European Network on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (EUROMENE): Expert Consensus on the Diagnosis, Service Provision, and Care of People with ME/CFS in Europe

Luis Nacul, François Jérôme Authier, Carmen Scheibenbogen, Lorenzo Lorusso, Ingrid Bergliot Helland, Jose Alegre Martin, Carmen Adella Sirbu, Anne Marit Mengshoel, Olli Polo, Uta Behrends, Henrik Nielsen, Patricia Grabowski, Slobodan Sekulic, Nuno Sepulveda, Fernando Estévez-López, Pawel Zalewski, Derek F H Pheby, Jesus Castro-Marrero, Giorgos K Sakkas, Enrica Capelli, Ivan Brundsdlund, John Cullinan, Angelika Krumina, Jonas Bergquist, Modra Murovska, Ruud C W Vermuelen, Eliana M Lacerda, Luis Nacul, François Jérôme Authier, Carmen Scheibenbogen, Lorenzo Lorusso, Ingrid Bergliot Helland, Jose Alegre Martin, Carmen Adella Sirbu, Anne Marit Mengshoel, Olli Polo, Uta Behrends, Henrik Nielsen, Patricia Grabowski, Slobodan Sekulic, Nuno Sepulveda, Fernando Estévez-López, Pawel Zalewski, Derek F H Pheby, Jesus Castro-Marrero, Giorgos K Sakkas, Enrica Capelli, Ivan Brundsdlund, John Cullinan, Angelika Krumina, Jonas Bergquist, Modra Murovska, Ruud C W Vermuelen, Eliana M Lacerda

Abstract

Designed by a group of ME/CFS researchers and health professionals, the European Network on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (EUROMENE) has received funding from the European Cooperation in Science and Technology (COST)-COST action 15111-from 2016 to 2020. The main goal of the Cost Action was to assess the existing knowledge and experience on health care delivery for people with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in European countries, and to enhance coordinated research and health care provision in this field. We report our findings and make recommendations for clinical diagnosis, health services and care for people with ME/CFS in Europe, as prepared by the group of clinicians and researchers from 22 countries and 55 European health professionals and researchers, who have been informed by people with ME/CFS.

Keywords: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome; care; diagnosis; health services.

Conflict of interest statement

CS has a clinical study grant and speaker honoraria from Takeda and Fresenius and is consultant for Celltrend. RV is consultant for Alfasigma SpA Bologna Italy. JAM has collaborated with Vitae, Pharmanord, Vinas Laboratories, in research on coenzyme Q10, NADH, selenium, and melatonin and has a patent with Grifols Laboratories for the use of alpha-1-antiprypsin in CFS. LN has been a Committee Member, UK NICE guidelines on ME/CFS 2021. JC-M has received research support and honoraria from VITAE Health Innovation, PharmaNord, Viñas Laboratories on treatments of Coenzyme Q10 plus NADH, selenium, and melatonin plus zinc in people with ME/CFS from Spain. All other authors declare no conflicts of interest.

References

    1. EUROMENE. [(accessed on 14 May 2021)]; Available online: .
    1. Strand E.B., Nacul L., Mengshoel A.M., Helland I.B., Grabowski P., Krumina A., Alegre-Martin J., Efrim-Budisteanu M., Sekulic S., Pheby D., et al. Myalgic encephalomyelitis/chronic fatigue Syndrome (ME/CFS): Investigating care practices pointed out to disparities in diagnosis and treatment across European Union. PLoS ONE. 2019;14:e0225995. doi: 10.1371/journal.pone.0225995.
    1. Carruthers B., Jain A.K., de Meirleir K.L., Peterson D.L., Klimas N.G., Lerner A.M., Bested A.C., Flor-Henry P., Joshi P., Powles A.P., et al. Myalgic encephalomyelitis/chronic fatigue syndrome: Clinical working case definition, diagnostic and treatment protocols. J. Chronic Fatigue Syndr. 2003;11:7–115. doi: 10.1300/J092v11n01_02.
