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

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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