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[[File:ME CFS symptoms CCC.png|frameless|upright=0.75|right|Simplified Canadian Consensus Criteria for ME/CFS.]]
[[File:ME CFS symptoms CCC.png|frameless|upright = 0.75|right|Simplified Canadian Consensus Criteria for ME/CFS.]]
The [[Canadian Consensus Criteria|Canadian consensus criteria]] (CCC) or the '''Canadian working definition''' are a proposed clinical criteria for [[ME/CFS]], published in 2003, and frequently used as a case definition in research.<ref name="Carruthers, 2003" /> The Canadian definition is a strictest diagnostic criteria, selecting a smaller group of patients than the [[Fukuda criteria]] and a more severely impaired population.<ref>http://www.meaction.net/2015/12/10/norwegian-researchers-ask-what-exactly-is-m-e/</ref> Adults are diagnosed after a minimum of six months of illness and children after a minimum of three months.
The [[Canadian Consensus Criteria|Canadian consensus criteria]] (CCC) or the '''Canadian working definition''' are a proposed clinical criteria for [[ME/CFS]], published in 2003, and frequently used as a case definition in research.<ref name="Carruthers, 2003">{{Citation | last1 = Carruthers | first1 = Bruce M. | author-link1 = Bruce Carruthers | last2 = Jain | first2 = Anil Kumar | author-link2 = Anil Kumar Jain | last3 = De Meirleir | first3 = Kenny L. | author-link3 = Kenny De Meirleir | last4 = Peterson | first4 = Daniel L. | author-link4 = Daniel Peterson | last5 = Klimas | first5 = Nancy G. | author-link5 = Nancy Klimas | last6 = Lerner | first6 = A. Martin | author-link6 = Martin Lerner | last7 = Bested | first7 = Alison C. | author-link7 = Alison Bested | last8 = Flor-Henry | first8 = Pierre | author-link8 = Pierre Flor-Henry | last9 = Joshi | first9 = Pradip | author-link9 = Pradip Joshi | last10 = Powles | first10 = AC Peter | author-link10 = A C Peter Powles | last11 = Sherkey | first11 = Jeffrey A. | author-link11 = Jeffrey Sherkey | last12 = van de Sande | first12 = Marjorie I. | author-link12 = Marjorie van de Sande | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols | journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | pages = 7-115 | date = 2003 | pmid = | doi =  10.1300/J092v11n01_02 | url = http://www.meresearch.org.uk/wp-content/uploads/2012/11/2003-Carruthers-Canadian-Definition-JCFS.pdf }}</ref> The Canadian definition is a strictest diagnostic criteria, selecting a smaller group of patients than the [[Fukuda criteria]] and a more severely impaired population.<ref>http://www.meaction.net/2015/12/10/norwegian-researchers-ask-what-exactly-is-m-e/</ref> Adults are diagnosed after a minimum of six months of illness and children after a minimum of three months.