    1. Carruthers B.M., van de Sande M.I., De Meirleir K.L., Klimas N.G., Broderick G., Mitchell T., Staines D., Powles A.C., Speight N., Vallings R., et al. Myalgic encephalomyelitis: International Consensus Criteria. J. Intern. Med. 2011;270:327–338. doi: 10.1111/j.1365-2796.2011.02428.x.
    1. Rowe P.C., Underhill R.A., Friedman K.J., Gurwitt A., Medow M.S., Schwartz M.S., Speight N., Stewart J.M., Vallings R., Rowe K.S. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Diagnosis and Management in Young People: A Primer. Front. Pediatr. 2017;5:121. doi: 10.3389/fped.2017.00121.
    1. Jason L.A., Sunnquist M. The Development of the DePaul Symptom Questionnaire: Original, Expanded, Brief, and Pediatric Versions. Front. Pediatr. 2018;6:330. doi: 10.3389/fped.2018.00330.
    1. Institute of Medicine (IOM) Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. The National Academies Press; Washington, DC, USA: 2015.
    1. Nacul L., O’Boyle S., Palla L., Nacul F.E., Mudie K., Kingdon C.C., Cliff J.M., Clark T.G., Dockrell H.M., Lacerda E.M. How Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Progresses: The Natural History of ME/CFS. Front. Neurol. 2020;11:826. doi: 10.3389/fneur.2020.00826.
    1. Roberts E., Wessely S., Chalder T., Chang C.-K., Hotopf M. Mortality of people with chronic fatigue syndrome: A retrospective cohort study in England and Wales from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Clinical Record Interactive Search (CRIS) Register. Lancet. 2016;387:1638–1643. doi: 10.1016/S0140-6736(15)01223-4.
    1. Smith W.R., Noonan C., Buchwald D. Mortality in a cohort of chronically fatigued patients. Psychol. Med. 2006;36:1301–1306. doi: 10.1017/S0033291706007975.
    1. McManimen S.L., Devendorf A.R., Brown A.A., Moore B.C., Moore J.H., Jason L.A. Mortality in patients with myalgic encephalomyelitis and chronic fatigue syndrome. Fatigue Biomed. Health Behav. 2016;4:195–207. doi: 10.1080/21641846.2016.1236588.
    1. Nacul L.C., Lacerda E.M., Pheby D., Campion P., Molokhia M., Fayyaz S., Leite J.C., Poland F., Howe A., Drachler M.L. Prevalence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in three regions of England: A repeated cross-sectional study in primary care. BMC Med. 2011;9:91. doi: 10.1186/1741-7015-9-91.
    1. Estevez-Lopez F., Castro-Marrero J., Wang X., Bakken I.J., Ivanovs A., Nacul L., Sepulveda N., Strand E.B., Pheby D., Alegre J., et al. Prevalence and incidence of myalgic encephalomyelitis/chronic fatigue syndrome in Europe-the Euro-epiME study from the European network EUROMENE: A protocol for a systematic review. BMJ Open. 2018;8:e020817. doi: 10.1136/bmjopen-2017-020817.
    1. Valdez A.R., Hancock E.E., Adebayo S., Kiernicki D.J., Proskauer D., Attewell J.R., Bateman L., Demaria A., Jr., Lapp C.W., Rowe P.C., et al. Estimating Prevalence, Demographics, and Costs of ME/CFS Using Large Scale Medical Claims Data and Machine Learning. Front. Pediatr. 2019;6:412. doi: 10.3389/fped.2018.00412.
    1. Bakken I.J., Tveito K., Gunnes N. Two age peaks in the incidence of chronic fatigue syndrome/myalgic encephalomyelitis: A population-based registry study from Norway 2008–2012. BMC Med. 2014;12:167.
