criteria improve the diagnosis of chronic fatigue syndrome?"
==========================================
Re:Will adopting the Canadian criteria improve the diagnosis of
chronic fatigue syndrome?
Barba Bright, Patient
none
Re: Ending the stalemate over CFS/ME. Godlee 342:doi:10.1136/bmj.d3956
Dr Crawley and Prof White suggest that the Canadian Consensus Croteria
are too unwieldy for easy use because they contain 65 discrete
symptoms and 14 comorbid conditions before exclusionary conditions are
considered.
I would like to point out that most of the discrete symptoms in the
CCC are so simple to recognise that a GP working through the list with
the patient would be able to reach an outline diagnosis under these
criteria within ten minutes.
Compare this to the diagnostic criteria for MS, which rests mainly on
the number and frequency of attacks and lesions, but requires MRI, CSF
and VEP, as well as specialist understanding of a raft of complicated
definitions of what constitutes an attack, how to tell whether attacks
are discrete, how abnormality is defined and what constitutes clinical
evidence. A diagnosis of MS can take years.
I suspect the complexity of the use of the CCC is being rather overstated.
Competing interests: None declared
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Re:Re:Will adopting the Canadian criteria improve the diagnosis of
chronic fatigue syndrome?
Ellen M Goudsmit, Health Psychologist
UEL
Re: Ending the stalemate over CFS/ME. Godlee 342:doi:10.1136/bmj.d3956
As all ME and CFS specialists are aware, the Canadian criteria
published in 2003 were revised in 2010 to address some of the flaws
described in the BMJ and elsewhere.
They include a number of improvements. For example, they were designed
for use in both clinical practice and research. (The CDC case
definition was formulated for research alone).
Secondly, they are limited to six criteria with a comparatively
concise list of examples to improve diagnostic precision.
Thirdly, the physician does not have to plough through a whole issue
of a journal but can get the essential details on one page of A4. It's
focused, evidence-based and infititely more accurate than what went
before.
If the scientific process is to take its course, practitioners and
researchers need to be aware of important developments and adapt their
practice where it is in the patients' interest to do so. The new
criteria may not be perfect, but CFS is a complex disorder and if IBS
has Rome III, why can we not give some serious consideration to Canada
II?
Jason LA, Evans M, Porter N et al. The development of a revised
Canadian Myalgic Encephalomyelitis Chronic Fatigue Syndrome case
definition. American Journal of Biochemistry and Biotechnology 2010; 6
(2): 120-135.
Dr Ellen Goudsmit C.Psychol FBPsS
Competing interests: None declared
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Published 20 July 2011
------------
Re:Will adopting the Canadian criteria improve the diagnosis of
chronic fatigue syndrome?
Nasim Marie Jafry, author of The State of Me
Edinburgh
Re: Ending the stalemate over CFS/ME. Godlee 342:doi:10.1136/bmj.d3956
Dr Crawley suggests PEM [post-exertional malaise] *may* need
incorporating into criteria for the diagnosis of CFS. It is not a
question of may, it is a question of being essential. PEM is the
hallmark symptom of the neuroimmune illness ME and without including
it we are going to get nowhere. ME will continue to be misdiagnosed
and overdiagnosed in those who have a less complex fatigue, the kind
that responds to CBT and GET.
'I suspect the complexity of the use of the CCC is being rather
overstated,' says Barbara Bright. I suspect Barbara is right.
Competing interests: None declared
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Published 20 July 2011
----------
Re:Will adopting the Canadian criteria improve the diagnosis of
chronic fatigue syndrome?
Derek Enlander, Physician
ME/CFS center New York
Re: Ending the stalemate over CFS/ME. Godlee 342:doi:10.1136/bmj.d3956
Dear Editor
With all due respects to my colleagues Prof Peter White et al, the
recent NICE and Pace studies used criteria (Oxford criteria etc) that
complicated rather than simplified the diagnosis. The cohorts by
virtue of these criteria were in reality non specific fatigue. The
Canadian Consensus criteria are not perfect but are in my opinion the
best criteria we have in making the clinical diagnosis of Myalgic
Encephalomyelitis. In this instance it rules out the psychiatric
psychosomatic patients that might be included in the NICE and PACE
studies. These studies paid attention to a relatively non accepted
Oxford list of Criteria.
The statement that the diagnosis of M.E. is difficult is of course
accepted, making the diagnosis less difficult by dropping differential
diagnoses is not acceptable.
The inclusion of physical criteria may be unpalatable for those of a
psychiatric bent. However over the past few years, we have multiple
papers that show CVS, neurological and immunological abnormalities
which portray M.E. as physical problem.
Derek Enlander MD
New York
1. Godlee F. Ending the stalemate over CFS/ME. BMJ 2011;342:d3956
2. Crawley, E, White PD et al ; reply Ending the stalemate over
CFS/ME. BMJ 2011;342:d3956.
3. Carruthers BM, Jain AK, De Meirleir KL, et al. Myalgic
Encephalomyelitis/Chronic Fatigue Syndrome: Clinical working case
definition, diagnostic and treatment protocols. Journal CFS
2003;11:18- 154.
4. National Institute for Health and Clinical Excellence. Clinical
guideline CG53. Chronic fatigue syndrome/myalgic encephalomyelitis (or
encephalopathy): diagnosis and management. London, NICE, 2007.
http://guidance.nice.org.uk/CG53.
5. Jason LA, Evans M, Porter N et al. The development of a revised
Canadian myalgic encephalomyelitis chronic fatigue syndrome case
definition. Am J Biochem Biotech 2010;6:120-135.
6. Reeves WC, Lloyd A, Vernon SD, et al. International Chronic Fatigue
Syndrome Study Group. Identification of ambiguities in the 1994
chronic fatigue syndrome research case definition and recommendations
for resolution. BMC Health Serv Res 2003;3(1):25.
Competing interests: Author of The CFS HandBook (www.amazon.com), a
book portraying certain Physical aspects of M.E.
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Published 20 July 2011
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