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vector-toc-level-1"> <a class="vector-toc-link" href="#Causes"> <div class="vector-toc-text"> 4 Causes </div> </a> <button aria-controls="toc-Causes-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Causes subsection </button> <ul id="toc-Causes-sublist" class="vector-toc-list"> <li id="toc-Risk_factors" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Risk_factors"> <div class="vector-toc-text"> 4.1 Risk factors </div> </a> <ul id="toc-Risk_factors-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Viral_infections" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Viral_infections"> <div class="vector-toc-text"> 4.2 Viral infections </div> </a> <ul id="toc-Viral_infections-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Pathophysiology" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Pathophysiology"> <div class="vector-toc-text"> 5 Pathophysiology </div> </a> <button aria-controls="toc-Pathophysiology-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Pathophysiology subsection </button> <ul id="toc-Pathophysiology-sublist" class="vector-toc-list"> <li id="toc-Neurological" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Neurological"> <div class="vector-toc-text"> 5.1 Neurological </div> </a> <ul id="toc-Neurological-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Immunological" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Immunological"> <div class="vector-toc-text"> 5.2 Immunological </div> </a> <ul id="toc-Immunological-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Energy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Energy"> <div class="vector-toc-text"> 5.3 Energy </div> </a> <ul id="toc-Energy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Other" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Other"> <div class="vector-toc-text"> 5.4 Other </div> </a> <ul id="toc-Other-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Diagnosis" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Diagnosis"> <div class="vector-toc-text"> 6 Diagnosis </div> </a> <button aria-controls="toc-Diagnosis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Diagnosis subsection </button> <ul id="toc-Diagnosis-sublist" class="vector-toc-list"> <li id="toc-Diagnostic_criteria" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Diagnostic_criteria"> <div class="vector-toc-text"> 6.1 Diagnostic criteria </div> </a> <ul id="toc-Diagnostic_criteria-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Clinical_assessment" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Clinical_assessment"> <div class="vector-toc-text"> 6.2 Clinical assessment </div> </a> <ul id="toc-Clinical_assessment-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Differential_diagnosis" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Differential_diagnosis"> <div class="vector-toc-text"> 6.3 Differential diagnosis </div> </a> <ul id="toc-Differential_diagnosis-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Management" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Management"> <div class="vector-toc-text"> 7 Management </div> </a> <button aria-controls="toc-Management-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Management subsection </button> <ul id="toc-Management-sublist" class="vector-toc-list"> <li id="toc-Pacing_and_energy_management" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Pacing_and_energy_management"> <div class="vector-toc-text"> 7.1 Pacing and energy management </div> </a> <ul id="toc-Pacing_and_energy_management-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Symptom_relief" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Symptom_relief"> <div class="vector-toc-text"> 7.2 Symptom relief </div> </a> <ul id="toc-Symptom_relief-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Severe_ME/CFS" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Severe_ME/CFS"> <div class="vector-toc-text"> 7.3 Severe ME/CFS </div> </a> <ul id="toc-Severe_ME/CFS-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Prognosis" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Prognosis"> <div class="vector-toc-text"> 8 Prognosis </div> </a> <ul id="toc-Prognosis-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Epidemiology" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Epidemiology"> <div class="vector-toc-text"> 9 Epidemiology </div> </a> <ul id="toc-Epidemiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-History" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#History"> <div class="vector-toc-text"> 10 History </div> </a> <ul id="toc-History-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Society_and_culture" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Society_and_culture"> <div class="vector-toc-text"> 11 Society and culture </div> </a> <button aria-controls="toc-Society_and_culture-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Society and culture subsection </button> <ul id="toc-Society_and_culture-sublist" class="vector-toc-list"> <li id="toc-Controversy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Controversy"> <div class="vector-toc-text"> 11.1 Controversy </div> </a> <ul id="toc-Controversy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Doctor–patient_relations" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Doctor–patient_relations"> <div class="vector-toc-text"> 11.2 Doctor–patient relations </div> </a> <ul id="toc-Doctor–patient_relations-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Economic_and_social_impact" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Economic_and_social_impact"> <div class="vector-toc-text"> 11.3 Economic and social impact </div> </a> <ul id="toc-Economic_and_social_impact-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Advocacy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Advocacy"> <div class="vector-toc-text"> 11.4 Advocacy </div> </a> <ul id="toc-Advocacy-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Research" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Research"> <div class="vector-toc-text"> 12 Research </div> </a> <button aria-controls="toc-Research-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Research subsection </button> <ul id="toc-Research-sublist" class="vector-toc-list"> <li id="toc-Funding" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Funding"> <div class="vector-toc-text"> 12.1 Funding </div> </a> <ul id="toc-Funding-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Directions" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Directions"> <div class="vector-toc-text"> 12.2 Directions </div> </a> <ul id="toc-Directions-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Challenges" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Challenges"> <div class="vector-toc-text"> 12.3 Challenges </div> </a> <ul id="toc-Challenges-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> 13 See also </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> 14 References </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> 15 External links </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" > Toggle the table of contents </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading">Myalgic encephalomyelitis/chronic fatigue syndrome</h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 54 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-54" aria-hidden="true" > 54 languages </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D9%85%D8%AA%D9%84%D8%A7%D8%B2%D9%85%D8%A9_%D8%A7%D9%84%D8%AA%D8%B9%D8%A8_%D8%A7%D9%84%D9%85%D8%B2%D9%85%D9%86" title="متلازمة التعب المزمن – Arabic" lang="ar" hreflang="ar" data-title="متلازمة التعب المزمن" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target">العربية</a></li><li class="interlanguage-link interwiki-az mw-list-item"><a href="https://az.wikipedia.org/wiki/Xroniki_yor%C4%9Funluq_sindromu" title="Xroniki yorğunluq sindromu – Azerbaijani" lang="az" hreflang="az" data-title="Xroniki yorğunluq sindromu" data-language-autonym="Azərbaycanca" data-language-local-name="Azerbaijani" class="interlanguage-link-target">Azərbaycanca</a></li><li class="interlanguage-link interwiki-azb mw-list-item"><a href="https://azb.wikipedia.org/wiki/%DA%A9%D8%B1%D9%88%D9%86%DB%8C%DA%A9_%DB%8C%D9%88%D8%B1%D8%BA%D9%88%D9%86%D9%84%D9%88%D9%82_%D8%B3%D9%86%D8%AF%D8%B1%D9%88%D9%85%DB%8C" title="کرونیک یورغونلوق سندرومی – South Azerbaijani" lang="azb" hreflang="azb" data-title="کرونیک یورغونلوق سندرومی" data-language-autonym="تۆرکجه" data-language-local-name="South Azerbaijani" class="interlanguage-link-target">تۆرکجه</a></li><li