DIAGNOSTIC CRITERIA The New International Consensus Criteria for ME - content and context by Professor Bruce M.Carruthers, MD,CM, FRCP(C) The New International Consensus Criteria for M.E. - content and context By Bruce M.Carruthers, MD,CM, FRCP(C). CONTENTS Sir William Osler said “Look wise, say nothing and grunt. Speech was given to conceal thought.” This is a typically Canadian form of advice. As a compatriot, it is with great trepidation that I deviate from it. In the new ICC the general thrust of the 2003 Canadian Consensus Criteria is retained but developed further. • We recognize the international scope of the problem of ME and its solution by moving to an international consensus panel. • The 6 month waiting period is no longer required, but left to clinical judgment. • The distinct dynamical symptom pattern of Post-Exertional-Neuroimmune-Exhaustion is kept criterial and further articulated as having the dynamical structure of unusual physical and/or cognitive fatiguability after the appropriate kind of exertion, which may be immediate or delayed, and has a prolonged recovery period. • Other symptoms and signs arising from dysfunction within the following subsystems often share a coherent dynamics with PENE, to suggest an interactive underlying causal context- neurological (neuro-cognitive, pain processing, sleep disturbances, neuro-sensory Invest in ME (Charity Nr. 1114035) and motor), immune, gastrointestinal, genitourinary and endocrine subsystems, as well as dysfunction in the energy production and transport systems-cardiovascular, microvascular, respiratory, and maintenance of thermostatic homeostasis and intolerance of temperature extremes). • Interactive dynamical pattern matches between the criterial PENE symptom pattern and the symptom/sign patterns arising from other patho-physiological subsystems are first articulated in individual patients and then as projectable in individuals, if they remain coherent and consistent over time, as well as onto larger groups of similar patients. Thus these observations become mutually confirmable as pointing to real and natural structures/patterns/kinds that exist “out there” as part of the causal structure of the body in its world- and not as creatures of the mind that happens to be trying to observe and re-present it (nominalist, constructed kinds). • Modulations for paediatric cases are added. • Exclusions that are likely to become necessary for the individual case as part of her/his differential diagnosis are listed. • The ICC keeps its focus on selecting relatively homogeneous subsets of patients with interactive symptoms, essential for clinical research if its observations are to be properly controlled, while including a discussion of recent pertinent research results. www.investinme.org Page 8 of 108
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