History of myalgic encephalomyelitis and chronic fatigue syndrome

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Myalgic encephalomyelitis has occurred in both epidemic and sporadic form since at least the 1930s, although is probably much older. The first recorded outbreak of epidemic myalgic encephalomyelitis was in 1934 in Los Angeles and was thought to be an outbreak of atypical polio. After the outbreak in Akureyri, Iceland in 1946, the disease came to be called "Akureyri Disease" or Icelandic disease through much of the 1940s and 1950s. It was named myalgic encephalomyelitis after London's Royal Free Hospital outbreak in 1955. Other names included benign myalgic encephalomyelitis and epidemic neuromyasthenia.

After the Incline Village outbreak in Nevada in 1984, the disease came to be called and redefined as Chronic Fatigue Syndrome. The most recent was putative outbreak was in Arizona in 1996. 

19th century[edit | edit source]

Several descriptions of illness resembling those of chronic fatigue syndrome have been reported for at least two hundred years.[1] In the 19th century, neurologist George Miller Beard popularized the concept of neurasthenia, with symptoms including fatigue, anxiety, headache, impotence, neuralgia and depression.[2] This concept remained popular well into the 20th century, eventually coming to be seen as a behavioral rather than physical condition, with a diagnosis that excluded post-viral syndromes. Neurasthenia has largely been abandoned as a medical diagnosis.[3] The ICD-10 system of the World Health Organization now categorizes neurasthenia under (F48 Other neurotic disorders) which specifically excludes chronic fatigue syndrome.[4]

Epidemic myalgic encephalomyelitis (1930s-1960s)[edit | edit source]

In 1938, Alexander Gilliam described an illness that resembled poliomyelitis, interviewing patients and reviewing records of one of several clusters which had occurred in Los Angeles, United States in 1934.[5] The Los Angeles County Hospital outbreak included all or most of its nurses and doctors.[6] Gilliam called the outbreak "atypical poliomyelitis" and described the symptoms as: rapid muscle weakness, vasomotor instability, clonic twitches and cramps, ataxia, severe pain (usually aggravated by exercise), neck and back stiffness, menstrual disturbance and dominant sensory involvement.

Novices and convent candidates at a Wisconsin convent were diagnosed with "encephalitis" in 1936. Two towns in Switzerland had outbreaks of "abortive poliomyelitis" in 1937, and 73 Swiss soldiers were given the same diagnosis in 1939. Outbreaks in Iceland were called "Akureyri disease" or "simulating poliomyelitis" and were later called "Iceland disease." Eight hundred people in Adelaide, Australia became ill during 1949-1951 with a disease "resembling poliomyelitis." Two smaller clusters in the United States during 1950 were diagnosed as "Epidemic neuromyasthenia" and "resembling Iceland disease simulating acute anterior poliomyelitis." Additional outbreaks of poliomyelitis-like "mystery diseases" occurred from the 1950s through the 1980s, in Denmark, the United States, South Africa, and Australia, among others.[6]

Several outbreaks of a polio-resembling illness occurred in Britain in the 1950s.[7] A 1955 outbreak at the Royal Free Hospital Group was later called Royal Free disease or benign myalgic encephalomyelitis.[8][9] After the Royal Free Hospital outbreak, a disorder with similar symptoms was found among the general population and the epidemic form came to be considered the exception.[10][11] Pathology findings, from both monkeys intentionally infected with biological fluids from patients[12] and from rare human casualties,[13] led to the conclusion that the disorder was caused by inflammation of the brain and the spinal cord, particularly the afferent nerve roots, perhaps with neuroimmune etiology.[14]

Mass hysteria (1960s-1970s)[edit | edit source]

In the 1960s and 1970s, chronic fatigue symptoms were often attributed to chronic brucellosis, but typically people were seen as having psychiatric disorders, in particular depression.[6] Epidemic cases of benign myalgic encephalomyelitis were called mass hysteria by psychiatrists McEvedy and Beard in 1970,[15] provoking criticism in letters to the editor of the British Medical Journal by outbreak researchers, attending physicians, and physicians who fell ill.[16][17][18][19][20][21][22][23][24] The psychiatrists were faulted for not adequately investigating the patients they described,[25] and their conclusions have been refuted.[26][27][28] In 1978 a symposium held at the Royal Society of Medicine (RSM) concluded that epidemic myalgic encephalomyelitis was a distinct disease entity with a clear organic basis.[29]

Neurological classification[edit | edit source]

Myalgic encephalomyelitis was first classified as a neurological disease when the World Health Organization published the of ICD-8 classification manual in 1969.[30][31] Myalgic encephalomyelitis was given ICD-8 code 323, and grouped with the other forms of encephalomyelitis under the Diseases of the Nervous System section.[31]

In the later Ninth revision (1977), the ICD-9, the entry for myalglc encephalomyelitis is uses code 323.9 and remains a disease of the nervous system, along with the other forms of encephalomyelitis.[32] There is no mention of a chronic fatigue syndrome (the term was had not been proposed at the time) and there was no mention of an illness named "chronic fatigue".