class="interlanguage-link interwiki-be mw-list-item"><a href="https://be.wikipedia.org/wiki/%D0%A1%D1%96%D0%BD%D0%B4%D1%80%D0%BE%D0%BC_%D1%85%D1%80%D0%B0%D0%BD%D1%96%D1%87%D0%BD%D0%B0%D0%B9_%D1%81%D1%82%D0%BE%D0%BC%D0%BB%D0%B5%D0%BD%D0%B0%D1%81%D1%86%D1%96" title="Сіндром хранічнай стомленасці – Belarusian" lang="be" hreflang="be" data-title="Сіндром хранічнай стомленасці" data-language-autonym="Беларуская" data-language-local-name="Belarusian" class="interlanguage-link-target">Беларуская</a></li><li class="interlanguage-link interwiki-be-x-old mw-list-item"><a href="https://be-tarask.wikipedia.org/wiki/%D0%A1%D1%8B%D0%BD%D0%B4%D1%80%D0%BE%D0%BC_%D1%85%D1%80%D0%B0%D0%BD%D1%96%D1%87%D0%BD%D0%B0%D0%B9_%D1%81%D1%82%D0%BE%D0%BC%D0%BB%D0%B5%D0%BD%D0%B0%D1%81%D1%8C%D1%86%D1%96" title="Сындром хранічнай стомленасьці – Belarusian (Taraškievica orthography)" lang="be-tarask" hreflang="be-tarask" data-title="Сындром хранічнай стомленасьці" data-language-autonym="Беларуская (тарашкевіца)" data-language-local-name="Belarusian (Taraškievica orthography)" class="interlanguage-link-target">Беларуская (тарашкевіца)</a></li><li class="interlanguage-link interwiki-bg mw-list-item"><a href="https://bg.wikipedia.org/wiki/%D0%A1%D0%B8%D0%BD%D0%B4%D1%80%D0%BE%D0%BC_%D0%BD%D0%B0_%D1%85%D1%80%D0%BE%D0%BD%D0%B8%D1%87%D0%BD%D0%B0%D1%82%D0%B0_%D1%83%D0%BC%D0%BE%D1%80%D0%B0" title="Синдром на хроничната умора – Bulgarian" lang="bg" hreflang="bg" data-title="Синдром на хроничната умора" data-language-autonym="Български" data-language-local-name="Bulgarian" class="interlanguage-link-target">Български</a></li><li class="interlanguage-link interwiki-bs mw-list-item"><a href="https://bs.wikipedia.org/wiki/Sindrom_hroni%C4%8Dnog_umora" title="Sindrom hroničnog umora – Bosnian" lang="bs" hreflang="bs" data-title="Sindrom hroničnog umora" data-language-autonym="Bosanski" data-language-local-name="Bosnian" class="interlanguage-link-target">Bosanski</a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/S%C3%ADndrome_de_fatiga_cr%C3%B2nica" title="Síndrome de fatiga crònica – Catalan" lang="ca" hreflang="ca" data-title="Síndrome de fatiga crònica" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target">Català</a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Chronick%C3%BD_%C3%BAnavov%C3%BD_syndrom" title="Chronický únavový syndrom – Czech" lang="cs" hreflang="cs" data-title="Chronický únavový syndrom" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target">Čeština</a></li><li class="interlanguage-link interwiki-da mw-list-item"><a href="https://da.wikipedia.org/wiki/Kronisk_tr%C3%A6thedssyndrom" title="Kronisk træthedssyndrom – Danish" lang="da" hreflang="da" data-title="Kronisk træthedssyndrom" data-language-autonym="Dansk" data-language-local-name="Danish" class="interlanguage-link-target">Dansk</a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Myalgische_Enzephalomyelitis/Chronisches_Fatigue-Syndrom" title="Myalgische Enzephalomyelitis/Chronisches Fatigue-Syndrom – German" lang="de" hreflang="de" data-title="Myalgische Enzephalomyelitis/Chronisches Fatigue-Syndrom" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target">Deutsch</a></li><li class="interlanguage-link interwiki-dv mw-list-item"><a href="https://dv.wikipedia.org/wiki/%DE%86%DE%B0%DE%83%DE%AE%DE%82%DE%A8%DE%86%DE%B0_%DE%8A%DE%AC%DE%93%DE%A9%DE%8E%DE%B0_%DE%90%DE%A8%DE%82%DE%B0%DE%91%DE%B0%DE%83%DE%AF%DE%89%DE%B0" title="ކްރޮނިކް ފެޓީގް ސިންޑްރޯމް – Divehi" lang="dv" hreflang="dv" data-title="ކްރޮނިކް ފެޓީގް ސިންޑްރޯމް" data-language-autonym="ދިވެހިބަސް" data-language-local-name="Divehi" class="interlanguage-link-target">ދިވެހިބަސް</a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%A3%CF%8D%CE%BD%CE%B4%CF%81%CE%BF%CE%BC%CE%BF_%CF%84%CE%B7%CF%82_%CF%87%CF%81%CF%8C%CE%BD%CE%B9%CE%B1%CF%82_%CE%BA%CE%BF%CF%80%CF%8E%CF%83%CE%B5%CF%89%CF%82" title="Σύνδρομο της χρόνιας κοπώσεως – Greek" lang="el" hreflang="el" data-title="Σύνδρομο της χρόνιας κοπώσεως" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target">Ελληνικά</a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/S%C3%ADndrome_de_fatiga_cr%C3%B3nica" title="Síndrome de fatiga crónica – Spanish" lang="es" hreflang="es" data-title="Síndrome de fatiga crónica" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target">Español</a></li><li class="interlanguage-link interwiki-eo mw-list-item"><a href="https://eo.wikipedia.org/wiki/Sindromo_de_kronika_laceco" title="Sindromo de kronika laceco – Esperanto" lang="eo" hreflang="eo" data-title="Sindromo de kronika laceco" data-language-autonym="Esperanto" data-language-local-name="Esperanto" class="interlanguage-link-target">Esperanto</a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D8%B3%D9%86%D8%AF%D8%B1%D9%85_%D8%AE%D8%B3%D8%AA%DA%AF%DB%8C_%D9%85%D8%B2%D9%85%D9%86" title="سندرم خستگی مزمن – Persian" lang="fa" hreflang="fa" data-title="سندرم خستگی مزمن" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target">فارسی</a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Enc%C3%A9phalomy%C3%A9lite_myalgique/syndrome_de_fatigue_chronique" title="Encéphalomyélite myalgique/syndrome de fatigue chronique – French" lang="fr" hreflang="fr" data-title="Encéphalomyélite myalgique/syndrome de fatigue chronique" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target">Français</a></li><li class="interlanguage-link interwiki-ga mw-list-item"><a href="https://ga.wikipedia.org/wiki/Einceifilimial%C3%ADteas_miailgeach" title="Einceifilimialíteas miailgeach – Irish" lang="ga" hreflang="ga" data-title="Einceifilimialíteas miailgeach" data-language-autonym="Gaeilge" data-language-local-name="Irish" class="interlanguage-link-target">Gaeilge</a></li><li class="interlanguage-link interwiki-gl mw-list-item"><a href="https://gl.wikipedia.org/wiki/S%C3%ADndrome_de_fatiga_cr%C3%B3nica" title="Síndrome de fatiga crónica – Galician" lang="gl" hreflang="gl" data-title="Síndrome de fatiga crónica" data-language-autonym="Galego" data-language-local-name="Galician" class="interlanguage-link-target">Galego</a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EB%A7%8C%EC%84%B1%ED%94%BC%EB%A1%9C%EC%A6%9D%ED%9B%84%EA%B5%B0" title="만성피로증후군 – Korean" lang="ko" hreflang="ko" data-title="만성피로증후군" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target">한국어</a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D4%BD%D6%80%D5%B8%D5%B6%D5%AB%D5%AF%D5%A1%D5%AF%D5%A1%D5%B6_%D5%B0%D5%B8%D5%A3%D5%B6%D5%A1%D5%AE%D5%B8%D6%82%D5%A9%D5%B5%D5%A1%D5%B6_%D5%B0%D5%A1%D5%B4%D5%A1%D5%AD%D5%BF%D5%A1%D5%B6%D5%AB%D5%B7" title="Խրոնիկական հոգնածության համախտանիշ – Armenian" lang="hy" hreflang="hy" data-title="Խրոնիկական հոգնածության համախտանիշ" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target">Հայերեն</a></li><li class="interlanguage-link interwiki-hi mw-list-item"><a href="https://hi.wikipedia.org/wiki/%E0%A4%A6%E0%A5%80%E0%A4%B0%E0%A5%8D%E0%A4%98%E0%A4%95%E0%A4%BE%E0%A4%B2%E0%A4%BF%E0%A4%95_%E0%A4%A5%E0%A4%95%E0%A4%BE%E0%A4%A8_%E0%A4%B8%E0%A4%82%E0%A4%B2%E0%A4%95%E0%A5%8D%E0%A4%B7%E0%A4%A3" title="दीर्घकालिक थकान संलक्षण – Hindi" lang="hi" hreflang="hi" data-title="दीर्घकालिक थकान संलक्षण" data-language-autonym="हिन्दी" data-language-local-name="Hindi" class="interlanguage-link-target">हिन्दी</a></li><li class="interlanguage-link interwiki-hr badge-Q17437796 badge-featuredarticle mw-list-item" title="featured article badge"><a href="https://hr.wikipedia.org/wiki/Sindrom_kroni%C4%8Dnog_umora" title="Sindrom kroničnog umora – Croatian" lang="hr" hreflang="hr" data-title="Sindrom kroničnog umora" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target">Hrvatski</a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Sindrom_keletihan_kronis" title="Sindrom keletihan kronis – Indonesian" lang="id" hreflang="id" data-title="Sindrom keletihan kronis" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target">Bahasa Indonesia</a></li><li class="interlanguage-link interwiki-is mw-list-item"><a href="https://is.wikipedia.org/wiki/ME-sj%C3%BAkd%C3%B3mur" title="ME-sjúkdómur – Icelandic" lang="is" hreflang="is" data-title="ME-sjúkdómur" data-language-autonym="Íslenska" data-language-local-name="Icelandic" class="interlanguage-link-target">Íslenska</a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Sindrome_da_fatica_cronica" title="Sindrome da fatica cronica – Italian" lang="it" hreflang="it" data-title="Sindrome da fatica cronica" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target">Italiano</a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%AA%D7%A1%D7%9E%D7%95%D7%A0%D7%AA_%D7%94%D7%AA%D7%A9%D7%99%D7%A9%D7%95%D7%AA_%D7%94%D7%9B%D7%A8%D7%95%D7%A0%D7%99%D7%AA" title="תסמונת