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=== CDC Intervention === In 1987, researchers from the US [[Centers for Disease Control]] & Prevention ([[CDC]]) decided to treat the Lake Tahoe outbreak of M.E. as well as other M.E. outbreaks from the mid-1980s as an entirely new illness, yet another decision based on a complete lack of patient examination.<ref>[https://www.cdc.gov/mmwr/preview/mmwrhtml/00000740.htm Chronic Fatigue Possibly Related to Epstein-Barr Virus -- Nevada - MMWR - CDC]</ref> It was only after the doctors managing the epidemics used over $200,000 of their own money to fund MRIs, that they found their patients had brain lesions indistinguishable from those found in people with AIDS. Nonetheless, these findings were dismissed because they were not present in all patients and in 1988 the CDC christened the illness [[chronic fatigue syndrome]] (CFS) instead of ME, effectively because three ME experts left the committee meeting early due to (1) a lack of patient information and (2) the remaining members’ preoccupation with Epstein-Barr Virus, which was biologically incapable of causing the outbreaks due to the virus’s extensive latency period. CFS is a highly contentious concept to patients and specialists. Because of the similarity in terminology, CFS is often confused with “chronic fatigue”; many believe this to have been intentional for the benefit of disability insurance companies. ([[Osler's Web]], [[Hillary Johnson]], pp 217 – 219). In 1993 the term chronic fatigue syndrome was added to the alphabetic list of the WHO ICD classification under R53.82 “Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified.” Although neither CFS nor its criteria were developed to replace ME, many, particularly in the psychiatry field, falsely promoted the notion that ME was synonymous with CFS. The first CFS criteria ([[Holmes criteria]]) published in 1988 by Holmes (5) were in fact created “to provide a rational basis for evaluating patients who have chronic fatigue of undetermined cause.” ==== CFS research and Psychiatric paradigm ==== Research increased after the CFS criteria were further relaxed in 1994, but it was criticized for its over-inclusiveness. With all objective signs now expunged, the obvious possibility of misdiagnosis bedeviled clinical and research work. Lacking a diagnostic laboratory test of any kind, CFS is frequently misdiagnosed in patients presenting symptoms to other similar biological conditions, infections such as [[Lyme disease]] (for which standard testing produces an extremely high rate of false-negatives) or [[Epstein-Barr virus]] (the cause of glandular fever/infectious mononucleosis), or psychological conditions. A lack of information and awareness has led to both ME and CFS patients being stigmatized, sometimes as hypochondriacs or lazy, yet at other times as over-active and perfectionist. More accurate criteria should help to increase homogeneity and identify pathology. It has also been noted that some journals operate pro-psychiatric editorial policies, resulting in a narrow range of opinions and undermining the physicians’ understanding of the illness. A major recurrent criticism of CFS is that it does not make [[post-exertional malaise]] or muscle weakness an essential criteria, thus leading to the uncertainty and controversy over the appropriateness of physical rehabilitation programmes. ==== ME Redux ==== Recent research on CFS may be relevant to ME. For example, studies have revealed pathologically delayed recovery of muscle strength, cardiac and vascular abnormalities, and defects in cellular metabolism. Neurocognitive dysfunction has been objectively observed; and physiological abnormalities relating to immune activity, [[gene expression]], oxidative stress, and nervous system have also been found, plus many psychological and psychiatric studies have also been done. The CDC now recognizes CFS as a serious illness but also [listed] ME as a differential diagnosis on their website [until 2011], reflecting the incompatibility of the traditional definitions by stating the following: “Various terms are often used interchangeably with CFS. CFS is the preferred term because it has an internationally accepted case definition that is used in research and clinical settings. The name [[Chronic Fatigue Immune Dysfunction Syndrome]] (CFIDS) was introduced soon after CFS was defined; there is no case definition for CFIDS, and the name implies an understanding about the pathophysiology of CFS that does not currently exist. Chronic active Epstein-Barr virus (EBV) infection (chronic mononucleosis) was thought to be the cause of CFS during the 1980s, and this association is now known to be rare. However, post-infection fatigue syndromes have been associated with EBV and other infectious agents. The name myalgic encephalomyelitis (ME) was coined in the 1950s to clarify well-documented outbreaks of disease; however, ME is accompanied by neurologic and muscular signs and has a case definition distinct from that of CFS” (Centers for Disease Control and Prevention). Patients and specialists alike have long lobbied for a name and definition change or reversal of “CFS”. In January 2007, the American “CFS Name Change Advisory Board” consisting of doctors [[Lucinda Bateman]], [[David Bell]], [[Paul Cheney]], [[Leonard Jason]], [[Nancy