Onset of ME/CFS

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The onset of ME/CFS can be sudden (acute) or gradual.[1][2] Sudden onset is more common.[3] Dr. Melvin Ramsay and Dr. Byron Hyde both describe sudden/acute onsets for myalgic encephalomyelitis (ME)[4] as oppose to ME/CFS being acute or gradual.[2] In cases of sudden onset, it is usually easy to identify the trigger of the illness, such as physical trauma, overwhelming stress, or a viral/bacterial infection.[1] Children, particularly adolescents, will more likely have an acute illness like the flu or mononucleosis as their onset.[5]

Acute symptoms develop over hours to days. 85% of patients report a trigger. 72% of ME/CFS patients report that a bacterial or a viral infection was their onset of ME/CFS; 4.5% trauma; 4.5% surgery or childbirth; 2.2% allergic reaction; 1.7% stress or trauma.[6]

Genes are being considered for a risk in developing ME/CFS as sometimes several members of the same family will develop ME/CFS.[7][8]

Pre-onset triggers[edit | edit source]

The International Consensus Criteria (ICC) Primer includes a patient assessment form, which includes factors that may have triggered ME, these can be infectious (for example, a virus), or non-infectious (for example, exposure to chemical toxins or severe physical injury).

Infectious exposure or events[edit | edit source]

Non-infectious exposure or events[edit | edit source]

Other triggers have been recognized besides these, and some people report several potential triggers or no known cause.[1]

Is ME always caused by a virus[edit | edit source]

A small number of ME patient charities, for example The Hummingbirds' Foundation for ME hold the view that ME is always caused by a virus, but chronic fatigue syndrome (CFS) may have non-viral triggers, and do not recognize bacterial infections or non-infectious events as a potential cause or trigger.[9]

The onset events recognized as potential causes or triggers in the ICC are based on events prior to illness that have been reported by patients meeting the diagnostic criteria for ICC ME or based on the consensus of experts. The exact cause has not yet been identified in research. Chu et al. (2019) reported on pre-onset events for patients meeting the CFS Fukuda criteria only.[1]

Development of ME[edit | edit source]

The International Consensus Criteria for ME recognizes that ME can develop

  • suddenly
  • gradually, or
  • after an infectious disease (for example, viral or bacterial outbreaks within a community)
  • have a non-infectious event shortly before onset
  • there may not be any potential trigger identified when ME begins

Criteria[edit | edit source]

  • In the Holmes criteria, description of the main symptom complex as initially developing over a few hours to a few days is an optional criteria for diagnosis, under the section Minor Symptom Criteria.[10]

Notable studies[edit | edit source]

See also[edit | edit source]

 Learn more[edit | edit source]

References[edit | edit source]

  1. 1.01.11.21.31.4 Chu, Lily; Valencia, Ian J.; Garvert, Donn W.; Montoya, Jose G. (January 14, 2019). "Onset patterns and course of myalgic encephalomyelitis/ chronic fatigue syndrome". Frontiers in Pediatrics. doi:10.3389/fped.2019.00012.
  2. 2.02.12.2 "Presentation and Clinical Course of ME/CFS | Information for Healthcare Providers | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome ME/CFS | CDC". Centers for Disease Control. December 12, 2018. Retrieved February 7, 2019.
  3. "Is CFS a Real Disease? — Watchtower ONLINE LIBRARY". wol.jw.org. August 22, 1992. Could CFS Be Depression?. Retrieved February 8, 2019. sudden onset in 85 percent of patients
  4. 4.04.1 Evans, Meredyth; Jason, Leonard (2018). "Onset patterns of chronic fatigue syndrome and myalgic encephalomyelitis" (PDF). Research on Chronic Diseases: 2.
  5. "Symptoms and Diagnosis of ME/CFS in Children | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome". Centers for Disease Control. January 18, 2019. Retrieved January 29, 2019.
  6. "CDC Public Health Grand Rounds - Chronic Fatigue Syndrome - Advancing Research and Clinical Education" (PDF). cdc.gov. p. 6.
  7. "Possible Causes | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | CDC". Centers for Disease Control. July 14, 2017. Causes. Retrieved October 15, 2018.
  8. Dr. Ron Davis Gives an Update on ME/CFS Research, retrieved April 24, 2021
  9. Bassett, Jodi (2010). "M.E.: The medical facts". The Hummingbirds' Foundation for ME. Retrieved February 9, 2019. Myalgic encephalomyelitis is a systemic acutely acquired illness initiated by a virus infection which is characterised by post encephalitic damage to the brain stem; a nerve centre through which many spinal nerve tracts connect with higher centres in the brain in order to control all vital bodily functions – this is always damaged in M.E. (Hence the name Myalgic Encephalomyelitis.) The CNS is diffusely injured at several levels, these include the cortex, the limbic system, the basal ganglia, the hypothalamus and areas of the spinal cord and its appendages. This persisting multilevel central nervous system (CNS) dysfunction, and in particular, inconsistent CNS dysfunction is undoubtedly both the chief cause of disability in M.E. and the most critical in the definition of the entire disease process.
  10. The 1988 Holmes Definition for CFS
  11. Bakken, Inger Johanne; Tveito, Kari; Gunnes, Nina; Ghaderi, Sara; Stoltenberg, Camilla; Trogstad, Lill; Håberg, Siri Eldevik; Magnus, Per (October 1, 2014). "Two age peaks in the incidence of chronic fatigue syndrome/myalgic encephalomyelitis: a population-based registry study from Norway 2008-2012". BMC medicine. 12: 167. doi:10.1186/s12916-014-0167-5. ISSN 1741-7015. PMC 4189623. PMID 25274261.

myalgic encephalomyelitis (ME) - 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 Consensus Criteria (ICC) - A set of diagnostic criteria, based on the Canadian Consensus Criteria, that argued for the abandonment of the term "chronic fatigue syndrome" and encouraged the sole use of the term "myalgic encephalomyelitis".

chronic disease a disease or condition that usually lasts for 3 months or longer and may get worse over time

myalgic encephalomyelitis (ME) - 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.

brainstem Region of the midbrain in adults, includes midbrain, pons, and medulla oblongata and develops.

myalgic encephalomyelitis (ME) - 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.

myalgic encephalomyelitis (ME) - 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.

central nervous system (CNS) - One of the two parts of the human nervous system, the other part being the peripheral nervous system. The central nervous system consists of the brain and spinal cord, while the peripheral nervous system consists of nerves that travel from the central nervous system into the various organs and tissues of the body.

limbic system The limbic system is a group of structures between the forebrain and hindbrain mostly linked to emotions, memories and behavior. Includes the amygdala, limbic cortex, hypothalamus, cingulate gyrus, parahippocampal gyrus, hippocampus and hippocampal formation, dentate gyrus, subicular complex and septal area.

ganglion A ganglion is a group of neuron cell bodies in the peripheral nervous system. Plural: ganglia / ganglions

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From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history.