==Definition==  
==Definition==


{| class="wikitable"  
{| class="wikitable"  
|+'''Canadian Consensus Criteria''' for Myalgic Encephalomyelitis/<wbr>Chronic Fatigue Syndrome<ref name=":0">{{Cite web | url = http://www.investinme.org/Documents/PDFdocuments/Canadian_ME_Overview_A4.pdf | title=Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Clinical Case Definition and Guidelines for Medical Practitioners - An Overview fo the Canadian Consensus Document | date = |access-date=|website=Invest in ME Research | last = Carruthers | first = Bruce | authorlink = Bruce Carruthers | last2 = van de Sande | first2 = Marjorie | authorlink2 = Marjorie van de Sande| archive-url = | archive-date = |url-status = | page=4|quote=Physical or mental exertion often causes debilitating malaise and/or fatigue, generalized pain, deterioration of cognitive functions, and worsening of other symptoms that may occur immediately after activity or be delayed. Patients experience rapid muscle fatigue and lack endurance.}}</ref>  
|+'''Canadian Consensus Criteria''' for Myalgic Encephalomyelitis/<wbr>Chronic Fatigue Syndrome<ref name=":0">{{Cite web | url = http://www.investinme.org/Documents/PDFdocuments/Canadian_ME_Overview_A4.pdf | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Clinical Case Definition and Guidelines for Medical Practitioners - An Overview fo the Canadian Consensus Document | date = | access-date = | website = Invest in ME Research | last = Carruthers | first = Bruce | author-link = Bruce Carruthers | last2 = van de Sande | first2 = Marjorie | author-link2 = Marjorie van de Sande | archive-url = | archive-date = |url-status = | page = 4 |quote = Physical or mental exertion often causes debilitating malaise and/or fatigue, generalized pain, deterioration of cognitive functions, and worsening of other symptoms that may occur immediately after activity or be delayed. Patients experience rapid muscle fatigue and lack endurance.}}</ref>  
| colspan="3" |A patient with [[ME/CFS]] will meet the criteria for fatigue, [[post-exertional malaise]] and/or [[Chronic fatigue|fatigue]], [[sleep dysfunction]] and [[pain]]; have two or more [[Nervous system|neurological]]/[[Cognitive dysfunction|cognitive]] manifestations and one or more symptoms from two of the categories of (a) [[Autonomic nervous system|autonomic]], (b) [[Neuroendocrine symptoms|neuroendocrine]] and (c) [[:Category:Immune signs and symptoms|immune manifestations]]; and adhere to [[#item7|item 7]].
| colspan="3" |A patient with [[ME/CFS]] will meet the criteria for fatigue, [[post-exertional malaise]] and/or [[Chronic fatigue |fatigue]], [[sleep dysfunction]] and [[pain]]; have two or more [[Nervous system|neurological]]/[[Cognitive dysfunction |cognitive]] manifestations and one or more symptoms from two of the categories of (a) [[Autonomic nervous system|autonomic]], (b) [[Neuroendocrine symptoms|neuroendocrine]] and (c) [[:Category:Immune signs and symptoms|immune manifestations]]; and adhere to [[#item7|item 7]].
|-
|-
| style="background-color: Orange;color:black;text-shadow:none" |1  
| style="background-color: Orange;color:black;text-shadow:none" |1  
|'''[[Chronic fatigue|Fatigue]]'''<br />Required
|'''[[Chronic fatigue |Fatigue]]'''<br />Required
|The patient must have a significant degree of new onset, unexplained, persistent, or recurrent physical and mental [[fatigue]] that [[Substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities|substantially reduces activity level]].
|The patient must have a significant degree of new onset, unexplained, persistent, or recurrent physical and mental [[fatigue]] that [[Substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities|substantially reduces activity level]].
|-
|-
| style="background-color: Gold;color:black;text-shadow:none" |2
| style="background-color: Gold;color:black;text-shadow:none" |2
|'''[[Post-exertional malaise|Post-Exertional Malaise]] and/or Post-Exertional Fatigue'''<br />Required
|'''[[Post-exertional malaise |Post-Exertional Malaise]] and/or Post-Exertional Fatigue'''<br />Required
|There is an inappropriate [[lack of stamina|loss of physical and mental stamina]], rapid [[Muscle fatigability|muscular]] and [[cognitive dysfunction|cognitive fatigability]], [[Post-exertional malaise|post-exertional malaise]] and/or post-exertional fatigue and a tendency for other associated symptoms within the patient’s cluster of symptoms to worsen.  
|There is an inappropriate [[lack of stamina|loss of physical and mental stamina]], rapid [[Muscle fatigability|muscular]] and [[cognitive dysfunction |cognitive fatigability]], [[Post-exertional malaise |post-exertional malaise]] and/or post-exertional fatigue and a tendency for other associated symptoms within the patient’s cluster of symptoms to worsen.  
There is a [[Recovery period is prolonged, usually taking 24 hours or longer|pathologically slow recovery period – usually 24 hours or longer]].
There is a [[Recovery period is prolonged, usually taking 24 hours or longer|pathologically slow recovery period – usually 24 hours or longer]].
|-
|-
| style="background-color: Plum;color:black;text-shadow:none" |3
| style="background-color: Plum;color:black;text-shadow:none" |3
|[[Sleep dysfunction|'''Sleep Dysfunction''']] (*) <br />Required
|[[Sleep dysfunction |'''Sleep Dysfunction''']] (*) <br />Required
|There is [[unrefreshing sleep]] or sleep quantity or rhythm disturbances such as [[reversed or chaotic diurnal sleep rhythms]]. Note that patients without sleep dysfunction can still meet the diagnostic criteria if their illness began with an infection — see [[#star|(*)]] below.  
|There is [[unrefreshing sleep]] or sleep quantity or rhythm disturbances such as [[reversed or chaotic diurnal sleep rhythms]]. Note that patients without sleep dysfunction can still meet the diagnostic criteria if their illness began with an infection — see [[#star|(*)]] below.  
|-
|-
| style="background-color: Tomato;color:black;text-shadow:none" |4
| style="background-color: Tomato;color:black;text-shadow:none" |4
|[[Pain|'''Pain''']] (*) <br />Required  
|[[Pain |'''Pain''']] (*) <br />Required  
|There is a significant degree of [[myalgia]]. Pain can be experienced in the [[Myalgia|muscles]], and/or [[Arthralgia|joints]], and is often widespread and migratory in nature. Often there are significant [[headache]]s of new type, pattern or severity. Note that patients without pain can still meet the diagnostic criteria if their illness began with an infection — see [[#star|(*)]] below.
|There is a significant degree of [[myalgia]]. Pain can be experienced in the [[Myalgia|muscles]], and/or [[Arthralgia|joints]], and is often widespread and migratory in nature. Often there are significant [[headache]]s of new type, pattern or severity. Note that patients without pain can still meet the diagnostic criteria if their illness began with an infection — see [[#star|(*)]] below.
|-
|-
| style="background-color:LightGreen;color:black;text-shadow:none" |5
| style="background-color:LightGreen;color:black;text-shadow:none" |5
|'''[[Nervous system|Neurological]] / [[Cognitive dysfunction|Cognitive Manifestations]]'''<br />Two or more
|'''[[Nervous system|Neurological]] / [[Cognitive dysfunction |Cognitive Manifestations]]'''<br />Two or more
|'''<u>Two or more</u>''' of the following difficulties should be present: 
|'''<u>Two or more</u>''' of the following difficulties should be present: 
* [[Confusion]]
* [[Confusion]]
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* [[Disorientation]]
* [[Disorientation]]
* [[Difficulty with information processing|Difficulty with information processing]], categorizing and word retrieval ([[word-finding problems]])
* [[Difficulty with information processing|Difficulty with information processing]], categorizing and word retrieval ([[word-finding problems]])
* Perceptual and sensory disturbances (for example [[spatial instability]] and [[spacial disorientation|disorientation]] and [[inability to focus vision]])
* Perceptual and sensory disturbances (for example [[spatial instability]] and [[spacial disorientation |disorientation]] and [[inability to focus vision]])