Klimas]], [[Charles Lapp]], and [[Daniel Peterson]]–several of whom were present in the 1980s outbreaks–agreed that “CFS downplays the severity of the disease and is hurtful to patients” and publicized their deliberation that CFS should now be termed ME. However, no statement was made on definition, and considering the slew of misdiagnosed individuals accrued within the “CFS” umbrella since 1988, other doctors, researchers, and ME experts insist that the CFS illness described by the CDC and [[Oxford criteria]] in the UK, no longer represents ME. There are historical reasons for choosing myalgic encephalomyelitis as the name, however the acute post-viral onset, brain inflammation, neurological damage, and extremely specific pattern of muscle fatigue inherent in ME are not a required part of any CFS diagnosis. Multiple studies from Jason et al. show most people with a CFS diagnosis do not have myalgic encephalomyelitis. In 2003 a group of international specialists published the consensus definition of an illness now termed [[ME/CFS]] the criteria of which, including CNS and exertional signs, was more like that of ME than CFS. However, there is no ICD code for “ME/CFS” or “CFS/ME.” Although ME remains under ICD G93.3 as “benign myalgic encephalomyelitis,” Professor [[Malcolm Hooper]] (6) explains: “The word ‘benign’ was used because it was thought at the time that the disorder was not fatal (as poliomyelitis could be, with which it had some similarity), but it was quickly realised by clinicians that ME was not a benign condition, as it has such high morbidity… By 1988 clinicians had stopped using the word ‘benign’ and referred to it as ME, the first to do so being Dr. [[Melvin Ramsay]].” The ICD-10-CM officially states that ME and CFS are two separate entities, each mutually exclusive of the other. ME is listed as subset of G93.3 [[Postviral fatigue syndrome]] under Diseases of the nervous system, while CFS is listed under R53.82 as a subset of Malaise and fatigue. Both entities have “a type 1 exclusion” listed for the other, which is “used when two conditions cannot occur together.” The World Health Organization’s (WHO) International Classification of Diseases (ICD) page for ME explicitly states R53.82 Chronic Fatigue Syndrome as a type 1 exclusion that “should never be used at the same time as G93.3. A type 1 excludes note is used when two conditions cannot occur together.”--[[User:DxCFS|DxCFS]] ([[User talk:DxCFS|talk]]) 20:20, 16 December 2016 (PST) - Except for the blog the ME post came from, I found nothing about ME being Dx for those farther from Equator but rather MS. (I don't even believe the one about MS.) Since ME seems to be more common in people who live farther from the equator, another theory proposes that decreased sunlight exposure and possibly decreased [[vitamin D]] production may help cause ME. This theory is bolstered by recent research into the biochemistry of vitamin D, which has shown that it is an important immune system regulator.--[[User:DxCFS|DxCFS]] ([[User talk:DxCFS|talk]]) 20:20, 16 December 2016 (PST) - Environment Tab I don't think the beliefs about the disease are completely inline with the following two paragraphs anymore. Move them here for others to decide and find research and clinical citations. The most popular hypothesis is that a flu-like virus or viral infection or retroviral reactivation primes a susceptible immune system for an abnormal reaction later in life. On a molecular level, this might occur if there is a structural similarity between the infectious virus and some component of the central nervous system, leading to eventual confusion in the immune system. Research has shown that, much like the relationship between HIV and AIDS, the immune dysfunction accompanying ME can lead to temporary or permanent disease progression, regardless of the infection or combination of infections to which the ME sufferer is exposed. Additionally, ME sufferers can be more prone to opportunistic infections.--[[User:DxCFS|DxCFS]] ([[User talk:DxCFS|talk]]) 21:06, 16 December 2016 (PST) ---- A Rainbow at Night - Blog no longer exists and could not find these quotes and info in a PDF or anywhere else. Moving here so someone can find info somewhere and cite. Seems very specific so I think it needed to be moved until we can find like information. "The later course of ME is difficult to predict, and may either become consistently severe, improve to a plateau, or be markedly relapse-remitting. In some, even prolonged severe incapacitation can be relieved by unpredictable remission, although relapse is always possible. The degree of impairment and complexity depends on the degree of diffuse brain injury and end organ involvement." There are no standard subtypes. Some researchers and clinicians have proposed distinguishing between a relapsing-remitting and progressive course. [citation needed] However, it is difficult to distinguish between natural variation in the population of ME patients who might share a common disease process but owing to individual, genetic, or environmental differences, have different symptom clusters or disease course versus heterogeneity created by imprecise criteria and misdiagnosis.--[[User:MEcfsFMS|MEcfsFMS]] ([[User talk:MEcfsFMS|talk]]) 22:19, 7 September 2018 (EDT)
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