special subjects
Chronic Fatigue Syndrome
Diagnosis of Chronic Fatigue Syndrome
Clinical criteria Laboratory evaluation to exclude non-CFS disorders The diagnosis of CFS is made by the characteristic history combined with a normal physical examination and normal laboratory test results. Any abnormal physical findings or laboratory results must be evaluated and alternative diagnoses that cause those findings and/or the patient's symptoms excluded before the diagnosis of CFS can be made. The case definition is often useful but should be considered an epidemiologic and research tool and in some circumstances should not be strictly applied to individual patients. nitrogen, creatinine, erythrocyte sedimentation rate, and thyroid-stimulating hormone. If indicated by clinical findings, further testing in selected patients may include chest x-ray, Testing , and In February 2015, the Institute of Medicine (now the Health and Medicine Division of The National Academies of Science, Engineering, and Medicine ["the National Academies"]) published an extensive review of this disease calledBeyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. In this review, they proposed a new name, systemic exertion intolerance disease (SEID), and new diagnostic criteria that simplified the diagnosis and emphasized the most consistent features (see table). In addition, the review clearly emphasized the validity of this debilitating disease. Referring the patient and family members to this document can help improve their understanding and emphasize the validity of their often disabling disease. Diagnosis requires that the patient have the following 3 symptoms: A substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities that persists for more than 6 months and is accompanied by fatigue, which is often profound, is of new or definite onset (not lifelong), is not the result of ongoing excessive exertion, and is not substantially alleviated by rest Post-exertional malaise† Unrefreshing sleep† At least one of the following manifestations is also required: Cognitive impairment† Orthostatic intolerance *Diagnostic criteria proposed by the Institute of Medicine(now the Health and Medicine Division of The National Academies of Science, Engineering, and Medicine) in February 2015. † Frequency and severity of symptoms should be assessed. The diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) should be questioned if patients do not have these symptoms at least half of the time with moderate, substantial, or severe intensity. 