephalomyelitis / Chronic Fatigue Syndrome", Nightingale Research Foundation, Ottawa, Canada with editorial and conceptual advice from Levine P and Goldstein J., 724+23p, ISBN 0-9695662-0-4</ref> | ||
'''ME''' is an [[endemic]] disease which is subject to periodic [[epidemic]]s.<ref name="Ramsay1986">Ramsay AM (1986), "Postviral Fatigue Syndrome. The saga of Royal Free disease", London, ISBN 0-906923-96-4</ref> While the prognosis is poor, recorded fatalities are relatively rare. | '''ME''' is an [[endemic]] disease which is subject to periodic [[epidemic]]s.<ref name="Ramsay1986">Ramsay AM ([[1986]]), "Postviral Fatigue Syndrome. The saga of Royal Free disease", London, ISBN 0-906923-96-4</ref> While the prognosis is poor, recorded fatalities are relatively rare. | ||
Patients experience a multitude of functional problems, such as [[exercise intolerance]], [[orthostatic intolerance]], [[chronic fatigue]], [[muscle]] pain and weakness, [[sensory system|sensory]] disturbances, [[information processing]] problems of the [[brain]], [[concentration]] loss, [[malaise]], [[emotion|emotional]] disturbances and [[sleep]] disturbances.<ref name="Carruthers2003">Carruthers BM, Jain AK, DeMeirleir KL, Peterson DL, Klimas NG, Lerner AM, Bested AC, Flor-Henry P, Joshi P, Powles ACP, Sherkey JA, Van de Sande MI (2003), "Myalgic Encephalomyelitis / Chronic Fatigue Syndrome : Clinical Working case Definition, Diagnostic and Treatment Protocols", Journal of Chronic Fatigue Syndrome, Vol. 11 (1)</ref> | Patients experience a multitude of functional problems, such as [[exercise intolerance]], [[orthostatic intolerance]], [[chronic fatigue]], [[muscle]] pain and weakness, [[sensory system|sensory]] disturbances, [[information processing]] problems of the [[brain]], [[concentration]] loss, [[malaise]], [[emotion|emotional]] disturbances and [[sleep]] disturbances.<ref name="Carruthers2003">Carruthers BM, Jain AK, DeMeirleir KL, Peterson DL, Klimas NG, Lerner AM, Bested AC, Flor-Henry P, Joshi P, Powles ACP, Sherkey JA, Van de Sande MI ([[2003]]), "Myalgic Encephalomyelitis / Chronic Fatigue Syndrome : Clinical Working case Definition, Diagnostic and Treatment Protocols", Journal of Chronic Fatigue Syndrome, Vol. 11 (1)</ref> | ||
==Diagnosis== | ==Diagnosis== | ||
The CNS inflammation | ME is defined by the following diagnostic criteria.<ref> Ramsay AM, Dowsett EG, "Myalgic Encephalomyelitis -- Then and Now: An Epidemiological Introduction", in: Hyde ([[1992]]), chapter 4, pp. 81-84</ref> | ||
<div style="border:1px solid black; background-color:#FFEE99;"> | |||
# Generalised or localised muscle fatigue after minimal exercise with '''prolonged''' recovery time. | |||
# Neurological disturbance, especially of cognitive, autonomic and sensory functions, often accompanied by marked emotional lability and sleep reversal. | |||
# Variable involvement of cardiac and other bodily systems. | |||
# An extended relapsing course with a tendency to chronicity. | |||
# Marked variability of symptoms both within and between episodes.</div> | |||
The CNS inflammation indicated by the name does not show on [[MRI]] scans as with [[multiple sclerosis]], but has been observed in [[autopsy|autopsies]] as was the case for [[Sophia Mirza]]. | |||
The diagnostic criteria were formulated by ME researcher [[A. Melvin Ramsay]], who had witnessed the epidemic at the [[Royal Free Hospital]] in [[1955]], after an extensive study of the numerous outbreaks that had been documented.<ref name=Ramsay1986>Ramsay AM ([[1986]]), "Postviral Fatigue Syndrome. The saga of Royal Free disease", London, ISBN 0-906923-96-4</ref> | |||
==History== | |||
