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ME CFS Consensus Document 1

ME CFS Consensus Document 1

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Published by Cheryl Benson

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Published by: Cheryl Benson on Jun 10, 2010
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EDITORIALChronic Fatigue Syndrome Guidelines 1
Kenny De Meirleir  Neil McGregor 
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome:Clinical Working Case Definition, Diagnosticand Treatment Protocols 7
 Bruce M. Carruthers Anil Kumar JainKenny L. De Meirleir  Daniel L. Peterson Nancy G. Klimas A. Martin Lerner  Alison C. Bested Pierre Flor-HenryPradip Joshi A. C. Peter Powles Jeffrey A. Sherkey Marjorie I. van de Sande
Recent years have brought growing recognition of the need for clinical criteria formyalgic encephalomyelitis (ME), which is also called chronic fatigue syndrome
Volume 11Number 12003
(CFS).AnExpertSubcommitteeofHealthCanadaestablishedtheTermsofRefer-ence,andselectedanExpertMedicalConsensusPanelrepresentingtreatingphysi-cians, teaching faculty and researchers. A Consensus Workshop was held onMarch 30 to April 1, 2001 to culminate the review process and establish consen-susforaclinicalworkingcasedefinition,diagnosticprotocolsandtreatmentpro-tocols. We present a systematic clinical working case definition that encouragesa diagnosis based on characteristic patterns of symptom clusters, which reflectspecific areas of pathogenesis. Diagnostic and treatment protocols, and a shortoverview of research are given to facilitate a comprehensive and integrated ap-proach to this illness. Throughout this paper, “myalgic encephalomyelitis” and“chronic fatigue syndrome” are used interchangeably and this illness is referredto as “ME/CFS.”KEYWORDS. Clinical case definition, myalgic encephalomyelitis, chronic fa-tigue syndrome, ME, CFS, diagnostic protocol, treatment protocol
Monitoring a Hypothetical Channelopathy in Chronic FatigueSyndrome: Preliminary Observations 117
 Jo NijsChristian Demanet  Neil R. McGregor Pascale De Becker  Michel VerhasPatrick EnglebienneKenny De Meirleir 
This study was aimed at monitoring of a previously suggested channelopathy inChronic Fatigue Syndrome, and at searching for possible explanations by meansof immune system characteristics. Twenty-seven CFS patients and 20 age and sexmatched healthy volunteers were recruited. RNase L-ratio, percent of the norm of whole body potassium content, serum electrolytes (sodium, calcium and potas-sium), immune cells, blood cell count and erythrocyte sedimentation rate were de-termined. More than fifty percent of our patients presented with abnormal wholebody potassium content. Eight patients had increased, while six had depleted po-tassium content. Discriminant function analysis revealed that the CFS patients andcontrol subjects could be differentiatedon immunophenotyping with the predomi-nant cell differences being the increase in CD19+ CD5+ (mature B-) cells and thedecreaseinCD3
CD16+CD56+(NK)cellsinboththepercentageandcountdis-tributions. The fall in NK-cells was very strongly associated with increases in theRNaseL-ratioandfallsinserumcalciumlevels.Inaddition,fourpatientswithlowserum calcium levels showed lower whole body potassium levels. In conclusion,these observations suggest a channelopathy in a subset of CFS patients, probablyinduced by the deregulated 2-5A RNase L antiviral pathway.KEYWORDS. Chronic fatigue syndrome, channelopathy, immunity, RNase L,potassium
Gulf War Illnesses: Chemical, Biological and RadiologicalExposures Resulting in Chronic Fatiguing IllnessesCan Be Identified and Treated 135
Garth L. NicolsonPaul Berns Marwan Y. Nasralla Jörg Haier  Nancy L. Nicolson Meryl Nass
Gulf War illnesses involve multiple, complex chronic signs and symptoms thatloosely fit the clinical criteria for Chronic Fatigue Syndrome/Myalgic Encephalo-myelitis (CFS/ME) and/or Fibromyalgia Syndrome (FMS). Most Gulf War illnesspatients had multiple exposures: (a) complex chemical mixtures, including organ-ophosphate pesticides, anti-nerve agents, carbamates and possibly nerve and blis-ter agents, (b) radiological sources, subjecting patients to both heavy metal andradiation effects, and (c) biological sources, including bacteria and toxins and theeffects of multiple vaccines. Chemically exposed patients may benefit by remov-ing offending chemicals and depleting toxic chemicals from the patient’s systemand other symptomatic treatments. Patients with systemic infections, includingmycoplasma and other chronic bacterial infections, can be treated with antibioticsand additional nutritional supplementation. Some patients may have their illnesslinked to radiological exposures, and a minority to battlefield stress. The vaccinesare a prime suspect for immune dysfunction and chronic infections. The multiple,complexexposuresresultedinpoorlydefinedchronicillnesses,butsubsetsofGulf Warillnesscanbeidentifiedandeffectivelytreatedusingappropriateprocedures.KEYWORDS. Gulf War Syndrome, Fibromyalgia Syndrome, Chronic FatigueSyndrome, chemical exposures, infections, uranium, antibiotics, vaccines, chemi-cal and biological warfare

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