This is purely an informational post. I sometimes share articles about ME on Facebook and Twitter, but I can’t be sure anyone reads them, very few people at least let me know that they’ve read them. So occasionally I’m going to write a blog post highlighting a particular article that I want to share, in the hope it will reach more people.
So, for anyone who thinks ME is nothing more than ‘being tired’, this is for you! Below are the symptoms a person must have in order to be diagnosed with ME. I have taken this information from the ME International Consensus Criteria, published in the Journal of Internal Medicine 2011. (The ME International Consensus Criteria is an update of the Canadian Consensus Criteria, the proposed clinical criteria for ME published in 2003.)
I will highlight with a tick if I have one or more symptom from each category. I also experience symptoms not listed here. For example, for women, ME can affect the menstrual cycle. I won’t go into each and every way this affects me, but it’s only since I’ve had ME that I experience painful ovulation. I can tell exactly when I ovulate, and from which ovary, which, if it wasn’t so painful, would be pretty cool!
Myalgic Encephalomyelitis: International Consensus Criteria
Myalgic encephalomyelitis (ME), also referred to in literature as chronic fatigue syndrome (CFS), is a complex disease involving profound dysregulation of the central nervous system (CNS) and immune system, dysfunction of cellular energy metabolism and ion transport and cardiovascular abnormalities. The underlying pathophysiology produces measurable abnormalities in physical and cognitive function and provides a basis for understanding the symptomatology. Thus, the development of International Consensus Criteria that incorporate current knowledge should advance the understanding of ME by health practitioners and benefit both the physician and patient in the clinical setting as well as clinical researchers.
Using ‘fatigue’ as a name of a disease gives it exclusive emphasis and has been the most confusing and misused criterion. No other fatiguing disease has ‘chronic fatigue’ attached to its name – e.g. cancer/chronic fatigue, multiple sclerosis/chronic fatigue – except ME/CFS. Fatigue in other conditions is usually proportional to effort or duration with a quick recovery and will recur to the same extent with the same effort or duration that same or next day. The pathological low threshold of fatigability of ME described in the following criteria often occurs with minimal physical or mental exertion and with reduced ability to undertake the same activity within the same or several days.
Myalgic encephalomyelitis is an acquired neurological disease with complex global dysfunctions. Pathological dysregulation of the nervous, immune and endocrine systems, with impaired cellular energy metabolism and ion transport are prominent features. Although signs and symptoms are dynamically interactive and causally connected, the criteria are grouped by regions of pathophysiology to provide general focus.
A patient will meet the criteria for postexertional neuroimmune exhaustion (A).
At least one symptom from three neurological impairment categories (B).
At least one symptom from three immune/gastro-intestinal/genitourinary impairment categories (C).
At least one symptom from energy metabolism/transport impairments (D).
A. Postexertional neuroimmune exhaustion: compulsory
This cardinal feature is a pathological inability to produce sufficient energy on demand with prominent symptoms primarily in the neuroimmune regions. Characteristics are as follows:
1. Marked, rapid physical and/or cognitive fatigability in response to exertion, which may be minimal such as activities of daily living or simple mental tasks, can be debilitating and cause a relapse. ✔
2. Postexertional symptom exacerbation:e.g.acute flu-like symptoms, pain and worsening of other symptoms. ✔
3. Postexertional exhaustion may occur immediately after activity or be delayed by hours or days. ✔
4. Recovery period is prolonged, usually taking 24 h or longer. A relapse can last days, weeks or longer. ✔
5. Low threshold of physical and mental fatigability (lack of stamina) results in a substantial reduction in pre-illness activity level. ✔
Operational notes: For a diagnosis of ME, symptom severity must result in a significant reduction of a patient’s premorbid activity level. Mild (an approximate 50% reduction in pre-illness activity level), moderate (mostly housebound), severe (mostly bedridden) or very severe (totally bedridden and need help with basic functions). There may be marked fluctuation of symptom severity and hierarchy from day to day or hour to hour. Consider activity, context and interactive effects. Recovery time: e.g. Regardless of a patient’s recovery time from reading for ½ hour, it will take much longer to recover from grocery shopping for ½ hour and even longer if repeated the next day – if able. Those who rest before an activity or have adjusted their activity level to their limited energy may have shorter recovery periods than those who do not pace their activities adequately.Impact: e.g. An outstanding athlete could have a 50% reduction in his/her pre-illness activity level and is still more active than a sedentary person.