[[Ataxia]], [[muscle weakness]] and [[fasciculation]]s are common. There may be [[#overloadnote|overload<sup>1</sup> phenomena]]: [[cognitive overload]], [[sensory overload]] (for example [[photophobia]] and [[Hyperacusis|hypersensitivity to noise]]) and/or [[emotional overload]], which may lead to [[#crashnote|crash<sup>2</sup> periods]] and/or [[anxiety]].
[[Ataxia]], [[muscle weakness]] and [[fasciculation]]s are common. There may be [[#overloadnote |overload<sup>1</sup> phenomena]]: [[cognitive overload]], [[sensory overload]] (for example [[photophobia]] and [[Hyperacusis|hypersensitivity to noise]]) and/or [[emotional overload]], which may lead to [[#crashnote |crash<sup>2</sup> periods]] and/or [[anxiety]].
|-
|-
| rowspan="5" style="background-color: CornflowerBlue;color:black;text-shadow:none" |6
| rowspan="5" style="background-color: CornflowerBlue;color:black;text-shadow:none" |6
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|- class="dark" style="background-color: #f1f1f1;"
|- class="dark" style="background-color: #f1f1f1;"
|(a) '''Autonomic Manifestations'''
|(a) '''Autonomic Manifestations'''
* [[Orthostatic intolerance]] (either [[neurally mediated hypotension]], [[postural orthostatic tachycardia syndrome]] or [[Orthostatic hypotension|delayed orthostatic hypotension]])
* [[Orthostatic intolerance]] (either [[neurally mediated hypotension]], [[postural orthostatic tachycardia syndrome]] or [[Orthostatic hypotension |delayed orthostatic hypotension]])
* [[Light-headedness]]
* [[Light-headedness]]
* [[Extreme pallor]]
* [[Extreme pallor]]
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* Recurrent [[sore throat]]
* Recurrent [[sore throat]]
* Recurrent [[flu-like symptoms]]
* Recurrent [[flu-like symptoms]]
* [[Malaise|General malaise]]
* [[Malaise |General malaise]]
* New [[food sensitivities]], medication sensitivities and/or [[chemical sensitivities]]
* New [[food sensitivities]], medication sensitivities and/or [[chemical sensitivities]]
|-
|-
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| style="background-color: HotPink;color:black;text-shadow:none" |<span id="item7">7</span>
| style="background-color: HotPink;color:black;text-shadow:none" |<span id="item7">7</span>
|'''The Illness Persists for at Least Six Months'''<br />Required
|'''The Illness Persists for at Least Six Months'''<br />Required
|It usually has a [[#starstar|distinct onset, (**)]] although it may be gradual. Preliminary diagnosis may be possible earlier. Three months is appropriate for [[Pediatric myalgic encephalomyelitis/chronic fatigue syndrome|children]].
|It usually has a [[#starstar|distinct onset, (**)]] although it may be gradual. Preliminary diagnosis may be possible earlier. Three months is appropriate for [[Pediatric myalgic encephalomyelitis/chronic fatigue syndrome |children]].
|}
|}
To be included, the symptoms must have begun or have been significantly altered after the onset of this illness. It is unlikely that a patient will suffer from all symptoms in criteria 5 & 6. The disturbances tend to form symptom clusters that may fluctuate and change over time. [[Pediatric myalgic encephalomyelitis/chronic fatigue syndrome|Children]] often have numerous prominent symptoms but their order of severity tends to vary from day to day.   
To be included, the symptoms must have begun or have been significantly altered after the onset of this illness. It is unlikely that a patient will suffer from all symptoms in criteria 5 & 6. The disturbances tend to form symptom clusters that may fluctuate and change over time. [[Pediatric myalgic encephalomyelitis/chronic fatigue syndrome |Children]] often have numerous prominent symptoms but their order of severity tends to vary from day to day.   


<span id="star">'''(*)'''</span> There is a small number of patients who have no pain or sleep dysfunction, but no other diagnosis fits except ME/CFS. A diagnosis of ME/CFS can be entertained when this group has an infectious illness type onset.   
<span id="star">'''(*)'''</span> There is a small number of patients who have no pain or sleep dysfunction, but no other diagnosis fits except ME/CFS. A diagnosis of ME/CFS can be entertained when this group has an infectious illness type onset.   
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<span id="crashnote">2</span> [[crash|"Crash"]] refers to a temporary period of immobilizing physical and /or cognitive fatigue.
<span id="crashnote">2</span> [[crash|"Crash"]] refers to a temporary period of immobilizing physical and /or cognitive fatigue.


