22 July 2011
Researchers and clinicians from as far afield as Canada, Belgium, USA, Australia, New Zealand, Norway, Italy, Ireland, Korea, Chile, Japan and Latvia have joined forces to propose the development of International Consensus Criteria to help “help clarify the unique signature of ME.,” in a paper published online on Wednesday (20 July).
The UK is represented by Terry Mitchell, former clinical champion for CFS/M.E. in East Angla (retired) and Nigel Speight, Medical Adviser to the ME Association and 25% Group.
As well as describing distinct symptom clusters and underlying interactions, the panel is developing Physicians’ Guidelines and says, “Individuals meeting the International Consensus Criteria have myalgic encephalomyelitis and should be removed from the Reeves empirical criteria and the National Institute for Clinical Excellence (NICE) criteria for chronic fatigue syndrome.”
The basis of the new criteria was the Canadian Consensus document, recently revised.
The latest criteria, which no longer require a six-month wait before diagnosis, aim to establish “a more selective set of clinical criteria that would identify patients who have neuroimmune exhaustion with a pathological low-threshold of fatigability and symptom flare in response to exertion.”
“The label ‘chronic fatigue syndrome’ (CFS) has persisted for many years because of lack of knowledge of the etiological agents and of the disease process.
“In view of more recent research and clinical experience that strongly point to widespread inflammation and multisystemic neuropathology, it is more appropriate and correct to use the term ‘myalgic encephalomyelitis’ (M.E.) because it indicates an underlying pathophysiology.
“It is also consistent with the neurological classification of M.E. in the World Health Organisation’s International Classification of Diseases (ICD G93.3).
“Consequently, an International Consensus Panel consisting of clinicians, researchers, teaching faculty and an independent patient advocate was formed with the purpose of developing criteria based on current knowledge.
Thirteen countries and a wide range of specialties were represented. Collectively, members have approximately 400 years of both clinical and teaching experience, authored hundreds of peer reviewed publications, diagnosed or treated approximately 50,000 ME patients, and several members coauthored previous criteria. The expertise and experience of the panel members as well as PubMed and other medical sources were utilized in a progression of suggestions/drafts/reviews/revisions. The authors, free of any sponsoring organization, achieved 100% consensus through a Delphi type process.
“The scope of this paper is limited to criteria of M.E. and their application. Accordingly, the criteria reflect the complex symptomatology. Operational notes enhance clarity and specificity by providing guidance in the expression and interpretation of symptoms. Clinical and research application guidelines promote optimal recognition of ME by primary physicians and other health care providers, improve consistency of diagnoses in adult and paediatric patients internationally, and facilitate clearer identification of patients for research studies.” (Copyright © 2011 The Association for the Publication of the Journal of Internal Medicine).
The complexity of symptoms to be tested under the Canadian Consensus document was recently criticised by some UK clinicians as impractical.
The latest consensus paper says: “The International Symptom Scale should not be part of the initial clinical interview because it may disturb the weighting and significance of results obtained for an individual patient. When used periodically, it can help position the patient within the group, orient the treatment program and monitor its effectiveness.”