    1. Kingdon C.C., Bowman E.W., Curran H., Nacul L., Lacerda E.M. Functional Status and Well-Being in People with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Compared with People with Multiple Sclerosis and Healthy Controls. Pharm. Open. 2018;2:381–392. doi: 10.1007/s41669-018-0071-6.
    1. Nacul L.C., Lacerda E.M., Campion P., Pheby D., de L Drachler M., Leite J.C., Poland F., Howe A., Fayyaz S. The functional status and well being of people with myalgic encephalomyelitis/chronic fatigue syndrome and their carers. BMC Public Health. 2011;11:402. doi: 10.1186/1471-2458-11-402.
    1. Kennedy G., Underwood C., Belch J.J. Physical and functional impact of chronic fatigue syndrome/myalgic encephalomyelitis in childhood. Pediatrics. 2010;125:e1324–e1330. doi: 10.1542/peds.2009-2644.
    1. Jason L.A., Benton M.C., Valentine L., Johnson A., Torres-Harding S. The economic impact of ME/CFS: Individual and societal costs. Dyn. Med. 2008;7:6. doi: 10.1186/1476-5918-7-6.
    1. Lloyd A.R., Pender H. The economic impact of chronic fatigue syndrome. Med. J. Aust. 1992;157:599–601. doi: 10.5694/j.1326-5377.1992.tb137401.x.
    1. Hunter R.M., James M., Paxman J. Counting the Cost—Chronic Fatigue Syndrome/Myalgic Encephalomyelitis. 2020health, The Optimum Health Clinic Foundation; London, UK: 2017.
    1. Pheby D.F., Araja D., Berkis U., Brenna E., Cullinan J., De Korwin J.D., Gitto L., Hughes D.A., Hunter R.M., Trepel D., et al. The Development of a Consistent Europe-Wide Approach to Investigating the Economic Impact of Myalgic Encephalomyelitis (ME/CFS): A Report from the European Network on ME/CFS (EUROMENE) Healthcare. 2020;8:88. doi: 10.3390/healthcare8020088.
    1. Castro-Marrero J., Faro M., Zaragoza M.C., Aliste L., de Sevilla T.F., Alegre J. Unemployment and work disability in individuals with chronic fatigue syndrome/myalgic encephalomyelitis: A community-based cross-sectional study from Spain. BMC Public Health. 2019;19:840. doi: 10.1186/s12889-019-7225-z.
    1. Lacerda E.M., Mcdermott C., Kingdon C.C., Butterworth J., Cliff J.M., Nacul L. Hope, disappointment and perseverance: Reflections of people with Myalgic encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Multiple Sclerosis participating in biomedical research: A qualitative focus group study. Health Expect. 2019;22:373–384. doi: 10.1111/hex.12857.
    1. Bhatia S., Olczyk N., Jason L.A., Alegre J., Fuentes-Llanos J., Castro-Marrero J. A Cross-National Comparison of Myalgic Encephalomyelitis and Chronic Fatigue Syndrome at Tertiary Care Settings from the US and Spain. Am. J. Soc. Sci. Humanit. 2019;5:104–115. doi: 10.20448/801.51.104.115.
    1. Mudie K., Esteves-Lopez F., Sekulik S., Ivanovs A., Sepulveda N., Zalewsky P., Mengshoel A.M., de Korwin J., Hinic Capo N., Alegre-Martin J., et al. Recommendations for Epidemiological Research in ME/CFS from the EUROMENE Epidemiology Working Group. Preprints. 2020:2020090744. doi: 10.20944/preprints202009.0744.v1.
    1. Fukuda K., Straus S.E., Hickie I., Sharpe M.C., Dobbins J.G., Komaroff A. The chronic fatigue syndrome: A comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann. Intern. Med. 1994;121:953–959. doi: 10.7326/0003-4819-121-12-199412150-00009.