== Idiopathic chronic fatigue ==
==Idiopathic chronic fatigue==
People with [[chronic fatigue]] (lasting at least six months) but not meeting the criteria for ME/CFS should be diagnosed with [[idiopathic chronic fatigue]] instead.
People with [[chronic fatigue]] (lasting at least six months) but not meeting the criteria for ME/CFS should be diagnosed with [[idiopathic chronic fatigue]] instead.


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[[Bruce Carruthers]], [[Anil Kumar Jain]], [[Kenny de Meirleir]], [[Daniel Peterson]], [[Nancy Klimas]], [[A Martin Lerner]], [[Alison Bested]], [[Pierre Flor-Henry]], [[Pradip Joshi]], [[A C Peter Powles]], [[Jeffrey Sherkey]], [[Marjorie van de Sande]]<ref>http://sacfs.asn.au/download/consensus_overview_me_cfs.pdf</ref>
[[Bruce Carruthers]], [[Anil Kumar Jain]], [[Kenny de Meirleir]], [[Daniel Peterson]], [[Nancy Klimas]], [[A Martin Lerner]], [[Alison Bested]], [[Pierre Flor-Henry]], [[Pradip Joshi]], [[A C Peter Powles]], [[Jeffrey Sherkey]], [[Marjorie van de Sande]]<ref>http://sacfs.asn.au/download/consensus_overview_me_cfs.pdf</ref>


==Diagram of ME/CFS symptoms ==
==Diagram of ME/CFS symptoms==
[[File:ME CFS symptoms CCC.png|550px|thumb|center|Simplified diagram of ME/CFS Canadian consensus criteria symptoms]]
[[File:ME CFS symptoms CCC.png|550px|thumb|center|Simplified diagram of ME/CFS Canadian consensus criteria symptoms]]


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*[[International Consensus Criteria]]
*[[International Consensus Criteria]]


