Abstract
Myalgic encephalomyelitis (ME), described in the medical literature since 1938, is characterized by distinctive muscular symptoms, neurological symptoms, and signs of circulatory impairment. The only mandatory feature of chronic fatigue syndrome (CFS), introduced in 1988 and redefined in 1994, is chronic fatigue, which should be accompanied by at least four or more out of eight “additional” symptoms. The use of the abstract, polythetic criteria of CFS, which define a heterogeneous patient population, and self-report has hampered both scientific progress and accurate diagnosis. To resolve the “diagnostic impasse” the Institute of Medicine proposes that a new clinical entity, systemic exercise intolerance disease (SEID), should replace the clinical entities ME and CFS. However, adopting SEID and its defining symptoms, does not resolve methodological and diagnostic issues. Firstly, a new diagnostic entity cannot replace two distinct, partially overlapping, clinical entities such as ME and CFS. Secondly, due to the nature of the diagnostic criteria, the employment of self-report, and the lack of criteria to exclude patients with other conditions, the SEID criteria seem to select an even more heterogeneous patient population, causing additional diagnostic confusion. This article discusses methodological and diagnostic issues related to SEID and proposes a methodological solution for the current “diagnostic impasse”.
Highlights
In 1938 a detailed analysis of an outbreak of “atypical poliomyelitis” among the personnel of the Los Angeles County General Hospital during the summer of 1934 was published [1]
Myalgic encephalomyelitis (ME) has been described under various names, mainly on account of outbreaks [2,3], and in 1956 myalgic encephalomyelitis (ME) was identified as a new clinical entity [4] in response to an outbreak in the Royal Free Hospital in London in 1955 [5] and earlier outbreaks all over the world
Jason et al [20], for example, observed that even when these thresholds are applied, 4.7% of the healthy controls still met the diagnostic criteria for chronic fatigue syndrome (CFS) [9] and at least 4% of the patients would not meet the diagnosis of CFS, since their “fatigue” would be insufficient
Summary
In 1938 a detailed analysis of an outbreak of “atypical poliomyelitis” among the personnel of the Los Angeles County General Hospital during the summer of 1934 was published [1]. The diagnostic criteria for ME and CFS define two distinct, partially overlapping, clinical. Diagnostic criteria for ME and CFS define two distinct, partially overlapping, clinical entities (see entities (see Figure 1). 1980s/1990s the the Institute of Medicine (IOM) partly was asked define diagnostic criteria myalgic [8,9], encephalomyelitis/chronic fatigue(IOM). Intolerance disease (SEID), defined by new diagnostic criteria, should replace the clinical entities ME. In response to that request, the IOM proposed that a new clinical entity, systemic exercise intolerance and CFS. This clinical entity SEID has already been embraced by some researchers [15]. This article disease (SEID), defined by new diagnostic criteria, should replace the clinical entities ME and CFS. This paragraph discusses implications of the starting points of the development process, which significantly affected the outcome, which will be discussed in the paragraph
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