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2004 Australian
ME/CFS Guidelines
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"A hallmark of
the condition is that symptoms are usually worsened
with minimal physical and mental exertion. Early
intervention and
positive diagnosis often results in better
prognosis."
 In
2004, South Australian State Government introduced a
clinical guidelines booklet based
on the Canadian Consensus Document for
ME/CFS. It varies slightly and is more abbreviated than the
Overview of the Consensus Document, nevertheless it is yet another
resource to address the shortcomings of the U.S.
CDC CFS case definition(Fukuda, 1994).
In the Australian document, once again the emphasis is correctly
removed from 'fatigue' and placed on post-exertional malaise
with prolonged recovery time, neurological/cognitive
manifestations, sleep disorder, pain and autonomic manifestations.
Like the Canadian Consensus Overview, it targets the busy
clinician and offers concise symptom and disability checklists.
Of note in this document:
"The hallmark of ME/CFS is that increased physical or mental
exertion results in worsening symptoms, often with a delayed
impact (i.e. it is felt later the same day or next day), and
lasting for more than 24 hours. Recovery from such relapses
may take days, weeks or even months." This is
significant in this document, since most other formal guidelines
and definitions currently in use are vague about the "delayed"
reaction to exertion and the "24 hours or longer" post-exertion
recovery time. (e.g. Some patients have gone undiagnosed for
years, as they felt relatively okay after a day of exertion, and
did not associate the crushing flu-like feeling that came on
suddenly one or two days later and lasted a few days, or even
weeks, repeating
this cycle until completely disabled. (Drs.
Ramsay and
Dowsett stress this fact in their articles and definitions.) And other
patients may over-exert and end up mostly bedridden for a month or
longer, which is far more than 24 hours. Or, this type of
variance can happen in the same patient at different points in the
disease progression.) See the
Xenon SPECT scan images that demonstrate post-exertional brain
hypoperfusion on the
Neurology Research page.
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