Chronic fatigue syndrome (1980s & 1990s)[edit | edit source]

The illness gained national attention in the United States when the popular magazine Hippocrates ran a cover story of an epidemic at Lake Tahoe, Nevada, in the mid-1980s.[33] The designation Chronic Epstein-Barr Virus was in use in the U.S.,[34][35] but the magazine used the term "Raggedy Ann Syndrome" to note the fatigue and loss of muscle power patients felt.[36]

Researchers investigating the Lake Tahoe cluster did not find evidence that EBV was involved, and they proposed the name chronic fatigue syndrome, describing the main symptom of the illness.[37][38] They published the first working case definition for CFS in 1988.[39] Research increased considerably, and more so after the criteria were relaxed in 1994.[40]

In 1990, researchers presented evidence they found DNA sequences very similar to the human HTLV-II retrovirus in some CFS patients, at a conference in Kyoto, Japan.[41][42] Their study was later published in the Proceedings of the National Academy of Sciences.[43] A reporter on Prime Time Live stated the announcement made headlines all over the world.[44] The CDC first ignored their findings then later conducted a study and published a paper that refuted the hypothesis.[45]

In the United Kingdom, the Chief Medical Officer Kenneth Calman requested a report from the medical Royal Colleges in 1996. This led to the publication of a joint report in which the term "chronic fatigue syndrome" was found to be most representative.[46] This was followed in 2002 by a further report by the new CMO, Liam Donaldson.[47]

The U.S. Centers for Disease Control & Prevention (CDC) recognized CFS as a serious illness, and launched a campaign in June 2006 to raise public and medical awareness about it.[48][49]

XMRV[edit | edit source]

A 2009 study published in the journal Science reported an association between a retrovirus xenotropic murine leukemia virus-related virus (XMRV) and CFS. The editors of Science subsequently attached an "Editorial Expression of Concern" to the report to the effect that the validity of the study "is now seriously in question,"[50] and in September 2011, the authors published a "Partial Retraction" of their 2009 findings;[51] this was followed by a full retraction by the magazine’s Editor in Chief, after the authors failed to agree on a full retraction statement.[52] Also in September 2011, the Blood XMRV Scientific Research Working Group published a report, which concluded "that currently available XMRV/P-MLV assays, including the assays employed by the three participating laboratories that previously reported positive results on samples from CFS patients and controls, cannot reproducibly detect direct virus markers (RNA, DNA, or culture) or specific antibodies in blood samples from subjects previously characterized as XMRV/P-MLV positive (all but one with a diagnosis of CFS) or healthy blood donors."[53] In December 2011, the Proceedings of the National Academy of Sciences published a similar retraction for an August 2010 paper.[54] Some members of the patient community, who had viewed the XMRV findings as a source of hope for a possible cure, initially reacted negatively when the papers were called into question. One UK researcher reported verbal abuse after publishing an early paper indicating that the XMRV studies were flawed.[55]

Institute of Medicine Report[edit | edit source]

February 15, 2015, The National Academy of Medicine (known as the Institute of Medicine or IOM until June 2015) published a report on ME/CFS, Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness[56] proposing a new name – systemic exertion intolerance disease – and a new diagnostic criteria. It has since influenced government policy and healthcare for the disease in the United States and around the world.[57][58][59][60]

The proposed name proved to be highly unpopular and has not been widely adopted by government agencies or researchers and proposed criteria captured an overlapping but different subset of patients than stricter criteria like the International Consensus Criteria or the Canadian Consensus Criteria. Despite some positive impacts, its recommendations have remained controversial among many patients and advocacy groups.

See also[edit | edit source]

References[edit | edit source]

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myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

Centers for Disease Control and Prevention (CDC) - The Centers for Disease Control and Prevention is a U.S. government agency dedicated to epidemiology and public health. It operates under the auspices of the Department of Health and Human Services.

assay 1. (verb) analysis (as of an ore or drug) to determine the presence, absence, or quantity of one or more components. 2. (noun) In biochemistry, any laboratory protocol used to test a sample for one or more qualities.

antibodies Antibody/immunoglobulin refers to any of a large number of specific proteins produced by B cells that act against an antigen in an immune response.

Institute of Medicine report (IOM report) - A report that was commissioned by the U.S. government and was published by the Institute of Medicine on February 10, 2015. The report was titled "Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness" and proposed the term Systemic Exertion Intolerance Disease (SEID). Among its key findings were that "This disease is characterized by profound fatigue, cognitive dysfunction, sleep abnormalities, autonomic manifestations, pain, and other symptoms that are made worse by exertion of any sort." The report further stated "Between 836,000 and 2.5 million Americans suffer from myalgic encephalomyelitis/chronic fatigue syndrome."

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

International Classification of Diseases (ICD) - A system of medical diagnostic codes, created by the World Health Organization (WHO), to classify diseases and other health related conditions for the purpose of international diagnostic consistency. By having common diagnostic codes around the world, health researchers are better able to quantify and track disease burdens. The most current version is called ICD-11. (Learn more: www.who.int)

World Health Organization (WHO) - "A specialized agency of the United Nations that is concerned with public health. It was established on 7 April 1948, and is headquartered in Geneva, Switzerland. The WHO is a member of the United Nations Development Group. Its predecessor, the Health Organization, was an agency of the League of Nations." The International Statistical Classification of Diseases and Related Health Problems (ICD) is maintained by WHO.

etiology The cause of origin, especially of a disease.

BMJ The BMJ (previously the British Medical Journal) is a weekly peer-reviewed medical journal.

Centers for Disease Control and Prevention (CDC) - The Centers for Disease Control and Prevention is a U.S. government agency dedicated to epidemiology and public health. It operates under the auspices of the Department of Health and Human Services.

The information provided at this site is not intended to diagnose or treat any illness.
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