Case definitions integrating empiric and consensus perspectives

Abstract

Background There has been considerable controversy regarding how to name and define the illnesses known as myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS). The IOM report has proposed a new clinical criteria and name for this illness, but aspects of these recommendations have been scrutinized by patients and scientists. Purpose It is possible that both empiric and consensus approaches could be used to help settle some of these diagnostic challenges. Using patient samples collected in the United States, Great Britain, and Norway (N=556), the current study attempted to categorize patients using more general as well as more restricted case definitions. Results Overall, the outcomes suggest that there might be four groupings of patients, with the broadest category involving those with chronic fatigue (N=62), defined by 6 or more months of fatigue which can be cannot be explained by medical or psychiatric conditions. A second category involves those patients that have chronic fatigue that can be explained by a medical or psychiatric condition (N=47). A third category involves more specific criteria that have been posited both by the IOM report, a Canadian Clinical Case criteria, a ME-ICC criteria and a more empiric approach. These efforts have specified domains of substantial reductions of activity, post-exertional malaise, neurocognitive impairment, and sleep dysfunction (N=346). Patients with these characteristics were more functionally impaired than those meeting just chronic fatigue criteria, p < .05. Finally, those meeting even more restrictive ME criteria proposed by Ramsay, identified a smaller and even more impaired group, p < .05. Discussion The advantages of using such empirical and consensus approaches to develop reliable classification and diagnostic efforts are discussed.

The Effect of Curcumin on Patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: An Open Label Study

“…Patients with ME had a significantly higher CDC, CFS and CDC rest symptom scores than the patients with CFS and atypical ME. This is in line with previous studies of Jason et al[56] [57] suggesting that CFS and ME are not different but merely are a continuum in disease severity expression.However, more importantly, the favorable effects of curcumin are both present in CFS and in ME patients.…”

Assessing current functioning as a measure of significant reduction in activity level

“…[8,19,20,21,22] In the present study, it was found that Role-Physical and Social Functioning were significantly correlated to both the current hours and percent reduction in hours spent on different activities. These findings demonstrate that as current hours decrease and percent reduction in hours increases, the scores on the Role-Physical and Social Functioning scales will decrease, indicating worse functioning.…”

Subtyping Patients with Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS) By Course of Illness

“…Symptom frequency and severity were converted to a 100-point scale, and were averaged to create one composite score for each symptom. Symptoms were compiled into domains [23] based on symptomology suggested by the Canadian Clinical Criteria for ME/CFS [2] and select other symptoms categories that were empirically identified through factor analysis [23,2,7]. The domain composite scores were calculated by converting the frequency and severity for each symptom in the domain and averaging them to create one score.…”