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Myalgic encephalomyelitis: Difference between revisions
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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. | 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, | 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. A multitude of, sometimes significantly different, CFS definitions have been designed, but the [[Fukuda definition of CFS|Fukuda definition]] of 1994<ref name="Fukuda1994">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>, based on the anecdotal experience of a the members of a study group, is practiced most frequently. What they all have in common is that they score symptoms. | ||
It is easier to count symptoms than to diagnose the underlying disease, but the CFS populations 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 Fukuda definition of CFS<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> | |||
===Refocus=== | |||
In the early [[21st century]], research on CFS produced various breakthroughs regarding the [[etiology]] and nature of myalgic encephalomyelitis. Since then, researchers and their organizations like the [[IACFS/ME]] are often denoting their focus as ME/CFS or CFS/ME, following [[patient organization]]s that had done the same. Actual scientific research still commonly uses CFS patient selections, but with an interest in subgroups within the CFS populations.<ref>Tan EM, Sugiura K, Gupta S (2002), "The Case Definition of Chronic Fatigue Syndrome", J Clin Immunol, Vol. 22, No. 1, pp. 8-12</ref><ref>Siegel SD, Antoni MH, Fletcher MA, Maher K, Segota MC, Klimas N (2006), "Impaired natural immunity, cognitive dysfunction, and physical symptoms in patients with chronic fatigue syndrome: preliminary evidence for a subgroup?", J Psychosom Res. 2006 Jun;60(6):559-566, PMID: 16731230</ref> | |||
{{refs}} | {{refs}} | ||
Revision as of 14:34, 25 October 2008
Benign myalgic encephalomyelitis
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. Mild chronic inflammation was found in 95% of 165 stomach biopsy specimens of patients selected by CFS criteria by Chia & Chia.[5]
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, as well as sporadic cases.[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.[6] The oldest of the documented outbreaks occurred in Los Angeles, 1934.[7] In 1969, the WHO included ME in their classification. The name 'epidemic neurasthenia' remained in use for some time alongside ME.[8]
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).[9] While intended for research purposes only, CFS criteria became a common clinical working diagnosis as well. A multitude of, sometimes significantly different, CFS definitions have been designed, but the Fukuda definition of 1994[10], based on the anecdotal experience of a the members of a study group, is practiced most frequently. What they all have in common is that they score symptoms.
It is easier to count symptoms than to diagnose the underlying disease, but the CFS populations and patient selections may contain a significant number of patients that would not be diagnosed with ME.[11] 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.[3] It compared favourably to the Fukuda definition of CFS[12]
Refocus
In the early 21st century, research on CFS produced various breakthroughs regarding the etiology and nature of myalgic encephalomyelitis. Since then, researchers and their organizations like the IACFS/ME are often denoting their focus as ME/CFS or CFS/ME, following patient organizations that had done the same. Actual scientific research still commonly uses CFS patient selections, but with an interest in subgroups within the CFS populations.[13][14]
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