=== Generally accepted criteria for diagnosis ===
=== Generally accepted criteria for diagnosis===
*Canadian consensus criteria (CCC).<ref name="Carruthers, 2003" /> A diagnosis of moderate and severe forms of [[ME/CFS]] are accurately made using these criteria. Adults can be diagnosed at 6 months while pediatric cases are diagnosed at three months.
*Canadian consensus criteria (CCC).<ref name="Carruthers, 2003" /> A diagnosis of moderate and severe forms of [[ME/CFS]] are accurately made using these criteria. Adults can be diagnosed at 6 months while pediatric cases are diagnosed at three months.
*[[International Consensus Criteria|International consensus criteria]] (ICC).<ref name=":1">{{Cite journal | last = Carruthers | first = Bruce M. | authorlink = Bruce Carruthers | last2 = van de Sande | first2 = Marjorie I. | authorlink2 = Marjorie van de Sande | last3 = De Meirleir | first3 = Kenny L. | author-link3=Kenny De Meirleir | last4 = Klimas | first4 = Nancy G. | author-link4=Nancy Klimas | last5 = Broderick | first5 = Gordon | authorlink5 = Gordon Broderick | last6 = Mitchell | first6 = Terry | authorlink6 = Terry Mitchell | last7 = Staines | first7 = Donald | authorlink7 = Donald Staines | last8 = Powles | first8 = A.C. Peter | authorlink8 = AC Peter Powles | last9 = Speight | first9 = Nigel | author-link9 = Nigel Speight | last10 = Vallings | first10 = Rosamund | author-link10 = Rosamund Vallings | last11 = Bateman | first11 = Lucinda | authorlink11 = Lucinda Bateman | last12 = Baumgarten-Austrheim| first12 = Barbara | authorlink12 = Barbara Baumgarten-Austrheim | last13 = Bell | first13 = David | author-link13=David Bell | last14 = Carlo-Stella | first14 = Nicoletta |author-link14=Nicoletta Carlo-Stella | last15 = Chia | first15 = John | authorlink15 = John Chia | last16 = Darragh | first16 = Austin | authorlink16 = Austin Darragh | last17 = Jo | first17 = Daehyun | authorlink17 = Daehyun Jo | last18 = Lewis | first18 = Donald | author-link18=Donald Lewis | last19 = Light | first19 = Alan | authorlink19 = Alan Light | last20 = Marshall-Gradisnik | first20 = Sonya | authorlink20 = Sonya Marshall-Gradisnik | last21 = Mena | first21 = Ismael | author-link21=Ismael Mena | last22 = Mikovits | first22 = Judy | authorlink22 = Judy Mikovits | last23 = Miwa | first23 = Kunihisa | authorlink23 = Kunihisa Miwa | last24 = Murovska | first24 = Modra | authorlink24 = Modra Murovska | last25 = Pall | first25 = Martin | authorlink25 = Martin Pall | last26 = Stevens | first26 = Staci | authorlink26 = Staci Stevens | date = 2011-08-22 | title = Myalgic encephalomyelitis: International Consensus Criteria | url = https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2796.2011.02428.x|journal=Journal of Internal Medicine|language=en|volume=270|issue=4 | pages = 327–338|doi=10.1111/j.1365-2796.2011.02428.x|issn=0954-6820|pmc=3427890|pmid=21777306|via=}}</ref> These criteria will accurately diagnose [[myalgic encephalomyelitis]] (ME). There is no requirement that the individual have symptoms for a specified period of time for diagnosis, as opposed to CCC, [[Fukuda criteria|Fukuda]], and [[Systemic Exertion Intolerance Disease|SEID]], which all require 6 months in adults.
*[[International Consensus Criteria|International consensus criteria]] (ICC).<ref name=":1">{{Cite journal | last = Carruthers | first = Bruce M. | author-link = Bruce Carruthers | last2 = van de Sande | first2 = Marjorie I. | author-link2 = Marjorie van de Sande | last3 = De Meirleir | first3 = Kenny L. | author-link3 = Kenny De Meirleir | last4 = Klimas | first4 = Nancy G. | author-link4 = Nancy Klimas | last5 = Broderick | first5 = Gordon | author-link5 = Gordon Broderick | last6 = Mitchell | first6 = Terry | author-link6 = Terry Mitchell | last7 = Staines | first7 = Donald | author-link7 = Donald Staines | last8 = Powles | first8 = A.C. Peter | author-link8 = A C Peter Powles | last9 = Speight | first9 = Nigel | author-link9 = Nigel Speight | last10 = Vallings | first10 = Rosamund | author-link10 = Rosamund Vallings | last11 = Bateman | first11 = Lucinda | author-link11 = Lucinda Bateman | last12 = Baumgarten-Austrheim | first12 = Barbara | author-link12 = Barbara Baumgarten-Austrheim | last13 = Bell | first13 = David | author-link13 = David Bell | last14 = Carlo-Stella | first14 = Nicoletta | author-link14 = Nicoletta Carlo-Stella | last15 = Chia | first15 = John | author-link15 = John Chia | last16 = Darragh | first16 = Austin | author-link16 = Austin Darragh | last17 = Jo | first17 = Daehyun | author-link17 = Daehyun Jo | last18 = Lewis | first18 = Donald | author-link18 = Donald Lewis | last19 = Light | first19 = Alan | author-link19 = Alan Light | last20 = Marshall-Gradisnik | first20 = Sonya | author-link20 = Sonya Marshall-Gradisnik | last21 = Mena | first21 = Ismael | author-link21 = Ismael Mena | last22 = Mikovits | first22 = Judy | author-link22 = Judy Mikovits | last23 = Miwa | first23 = Kunihisa | author-link23 = Kunihisa Miwa | last24 = Murovska | first24 = Modra | author-link24 = Modra Murovska | last25 = Pall | first25 = Martin | author-link25 = Martin Pall | last26 = Stevens | first26 = Staci | author-link26 = Staci Stevens | date = 2011-08-22 | title = Myalgic encephalomyelitis: International Consensus Criteria | url = https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2796.2011.02428.x|journal = Journal of Internal Medicine |language = en | volume = 270 | issue = 4 | pages = 327–338|doi = 10.1111/j.1365-2796.2011.02428.x|issn = 0954-6820|pmc = 3427890|pmid = 21777306|via = }}</ref> These criteria will accurately diagnose [[myalgic encephalomyelitis]] (ME). There is no requirement that the individual have symptoms for a specified period of time for diagnosis, as opposed to CCC, [[Fukuda criteria|Fukuda]], and [[Systemic Exertion Intolerance Disease |SEID]], which all require 6 months in adults.
*[[CDC Myalgic Encephalomyelitis/Chronic Fatigue Syndrome 2017 diagnostic criteria]] - originally known as the [[Systemic Exertion Intolerance Disease|Systemic exertion intolerance disease]] (SEID) criteria<ref name="CDC-symptoms">{{Cite web |url = https://www.cdc.gov/me-cfs/symptoms-diagnosis/symptoms.html | title = Symptoms {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|website=[[Centers for Disease Control and Prevention]] | date = Jan 27, 2021|access-date = 2021-02-25}}</ref><ref>{{Cite web | url = http://iom.nationalacademies.org/~/media/Files/Report%20Files/2015/MECFS/MECFScliniciansguide.pdf | title=Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome - Redefining an Illness | last = Clayton | first = Ellen Wright | date = 2015 | website = National Academies| archive-url = | archive-date = |url-status = | access-date= | authorlink = Ellen Wright Clayton | last2 = Alegria | first2 = Margarita | authorlink2 = Margarita Alegria | authorlink3 = Lucinda Bateman | authorlink4 = Lily Chu | authorlink5 = Charles Cleeland | authorlink6 = Ronald Davis | authorlink7 = Betty Diamond | authorlink8 = Theodore Ganiats |authorlink9=Betsy Keller | last3 = Bateman | first3 = Lucinda | last4 = Chu| first4 = Lily | last5 = Cleeland | first5 = Charles | last6 = Davis | first6 = Ronald | last7 = Diamond | first7 = Betty | last8 = Ganiats | first8 = Theodore | last9 = Keller | first9 = Betsy | last10 = Klimas | first10 = Nancy |authorlink10=Nancy Klimas | last11 = Lerner | first11 = A. Martin |authorlink11=Martin Lerner | last12 = Mulrow| first12 = Cynthia |authorlink12=Cynthia Mulrow | last13 = Natelson | first13 = Benjamin | authorlink13 = Benjamin Natelson | last14 = Rowe | first14 = Peter |authorlink14=Peter Rowe | last15 = Shelanski | first15 = Michael | authorlink15=Michael Shelanski}}</ref> ME/CFS ([[Systemic Exertion Intolerance Disease|SEID]]) is accurately diagnosed when the [[Systemic Exertion Intolerance Disease#Diagnostic criteria|core symptoms]] are met. The [[Institute of Medicine report]] as a whole is a comprehensive review of the medical literature available at time of publication (2015). Adults can be diagnosed at 6 months while pediatric cases are diagnosed at three months.
*[[CDC Myalgic Encephalomyelitis/Chronic Fatigue Syndrome 2017 diagnostic criteria]] - originally known as the [[Systemic Exertion Intolerance Disease |Systemic exertion intolerance disease]] (SEID) criteria<ref name="CDC-symptoms">{{Cite web |url = https://www.cdc.gov/me-cfs/symptoms-diagnosis/symptoms.html | title = Symptoms {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | website = [[Centers for Disease Control and Prevention]] | date = Jan 27, 2021|access-date = 2021-02-25}}</ref><ref>{{Cite web | url = http://iom.nationalacademies.org/~/media/Files/Report%20Files/2015/MECFS/MECFScliniciansguide.pdf | title = Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome - Redefining an Illness | last = Clayton | first = Ellen Wright | date = 2015 | website = National Academies| archive-url = | archive-date = |url-status = | access-date = | author-link = Ellen Wright Clayton | last2 = Alegria | first2 = Margarita | author-link2 = Margarita Alegria | author-link3 = Lucinda Bateman | author-link4 = Lily Chu | author-link5 = Charles Cleeland | author-link6 = Ronald Davis | author-link7 = Betty Diamond | author-link8 = Theodore Ganiats | author-link9 = Betsy Keller | last3 = Bateman | first3 = Lucinda | last4 = Chu | first4 = Lily | last5 = Cleeland | first5 = Charles | last6 = Davis | first6 = Ronald | last7 = Diamond | first7 = Betty | last8 = Ganiats | first8 = Theodore | last9 = Keller | first9 = Betsy | last10 = Klimas | first10 = Nancy | author-link10 = Nancy Klimas | last11 = Lerner | first11 = A. Martin | author-link11 = Martin Lerner | last12 = Mulrow | first12 = Cynthia | author-link12 = Cynthia Mulrow | last13 = Natelson | first13 = Benjamin | author-link13 = Benjamin Natelson | last14 = Rowe | first14 = Peter | author-link14 = Peter Rowe | last15 = Shelanski | first15 = Michael | author-link15 = Michael Shelanski}}</ref> ME/CFS ([[Systemic Exertion Intolerance Disease |SEID]]) is accurately diagnosed when the [[Systemic Exertion Intolerance Disease#Diagnostic criteria|core symptoms]] are met. The [[Institute of Medicine report]] as a whole is a comprehensive review of the medical literature available at time of publication (2015). Adults can be diagnosed at 6 months while pediatric cases are diagnosed at three months.