התשישות הכרונית – Hebrew" lang="he" hreflang="he" data-title="תסמונת התשישות הכרונית" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target">עברית</a></li><li class="interlanguage-link interwiki-lv mw-list-item"><a href="https://lv.wikipedia.org/wiki/Hronisk%C4%81_noguruma_sindroms" title="Hroniskā noguruma sindroms – Latvian" lang="lv" hreflang="lv" data-title="Hroniskā noguruma sindroms" data-language-autonym="Latviešu" data-language-local-name="Latvian" class="interlanguage-link-target">Latviešu</a></li><li class="interlanguage-link interwiki-lb mw-list-item"><a href="https://lb.wikipedia.org/wiki/Chronescht_Middegkeetssyndrom" title="Chronescht Middegkeetssyndrom – Luxembourgish" lang="lb" hreflang="lb" data-title="Chronescht Middegkeetssyndrom" data-language-autonym="Lëtzebuergesch" data-language-local-name="Luxembourgish" class="interlanguage-link-target">Lëtzebuergesch</a></li><li class="interlanguage-link interwiki-lfn mw-list-item"><a href="https://lfn.wikipedia.org/wiki/Sindrom_de_fatiga_cronica" title="Sindrom de fatiga cronica – Lingua Franca Nova" lang="lfn" hreflang="lfn" data-title="Sindrom de fatiga cronica" data-language-autonym="Lingua Franca Nova" data-language-local-name="Lingua Franca Nova" class="interlanguage-link-target">Lingua Franca Nova</a></li><li class="interlanguage-link interwiki-mk mw-list-item"><a href="https://mk.wikipedia.org/wiki/%D0%A5%D1%80%D0%BE%D0%BD%D0%B8%D1%87%D0%B5%D0%BD_%D0%B7%D0%B0%D0%BC%D0%BE%D1%80" title="Хроничен замор – Macedonian" lang="mk" hreflang="mk" data-title="Хроничен замор" data-language-autonym="Македонски" data-language-local-name="Macedonian" class="interlanguage-link-target">Македонски</a></li><li class="interlanguage-link interwiki-ms mw-list-item"><a href="https://ms.wikipedia.org/wiki/Sindrom_lesu_kronik" title="Sindrom lesu kronik – Malay" lang="ms" hreflang="ms" data-title="Sindrom lesu kronik" data-language-autonym="Bahasa Melayu" data-language-local-name="Malay" class="interlanguage-link-target">Bahasa Melayu</a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Myalgische_encefalomyelitis/chronischevermoeidheidssyndroom" title="Myalgische encefalomyelitis/chronischevermoeidheidssyndroom – Dutch" lang="nl" hreflang="nl" data-title="Myalgische encefalomyelitis/chronischevermoeidheidssyndroom" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target">Nederlands</a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E6%85%A2%E6%80%A7%E7%96%B2%E5%8A%B4%E7%97%87%E5%80%99%E7%BE%A4" title="慢性疲労症候群 – Japanese" lang="ja" hreflang="ja" data-title="慢性疲労症候群" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target">日本語</a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Kronisk_utmattelsessyndrom" title="Kronisk utmattelsessyndrom – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Kronisk utmattelsessyndrom" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target">Norsk bokmål</a></li><li class="interlanguage-link interwiki-or mw-list-item"><a href="https://or.wikipedia.org/wiki/%E0%AC%95%E0%AD%8D%E0%AC%B0%E0%AC%A8%E0%AC%BF%E0%AC%95_%E0%AC%A5%E0%AC%95%E0%AC%BE_%E0%AC%B8%E0%AC%BF%E0%AC%A3%E0%AD%8D%E0%AC%A1%E0%AD%8D%E0%AC%B0%E0%AD%8B%E0%AC%AE" title="କ୍ରନିକ ଥକା ସିଣ୍ଡ୍ରୋମ – Odia" lang="or" hreflang="or" data-title="କ୍ରନିକ ଥକା ସିଣ୍ଡ୍ରୋମ" data-language-autonym="ଓଡ଼ିଆ" data-language-local-name="Odia" class="interlanguage-link-target">ଓଡ଼ିଆ</a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Zesp%C3%B3%C5%82_chronicznego_zm%C4%99czenia" title="Zespół chronicznego zmęczenia – Polish" lang="pl" hreflang="pl" data-title="Zespół chronicznego zmęczenia" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target">Polski</a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/S%C3%ADndrome_da_fadiga_cr%C3%B4nica" title="Síndrome da fadiga crônica – Portuguese" lang="pt" hreflang="pt" data-title="Síndrome da fadiga crônica" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target">Português</a></li><li class="interlanguage-link interwiki-ro mw-list-item"><a href="https://ro.wikipedia.org/wiki/Sindromul_de_oboseal%C4%83_cronic%C4%83" title="Sindromul de oboseală cronică – Romanian" lang="ro" hreflang="ro" data-title="Sindromul de oboseală cronică" data-language-autonym="Română" data-language-local-name="Romanian" class="interlanguage-link-target">Română</a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%A1%D0%B8%D0%BD%D0%B4%D1%80%D0%BE%D0%BC_%D1%85%D1%80%D0%BE%D0%BD%D0%B8%D1%87%D0%B5%D1%81%D0%BA%D0%BE%D0%B9_%D1%83%D1%81%D1%82%D0%B0%D0%BB%D0%BE%D1%81%D1%82%D0%B8" title="Синдром хронической усталости – Russian" lang="ru" hreflang="ru" data-title="Синдром хронической усталости" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target">Русский</a></li><li class="interlanguage-link interwiki-szy mw-list-item"><a href="https://szy.wikipedia.org/wiki/hinangelungelu%E2%80%99ay_a_imelang" title="hinangelungelu’ay a imelang – Sakizaya" lang="szy" hreflang="szy" data-title="hinangelungelu’ay a imelang" data-language-autonym="Sakizaya" data-language-local-name="Sakizaya" class="interlanguage-link-target">Sakizaya</a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/Chronic_fatigue_syndrome" title="Chronic fatigue syndrome – Simple English" lang="en-simple" hreflang="en-simple" data-title="Chronic fatigue syndrome" data-language-autonym="Simple English" data-language-local-name="Simple English" class="interlanguage-link-target">Simple English</a></li><li class="interlanguage-link interwiki-sk mw-list-item"><a href="https://sk.wikipedia.org/wiki/Chronick%C3%BD_%C3%BAnavov%C3%BD_syndr%C3%B3m" title="Chronický únavový syndróm – Slovak" lang="sk" hreflang="sk" data-title="Chronický únavový syndróm" data-language-autonym="Slovenčina" data-language-local-name="Slovak" class="interlanguage-link-target">Slovenčina</a></li><li class="interlanguage-link interwiki-sl mw-list-item"><a href="https://sl.wikipedia.org/wiki/Sindrom_kroni%C4%8Dne_utrujenosti" title="Sindrom kronične utrujenosti – Slovenian" lang="sl" hreflang="sl" data-title="Sindrom kronične utrujenosti" data-language-autonym="Slovenščina" data-language-local-name="Slovenian" class="interlanguage-link-target">Slovenščina</a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/%D0%A1%D0%B8%D0%BD%D0%B4%D1%80%D0%BE%D0%BC_%D1%85%D1%80%D0%BE%D0%BD%D0%B8%D1%87%D0%BD%D0%BE%D0%B3_%D1%83%D0%BC%D0%BE%D1%80%D0%B0" title="Синдром хроничног умора – Serbian" lang="sr" hreflang="sr" data-title="Синдром хроничног умора" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target">Српски / srpski</a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/Sindrom_kroni%C4%8Dnog_umora" title="Sindrom kroničnog umora – Serbo-Croatian" lang="sh" hreflang="sh" data-title="Sindrom kroničnog umora" data-language-autonym="Srpskohrvatski / српскохрватски" data-language-local-name="Serbo-Croatian" class="interlanguage-link-target">Srpskohrvatski / српскохрватски</a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/Krooninen_v%C3%A4symysoireyhtym%C3%A4" title="Krooninen väsymysoireyhtymä – Finnish" lang="fi" hreflang="fi" data-title="Krooninen väsymysoireyhtymä" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target">Suomi</a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/ME/CFS" title="ME/CFS – Swedish" lang="sv" hreflang="sv" data-title="ME/CFS" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target">Svenska</a></li><li class="interlanguage-link interwiki-th mw-list-item"><a href="https://th.wikipedia.org/wiki/%E0%B8%AD%E0%B8%B2%E0%B8%81%E0%B8%B2%E0%B8%A3%E0%B8%A5%E0%B9%89%E0%B8%B2%E0%B9%80%E0%B8%A3%E0%B8%B7%E0%B9%89%E0%B8%AD%E0%B8%A3%E0%B8%B1%E0%B8%87" title="อาการล้าเรื้อรัง – Thai" lang="th" hreflang="th" data-title="อาการล้าเรื้อรัง" data-language-autonym="ไทย" data-language-local-name="Thai" class="interlanguage-link-target">ไทย</a></li><li class="interlanguage-link interwiki-tr mw-list-item"><a href="https://tr.wikipedia.org/wiki/Kronik_yorgunluk_sendromu" title="Kronik yorgunluk sendromu – Turkish" lang="tr" hreflang="tr" data-title="Kronik yorgunluk sendromu" data-language-autonym="Türkçe" data-language-local-name="Turkish" class="interlanguage-link-target">Türkçe</a></li><li class="interlanguage-link interwiki-uk mw-list-item"><a href="https://uk.wikipedia.org/wiki/%D0%A1%D0%B8%D0%BD%D0%B4%D1%80%D0%BE%D0%BC_%D1%85%D1%80%D0%BE%D0%BD%D1%96%D1%87%D0%BD%D0%BE%D1%97_%D0%B2%D1%82%D0%BE%D0%BC%D0%B8" title="Синдром хронічної втоми – Ukrainian" lang="uk" hreflang="uk" data-title="Синдром хронічної втоми" data-language-autonym="Українська" data-language-local-name="Ukrainian" class="interlanguage-link-target">Українська</a></li><li class="interlanguage-link interwiki-ur