    1. Friedberg F., Batemen L., Bested A.C., Davenport T., Friedman K.J., Gurwitt A., Jason L.A., Lapp C.W., Stevens S.R., Underhill R.A., et al. ME/CFS: A Primer for Clinical Practitioners. IACFS/ME: International Association for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis; Chicago, IL, USA: 2012.
    1. Editorial What’s in a name? Systemic exertion intolerance disease. [(accessed on 5 May 2021)];Lancet. 2015 385:663. doi: 10.1016/S0140-6736(15)60270-7. (21 February 2015) Available online: .
    1. Jason L.A., Jordan K., Miike T., Bell D.S., Lapp C., Torres-Harding S., Rowe K., Gurwitt A., de Meirleir K., van Hoof E.L.S. A Pediatric Case Definition for Myalgic Encephalomyelitis and Chronic Fatigue Syndrome. J. Chronic Fatigue Syndr. 2006;13:1–44. doi: 10.1300/J092v13n02_01.
    1. Faro M., Sáez-Francàs N., Castro-Marrero J., Aliste L., Collado A., Alegre J. Impacto de la fibromialgia en el síndrome de fatiga crónica. Med. Clín. 2014;142:519–525. doi: 10.1016/j.medcli.2013.06.030.
    1. Ferrari R., Russell A.S. A Questionnaire Using the Modified 2010 American College of Rheumatology Criteria for Fibromyalgia: Specificity and Sensitivity in Clinical Practice. J. Rheumatol. 2014;40:1590. doi: 10.3899/jrheum.130367.
    1. Wolfe F., Clauw D.J., Fitzcharles M.A., Goldenberg D.L., Häuser W., Katz R.L., Mease P.J., Russell A.S., Russell I.J., Walitt B. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin. Arthritis Rheum. 2016;46:319–329. doi: 10.1016/j.semarthrit.2016.08.012.
    1. Lapp C.W. Initiating Care of a Patient with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Front. Pediatr. 2019;6:415. doi: 10.3389/fped.2018.00415.
    1. Beighton P., Solomon L., Soskolne C.L. Articular mobility in an African population. Ann. Rheum. Dis. 1973;32:413–418. doi: 10.1136/ard.32.5.413.
    1. Bragée B., Michos A., Drum B., Fahlgren M., Szulkin R., Bertilson B.C. Signs of Intracranial Hypertension, Hypermobility, and Craniocervical Obstructions in Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Front. Neurol. 2020:11. doi: 10.3389/fneur.2020.00828.
    1. Nacul L.C., Mudie K., Kingdon C.C., Clark T.G., Lacerda E.M. Hand Grip Strength as a Clinical Biomarker for ME/CFS and Disease Severity. Front. Neurol. 2018;9:992. doi: 10.3389/fneur.2018.00992.
    1. Hickie I., Davenport T., Vernon S.D., Nisenbaum R., Reeves W.C., Hadzi-Pavlovic D., Lloyd A. Are chronic fatigue and chronic fatigue syndrome valid clinical entities across countries and health-care settings? Aust. N. Z. J. Psychiatry. 2009;43:25–35. doi: 10.1080/00048670802534432.
    1. Boda W.L., Natelson B.H., Sisto S.A., Tapp W.N. Gait abnormalities in chronic fatigue syndrome. J. Neurol. Sci. 1995;131:156–161. doi: 10.1016/0022-510X(95)00108-E.
    1. Twisk F. The status of and future research into Myalgic Encephalomyelitis and Chronic Fatigue Syndrome: The need of accurate diagnosis, objective assessment, and acknowledging biological and clinical subgroups. Front. Physiol. 2014;5:109. doi: 10.3389/fphys.2014.00109.
    1. Nacul L., De Barros B., Kingdon C.C., Cliff J.M., Clark T.G., Mudie K., Dockrell H.M., Lacerda E.M. Evidence of Clinical Pathology Abnormalities in People with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) from an Analytic Cross-Sectional Study. Diagnostics. 2019;9:41. doi: 10.3390/diagnostics9020041.
