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New IOM definition for chronic fatigue syndrome.

Systemic exertion intolerance disease (SEID) is the latest name proposed for the condition called chronic fatigue syndrome in the US and myalgic encephalomyelitis in the UK. A 2015 US Institute of Medicine report recommends the name change because CFS/ME patients typically exhibit debility and exhaustion after exerting themselves. The authors hope that emphasizing this symptom will encourage doctors to see this "serious, complex, multisystem disease" as "real," according to Medscape. Fatigue, even chronic fatigue, is less specific and can be experienced for many physical and emotional reasons. Although myalgic encephalomyelitis ("brain and spinal cord inflammation with muscle pain") points to a more physiological condition, not all patients experience muscle pain.

The 235-page report, Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness, defines SEID as "a substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities that persists for more than 6 months and is accompanied by fatigue, which is often profound, is of new or definite onset (not lifelong), is not the result of ongoing excessive exertion, and is not substantially alleviated by rest," according to Medscape. Postexertional malaise, unrefreshing sleep, and cognitive impairment and/or orthostatic intolerance are the other defining characteristics of SEID. Some patients may also experience sore throat, sensitivity to external stimuli, gastrointestinal and genitourinary problems, and tender axillary/cervical lymph nodes. In addition to new diagnostic criteria, the IOM report recommends that SEID be given a new diagnostic code in the International Classification of Diseases, 10th revision.

The belief that patients' complaint of fatigue after exertion is simply the result of poor physical conditioning, remedied with exercise, is inaccurate, according to the report authors. Dr. Ellen Wright Clayton, chair of the IOM panel, says that patients with SEID exhibit reproducible signs of decreased exercise capacity with 2-day cardiopulmonary testing, orthostatic intolerance, and slowed processing on neuropsychiatric tests. "This is not a figment of their imagination,'" she told David Tuller at the New York Times. Dr. Lucinda Bateman, another member of the IOM panel, told Tuller, "We are hoping [the criteria] provide a very clear path for clinicians to make a diagnosis. ... We want to make sure that symptoms that maybe have been overlooked by clinicians have been put front and center."

The full report is available at http://iom. nationalacademies.org/Reports/2015/ME-CFS.aspx.

Tucker ME. IOM gives chronic fatigue syndrome a new name and definition [online article]. Medscape. February 10, 2015. Available at http://www.medscape.com/viewarticle/839532. Accessed September 2, 2015.

Tuller D. Chronic fatigue syndrome gets a new name. New York Times. February 11, 2015. Available at http://well.blogs.nytimes.com/2015/02/10/chronic-fatigue-syndrome-gets-a-new name. Accessed September 2, 2015.

briefed by Jule Klotter

jule@townsendletter.com

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Title Annotation:Shorts; Institute of Medicine
Author:Klotter, Jule
Publication:Townsend Letter
Article Type:Author abstract
Date:Nov 1, 2015
Words:459
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