mw-list-item"><a href="https://ur.wikipedia.org/wiki/%D8%AF%D8%A7%D8%A6%D9%85%DB%8C_%D8%AA%DA%BE%DA%A9%D8%A7%D9%88%D9%B9_%DA%A9%D8%A7_%D8%B9%D8%A7%D8%B1%D8%B6%DB%81" title="دائمی تھکاوٹ کا عارضہ – Urdu" lang="ur" hreflang="ur" data-title="دائمی تھکاوٹ کا عارضہ" data-language-autonym="اردو" data-language-local-name="Urdu" class="interlanguage-link-target">اردو</a></li><li class="interlanguage-link interwiki-vi mw-list-item"><a href="https://vi.wikipedia.org/wiki/H%E1%BB%99i_ch%E1%BB%A9ng_m%E1%BB%87t_m%E1%BB%8Fi_m%C3%A3n_t%C3%ADnh" title="Hội chứng mệt mỏi mãn tính – Vietnamese" lang="vi" hreflang="vi" data-title="Hội chứng mệt mỏi mãn tính" data-language-autonym="Tiếng Việt" data-language-local-name="Vietnamese" class="interlanguage-link-target">Tiếng Việt</a></li><li class="interlanguage-link interwiki-zh mw-list-item"><a href="https://zh.wikipedia.org/wiki/%E6%85%A2%E6%80%A7%E7%96%B2%E5%8B%9E%E7%97%87%E5%80%99%E7%BE%A4" title="慢性疲勞症候群 – Chinese" lang="zh" hreflang="zh" data-title="慢性疲勞症候群" data-language-autonym="中文" data-language-local-name="Chinese" class="interlanguage-link-target">中文</a></li> </ul> <div class="after-portlet after-portlet-lang"><a href="https://www.wikidata.org/wiki/Special:EntityPage/Q209733#sitelinks-wikipedia" title="Edit interlanguage links" class="wbc-editpage">Edit links</a></div> </div> </div> </div> </header> <div class="vector-page-toolbar"> <div class="vector-page-toolbar-container"> <div id="left-navigation"> <nav aria-label="Namespaces"> <div id="p-associated-pages" class="vector-menu vector-menu-tabs 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Click here for more information."><img alt="Featured article" src="//upload.wikimedia.org/wikipedia/en/thumb/e/e7/Cscr-featured.svg/20px-Cscr-featured.svg.png" decoding="async" width="20" height="19" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/e/e7/Cscr-featured.svg/30px-Cscr-featured.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/e/e7/Cscr-featured.svg/40px-Cscr-featured.svg.png 2x" data-file-width="466" data-file-height="443" /></a></div></div> </div> <div id="siteSub" class="noprint">From Wikipedia, the free encyclopedia</div> </div> <div id="contentSub"><div id="mw-content-subtitle">(Redirected from <a href="/w/index.php?title=Chronic_fatigue_syndrome&redirect=no" class="mw-redirect" title="Chronic fatigue syndrome">Chronic fatigue syndrome</a>)</div></div> <div id="mw-content-text" class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Chronic medical condition</div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">Not to be confused with <a href="/wiki/Fatigue#Chronic" title="Fatigue">chronic fatigue</a>, a symptom experienced in many chronic illnesses, including <a href="/wiki/Idiopathic_chronic_fatigue" title="Idiopathic chronic fatigue">idiopathic chronic fatigue</a>.</div> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Myalgic encephalomyelitis/chronic fatigue syndrome</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">Post-viral fatigue syndrome (PVFS), systemic exertion intolerance disease (SEID)<a href="#cite_note-IOM2015-1">[1]</a>: 20 </td></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><a href="/wiki/File:Icons_symptoms_ME_CFS.svg" class="mw-file-description"><img alt="Icons of the four key ME/CFS symptoms: low battery for profound fatigue, weak muscle for post-exertional malaise, bed for sleep problems and crossed wires in brain for cognitive difficulties." src="//upload.wikimedia.org/wikipedia/commons/thumb/c/c8/Icons_symptoms_ME_CFS.svg/220px-Icons_symptoms_ME_CFS.svg.png" decoding="async" width="220" height="274" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/c8/Icons_symptoms_ME_CFS.svg/330px-Icons_symptoms_ME_CFS.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/c/c8/Icons_symptoms_ME_CFS.svg/440px-Icons_symptoms_ME_CFS.svg.png 2x" data-file-width="864" data-file-height="1077" /></a></td></tr><tr><td colspan="2" class="infobox-full-data">The four primary symptoms of ME/CFS according to the <a href="/wiki/National_Institute_for_Health_and_Care_Excellence" title="National Institute for Health and Care Excellence">National Institute for Health and Care Excellence</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Rheumatology" title="Rheumatology">Rheumatology</a>, <a href="/wiki/Rehabilitation_medicine" class="mw-redirect" title="Rehabilitation medicine">rehabilitation medicine</a>, <a href="/wiki/Endocrinology" title="Endocrinology">endocrinology</a>, <a href="/wiki/Infectious_disease_(medical_specialty)" class="mw-redirect" title="Infectious disease (medical specialty)">infectious disease</a>, <a href="/wiki/Neurology" title="Neurology">neurology</a>, <a href="/wiki/Immunology" title="Immunology">immunology</a>, <a href="/wiki/General_practice" title="General practice">general practice</a>, <a href="/wiki/Paediatrics" class="mw-redirect" title="Paediatrics">paediatrics</a>, other specialists in ME/CFS<a href="#cite_note-NICE2021-2">[2]</a>: 58 </td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data"><a href="/wiki/Post-exertional_malaise" title="Post-exertional malaise">Worsening of symptoms with activity</a>, <a href="/wiki/Fatigue#Chronic" title="Fatigue">long-term fatigue</a>, sleep problems, others<a href="#cite_note-CDCsym2024-3">[3]</a></td></tr><tr><th scope="row" class="infobox-label">Usual onset</th><td class="infobox-data">Peaks at 10–19 and 30–39 years old<a href="#cite_note-pmid31379194-4">[4]</a></td></tr><tr><th scope="row" class="infobox-label">Duration</th><td class="infobox-data">Long-term<a href="#cite_note-5">[5]</a></td></tr><tr><th scope="row" class="infobox-label">Causes</th><td class="infobox-data">Unknown<a href="#cite_note-pmid37793728-6">[6]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Risk_factor" title="Risk factor">Risk factors</a></th><td class="infobox-data">Being female, <a href="/wiki/Genetics" title="Genetics">family history</a>, viral infections<a href="#cite_note-pmid37793728-6">[6]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic method</a></th><td class="infobox-data">Based on symptoms<a href="#cite_note-pmid37226227-7">[7]</a></td></tr><tr><th scope="row" class="infobox-label">Treatment</th><td class="infobox-data"><a href="/wiki/Symptomatic_treatment" title="Symptomatic treatment">Symptomatic</a><a href="#cite_note-CDC2024manage-8">[8]</a></td></tr><tr><th scope="row" class="infobox-label">Prevalence</th><td class="infobox-data">About 0.17% to 0.89% (pre-<a href="/wiki/COVID-19_pandemic" title="COVID-19 pandemic">COVID-19 pandemic</a>)<a href="#cite_note-Lim2020-9">[9]</a></td></tr></tbody></table> Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a disabling <a href="/wiki/Chronic_condition" title="Chronic condition">chronic illness</a>. People with ME/CFS experience profound <a href="/wiki/Fatigue" title="Fatigue">fatigue</a> that does not go away with rest, sleep issues, and problems with memory or concentration. Further common symptoms include <a href="/wiki/Dizziness" title="Dizziness">dizziness</a>, <a href="/wiki/Nausea" title="Nausea">nausea</a> and pain.<a href="#cite_note-CDCsym2024-3">[3]</a> The <a href="/wiki/Pathognomonic" title="Pathognomonic">hallmark</a> symptom is a <a href="/wiki/Post-exertional_malaise" title="Post-exertional malaise">worsening of the illness</a> which starts hours to days after minor physical or mental activity. This "crash" can last from hours or days to several months.<a href="#cite_note-IQWiG-2023-10">[10]</a> The cause of the disease is unknown.<a href="#cite_note-CDC_Clinical2024-11">[11]</a> ME/CFS often starts after an infection, such as <a href="/wiki/Infectious_mononucleosis" title="Infectious mononucleosis">mononucleosis</a>.<a href="#cite_note-Bateman-2021-12">[12]</a> It can run in families, but no <a href="/wiki/Genes" class="mw-redirect" title="Genes">genes</a> that contribute to ME/CFS have been confirmed.<a href="#cite_note-Dibble_McGrath_Ponting_2020_p.-13">[13]</a> ME/CFS is associated with changes in the nervous and immune systems, as well as in energy production.<a href="#cite_note-pmid38443223-14">[14]</a> Diagnosis is based on symptoms and a <a href="/wiki/Differential_diagnosis" title="Differential diagnosis">differential diagnosis</a> because no diagnostic test is available (<a href="/wiki/Diagnosis_of_exclusion" title="Diagnosis of exclusion">diagnosis by exclusion</a>).<a href="#cite_note-pmid37226227-7">[7]</a><a href="#cite_note-15">[15]</a> The illness can improve or worsen over time, but full recovery is uncommon.<a href="#cite_note-Bateman-2021-12">[12]</a> No therapies or medications are approved to treat the condition, and management is aimed at relieving symptoms.