    1. Tomas C., Finkelmeyer A., Hodgson T., Maclachlan L., Macgowan G.A., Blamire A.M., Newton J.L. Elevated brain natriuretic peptide levels in chronic fatigue syndrome associate with cardiac dysfunction: A case control study. Open Heart. 2017;4:e000697. doi: 10.1136/openhrt-2017-000697.
    1. Guenther S., Loebel M., Mooslechner A.A., Knops M., Hanitsch L.G., Grabowski P., Wittke K., Meisel C., Unterwalder N., Volk H.D., et al. Frequent IgG subclass and mannose binding lectin deficiency in patients with chronic fatigue syndrome. Hum. Immunol. 2015;76:729–735. doi: 10.1016/j.humimm.2015.09.028.
    1. National Institute of Neurological Disorders and Stroke (NINDS) Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. [(accessed on 11 April 2021)];2018 Available online: .
    1. Rowe K.S. Long Term Follow up of Young People with Chronic Fatigue Syndrome Attending a Pediatric Outpatient Service. Front. Pediatr. 2019;7:21. doi: 10.3389/fped.2019.00021.
    1. Williams M.V., Cox B., Lafuse W.P., Ariza M.E. Epstein-Barr Virus dUTPase Induces Neuroinflammatory Mediators: Implications for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Clin. Ther. 2019;41:848–863. doi: 10.1016/j.clinthera.2019.04.009.
    1. Shimosako N., Kerr J.R. Use of single-nucleotide polymorphisms (SNPs) to distinguish gene expression subtypes of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) J. Clin. Pathol. 2014;67:1078–1083. doi: 10.1136/jclinpath-2014-202597.
    1. Zhang L., Gough J., Christmas D., Mattey D.L., Richards S.C., Main J., Kerr J.R. Microbial infections in eight genomic subtypes of chronic fatigue syndrome/myalgic encephalomyelitis. J. Clin. Pathol. 2010;63:156–164. doi: 10.1136/jcp.2009.072561.
    1. Kerr J.R., Petty R., Burke B., Gough J., Fear D., Sinclair L.I., Mattey D.L., Richards S.C.M., Montgomery J., Baldwin D.A., et al. Gene expression subtypes in patients with chronic fatigue syndrome/myalgic encephalomyelitis. J. Infect. Dis. 2008;197:1171–1184. doi: 10.1086/533453.
    1. Kerr J.R., Burke B., Petty R., Gough J., Fear D., Mattey D.L., Axford J.S., Dalgleish A.G., Nutt D.J. Seven genomic subtypes of chronic fatigue syndrome/myalgic encephalomyelitis: A detailed analysis of gene networks and clinical phenotypes. J. Clin. Pathol. 2008;61:730–739. doi: 10.1136/jcp.2007.053553.
    1. Hives L., Bradley A., Richards J., Sutton C., Selfe J., Basu B., Maguire K., Sumner G., Gaber T., Mukherjee A., et al. Can physical assessment techniques aid diagnosis in people with chronic fatigue syndrome/myalgic encephalomyelitis? A diagnostic accuracy study. BMJ Open. 2017;7:e017521. doi: 10.1136/bmjopen-2017-017521.
    1. EMERGE Australia Pacing. [(accessed on 6 May 2021)]; Available online: .
    1. CureME Samples and Data. [(accessed on 6 May 2021)]; Available online: .
    1. Lacerda E.M., Bowman E.W., Cliff J.M., Kingdon C.C., King E.C., Lee J.S., Clark T.G., Dockrell H.M., Riley E.M., Curran H., et al. The UK ME/CFS Biobank for biomedical research on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Multiple Sclerosis. Open J. Bioresour. 2017;4:91. doi: 10.5334/ojb.28.
    1. Hays R.D., Sherbourne C.D., Mazel R.M. The RAND 36-Item Health Survey 1.0. Health Econ. 1993;2:217–227. doi: 10.1002/hec.4730020305.
