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A comparative RV of systemic & neurological symptoms in 12 outbreaks described as Chronic Fatigue Syndrome (CFS), epidemic neuromyasthenia, & ME

  [ 73 votes ]   [ Discuss This Article ] • January 5, 1994

Outbreaks of illnesses of unknown etiology typified by a chronic
relapsing course of constitutional symptoms and nervous system
involvement have collectively been referred to as chronic
fatigue syndrome, epidemic neuromyasthenia, and myalgic
encephalomyelitis. To examine heterogeneity of clinical
presentation, a comparative review was undertaken for 12
well-documented outbreaks reported since 1934. A systemic
syndrome characterized by excessive fatigue, myalgias,
headache, low-grade fever, and other constitutional symptoms
was common to cases in all outbreaks. However, marked
heterogeneity in the range of neurological features was
apparent. On the basis of predominant neurological
manifestations, outbreaks could be grouped into four levels of
increasing neurological involvement: affective
neuropsychological changes (level I); prominent cutaneous
sensory symptoms with both affective and cognitive
neuropsychological changes (level II); marked objective
paresis with cutaneous sensory as well as affective and
cognitive neuropsychological changes (level III); and
cutaneous sensory, affective and cognitive neuropsychological,
posterior column, cranial nerve, and mixed upper and lower
motor neuron changes (level IV). Groups with the most
prominent objective neurological findings (levels III and IV)
comprised exclusively outbreaks reported between the 1930s and
1950s. All but one outbreak in groups with less prominent
neurological findings (levels I and II) were reported between
the 1960s and 1980s; a range of neurological features was
observed for these groups. Because a complete neurological
examination is not emphasized as part of the diagnostic workup
in current outbreaks, it is possible that less obvious
neurological findings may be overlooked. Careful evaluation of
neurological features in epidemic and endemic cases of what is
now called chronic fatigue syndrome may be one approach to
distinguishing subtypes of what has been described in the past
as a nosological entity.

Briggs NC, Levine PH

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