<a href="#cite_note-NICE2021-2">[2]</a>: 29  <a href="/wiki/Pacing_(activity_management)" title="Pacing (activity management)">Pacing of activities</a> can help avoid worsening symptoms, and counselling may help in coping with the illness.<a href="#cite_note-CDC2024manage-8">[8]</a> Before the <a href="/wiki/COVID-19_pandemic" title="COVID-19 pandemic">COVID-19 pandemic</a>, ME/CFS affected 2 to 9 out of every 1000 people, depending on the definition.<a href="#cite_note-Lim2020-9">[9]</a> However, many people fit ME/CFS diagnostic criteria after contracting <a href="/wiki/Long_COVID" title="Long COVID">long COVID</a>.<a href="#cite_note-Davis-2023-16">[16]</a> ME/CFS occurs more often in women than in men. It most commonly affects adults between ages 40 and 60 but can occur at other ages, including childhood.<a href="#cite_note-CDCEpide2023-17">[17]</a> ME/CFS has a large social and economic impact, and the disease can be socially isolating.<a href="#cite_note-Boulazreg_2024-18">[18]</a> About a quarter of those affected are unable to leave their bed or home.<a href="#cite_note-IQWiG-2023-10">[10]</a>: 3  People with ME/CFS often face stigma in healthcare settings, and care is complicated by <a href="/wiki/Controversies_related_to_ME/CFS" title="Controversies related to ME/CFS">controversies around the cause and treatments</a> of the illness.<a href="#cite_note-Hussein-2024-19">[19]</a> Doctors may be unfamiliar with ME/CFS, as it is often not fully covered in medical school.<a href="#cite_note-Davis-2023-16">[16]</a> Historically, research funding for ME/CFS has been far below that of diseases with comparable impact.<a href="#cite_note-Tyson_2022-20">[20]</a> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Classification_and_terminology">Classification and terminology</h2>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=1" title="Edit section: Classification and terminology">edit</a>]</div> ME/CFS has been classified as a <a href="/wiki/Neurological_disease" class="mw-redirect" title="Neurological disease">neurological disease</a> by the <a href="/wiki/World_Health_Organization" title="World Health Organization">World Health Organization</a> (WHO) since 1969, initially under the name <a href="/wiki/History_of_ME/CFS#Case_definitions_(1986_onwards)" title="History of ME/CFS">benign myalgic encephalomyelitis</a>.<a href="#cite_note-21">[21]</a>: 564  The classification of ME/CFS as a neurological disease is based on symptoms which indicate a central role of the nervous system.<a href="#cite_note-pmid328732972-22">[22]</a> Alternatively, based on abnormalities in <a href="/wiki/Immune_cells" class="mw-redirect" title="Immune cells">immune cells</a>, ME/CFS is sometimes labelled a <a href="/wiki/Neuroimmunology" title="Neuroimmunology">neuroimmune</a> condition.<a href="#cite_note-Marshall-Gradisnik_2022-23">[23]</a> The disease can further be regarded as a <a href="/wiki/Post-acute_infection_syndrome" title="Post-acute infection syndrome">post-acute infection syndrome</a> (PAIS) or an infection-associated chronic illness.<a href="#cite_note-CDC_Clinical2024-11">[11]</a><a href="#cite_note-pmid35585196-24">[24]</a> PAISs such as <a href="/wiki/Long_COVID" title="Long COVID">long COVID</a> and <a href="/wiki/Post-treatment_Lyme_disease_syndrome" class="mw-redirect" title="Post-treatment Lyme disease syndrome">post-treatment Lyme disease syndrome</a> share many symptoms with ME/CFS and are suspected to have a similar cause.<a href="#cite_note-pmid35585196-24">[24]</a> Many names have been proposed for the illness. The most commonly used are chronic fatigue syndrome, myalgic encephalomyelitis, and the umbrella term myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Reaching consensus on a name has been challenging because the cause and pathology remain unknown.<a href="#cite_note-IOM2015-1">[1]</a>: 29–30  In the WHO's most recent classification, the <a href="/wiki/ICD-11" title="ICD-11">ICD-11</a>, chronic fatigue syndrome and myalgic encephalomyelitis are named under post-viral fatigue syndrome.<a href="#cite_note-ICD11-25">[25]</a> The term post-infectious fatigue syndrome was initially proposed as a subset of 'chronic fatigue syndrome' with a documented triggering infection, but might also be used as a synonym of ME/CFS or as a broader set of fatigue conditions after infection.<a href="#cite_note-pmid35585196-24">[24]</a> Many individuals with ME/CFS object to the term chronic fatigue syndrome. They consider the term simplistic and trivialising, which in turn prevents the illness from being taken seriously.<a href="#cite_note-IOM2015-1">[1]</a>: 234 <a href="#cite_note-Bhatia-2023-26">[26]</a> At the same time, there are also issues with the use of myalgic encephalomyelitis (myalgia means muscle pain and <a href="/wiki/Encephalitis" title="Encephalitis">encephalomyelitis</a> means brain and spinal cord inflammation), as there is only limited evidence of brain inflammation implied by the name.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 3  The umbrella term ME/CFS would retain the better-known phrase CFS without trivialising the disease, but some people object to this name too, as they see CFS and ME as distinct illnesses.<a href="#cite_note-Bhatia-2023-26">[26]</a> A 2015 report from the US Institute of Medicine recommended the illness be renamed systemic exertion intolerance disease (SEID) and suggested new diagnostic criteria.<a href="#cite_note-IOM2015-1">[1]</a> While the new name was not widely adopted, the diagnostic criteria were taken over by the CDC. Like CFS, the name SEID only focuses on a single symptom, and opinion from those affected was generally negative.<a href="#cite_note-28">[28]</a> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=2" title="Edit section: Signs and symptoms">edit</a>]</div> ME/CFS causes debilitating fatigue, sleep problems, and <a href="/wiki/Post-exertional_malaise" title="Post-exertional malaise">post-exertional malaise</a> (PEM, overall symptoms getting worse after mild activity). In addition, cognitive issues, <a href="/wiki/Orthostatic_intolerance" title="Orthostatic intolerance">orthostatic intolerance</a> (dizziness or nausea when upright) or other physical symptoms may be present (see also <a href="#Diagnostic_criteria">§ Diagnostic criteria</a>). Symptoms significantly reduce the ability to function and typically last for three to six months before a diagnosis can be confirmed.<a href="#cite_note-IQWiG-2023-10">[10]</a>: 13 <a href="#cite_note-NICE2021-2">[2]</a>: 11  ME/CFS usually starts after an infection. Onset can be sudden or more gradual over weeks to months.<a href="#cite_note-Bateman-2021-12">[12]</a> <div class="mw-heading mw-heading3"><h3 id="Core_symptoms">Core symptoms</h3>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=3" title="Edit section: Core symptoms">edit</a>]</div> People with ME/CFS experience persistent debilitating <a href="/wiki/Fatigue" title="Fatigue">fatigue</a>. It is made worse by normal physical, mental, emotional, and social activity, and is not a result of ongoing overexertion.<a href="#cite_note-CDCsym2024-3">[3]</a><a href="#cite_note-NICE2021-2">[2]</a>: 12  Rest provides limited relief from fatigue. Particularly in the initial period of illness, this fatigue is described as "flu-like". Individuals may feel restless and describe their experience as "wired but tired". When starting an activity, muscle strength may drop rapidly, which can lead to difficulty with coordination, clumsiness or sudden <a href="/wiki/Weakness" title="Weakness">weakness</a>.<a href="#cite_note-NICE2021-2">[2]</a>: 12, 57  Mental fatigue may make cognitive efforts difficult. The fatigue experienced in ME/CFS is of a longer duration and greater severity than in other conditions characterized by fatigue.<a href="#cite_note-IQWiG-2023-10">[10]</a>: 5–6  The hallmark feature of ME/CFS is a worsening of symptoms after exertion, known as <a href="/wiki/Post-exertional_malaise" title="Post-exertional malaise">post-exertional malaise</a> or post-exertional symptom exacerbation.<a href="#cite_note-pmid37793728-6">[6]</a> PEM involves increased fatigue and is disabling. It can also include flu-like symptoms, pain, cognitive difficulties, gastrointestinal issues, <a href="/wiki/Nausea" title="Nausea">nausea</a>, and sleep problems.