The diagnosis of Myalgic encephalomyelitis was introduced in [[1956]], identifying a number of [[outbreak]]s that had received different names in various parts of the world, including '''atypical poliomyelitis''' and '''epidemic neurasthenia''', but produced the same symptoms and findings. These included signs of damage to the brain and spinal chord, protracted muscle pain with [[paresis]] and cramp, emotional disturbances and a course with relapses.<ref>Acheson DE ([[1956]]), "A New Clinical Entity?", Leading Article, Lancet, May 26, pp. 789-90</ref> The oldest of the documented outbreaks occurred in [[Los Angeles]], [[1934]].<ref>Gilliam AG ([[1938]]), "Epidemiological Study on an Epidemic, Diagnosed as Poliomyelitis, Occurring among the Personnel of Los Angeles County General Hospital during the Summer of 1934", United States Treasury Department Public Health Service Public Health Bulletin, No. 240, pp. 1-90. Washington, DC, Government Printing Office</ref> In [[1969]], the WHO included ME in their classification. The name 'epidemic neurasthenia' remained in use for some time alongside ME.<ref>Parish JG, "Early outbreaks of 'epidemic neuromyasthenia'" ([[1978]]), Postgraduate Medical Journal, Vol 54, 711-717</ref> | |||
A symposium on epidemic neuromyasthenia was held at the [[Royal Society of Medicine]] in April [[1978]], co-chaired by Ramsay. This lead to the formation of the [[Study Group on the subject of Myalgic Encephalomyelitis]], of which Ramsay was a member. | |||
==Chronic fatigue syndrome== | ==Chronic fatigue syndrome== | ||
Research where patients are selected with a [[diagnosis]] of ME is relatively rare outside the recorded epidemics. Since the early [[1990s]], commonly a simplifying working diagnosis is used to select patients, known as [[chronic fatigue syndrome]] (CFS).<ref>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", Annals of Internal Medicine, 108 (3), 387-389</ref> While intended for research purposes only, CFS criteria became a common clinical working diagnosis as well, almost replacing the main diagnosis of ME entirely. | Research where patients are selected with a [[diagnosis]] of ME is relatively rare outside the recorded epidemics. Since the early [[1990s]], commonly a simplifying working diagnosis is used to select patients, known as [[chronic fatigue syndrome]] (CFS).<ref>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", Annals of Internal Medicine, 108 (3), 387-389</ref> While intended for research purposes only, CFS criteria became a common clinical working diagnosis as well, almost replacing the main diagnosis of ME entirely. | ||
CFS is easier to diagnose than ME, but the CFS population and patient selections may contain a significant number of patients that would not be diagnosed with ME.<ref>Lavrich C, Kenney KK, Lapp C, Herd J, Kahn D, Levine S, Klimas NG, Jason LA (2003), "Recommendations of the Name Change Workgroup Presented to DHSS CFS Advisory Committee", September</ref> In [[2003]], an attempt was made to devise a clinical working case definition that would minimalize this drawback, the [[Canadian consensus definition of ME/CFS]].<ref name="Carruthers2003"> It compared favourably to the prevailing Fukuda definition of CFS<ref>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", Annals of Internal Medicine 121 (12), 953-959</ref><ref>Jason LA, Torres-Harding SR, Jurgens A, Helgerson J (2004), "Comparing the Fukuda et al. Criteria and the Canadian Case Definition for Chronic Fatigue Syndrome", Journal of Chronic Fatigue Syndrome, vol.12 p:39-52</ref> | CFS is easier to diagnose than ME, but the CFS population and patient selections may contain a significant number of patients that would not be diagnosed with ME.<ref>Lavrich C, Kenney KK, Lapp C, Herd J, Kahn D, Levine S, Klimas NG, Jason LA ([[2003]]), "Recommendations of the Name Change Workgroup Presented to DHSS CFS Advisory Committee", September</ref> In [[2003]], an attempt was made to devise a clinical working case definition that would minimalize this drawback, the [[Canadian consensus definition of ME/CFS]].<ref name="Carruthers2003"> It compared favourably to the prevailing Fukuda definition of CFS<ref>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", Annals of Internal Medicine 121 (12), 953-959</ref><ref>Jason LA, Torres-Harding SR, Jurgens A, Helgerson J ([[2004]]), "Comparing the Fukuda et al. Criteria and the Canadian Case Definition for Chronic Fatigue Syndrome", Journal of Chronic Fatigue Syndrome, vol.12 p:39-52</ref> | ||