==Learn more==
==Learn more==
*[http://www.investinme.org/Documents/PDFdocuments/Canadian_ME_Overview_A4.pdf A Clinical Case Definition and Guidelines for Medical Practitioners - An Overview of the Canadian Consensus Document]<ref name=":0" /> (the above 7 criteria are listed on page 2 of this document).
*[http://www.investinme.org/Documents/PDFdocuments/Canadian_ME_Overview_A4.pdf A Clinical Case Definition and Guidelines for Medical Practitioners - An Overview of the Canadian Consensus Document]<ref name=":0" /> (the above 7 criteria are listed on page 2 of this document).
*[http://www.meresearch.org.uk/wp-content/uploads/2012/11/2003-Carruthers-Canadian-Definition-JCFS.pdf Canadian Consensus Report - ''Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols'']<ref name="Carruthers, 2003" /> (full version of the Canadian consensus criteria).
*[http://www.meresearch.org.uk/wp-content/uploads/2012/11/2003-Carruthers-Canadian-Definition-JCFS.pdf Canadian Consensus Report - ''Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols'']<ref name="Carruthers, 2003" /> (full version of the Canadian consensus criteria).
*An Overview of the Canadian Consensus Document in French - [http://iacfsme.org/Portals/0/pdf/Abrege%20du%20C.c.%20sur%20EM-SFC.PDF Encéphalomyélite myalgique/syndrome de fatigue chronique: Définition clinique et lignes directrices à l’intention des médecins, Abrégé du Consensus canadien]<ref>{{Cite web | url = http://iacfsme.org/Portals/0/pdf/Abrege%20du%20C.c.%20sur%20EM-SFC.PDF | title = Encéphalomyélite myalgique /syndrome de fatigue chronique: Définition cliniqueet lignes directricesà l’intention des médecins - Abrégé duConsensus canadien | last = Carruthers | first = Bruce | authorlink = Bruce Carruthers | last2 = van de Sande | first2 = Marjorie | authorlink2 = Marjorie van de Sande | date = |website=IACFS/ME| archive-url = | archive-date = |url-status = | access-date=}}</ref>
*An Overview of the Canadian Consensus Document in French - [http://iacfsme.org/Portals/0/pdf/Abrege%20du%20C.c.%20sur%20EM-SFC.PDF Encéphalomyélite myalgique/syndrome de fatigue chronique: Définition clinique et lignes directrices à l’intention des médecins, Abrégé du Consensus canadien]<ref>{{Cite web | url = http://iacfsme.org/Portals/0/pdf/Abrege%20du%20C.c.%20sur%20EM-SFC.PDF | title = Encéphalomyélite myalgique /syndrome de fatigue chronique: Définition cliniqueet lignes directricesà l’intention des médecins - Abrégé duConsensus canadien | last = Carruthers | first = Bruce | author-link = Bruce Carruthers | last2 = van de Sande | first2 = Marjorie | author-link2 = Marjorie van de Sande | date = | website = IACFS/ME | language = fr | archive-url = | archive-date = |url-status = | access-date = }}</ref>
==References==
==References==
<references>
{{Reflist}}
<ref name="Carruthers, 2003">{{Citation | last1 = Carruthers | first1 = Bruce M. | authorlink1 = Bruce Carruthers | last2 = Jain | first2 = Anil Kumar | authorlink2 = Anil Kumar Jain | last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny De Meirleir | last4 = Peterson | first4 = Daniel L. | authorlink4 = Daniel Peterson | last5 = Klimas | first5 = Nancy G. | authorlink5 = Nancy Klimas | last6 = Lerner | first6 = A. Martin | authorlink6 = Martin Lerner | last7 = Bested | first7 = Alison C. | authorlink7 = Alison Bested | last8 = Flor-Henry | first8 = Pierre | authorlink8 = Pierre Flor-Henry | last9 = Joshi | first9 = Pradip | authorlink9 = Pradip Joshi | last10  = Powles | first10 = AC Peter | authorlink10 = AC Peter Powles | last11  = Sherkey | first11 = Jeffrey A.| authorlink11 = Jeffrey Sherkey | last12  = van de Sande | first12 = Marjorie I. | authorlink12 = Marjorie van de Sande | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols | journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | pages = 7-115 | date = 2003 | pmid  = | doi  = 10.1300/J092v11n01_02 | url = http://www.meresearch.org.uk/wp-content/uploads/2012/11/2003-Carruthers-Canadian-Definition-JCFS.pdf }}</ref>
</references>