<a href="#cite_note-IQWiG-2023-10">[10]</a>: 6  <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Timeframe_of_PEM_from_daily_activities.jpg" class="mw-file-description"><img alt="The onset of PEM is usually within two days. Peak PEM occurs within seven, while recovery can take months." src="//upload.wikimedia.org/wikipedia/commons/thumb/9/91/Timeframe_of_PEM_from_daily_activities.jpg/330px-Timeframe_of_PEM_from_daily_activities.jpg" decoding="async" width="330" height="121" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/91/Timeframe_of_PEM_from_daily_activities.jpg/495px-Timeframe_of_PEM_from_daily_activities.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/91/Timeframe_of_PEM_from_daily_activities.jpg/660px-Timeframe_of_PEM_from_daily_activities.jpg 2x" data-file-width="2008" data-file-height="734" /></a><figcaption>Typical timeframes of post-exertional malaise after normal daily activities</figcaption></figure> All types of activities that require energy, whether physical, cognitive, social, or emotional, can trigger PEM.<a href="#cite_note-NICE-2021-D-29">[29]</a>: 49  Examples include attending a school event, food shopping, or even taking a shower.<a href="#cite_note-CDCsym2024-3">[3]</a> For some, being in a stimulating environment can be sufficient to trigger PEM.<a href="#cite_note-NICE-2021-D-29">[29]</a>: 49  PEM usually starts 12 to 48 hours after the activity,<a href="#cite_note-CDC_strategies2024-30">[30]</a> but can also follow immediately after. PEM can last hours, days, weeks, or months.<a href="#cite_note-IQWiG-2023-10">[10]</a>: 6  Extended periods of PEM, commonly referred to as "crashes" or "flare-ups" by people with the illness, can lead to a prolonged relapse.<a href="#cite_note-NICE-2021-D-29">[29]</a>: 50  Unrefreshing sleep is a further core symptom. People wake up exhausted and stiff rather than restored after a night's sleep. This can be caused by a pattern of <a href="/wiki/Sleep_inversion" title="Sleep inversion">sleeping during the day and being awake at night</a>, shallow sleep, or broken sleep. However, even a full night's sleep is typically non-restorative. Some individuals experience insomnia, <a href="/wiki/Hypersomnia" title="Hypersomnia">hypersomnia</a> (excessive sleepiness), or vivid nightmares.<a href="#cite_note-NICE-2021-D-29">[29]</a>: 50  <a href="/wiki/Cognitive_dysfunction" class="mw-redirect" title="Cognitive dysfunction">Cognitive dysfunction</a> in ME/CFS can be as disabling as physical symptoms, leading to difficulties at work or school, as well as in social interactions.<a href="#cite_note-IQWiG-2023-10">[10]</a>: 7  People with ME/CFS sometimes describe it as "brain fog",<a href="#cite_note-CDCsym2024-3">[3]</a> and report a slowdown in information processing.<a href="#cite_note-IQWiG-2023-10">[10]</a>: 7  Individuals may have difficulty speaking, struggling to find words and names. They may have trouble concentrating or multitasking, or may have difficulties with short-term memory.<a href="#cite_note-NICE2021-2">[2]</a> Tests often show problems with short-term visual memory, <a href="/wiki/Mental_chronometry" title="Mental chronometry">reaction time</a> and <a href="/wiki/Reading_speed" class="mw-redirect" title="Reading speed">reading speed</a>. There may also be problems with <a href="/wiki/Attention" title="Attention">attention</a> and <a href="/wiki/Verbal_memory" title="Verbal memory">verbal memory</a>.<a href="#cite_note-pmid35140252-31">[31]</a> People with ME/CFS often experience <a href="/wiki/Orthostatic_intolerance" title="Orthostatic intolerance">orthostatic intolerance</a>, symptoms that start or worsen with standing or sitting. Symptoms, which include nausea, lightheadedness, and cognitive impairment, often improve again after lying down.<a href="#cite_note-Bateman-2021-12">[12]</a> Weakness and vision changes may also be triggered by the upright posture.<a href="#cite_note-CDCsym2024-3">[3]</a> Some have <a href="/wiki/Postural_orthostatic_tachycardia_syndrome" title="Postural orthostatic tachycardia syndrome">postural orthostatic tachycardia syndrome</a> (POTS), an excessive increase in <a href="/wiki/Heart_rate" title="Heart rate">heart rate</a> after standing up, which can result in <a href="/wiki/Syncope_(medicine)" title="Syncope (medicine)">fainting</a>.<a href="#cite_note-IQWiG-2023-10">[10]</a>: 7  Additionally, individuals may experience <a href="/wiki/Orthostatic_hypotension" title="Orthostatic hypotension">orthostatic hypotension</a>, a drop in blood pressure after standing.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 17  <div class="mw-heading mw-heading3"><h3 id="Other_common_symptoms">Other common symptoms</h3>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=4" title="Edit section: Other common symptoms">edit</a>]</div> Pain and <a href="/wiki/Hyperalgesia" title="Hyperalgesia">hyperalgesia</a> (an abnormally increased sensitivity to pain) are common in ME/CFS. The pain is not accompanied by swelling or redness.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 16  The pain can be present in muscles (<a href="/wiki/Myalgia" title="Myalgia">myalgia</a>) and <a href="/wiki/Arthralgia" title="Arthralgia">joints</a>. Individuals with ME/CFS may have chronic pain behind the eyes and in the neck, as well as <a href="/wiki/Neuropathic_pain" title="Neuropathic pain">neuropathic pain</a> (related to disorders of the nervous system).<a href="#cite_note-IQWiG-2023-10">[10]</a>: 8  Headaches and <a href="/wiki/Migraine" title="Migraine">migraines</a> that were not present before the illness can occur as well. However, chronic daily headaches may indicate an alternative diagnosis.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 16  Additional common symptoms include <a href="/wiki/Irritable_bowel_syndrome" title="Irritable bowel syndrome">irritable bowel syndrome</a> or other problems with digestion, chills and <a href="/wiki/Night_sweats" title="Night sweats">night sweats</a>, <a href="/wiki/Shortness_of_breath" title="Shortness of breath">shortness of breath</a> or an <a href="/wiki/Arrhythmia" title="Arrhythmia">irregular heartbeat</a>. Some experience sore <a href="/wiki/Lymph_node" title="Lymph node">lymph nodes</a> and a sore throat. People may also develop allergies or become sensitive to foods, lights, noise, smells or chemicals.<a href="#cite_note-CDCsym2024-3">[3]</a> <div class="mw-heading mw-heading2"><h2 id="Illness_severity">Illness severity</h2>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=5" title="Edit section: Illness severity">edit</a>]</div> ME/CFS often leads to serious disability, but the degree varies considerably.<a href="#cite_note-CDC_Clinical2024-11">[11]</a> ME/CFS is generally classified into four categories of illness severity:<a href="#cite_note-NICE2021-2">[2]</a>: 8 <a href="#cite_note-BMJbest_practice3-27">[27]</a>: 10  <ul><li>People with mild ME/CFS can usually still work and care for themselves, but they will need their free time to recover from these activities rather than engage in social and leisure activities.</li> <li>Moderate severity impedes <a href="/wiki/Activities_of_daily_living" title="Activities of daily living">activities of daily living</a> (self-care activities, such as making a meal). People are usually unable to work and require frequent rest.</li> <li>Those with severe ME/CFS are homebound and can do only limited activities of daily living, for instance brushing their teeth. They may be wheelchair-dependent and spend the majority of their time in bed.</li> <li>With very severe ME/CFS, people are mostly bedbound and cannot care for themselves.</li></ul> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:QoL_comparison_ME-CFS.svg" class="mw-file-description"><img alt="A bar graph showing the average quality of life score of those with ME/CFS." src="//upload.wikimedia.org/wikipedia/commons/thumb/f/fd/QoL_comparison_ME-CFS.svg/310px-QoL_comparison_ME-CFS.svg.png" decoding="async" width="310" height="338" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/fd/QoL_comparison_ME-CFS.svg/465px-QoL_comparison_ME-CFS.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/fd/QoL_comparison_ME-CFS.svg/620px-QoL_comparison_ME-CFS.svg.png 2x" data-file-width="592" data-file-height="646" /></a><figcaption>Results of a study on the <a href="/wiki/Quality_of_life" title="Quality of life">quality of life</a> of individuals with ME/CFS, showing it to be lower than in 20 other chronic conditions</figcaption></figure> Roughly a quarter of those living with ME/CFS fall into the mild category, and half fall into the moderate or moderate-to-severe categories.<a href="#cite_note-pmid37793728-6">[6]</a> The final quarter falls into the severe or very severe category.<a href="#cite_note-IQWiG-2023-10">[10]</a>: 3  Severity may change over time. Symptoms might get worse, improve, or the illness may go into remission for a period of time.