{{refs}} | {{refs}} | ||
Revision as of 12:32, 17 September 2008
Myalgic encephalomyelitis (ME) is a neurological disorder of the central nervous system (CNS), classified as a post-viral fatigue syndrome (ICD10 code: G93.3) by the World Health Organization (WHO). The name indicates inflammation of the brain and/or spinal cord accompanied by myalgia (muscle pain). The disease affects multiple bodily systems, including the immune, cardiovascular, neuroendocrine and metabolic.[1]
ME is an endemic disease which is subject to periodic epidemics.[2] While the prognosis is poor, recorded fatalities are relatively rare.
Patients experience a multitude of functional problems, such as exercise intolerance, orthostatic intolerance, chronic fatigue, muscle pain and weakness, sensory disturbances, information processing problems of the brain, concentration loss, malaise, emotional disturbances and sleep disturbances.[3]
Diagnosis
ME is defined by the following diagnostic criteria.[4]
- Generalised or localised muscle fatigue after minimal exercise with prolonged recovery time.
- Neurological disturbance, especially of cognitive, autonomic and sensory functions, often accompanied by marked emotional lability and sleep reversal.
- Variable involvement of cardiac and other bodily systems.
- An extended relapsing course with a tendency to chronicity.
- Marked variability of symptoms both within and between episodes.
The CNS inflammation indicated by the name does not show on MRI scans as with multiple sclerosis, but has been observed in autopsies as was the case for Sophia Mirza.
The diagnostic criteria were formulated by ME researcher A. Melvin Ramsay, who had witnessed the epidemic at the Royal Free Hospital in 1955, after an extensive study of the numerous outbreaks that had been documented.[2]
History
The diagnosis of Myalgic encephalomyelitis was introduced in 1956, identifying a number of outbreaks that had received different names in various parts of the world, including atypical poliomyelitis and epidemic neurasthenia, but produced the same symptoms and findings. These included signs of damage to the brain and spinal chord, protracted muscle pain with paresis and cramp, emotional disturbances and a course with relapses.[5] The oldest of the documented outbreaks occurred in Los Angeles, 1934.[6] In 1969, the WHO included ME in their classification. The name 'epidemic neurasthenia' remained in use for some time alongside ME.[7]
A symposium on epidemic neuromyasthenia was held at the Royal Society of Medicine in April 1978, co-chaired by Ramsay. This lead to the formation of the Study Group on the subject of Myalgic Encephalomyelitis, of which Ramsay was a member.
Chronic fatigue syndrome
Research where patients are selected with a diagnosis of ME is relatively rare outside the recorded epidemics. Since the early 1990s, commonly a simplifying working diagnosis is used to select patients, known as chronic fatigue syndrome (CFS).[8] While intended for research purposes only, CFS criteria became a common clinical working diagnosis as well, almost replacing the main diagnosis of ME entirely.
CFS is easier to diagnose than ME, but the CFS population and patient selections may contain a significant number of patients that would not be diagnosed with ME.[9] In 2003, an attempt was made to devise a clinical working case definition that would minimalize this drawback, the Canadian consensus definition of ME/CFS.Cite error: Closing </ref> missing for <ref> tag[10]
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