Definitions

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Contents 1 Types 2 Summary of definitions

Types

Myalgic Encephalomyelitis: International Consensus Criteria (2011)

Revised Canadian Consensus Definition (2010)

NICE Guidelines (2007)

Pediatric Case Definition (2006)

Empiric definition (2005)

Canadian Consensus Definition (2003)

Fukuda definition (1994)

Oxford definition (1991)

London definition (1994)

Australia definition (1990)

Holmes definition (1988)

Ramsay definition (1986)

There are and have been many definitions for the disease or diseases ME/CFS. The Canadian Consensus Definition tends to be the one most advocates (Patients, Doctors, etc) would like to see implemented as it is less likely to include those who are merely fatigued, those who have chronic fatigue for another reason, and those who have a mood disorder.

Summary of definitions

NICE guidelines 2007 CFS/ME (England & Wales, NHS)

That a patient have fatigue with all of the following features:

• new or had a specific onset (that is, it is not life long)
• persistent and/or recurrent
• unexplained by other conditions
• has resulted in a substantial reduction in activity level characterised by post-exertional malaise and/or fatigue (typically delayed, for example by at least 24 hours, with slow recovery over several days)
• and one or more symptoms
• The diagnosis should be reconsidered if the person has none of the following symptoms: post-exertional fatigue or malaise, cognitive difficulties, sleep disturbance, chronic pain.

Empiric 2005 CFS (US Centers for Disease Control and Prevention, Reeves)

• SF-36: ≤ 70 on the physical function or ≤ 50 on the role physical or ≤ 75 on the social function or ≤ 66 on the role emotional subscales
• MFI: ≥ 13 on the general fatigue or ≥ 10 on the reduced activity subscales
• Symptom Inventory: ≥ 4 of 8 symptoms and scoring ≥ 25

Canadian Criteria 2003 ME/CFS (Canada, Carruthers)

• Fatigue of significant degree & new onset
• Post-exertional malaise (with slow recovery - more than 24 hours)
• Sleep dysfunction (Unrefreshing sleep or poor sleep quality)
• Pain (Significant degree)
• Neurological/cognitive manifestations. (Two or more from a list)
• At least one symptom from two of the following categories.
  • Autonomic manifestations
  • Neuroendocrine manifestations:
  • Immune manifestations
• lllness persisting for at least 6 months

Fukuda 1994 CFS (US Centers for Disease control and Prevention)

• 6 months duration of fatigue
• Substantial functional impairment
• Four symptoms required
• Cognitive or neuropsychiatric symptoms may be present
• New onset required
• Exclusions: Clinically important medical conditions, melancholic depression, substance abuse, bipolar disorder, psychosis, eating disorders

Oxford Criteria 1991 CFS (UK, Sharpe)

• 6 months duration of fatigue
• Disabling functional impairment - affects physical and mental functioning
• No symptoms specified
• Cognitive or neuropsychiatric symptoms - may be present
• Definite onset required
• Exclusions: Known physical causes, psychosis, bipolar disorder, eating disorder, organic brain disease, substance abuse
• Other psychiatric disorders (depressive illness, anxiety disorders) are not reasons for exclusion

Australia 1990 CFS (Aus, Lloyd)

• 6 months duration of fatigue
• Substantial functional impairment - disruption of daily activities
• Postexertional fatigue
• No symptoms specified
• Cognitive or neuropsychiatric symptoms required
• New onset not required
• Exclusions: Known physical causes, psychosis, bipolar disorder, substance abuse, eating disorders

London 1990 ME/PVFS (Derived from Dowsett & Ramsay)

• Complaint of general or local muscular fatigue following minimal exertion with prolonged recovery time
• Neurological disturbance, especially of cognitive, autonomic, and sensory functions
• Variable involvement of cardiac and other systems, a prolonged relapsing course
• Syndrome commonly initiated by respiratory and/or gastrointestinal infection but an insidious or more dramatic onset after neurological, cardiac, or endocrine disability

Holmes 1988 CFS (US Centers for Disease Control and Prevention)

• 6 months duration of fatigue
• Functional activity - 50% decrease in activity
• Six or eight symptoms required; physical signs sometimes required
• Neuropsychiatric symptoms - may be present
• New onset required
• Exclusions: Extensive list of known physical causes, psychosis, bipolar disorder, substance abuse.

Ramsay 1986 ME

• Muscle phenomena (Fatiguability, pain, clumsiness)
• Circulatory impairment (Cold extremities, Hypersensitivity to climactic change, Ashen-grey facial pallor, some twenty or thirty minutes before the Patient complains of feeling ill)
• Cerebral dysfunction (Impairment of memory, concentration, emotional lability)
• Other common deviations from normal cerebral function
• Other features that can be attributed to involvement of the Autonomic nervous system. (Frequency of micturition (urination), hyperacusis (hypersensitivity to noise), episodic sweating, orthostatic tachycardia)