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Definitions of ME/CFS

One of the first definitions of ME/CFS originated from the work of Dr. Melvin Ramsay. According to Ramsay's definition, the three principal clinical elements of ME/CFS are:

1) A Unique Form of Muscle Fatiguability: where muscle power can take days to recover; and muscle tenderness together with twitchings or spasms can regularly occur.

2) Circulatory Impairment: encompassing cold extremities, heightened sensitivity to climatic change and excessive sweating.

3) Cerebral Dysfunction: encompassing deterioration in memory and concentration; as well as other cognitive difficulties, sleep disturbances and emotional changes.[1]

New Definitions Emerge

Following such definitions, a number of medical researchers and doctors went on to construct their own definitions of the condition.  Unfortunately, this has inevitably created some degree of confusion as some emphasize particular symptoms and elements differently.  Amongst these include, the U.S. Centre for Disease Control (C.D.C) Criteria devised in 1987[2] (updated in 1994)[3]; the Oxford Criteria[4], developed in 1990 by a group of UK experts; and the Australian group of researchers, led by Professor Lloyd, whose criteria placed extra emphasis on neuropsychological symptoms.[5][6]  Of these, the Centre for Disease Control (CDC) in America is perhaps the most internationally accepted definition.  However, in the opinion of two British doctors, Dr. Ramsay's original work remains the best clinical description to date.[7]

CDC Criteria

Centre for Disease Control (CDC) Criteria

CFS is a syndrome characterised by fatigue that is:

-medically unexplained (i.e. not caused by conditions such as anaemia)

-of new onset (i.e. not lifelong)

-of at least 6 months duration

-not the result of ongoing exertion (e.g. overwork or athletic over-training)

-not substantially relieved by rest

-causing a substantial reduction in previous levels of occupational, educational, social or personal activities.

In addition, there must be four or more of the following symptoms:

-self-reported problems with short-term memory or concentration (cognitive defects)

-sore throats

-tender neck (cervical) or armpit (axillary) glands

-muscle pain (myalgia)

-headaches of a new type, pattern or severity

-unrefreshing sleep

-post-exertional malaise lasting more than 24 hours

-multi-joint pain (arthralgia) without swelling or redness

Conditions which would exclude a diagnosis include:

-established medical disorders known to cause chronic fatigue

-major depressive illness with psychotic or melancholic features (but not anxiety states, somatisation disorder or non-melancholic/psychotic depression)

-any medication which causes fatigue as a side-effect

-eating disorders - anorexia, bulimia or severe obesity

-alcohol or substance abuse


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References


[1] Ramsay, M. (1988) ‘Myalgic Encephalomyelitis and Postviral Fatigue States: The Saga of Royal Free Disease’; Shepherd, C. (1999) ‘Living with M.E.’ p.6.

[2] Holmes, G. et al. (1988) ‘ Chronic fatigue syndrome: a working case definition,’ Annals of Internal Medicine, 108, p.387-9.

[3] Fukuda, K. et al. (1994) ‘The chronic fatigue syndrome:  a comprehensive approach to its definition and study,’ Annals of Internal Medicine, 121, p.953-9.  Correspondence: 1995, 123, p.74-6.

[4] Sharpe, M.C. et al. (1991) ‘A report – chronic fatigue syndrome: guide-lines for research,’ Journal of the Royal Society of Medicine,’ 84, p.118-21.

[5] Lloyd, A.R. et al. (1988) ‘What is myalgic encephalomyelitis?’ Lancet, 1, p.1286-7.

[6] Lloyd, A.R.  et al. (1990) ‘Prevalence of chronic fatigue syndrome in an Australian population,’ Medical Journal of Australia, 153, p.522-8.

[7] Shepherd, C. (1999) ‘Living with M.E.’ p.7; Macintyre, A. (1998) ‘M.E./Chronic Fatigue Syndrome: A Practical Guide, p.16.