In de Journal of Medical Diagnostic verscheen onlangs een overzichtsartikel
waarin de huidige situatie (verschillende diagnosecriteria, vragenlijstjes) geschetst wordt
en een 'nieuwe' aanpak in hoofdlijnen samengevat wordt:
een duidelijk onderscheid tussen ME (op basis van de oorspronkelijke criteria) en CVS, en
het gebruik van objectieve testmethoden, zoals dubbele fietstesten en cognitieve testen,
om de ernst van de symptomen en de beperkingen duidelijk te maken.
An accurate diagnosis of Myalgic Encephalomyelitis and chronic fatigue syndrome
requires strict clinical case definitions and objective test methods.
J Med Diagn Meth 6:249. doi: 10.4172/2168-9784.1000249.
Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS) are subject to controversy.
Although ME and CFS are often considered to be to be synonymous,
the case criteria for ME and CFS define two distinct diseases with partial overlap.
ME, recognized as a new clinical entity in the 1950ís,
is characterized by distinctive muscular, neurological and autonomic symptoms.
In contrast the core feature of CFS, introduced in 1988 and redefined in 1994, is chronic fatigue.
Some researchers consider CFS to be equivalent to (incapacitating) chronic fatigue (CF).
After the introduction of CFS,
other criteria for ME, ME/CFS, CFS and CF were introduced and used in research studies,
creating obfuscation and controversy.
The use of various diagnostic criteria has hampered effective research into ME and CFS.
Next to the various diagnostic criteria,
the assessment of symptoms is almost always based on
questionnaires and subjective measures, e.g. physical functioning.
Due to their nature subjective measures are incomparable over time and between patients.
Moreover subjective measures introduce a significant risk of bias,
for example due to researcher allegiance, the Hawthorne effect, and buy-in effects.
Despite the fact that ME and CFS (subclasses) lack a clear etiological explanation (yet),
the symptoms can and should be assessed by objective test measures,
since subjective measures are ambiguous, incomparable and minimize the risk of bias.
Objective test measures can also confirm the seriousness of both ME and CFS.
To resolve the diagnostic issues in research studies and clinical practice,
a clear distinction between ME and CFS (not ME), based on the original criteria, is crucial.
Although the use of objective test methods is more expensive and time-consuming and
severe cases cannot be subjected to these tests,
considering the (scientific) confusion originating from the use of subjective measures
it is essential to assess the symptoms of patients objectively
both in clinical practice and research settings.
Diagnosis; Myalgic encephalomyelitis; Chronic fatigue syndrome;
Symptoms assessment; Criteria; Methods