B. Neurological impairments: At least one symptom from three of the following four symptom categories
1. Neurocognitive impairments
a. Difficulty processing information: slowed thought, impaired concentration e.g. confusion, disorientation, cognitive overload, difficulty with making decisions, slowed speech, acquired or exertional dyslexia ✔
b. Short-term memory loss:e.g. difficulty remembering what one wanted to say, what one was saying, retrieving words, recalling information, poor working memory ✔
a. Headaches:e.g. chronic, generalized headaches often involve aching of the eyes, behind the eyes or back of the head that may be associated with cervical muscle tension; migraine; tension headaches ✔
b. Significant pain can be experienced in muscles, muscle-tendon junctions, joints, abdomen or chest. It is noninflammatory in nature and often migrates. e.g. generalized hyperalgesia, widespread pain (may meet fibromyalgia criteria), myofascial or radiating pain ✔
3. Sleep disturbance
a. Disturbed sleep patterns:e.g. insomnia, prolonged sleep including naps, sleeping most of the day and being awake most of the night, frequent awakenings, awaking much earlier than before illness onset, vivid dreams/nightmares ✔
b. Unrefreshed sleep:e.g. awaken feeling exhausted regardless of duration of sleep, day-time sleepiness ✔
4. Neurosensory, perceptual and motor disturbances
a. Neurosensory and perceptual:e.g. inability to focus vision, sensitivity to light, noise, vibration, odour, taste and touch; impaired depth perception ✔
b. Motor:e.g. muscle weakness, twitching, poor coordination, feeling unsteady on feet, ataxia ✔
Notes: Neurocognitive impairments, reported or observed, become more pronounced with fatigue. Overload phenomena may be evident when two tasks are performed simultaneously. Abnormal accommodation responses of the pupils are common.Sleep disturbances are typically expressed by prolonged sleep, sometimes extreme, in the acute phase and often evolve into marked sleep reversal in the chronic stage.Motor disturbances may not be evident in mild or moderate cases but abnormal tandem gait and positive Romberg test may be observed in severe cases.
C. Immune, gastro-intestinal and genitourinary Impairments: At least one symptom from three of the following five symptom categories
1. Flu-like symptoms may be recurrent or chronic and typically activate or worsen with exertion.e.g. sore throat, sinusitis, cervical and/or axillary lymph nodes may enlarge or be tender on palpitation ✔
2. Susceptibility to viral infections with prolonged recovery periods ✔ (a new symptom for me, my prolonged tonsillitis, 7 weeks and counting…)
3. Gastro-intestinal tract:e.g. nausea, abdominal pain, bloating, irritable bowel syndrome ✔
4. Genitourinary: e.g. urinary urgency or frequency, nocturia ✔
5. Sensitivities to food, medications, odours or chemicals ✔
Notes: Sore throat, tender lymph nodes, and flu-like symptoms obviously are not specific to ME but their activation in reaction to exertion is abnormal. The throat may feel sore, dry and scratchy. Faucial injection and crimson crescents may be seen in the tonsillar fossae, which are an indication of immune activation.
D. Energy production/transportation impairments: At least one symptom
1. Cardiovascular:e.g. inability to tolerate an upright position – orthostatic intolerance, neurally mediated hypotension, postural orthostatic tachycardia syndrome, palpitations with or without cardiac arrhythmias, light-headedness/dizziness ✔
2. Respiratory:e.g. air hunger, laboured breathing, fatigue of chest wall muscles ✔
3. Loss of thermostatic stability:e.g. subnormal body temperature, marked diurnal fluctuations; sweating episodes, recurrent feelings of feverishness with or without low grade fever, cold extremities ✔
4. Intolerance of extremes of temperature ✔
Notes: Orthostatic intolerance may be delayed by several minutes. Patients who have orthostatic intolerance may exhibit mottling of extremities, extreme pallor or Raynaud’s Phenomenon. In the chronic phase, moons of finger nails may recede.
So, does this help you non-believers?
PS Thanks to my friend S, who shared this article with me.