[[Category:Definitions]]
[[Category:Definitions]]
[[Category:Seminal works]]
[[Category:Seminal works]]
[[Category:Secondary sources]]
[[Category:Secondary sources]]

Latest revision as of 14:02, July 14, 2023

Simplified Canadian Consensus Criteria for ME/CFS.

The Canadian consensus criteria (CCC) or the Canadian working definition are a proposed clinical criteria for ME/CFS, published in 2003, and frequently used as a case definition in research.[1] The Canadian definition is a strictest diagnostic criteria, selecting a smaller group of patients than the Fukuda criteria and a more severely impaired population.[2] Adults are diagnosed after a minimum of six months of illness and children after a minimum of three months.

Definition[edit | edit source]

Canadian Consensus Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome[3]
A patient with ME/CFS will meet the criteria for fatigue, post-exertional malaise and/or fatigue, sleep dysfunction and pain; have two or more neurological/cognitive manifestations and one or more symptoms from two of the categories of (a) autonomic, (b) neuroendocrine and (c) immune manifestations; and adhere to item 7.
1   Fatigue
Required
The patient must have a significant degree of new onset, unexplained, persistent, or recurrent physical and mental fatigue that substantially reduces activity level.
2 Post-Exertional Malaise and/or Post-Exertional Fatigue
Required
There is an inappropriate loss of physical and mental stamina, rapid muscular and cognitive fatigabilitypost-exertional malaise and/or post-exertional fatigue and a tendency for other associated symptoms within the patient’s cluster of symptoms to worsen.

There is a pathologically slow recovery period – usually 24 hours or longer.

3 Sleep Dysfunction (*)
Required
There is unrefreshing sleep or sleep quantity or rhythm disturbances such as reversed or chaotic diurnal sleep rhythms. Note that patients without sleep dysfunction can still meet the diagnostic criteria if their illness began with an infection — see (*) below.
4 Pain (*)
Required
There is a significant degree of myalgia. Pain can be experienced in the muscles, and/or joints, and is often widespread and migratory in nature. Often there are significant headaches of new type, pattern or severity. Note that patients without pain can still meet the diagnostic criteria if their illness began with an infection — see (*) below.
5 Neurological / Cognitive Manifestations
Two or more
Two or more of the following difficulties should be present: 

Ataxiamuscle weakness and fasciculations are common. There may be overload1 phenomena: cognitive overload, sensory overload (for example photophobia and hypersensitivity to noise) and/or emotional overload, which may lead to crash2 periods and/or anxiety.