<a href="#cite_note-CDC_Clinical2024-11">[11]</a> People who feel better for a period of time may overextend their activities, triggering PEM and a worsening of symptoms.<a href="#cite_note-CDC_strategies2024-30">[30]</a> Those with severe and very severe ME/CFS experience more extreme and diverse symptoms. They may face severe weakness and greatly limited ability to move. They can lose the ability to speak, swallow, or communicate completely due to cognitive issues. They can further experience severe pain and hypersensitivities to touch, light, sound, and smells.<a href="#cite_note-NICE2021-2">[2]</a>: 50  Minor day-to-day activities can be sufficient to trigger PEM.<a href="#cite_note-Bateman-2021-12">[12]</a> Individuals with ME/CFS have decreased quality of life when evaluated by the <a href="/wiki/SF-36" title="SF-36">SF-36</a> questionnaire, especially in the domains of physical and social functioning, general health, and vitality. However, their emotional functioning and mental health are not much lower than those of healthy individuals.<a href="#cite_note-pmid28033311-32">[32]</a> Functional impairment in ME/CFS can be greater than <a href="/wiki/Multiple_sclerosis" title="Multiple sclerosis">multiple sclerosis</a>, <a href="/wiki/Heart_disease" class="mw-redirect" title="Heart disease">heart disease</a>, or <a href="/wiki/Lung_cancer" title="Lung cancer">lung cancer</a>.<a href="#cite_note-Bateman-2021-12">[12]</a> Fewer than half of people with ME/CFS are employed, and roughly one in five have a full-time job.<a href="#cite_note-Lim2020-9">[9]</a> <div class="mw-heading mw-heading2"><h2 id="Causes">Causes</h2>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=6" title="Edit section: Causes">edit</a>]</div> The cause of ME/CFS is not yet known.<a href="#cite_note-Bateman-2021-12">[12]</a> Between 60% and 80% of cases start after an infection, usually a viral infection.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 5 <a href="#cite_note-pmid37793728-6">[6]</a> A genetic factor is believed to contribute, but there is no single gene responsible for increased risk. Instead, many gene variants probably have a small individual effect, but their combined effect can be strong.<a href="#cite_note-Dibble_McGrath_Ponting_2020_p.-13">[13]</a> Other factors may include problems with the nervous and immune systems, as well as energy metabolism.<a href="#cite_note-Bateman-2021-12">[12]</a> ME/CFS is a biological disease, not a psychological condition,<a href="#cite_note-pmid28033311-32">[32]</a><a href="#cite_note-CDC_Clinical2024-11">[11]</a> and is not due to <a href="/wiki/Deconditioning" title="Deconditioning">deconditioning</a>.<a href="#cite_note-pmid28033311-32">[32]</a><a href="#cite_note-Bateman-2021-12">[12]</a> Besides viruses, other reported triggers include stress, traumatic events, and environmental exposures such as to <a href="/wiki/Mold" title="Mold">mould</a>.<a href="#cite_note-IQWiG-2023-10">[10]</a>: 21  Bacterial infections such as <a href="/wiki/Q_fever" title="Q fever">Q-fever</a> are other potential triggers.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 5  ME/CFS may further occur after physical trauma, such as an accident or surgery.<a href="#cite_note-CDC_Clinical2024-11">[11]</a> Pregnancy has been reported in around 3% to 10% of cases as a trigger.<a href="#cite_note-pmid37234076-33">[33]</a> ME/CFS can also begin with multiple minor triggering events, followed by a final trigger that leads to a clear onset of symptoms.<a href="#cite_note-pmid37793728-6">[6]</a> <div class="mw-heading mw-heading3"><h3 id="Risk_factors">Risk factors</h3>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=7" title="Edit section: Risk factors">edit</a>]</div> ME/CFS can affect people of all ages, ethnicities, and income levels, but it is more common in women than men.<a href="#cite_note-Lim2020-9">[9]</a> People with a history of frequent infections are more likely to develop it.<a href="#cite_note-pmid38443223-14">[14]</a> Those with family members who have ME/CFS are also at higher risk, suggesting a genetic factor.<a href="#cite_note-Dibble_McGrath_Ponting_2020_p.-13">[13]</a> In the United States, <a href="/wiki/White_Americans" title="White Americans">white Americans</a> are diagnosed more frequently than other groups,<a href="#cite_note-:0-34">[34]</a> but the illness is probably at least as prevalent among African Americans and Hispanics.<a href="#cite_note-CDCEpide2023-17">[17]</a> It used to be thought that ME/CFS was more common among those with higher incomes. Instead, people in minority groups or lower income groups may have increased risks due to poorer nutrition, lower healthcare access, and increased work stress.<a href="#cite_note-Lim2020-9">[9]</a> <div class="mw-heading mw-heading3"><h3 id="Viral_infections">Viral infections</h3>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=8" title="Edit section: Viral infections">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Post-acute_infection_syndrome" title="Post-acute infection syndrome">Post-acute infection syndrome</a></div> Viral infections have long been suspected to cause ME/CFS, based on the observation that ME/CFS sometimes occurs in outbreaks and is possibly connected to <a href="/wiki/Autoimmune_disease" title="Autoimmune disease">autoimmune diseases</a>.<a href="#cite_note-pmid37898798-35">[35]</a> How viral infections cause ME/CFS is unclear; it could be via <a href="/wiki/Virus_latency" title="Virus latency">viral persistence</a> or via a "hit and run" mechanism, in which infections dysregulate the immune system or cause autoimmunity.<a href="#cite_note-pmid30285773-36">[36]</a> Different types of viral infection have been implicated in ME/CFS, including airway infections, <a href="/wiki/Bronchitis" title="Bronchitis">bronchitis</a>, <a href="/wiki/Gastroenteritis" title="Gastroenteritis">gastroenteritis</a>, or an acute "flu-like illness".<a href="#cite_note-IQWiG-2023-10">[10]</a>: 226  Between 15% and 50% of people with <a href="/wiki/Long_COVID" title="Long COVID">long COVID</a> also meet the diagnostic criteria for ME/CFS.<a href="#cite_note-IQWiG-2023-10">[10]</a>: 228  Of people who get <a href="/wiki/Infectious_mononucleosis" title="Infectious mononucleosis">infectious mononucleosis</a>, which is caused by the <a href="/wiki/Epstein%E2%80%93Barr_virus" title="Epstein–Barr virus">Epstein–Barr virus</a> (EBV), around 8% to 15% develop ME/CFS, depending on criteria.<a href="#cite_note-IQWiG-2023-10">[10]</a>: 226  Other viral infections that can trigger ME/CFS are the <a href="/wiki/Influenza_A_virus_subtype_H1N1" title="Influenza A virus subtype H1N1">H1N1 influenza virus</a>, <a href="/wiki/Varicella_zoster_virus" title="Varicella zoster virus">varicella zoster</a> (the virus that causes <a href="/wiki/Chickenpox" title="Chickenpox">chickenpox</a> and <a href="/wiki/Herpes_zoster" class="mw-redirect" title="Herpes zoster">shingles</a>), and <a href="/wiki/SARS-CoV-1" title="SARS-CoV-1">SARS-CoV-1</a>.<a href="#cite_note-pmid37433988-37">[37]</a> Reactivation of latent viruses, in particular EBV and <a href="/wiki/Human_herpesvirus_6" title="Human herpesvirus 6">human herpesvirus 6</a>, has also been hypothesised to drive symptoms. EBV is present in about 90% of people, usually in a latent state.<a href="#cite_note-pmid37718435-38">[38]</a><a href="#cite_note-39">[39]</a>: 13  The levels of <a href="/wiki/Antibodies" class="mw-redirect" title="Antibodies">antibodies</a> to EBV are commonly higher in people with ME/CFS, indicating possible viral reactivation.<a href="#cite_note-Eriksen-40">[40]</a> <div class="mw-heading mw-heading2"><h2 id="Pathophysiology">Pathophysiology</h2>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=9" title="Edit section: Pathophysiology">edit</a>]</div> ME/CFS is associated with changes in several areas, including the nervous and immune systems, as well as disturbances in energy metabolism.<a href="#cite_note-CDC_Clinical2024-11">[11]</a><a href="#cite_note-pmid38443223-14">[14]</a> Neurological differences include <a href="/wiki/Autonomic_nervous_system" title="Autonomic nervous system">autonomic nervous system</a> dysfunction and a change in brain structure and <a href="/wiki/Metabolism" title="Metabolism">metabolism</a>.<a href="#cite_note-Maksoud2020-41">[41]</a> Observed changes in the <a href="/wiki/Immune_system" title="Immune system">immune system</a> include decreased <a href="/wiki/Natural_killer_cell" title="Natural killer cell">natural killer cell</a> function and, in some cases, <a href="/wiki/Autoimmunity" title="Autoimmunity">autoimmunity</a>.