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Fluctuating illness
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===Diagnostic criteria=== In the [[London criteria]] for [[myalgic encephalomyelitis]], fluctating symptoms are one of the five compulsory disagnostic criteria]: <blockquote>"Fluctuation of symptoms, from hour to hour and day to day"<ref name="Londoncriteria2014">{{Citation | url =http://www.axfordsabode.org.uk/me/mecrit2014.htm|archive-url=http://web.archive.org/web/20150923181011/http://www.axfordsabode.org.uk/me/mecrit2014.htm|archive-date=2015-09-23|url-status=dead | title = Myalgic Encephalomyelitis (ME). Criteria and clinical guidelines. 2014 | date = Oct 15, 2014 | last = Howes | first = Sandra | author-link = Sandra Howes | last2 = Goudsmit | first2 = Ellen M. |author2link = Ellen Goudsmit | last3 = Shepherd | first3 = Charles |author3link = Charles Shepherd}}</ref></blockquote> The [[International Consensus Criteria]] states: <blockquote>"There may be marked fluctuation of symptom severity and hierarchy from day to day or hour to hour. Consider activity, context and interactive effects."<ref name="ICC2011primer">{{citation | last1 = Carruthers | first1 = BM | authorlink1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | authorlink2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | authorlink3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | authorlink4 = Nancy Klimas | last5 = Broderick | first5 = G | authorlink5 = Gordon Broderick | last6 = Mitchell | first6 = T | authorlink6 = Terry Mitchell | last7 = Staines | first7 = D | author-link8 = Donald Staines | last8 = Powles | first8 = ACP | author-link8 = A C Peter Powles | last9 = Speight | first9 = N | author-link9 = Nigel Speight | last10 = Vallings | first10 = R | authorlink10 = Rosamund Vallings | last11 = Bateman | first11 = L | authorlink11 = Lucinda Bateman | last12 = Bell | first12 = DS | authorlink12 = David Bell | last13 = Carlo-Stella | first13 = N | authorlink13 = Nicoletta Carlo-Stella | last14 = Chia | first14 = J | authorlink14 = John Chia | last15 = Darragh | first15 = A | authorlink15 = Austin Darragh | last16 = Gerken | first16 = A | authorlink16 = Anne Gerken | last17 = Jo | first17 = D | authorlink17 = Daehyun Jo | last18 = Lewis | first18 = DP | authorlink18 = Donald Lewis | last19 = Light | first19 = AR | authorlink19 = Alan Light | last20 = Light | first20 = KC | authorlink20 = Kathleen Light | last21 = Marshall-Gradisnik | first21 = S | authorlink21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 = J | authorlink22 = John McLaren-Howard | last23 = Mena | first23 = I | authorlink23 = Ismael Mena | last24 = Miwa | first24 = K | authorlink24 = Kunihisa Miwa | last25 = Murovska | first25 = M | authorlink25= Modra Murovska | last26 = Stevens | first26 = SR | authorlink26 = Staci Stevens | title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012| isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf}}</ref></blockquote> The ICC also states that in ME "prominent symptoms tend to vary rapidly and dramatically."<ref name="ICC2011primer" />
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