    1. Varni J.W., Seid M., Kurtin P.S. PedsQL™ 4.0: Reliability and Validity of the Pediatric Quality of Life Inventory™ Version 4.0 Generic Core Scales in Healthy and Patient Populations. Med. Care. 2001;39:800–812. doi: 10.1097/00005650-200108000-00006.
    1. Johns M.W. A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep. 1991;14:540–545. doi: 10.1093/sleep/14.6.540.
    1. Northwestern University Health Measures. [(accessed on 11 April 2021)];2020 Available online: .
    1. Zigmond A.S., Snaith R.P. The Hospital Anxiety and Depression Scale. Acta Psychiatr. Scand. 1983;67:361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x.
    1. Spitzer R.L., Kroenke K., Williams J.B., Löwe B. A brief measure for assessing generalized anxiety disorder: The GAD-7. Arch. Intern. Med. 2006;166:1092–1097. doi: 10.1001/archinte.166.10.1092.
    1. Krupp L.B., Larocca N.G., Muir-Nash J., Steinberg A.D. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch. Neurol. 1989;46:1121–1123. doi: 10.1001/archneur.1989.00520460115022.
    1. Huskisson E.C. Measurement of pain. Lancet. 1974;2:1127–1131. doi: 10.1016/S0140-6736(74)90884-8.
    1. Tseng B.Y., Gajewski B.J., Kluding P.M. Reliability, responsiveness, and validity of the visual analog fatigue scale to measure exertion fatigue in people with chronic stroke: A preliminary study. Stroke Res. Treat. 2010:412964. doi: 10.4061/2010/412964.
    1. Buysse D.J., Reynolds C.F., Monk T.H., Berman S.R., Kupfer D.J. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193–213. doi: 10.1016/0165-1781(89)90047-4.
    1. Sletten D.M., Suarez G.A., Low P.A., Mandrekar J., Singer W. COMPASS 31: A refined and abbreviated Composite Autonomic Symptom Score. Mayo Clin. Proc. 2012;87:1196–1201. doi: 10.1016/j.mayocp.2012.10.013.
    1. Wolfe F., Clauw D.J., FitzCharles M., Goldenerberg D., Häuser W., Katz R.S., Russell I.J., Mease P.J. 2016 Revisions to the 2010/2011 Fibromyalgia Diagnostic Criteria. Abstract Number: 997. American College of Rheumatology/Association of Rheumatology Professionals Annual Meeting 2016, Washington DC, USA. [(accessed on 16 May 2021)]; Available online:
    1. Andersson G., Rozental A., Shafran R., Carlbring P. Long-term effects of internet-supported cognitive behaviour therapy. Expert Rev. Neurother. 2018;18:21–28. doi: 10.1080/14737175.2018.1400381.
    1. Geraghty K.J., Blease C. Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent. J. Health Psychol. 2018;23:127–138. doi: 10.1177/1359105316667798.
    1. Vink M., Vink-Niese A. The draft updated NICE guidance for ME/CFS highlights the unreliability of subjective outcome measures in non-blinded trials. J. Health Psychol. 2021:1359105321990810. doi: 10.1177/1359105321990810.
    1. Escorihuela R.M., Capdevila L., Castro J.R., Zaragozà N.C., Maurel S., Alegre J., Castro-Marrero J. Reduced heart rate variability predicts fatigue severity in individuals with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis. J. Transl. Med. 2020;18:4. doi: 10.1186/s12967-019-02184-z.
    1. Haß U., Herpich C., Norman K. Anti-Inflammatory Diets and Fatigue. Nutrients. 2019;11:2315. doi: 10.3390/nu11102315.
    1. Jason L., Muldowney K., Torres-Harding S. The Energy Envelope Theory and myalgic encephalomyelitis/chronic fatigue syndrome. AAOHN J. Off. J. Am. Assoc. Occup. Health Nurses. 2008;56:189–195.

Source: PubMed

3
S'abonner