IOM-rapporten 10FEB2015
Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome; Board on the Health of Select Populations; Institute of Medicine. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Washington (DC): National Academies Press (US); 2015 Feb 10.
Conclusion: It is clear from the evidence compiled by the committee
that ME/CFS is a serious, chronic, complex, multisystem
disease that frequently and dramatically limits the activities of
affected patients.
Conclusion: The committee agrees that the term “chronic fatigue
syndrome” often results in stigmatization and trivialization and
should no longer be used as the name of this illness.
Conclusion: There is sufficient evidence that fatigue in ME/CFS
is profound, not the result of ongoing excessive exertion, and not
substantially alleviated by rest. This fatigue results in a substantial
reduction or impairment in the ability to engage in pre-illness levels
of occupational, educational, social, or personal activities and
persists for more than 6 months.
Conclusion: There is sufficient evidence that PEM is a primary
feature that helps distinguish ME/CFS from other conditions.
Conclusion: Despite the absence of an objective alteration in sleep
architecture, the data are strong that the complaint of unrefreshing
sleep is universal among patients with ME/CFS when questions
about sleep specifically address this issue. While PSG is not
required to diagnose ME/CFS, its use to screen for treatable sleep
disorders when indicated is appropriate. Diagnosis of a primary
sleep disorder does not rule out a diagnosis of ME/CFS.
Conclusion: There is sufficient evidence that slowed information
processing is common in patients with ME/CFS, and a growing
body of evidence shows that it may play a central role in overall
neurocognitive impairment associated with the disease. Such a
deficit may be responsible for the disability that results in loss of
employment and loss of functional capacity in social environments.
Conclusion: Sufficient evidence indicates a high prevalence of orthostatic
intolerance in ME/CFS, as measured by objective heart
rate and blood pressure abnormalities during standing or headup
tilt testing or by patient-reported exacerbation of orthostatic
symptoms with standing in day-to-day life. These findings indicate
that orthostatic intolerance is a common and clinically important
finding in ME/CFS.
Sufficient evidence shows that pain is common in ME/CFS, and its
presentation supports the diagnosis. However, while pain worsens ME/CFS
when present, there is no conclusive evidence that the pain experienced by
ME/CFS patients can be distinguished from that experienced by healthy
people or those with other illnesses. Further, pain may be experienced in
many areas, and while comprehensively assessing a patient’s pain symptoms
is a challenging task, it is not specific to ME/CFS. Conclusion: The committee elected not to include pain as a required element of its recommended diagnostic criteria for ME/CFS.
Conclusion: Sufficient evidence supports the finding of immune
dysfunction in ME/CFS.
Conclusion: Evidence is insufficient to conclude that any specific
neuroendocrine abnormalities cause ME/CFS, or that any such
abnormalities either uniformly differentiate those with ME/CFS
from individuals with other illnesses or distinguish a subset of ME/
CSF patients.
Conclusion: There is sufficient evidence suggesting that ME/CFS
follows infection with EBV and possibly other specific infections.
Conclusion: There is sufficient evidence that orthostatic intolerance
and autonomic dysfunction are common in pediatric ME/CFS;
that neurocognitive abnormalities emerge when pediatric ME/CFS
patients are tested under conditions of orthostatic stress or distraction;
and that there is a high prevalence of profound fatigue,
unrefreshing sleep, and post-exertional exacerbation of symptoms
in these patients. There also is sufficient evidence that pediatric
ME/CFS can follow acute infectious mononucleosis and EBV.
NeuroImmunologisk Myalgisk Encefalomyelitt (ME) 