New Definition for Chronic Fatigue Syndrome Announced
By By: Philip K. Nelson, M.D. •
May 1, 1995
The long awaited, revised Case Definition for Chronic Fatigue Syndrome by Keiji Fukuda, M.D. and co-workers was published in the December 1994 Annals of Internal Medicine. The authors represent the CDC, the NIH, and a broad spectrum of researchers and clinicians working with Chronic Fatigue Syndrome patients. They also include a conceptual design for CFS and a set of research guidelines for use in studying patients with unexplained fatigue.
NEW CASE DEFINITION FOR CHRONIC FATIGUE SYNDROME:
Fatigue: Patients must have otherwise unexplained, relapsing fatigue that is new (not life-long); not the result of ongoing exertion; not relieved by rest; and that results in substantial decrease in levels of occupational, social, educational, or personal activities.
Symptoms: The patient must have four or more of the following eight symptoms. (Previously, the case definition required patients to have at least eight of a list of eleven symptoms.) Symptoms must have persisted for six months and must not have predated fatigue.
Self reported impairment of memory or concentration that affects occupational, social, educational, or personal activities.
Tender cervical (neck area) or axillary (underarm area) nodes.
Myalgias (muscle pain).
Arthralgias (pain along the nerve of a joint). No redness or swelling.
Headache of a new type.
Post-exertional malaise, lasting 24 hours.
OTHER ISSUES ADDRESSED IN THE ARTICLE:
Clinical and laboratory Evaluation Should Include:
Mental status exam. Evidence of psychiatric or neurologic disorders requires consultation.
Thorough physical examination.
Tests to rule out other illnesses. Tests should include the following:
Complete blood count.
Erythrocyte sedimentation rate.
Thyroid stimulating hormone.
Further testing may be suggested on an individual basis; for example, MRI to rule out multiple sclerosis.
The authors stated that conditions which can explain fatigue, in their opinion, rule out the diagnosis of Chronic Fatigue Syndrome. Examples of such conditions include:
A medical condition, such as untreated hypothyroidism, sleep apnea, narcolepsy, or the effects of some medications.
Previously diagnosed and unresolved medical conditions such as malignancy or chronic hepatitis.
Major psychiatric disorders, past or present, including major depressive disorder, bipolar disease, schizophrenia, anorexia nervosa, or butimia.
Substance abuse within two years before the onset of fatigue or at any time after the onset.
Conditions that do not explain fatigue, and thus are permitted in the Case Definition, include:
Conditions that cannot be confirmed by laboratory tests, such as fibromyalgia, anxiety disorders, non- psychotic depression or multiple chemical sensitivities.
Medical conditions which might cause fatigue but have been treated adequately; for example, hypothyroidism with normal blood thyroid levels.
Lyme disease or syphilis treated before the onset of CFS.
Any isolated or unexplained physical finding or laboratory test.
Idiopathic Chronic Fatigue
This is a new term defined as clinically evaluated chronic fatigue that fails to meet the above criteria. The reasons for failing to meet criteria should be specified.
Manasota CFS wishes to thank Dr. Nelson for summarizing the new case definition.
Excerpted from "Defining Chronic Fatigue Syndrome" by Philip K, Nelson, M.D., The Manasota Palmetto, January 1995, Sarasota, FL. Reprinted with permission.
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