Carruthers BM, Jain, AK, De Meirleir KL, Peterson DL, Klimas NG, Lerner AM, Bested AC, Henry PF, Joshi P, Powles ACP, Sherkey JA, van de Sande M. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols. Journal of Chronic Fatigue Syndrome, Vol. 11(1), 2003.
Clinical Working Case Definition of ME/CFS
A patient with ME/CFS will meet the criteria for fatigue, post-exertional malaise and/or fatigue, sleep dysfunction, and pain; have two or more neurological/cognitive manifestations and one or more symptoms from two or more of the categories of autonomic, neuroendocrine and immune manifestations; and adhere to item 7.
1. The patient must have a significant degree of new onset, unexplained, persistent or recurrent physical and mental fatigue that substantially reduces activity level.
2. Post-Exertional Malaise and/or Fatigue: There is an inappropriate loss of physical and mental stamina, rapid muscular and cognitive fatigability, post-exertional malaise and/or fatigue and/or pain and a tendency for other associated symptoms within the patient’s cluster of symptoms to worsen. There is a pathologically slow recovery period — usually 24 hours or longer.
3. Sleep Dysfunction: There is unrefreshed sleep or sleep quantity or rhythm disturbances such as reversed or chronic diurnal sleep rhythms.
4. There is a significant degree of myalgia. Pain can be experienced in the muscles and/or joints, and is often widespread and migratory in nature. Often there are significant headaches of new type, pattern or severity.
5. Neurological/Cognitive Manifestations: Two or more of the following difficulties should be present: confusion, impairment of concentration and short-term memory consolidation, disorientation, difficulty with information processing, categorizing and word retrieval, and perceptual and sensory disturbances — e.g. spatial instability and disorientation and inability to focus vision. Ataxia, muscle weakness and fasciculations are common. There may be overload phenomena: cognitive, sensory — e.g. photophobia and hypersensitivity to noise — and/or emotional overload, which may lead to “crash” periods and/or anxiety.
6. At least one symptom from two of the following categories:
a. Autonomic Manifestations: orthostatic intolerance (neurally mediated hypotension (NMH), postural orthostatic tachycardia syndrome (POTS), delayed postural hypotension); light-headedness; extreme pallor; nausea and irritable bowel syndrome; urinary frequency and bladder dysfunction; palpitations with or without cardiac arrrhythmias; exertional dyspnea.
b. Neuroendocrine Manifestations: loss of thermostatic stability (subnormal body temperature and marked diurnal fluctuation, sweating episodes, recurrent feelings of feverishness and cold extremities); intolerance of extremes of heat and cold; marked weight change (anorexia or abnormal appetite); loss of adaptability and worsening of symptoms with stress.
c. Immune Manifestations: tender lymph nodes; recurrent sore throat; recurrent flu-like symptoms; general malaise; new sensitivities to food, medications and/or chemicals.
7. The illness persists for at least six months. It usually has a distinct onset, although it may be gradual. Preliminary diagnosis may be possible earlier. Three months is appropriate for children.
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