Diagnostic Advances
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Jun 26, 2015; 5(2): 68-87
Published online Jun 26, 2015. doi: 10.5662/wjm.v5.i2.68
Accurate diagnosis of myalgic encephalomyelitis and chronic fatigue syndrome based upon objective test methods for characteristic symptoms
Frank NM Twisk
Frank NM Twisk, ME-de-patiënten Foundation, 1906 HB Limmen, The Netherlands
Author contributions: Twisk FNM designed the study and wrote the manuscript.
Conflict-of-interest: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Frank NM Twisk, MBA, BEd, BEc, ME-de-patiënten Foundation, Zonnedauw 15, 1906 HB Limmen, The Netherlands. frank.twisk@hetnet.nl
Telephone: +31-72-5054775
Received: November 5, 2014
Peer-review started: November 6, 2014
First decision: January 20, 2015
Revised: February 20, 2015
Accepted: May 26, 2015
Article in press: May 28, 2015
Published online: June 26, 2015

Although myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS) are considered to be synonymous, the definitional criteria for ME and CFS define two distinct, partially overlapping, clinical entities. ME, whether defined by the original criteria or by the recently proposed criteria, is not equivalent to CFS, let alone a severe variant of incapacitating chronic fatigue. Distinctive features of ME are: muscle weakness and easy muscle fatigability, cognitive impairment, circulatory deficits, a marked variability of the symptoms in presence and severity, but above all, post-exertional “malaise”: a (delayed) prolonged aggravation of symptoms after a minor exertion. In contrast, CFS is primarily defined by (unexplained) chronic fatigue, which should be accompanied by four out of a list of 8 symptoms, e.g., headaches. Due to the subjective nature of several symptoms of ME and CFS, researchers and clinicians have questioned the physiological origin of these symptoms and qualified ME and CFS as functional somatic syndromes. However, various characteristic symptoms, e.g., post-exertional “malaise” and muscle weakness, can be assessed objectively using well-accepted methods, e.g., cardiopulmonary exercise tests and cognitive tests. The objective measures acquired by these methods should be used to accurately diagnose patients, to evaluate the severity and impact of the illness objectively and to assess the positive and negative effects of proposed therapies impartially.

Keywords: Myalgic encephalomyelitis, Chronic fatigue syndrome, Symptoms, Diagnosis, Disability, Impact

Core tip: The diagnostic criteria for myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS) define two distinct clinical entities. Cognitive impairment and post-exertional “malaise” (a long-lasting aggravation of typical symptoms, e.g., muscle weakness and cognitive “brain fog”, after minor exertion) are obligatory for the diagnosis ME, while chronic fatigue is the only mandatory symptom for the diagnosis CFS. There is debate about the nature and severity of the symptoms in ME and CFS. For clinical and research purposes it is essential to accurately diagnose patients using objective tests for characteristic symptoms if possible. This article reviews accepted methods to assess various distinctive symptoms of ME and CFS.