6 At Least One Symptom From Two of the Following Three Categories
(autonomic, neuroendocrine, immune)
At Least One Symptom From Two of the Following Three Categories:
(a) Autonomic Manifestations
(b) Neuroendocrine Manifestations
(c) Immune Manifestations
7 The Illness Persists for at Least Six Months
Required
It usually has a distinct onset, (**) although it may be gradual. Preliminary diagnosis may be possible earlier. Three months is appropriate for children.

To be included, the symptoms must have begun or have been significantly altered after the onset of this illness. It is unlikely that a patient will suffer from all symptoms in criteria 5 & 6. The disturbances tend to form symptom clusters that may fluctuate and change over time. Children often have numerous prominent symptoms but their order of severity tends to vary from day to day.

(*) There is a small number of patients who have no pain or sleep dysfunction, but no other diagnosis fits except ME/CFS. A diagnosis of ME/CFS can be entertained when this group has an infectious illness type onset.

(**) Some patients have been unhealthy for other reasons prior to the onset of ME/ CFS and lack detectable triggers at onset or have more gradual or insidious onset.

1"Overload" refers to hypersensitivities to stimuli that have changed from pre-illness status.

2 "Crash" refers to a temporary period of immobilizing physical and /or cognitive fatigue.

Idiopathic chronic fatigue[edit | edit source]

People with chronic fatigue (lasting at least six months) but not meeting the criteria for ME/CFS should be diagnosed with idiopathic chronic fatigue instead.

Authors[edit | edit source]

Bruce Carruthers, Anil Kumar Jain, Kenny de Meirleir, Daniel Peterson, Nancy Klimas, A Martin Lerner, Alison Bested, Pierre Flor-Henry, Pradip Joshi, A C Peter Powles, Jeffrey Sherkey, Marjorie van de Sande[4]

Diagram of ME/CFS symptoms[edit | edit source]

Simplified diagram of ME/CFS Canadian consensus criteria symptoms

See also[edit | edit source]

Generally accepted criteria for diagnosis[edit | edit source]

Learn more[edit | edit source]

References[edit | edit source]

  1. 1.0 1.1 1.2 Carruthers, Bruce M.; Jain, Anil Kumar; De Meirleir, Kenny L.; Peterson, Daniel L.; Klimas, Nancy G.; Lerner, A. Martin; Bested, Alison C.; Flor-Henry, Pierre; Joshi, Pradip; Powles, AC Peter; Sherkey, Jeffrey A.; van de Sande, Marjorie I. (2003), "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols" (PDF), Journal of Chronic Fatigue Syndrome, 11 (2): 7–115, doi:10.1300/J092v11n01_02
  2. http://www.meaction.net/2015/12/10/norwegian-researchers-ask-what-exactly-is-m-e/
  3. 3.0 3.1 Carruthers, Bruce; van de Sande, Marjorie. "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Clinical Case Definition and Guidelines for Medical Practitioners - An Overview fo the Canadian Consensus Document" (PDF). Invest in ME Research. p. 4. Physical or mental exertion often causes debilitating malaise and/or fatigue, generalized pain, deterioration of cognitive functions, and worsening of other symptoms that may occur immediately after activity or be delayed. Patients experience rapid muscle fatigue and lack endurance.
  4. http://sacfs.asn.au/download/consensus_overview_me_cfs.pdf
  5. Carruthers, Bruce M.; van de Sande, Marjorie I.; De Meirleir, Kenny L.; Klimas, Nancy G.; Broderick, Gordon; Mitchell, Terry; Staines, Donald; Powles, A.C. Peter; Speight, Nigel; Vallings, Rosamund; Bateman, Lucinda; Baumgarten-Austrheim, Barbara; Bell, David; Carlo-Stella, Nicoletta; Chia, John; Darragh, Austin; Jo, Daehyun; Lewis, Donald; Light, Alan; Marshall-Gradisnik, Sonya; Mena, Ismael; Mikovits, Judy; Miwa, Kunihisa; Murovska, Modra; Pall, Martin; Stevens, Staci (August 22, 2011). "Myalgic encephalomyelitis: International Consensus Criteria". Journal of Internal Medicine. 270 (4): 327–338. doi:10.1111/j.1365-2796.2011.02428.x. ISSN 0954-6820. PMC 3427890. PMID 21777306.
  6. "Symptoms | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome". Centers for Disease Control and Prevention. January 27, 2021. Retrieved February 25, 2021.
  7. Clayton, Ellen Wright; Alegria, Margarita; Bateman, Lucinda; Chu, Lily; Cleeland, Charles; Davis, Ronald; Diamond, Betty; Ganiats, Theodore; Keller, Betsy; Klimas, Nancy; Lerner, A. Martin; Mulrow, Cynthia; Natelson, Benjamin; Rowe, Peter; Shelanski, Michael (2015). "Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome - Redefining an Illness" (PDF). National Academies.
  8. Carruthers, Bruce; van de Sande, Marjorie. "Encéphalomyélite myalgique /syndrome de fatigue chronique: Définition cliniqueet lignes directricesà l'intention des médecins - Abrégé duConsensus canadien" (PDF). IACFS/ME (in français).