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Post-exertional malaise
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=== PENE === Of all case definitions, the 2011 [[International Consensus Criteria]] (ICC)<ref name="ICC" /> offered the most precise and elaborated definition of the post-exertional symptoms that characterize ME. To differentiate it from post-exertional malaise, the term used in the [[Fukuda criteria]], the authors introduced a new name: '''Post-Exertional Neuroimmune Exhaustion''' (PENE).Β PENE is described as βa [[pathological inability to produce sufficient energy on demand with prominent symptoms primarily in the neuroimmune regions]]β<ref name="ICC" /> and has the following characteristics: # [[Marked, rapid physical and/or cognitive fatigability in response to exertion]], which may be minimal such as activities of daily living or simple mental tasks, can be debilitating and cause a relapse. # [[Post-exertional symptom exacerbation]]: e.g. acute [[flu-like symptoms]], [[pain]] and worsening of other symptoms. # [[Post-exertional exhaustion: immediate or delayed|Post-exertional exhaustion]] may occur immediately after activity or be [[delayed onset of post-exertional symptoms|delayed by hours or days]]. # [[Recovery period is prolonged, usually taking 24 hours or longer]]. A relapse can last days, weeks or longer. # [[lack of stamina|Low threshold of physical and mental fatigability]] (lack of stamina) results in a substantial reduction in pre-illness activity level. The definition fails however to make clear how frequent these symptoms must occur to diagnose PENE, but all must be present.
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