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Prognosis for myalgic encephalomyelitis and chronic fatigue syndrome
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=== Outbreaks === Longitudinal studies on ME outbreaks show that in its epidemic form, the disease tends to have a better prognosis. This might be because less strict diagnostic criteria were used in these studies or because patients were followed-up much earlier in their disease process (bypassing the normal six month waiting period). Levine et al. provided follow-up data from the outbreaks in the Nevada-California region ([[1984 Incline Village chronic fatigue syndrome outbreak|Incline Village]], [[1984 Truckee outbreak|Truckee]], [[1985 Yerington outbreak|Yerington]] and [[1986 Placerville outbreak|Placerville]]) during the 1980s. Twenty-nine patients were revaluated after a period of three years. Almost all subjects were able to return to pre-illness activity and the authors concluded that the overall prognosis was generally favorable.<blockquote>“Among the patients we observed were a marathon runner, a marathon bicyclist, avid skiers, mountain climbers, and other individuals pursuing an unusually physically active life-style prior to their acute illness. All of these patients attempted to continue their activities and most of them, after periods ranging from 6 to 18 months, eventually were able to resume their previous activities.”<ref>{{Cite journal | last = Levine | first = P. H. | author-link = Paul Levine | last2 = Jacobson | first2 = S. | authorlink2 = | last3 = Pocinki | first3 = A.G. | authorlink3 = Alan Pocinki | last4 = Cheney | first4 = P. | authorlink4 = Paul Cheney | last5 = Peterson | first5 = D. | authorlink5 = Daniel Peterson | last6 = Connelly | first6 = R.R. | last7 = Weil | first7 = R. | last8 = Robinson | first8 = S.M. | last9 = Ablashi | first9 = D.V. | authorlink9 = Dharam Ablashi| date = Aug 1992 | title = Clinical, epidemiologic, and virologic studies in four clusters of the chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/1323246|journal=Archives of Internal Medicine|volume=152|issue=8|pages=1611–1616|issn=0003-9926|pmid=1323246|quote=|via=}}</ref></blockquote>Another follow-up study however, concluded that only an estimated 41% of patients during these outbreaks would fulfill the Holmes criteria of ME/CFS. The recovery rate for these ME/CFS patients was only 15%, much lower than the 30% for all patients of the [[1984 Incline Village chronic fatigue syndrome outbreak|Lake Tahoe outbreak]].<ref>{{Cite journal | last = Strickland | first=Paula S. | last2 = Levine | first2 = Paul H. | last3 = Peterson | first3 = Daniel L. | last4 = O'Brien | first4 = Karen | last5 = Fears | first5 = Thomas| date = Jan 2001 | title = Neuromyasthenia and Chronic Fatigue Syndrome (CFS) in Northern Nevada/California | url = |journal=Journal of Chronic Fatigue Syndrome|language=en|volume=9|issue=3-4|pages=3–14|doi=10.1300/j092v09n03_02|issn=1057-3321|pmc=|pmid=|quote= | last6 = | first6 = | authorlink = | authorlink2 = Paul Levine|access-date= | authorlink3 = Daniel Peterson | author-link4 = | authorlink5 = |via=}}</ref> A 10 year follow-up of the outbreak at West Otago, [[New Zealand]] also reported a good prognosis. Though some needed to adapt their lifestyle to prevent relapses, most patients returned to premorbid activity.<ref>{{Cite journal | last = Levine | first = P. H. | last2 = Snow | first2 = P.G. | last3 = Ranum | first3 = B.A. | last4 = Paul | first4 = C. | last5 = Holmes | first5 = M. J. | date = 1997-04-14 | title = Epidemic neuromyasthenia and chronic fatigue syndrome in west Otago, New Zealand. A 10-year follow-up | url =https://www.ncbi.nlm.nih.gov/pubmed/9125006|journal=Archives of Internal Medicine|volume=157|issue=7 | pages = 750–754|issn=0003-9926|pmid=9125006}}</ref> Follow-up data is also available for the outbreak in Akureyri, Iceland. [[Björn Sigurdsson|Sigurdsson]] & Gudmundsson reported in 1955 that 13% of the patients he evaluated considered themselves completely recovered.<ref>{{Cite journal | last = Sigurdsson | first = B. | author-link = Björn Sigurdsson | date = 1956-05-26 | title = Clinical findings six years after outbreak of Akureyri disease|url=https://www.ncbi.nlm.nih.gov/pubmed/13320872|journal=Lancet (London, England)|volume=270|issue=6926 | pages = 766–767|issn=0140-6736|pmid=13320872}}</ref> In 1988, Byron Hyde reported about 10 Icelandic ME patients in the Lancet, 40 years after the initial outbreak. Two of them (20%) indicated a “total physical and intellectual recovery”.<ref>{{Cite journal | last = Hyde | first = B. | last2 = Bergmann | first2 = S. | author-link = Byron Hyde | date = 1988-11-19 | title = Akureyri disease (myalgic encephalomyelitis), forty years later |url =https://www.ncbi.nlm.nih.gov/pubmed/2903396|journal=Lancet (London, England)|volume=2|issue=8621|pages=1191–1192|issn=0140-6736|pmid=2903396|quote=|via=}}</ref>
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