<a href="#cite_note-pmid38443223-14">[14]</a> <div class="mw-heading mw-heading3"><h3 id="Neurological">Neurological</h3>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=10" title="Edit section: Neurological">edit</a>]</div> A range of structural, biochemical, and functional abnormalities are found in brain imaging studies of people with ME/CFS.<a href="#cite_note-Marshall-Gradisnik_2022-23">[23]</a><a href="#cite_note-Maksoud2020-41">[41]</a> Common findings are changes in the <a href="/wiki/Brainstem" title="Brainstem">brainstem</a> and the use of additional brain areas for cognitive tasks. Other consistent findings, based on a smaller number of studies, are low metabolism in some areas, reduced <a href="/wiki/Serotonin_transporter" title="Serotonin transporter">serotonin transporters</a>, and problems with <a href="/wiki/Neurovascular_coupling" class="mw-redirect" title="Neurovascular coupling">neurovascular coupling</a>.<a href="#cite_note-pmid328732972-22">[22]</a> <a href="/wiki/Neuroinflammation" title="Neuroinflammation">Neuroinflammation</a> has been proposed as an underlying mechanism of ME/CFS that could explain a large set of symptoms. Several studies suggest neuroinflammation in the <a href="/wiki/Brain_cortex" class="mw-redirect" title="Brain cortex">cortical</a> and <a href="/wiki/Limbic_system" title="Limbic system">limbic</a> regions of the brain. Individuals with ME/CFS, for instance, have higher brain <a href="/wiki/Lactic_acid" title="Lactic acid">lactate</a> and <a href="/wiki/Choline" title="Choline">choline</a> levels, which are signs of neuroinflammation. More direct evidence from two small <a href="/wiki/Positron_emission_tomography" title="Positron emission tomography">PET</a> studies of <a href="/wiki/Microglia" title="Microglia">microglia</a>, a type of immune cell in the brain, were contradictory, however.<a href="#cite_note-pmid38016575-42">[42]</a><a href="#cite_note-43">[43]</a> ME/CFS affects sleep. Individuals experience decreased <a href="/wiki/Sleep_efficiency" title="Sleep efficiency">sleep efficiency</a>, <a href="/wiki/Sleep_latency" class="mw-redirect" title="Sleep latency">take longer to fall asleep</a>, and take longer to achieve <a href="/wiki/REM_sleep" class="mw-redirect" title="REM sleep">REM sleep</a>, a phase of sleep characterised by rapid eye movement. Changes to <a href="/wiki/Non-REM_sleep" class="mw-redirect" title="Non-REM sleep">non-REM sleep</a> have also been found, together suggesting a role of the autonomic nervous system.<a href="#cite_note-pmid36948138-44">[44]</a> Individuals often have a <a href="/wiki/Chronotropic_incompetence" title="Chronotropic incompetence">blunted heart rate response to exercise</a>, but a higher heart rate during a <a href="/wiki/Tilt_table_test" title="Tilt table test">tilt table test</a> when the body is rotated from lying flat to an upright position. This again suggests dysfunction in the autonomic nervous system.<a href="#cite_note-pmid31651868-45">[45]</a> <div class="mw-heading mw-heading3"><h3 id="Immunological">Immunological</h3>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=11" title="Edit section: Immunological">edit</a>]</div> People with ME/CFS often have immune system abnormalities. A consistent finding in studies is a decreased function of natural killer cells, a type of immune cell that targets virus-infected and tumour cells.<a href="#cite_note-pmid31727160-46">[46]</a> They are also more likely to have active viral infections, correlating with cognitive issues and fatigue. <a href="/wiki/T_cell" title="T cell">T cells</a> show less metabolic activity. This may reflect they have reached an exhausted state and cannot respond effectively against <a href="/wiki/Pathogen" title="Pathogen">pathogens</a>.<a href="#cite_note-pmid38443223-14">[14]</a> Autoimmunity has been proposed to be a factor in ME/CFS. There is a subset of people with ME/CFS with increased levels of <a href="/wiki/Autoantibody" title="Autoantibody">autoantibodies</a>, possibly as a result of <a href="/wiki/Molecular_mimicry" title="Molecular mimicry">viral mimicry</a>.<a href="#cite_note-Autoimmunity_Reviews_pp._601–609-47">[47]</a> Some may have higher levels of autoantibodies to <a href="/wiki/Muscarinic_acetylcholine_receptor" title="Muscarinic acetylcholine receptor">muscarinic acetylcholine receptors</a> as well as to <a href="/wiki/%CE%922_adrenergic_receptor" class="mw-redirect" title="Β2 adrenergic receptor">β2 adrenergic receptors</a>.<a href="#cite_note-Autoimmunity_Reviews_pp._601–609-47">[47]</a><a href="#cite_note-pmid38443223-14">[14]</a> Problems with these receptors can lead to impaired blood flow.<a href="#cite_note-Autoimmunity_Reviews_2020_p.-48">[48]</a> <div class="mw-heading mw-heading3"><h3 id="Energy">Energy</h3>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=12" title="Edit section: Energy">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Work_rate_at_ventilatory_threshold.jpg" class="mw-file-description"><img alt="A scatterplot with fifty datapoints. They show that people with ME/CFS score worse in work rate at ventilatory threshold than those with unexplained chronic fatigue on the second day of a 2-day exercise test." src="//upload.wikimedia.org/wikipedia/commons/thumb/f/f2/Work_rate_at_ventilatory_threshold.jpg/300px-Work_rate_at_ventilatory_threshold.jpg" decoding="async" width="300" height="273" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/f2/Work_rate_at_ventilatory_threshold.jpg/450px-Work_rate_at_ventilatory_threshold.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/f2/Work_rate_at_ventilatory_threshold.jpg/600px-Work_rate_at_ventilatory_threshold.jpg 2x" data-file-width="1184" data-file-height="1079" /></a><figcaption>When people with ME/CFS exercise on consecutive days, their performance declines on the second day, unlike those with <a href="/wiki/Idiopathic_chronic_fatigue" title="Idiopathic chronic fatigue">unexplained chronic fatigue</a> (ICF).</figcaption></figure> Objective signs of PEM have been found with the <a href="/wiki/2-day_CPET" title="2-day CPET">2-day cardiopulmonary exercise test</a>.<a href="#cite_note-pmid33327624-49">[49]</a> People with ME/CFS have lower performance compared to healthy controls on the first test. On the second test, healthy people's scores stay roughly the same or increase slightly, while those with ME/CFS have a clinically significant decrease in work rate at the <a href="/wiki/Anaerobic_threshold" class="mw-redirect" title="Anaerobic threshold">anaerobic threshold</a>. Potential causes include mitochondrial dysfunction, and issues with the transport and use of oxygen.<a href="#cite_note-Franklin-2022-50">[50]</a> Some of the usual recovery processes following exercise may be lacking, providing an alternative explanation for PEM.<a href="#cite_note-pmid38443223-14">[14]</a> Studies have observed <a href="/wiki/Mitochondrial_disease" title="Mitochondrial disease">mitochondrial abnormalities</a> in cellular energy production, but differences between studies make it hard to draw clear conclusions.<a href="#cite_note-holden2020-51">[51]</a> <a href="/wiki/Adenosine_triphosphate" title="Adenosine triphosphate">ATP</a>, the primary energy carrier in cells, is likely more frequently produced from <a href="/wiki/Lipid" title="Lipid">lipids</a> and <a href="/wiki/Amino_acid" title="Amino acid">amino acids</a> than from <a href="/wiki/Carbohydrate" title="Carbohydrate">carbohydrates</a>.<a href="#cite_note-pmid38443223-14">[14]</a> <div class="mw-heading mw-heading3"><h3 id="Other">Other</h3>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=13" title="Edit section: Other">edit</a>]</div> Some people with ME/CFS have abnormalities in their <a href="/wiki/Hypothalamic%E2%80%93pituitary%E2%80%93adrenal_axis" title="Hypothalamic–pituitary–adrenal axis">hypothalamic–pituitary–adrenal axis</a> hormones. This can include <a href="/wiki/Adrenal_insufficiency" title="Adrenal insufficiency">lower cortisol levels</a>, less change in cortisol levels throughout the day, and a weaker reaction to stress and stimuli.<a href="#cite_note-Morris2016rev-52">[52]</a> Other proposed abnormalities are reduced <a href="/wiki/Cerebral_blood_flow" class="mw-redirect" title="Cerebral blood flow">blood flow to the brain</a> under orthostatic stress (as found in a tilt table test), <a href="/wiki/Small_fiber_neuropathy" class="mw-redirect" title="Small fiber neuropathy">small-fibre neuropathy</a>, and an increase in the amount of <a href="/wiki/Gut_microbiota" title="Gut microbiota">gut microbes</a> entering the blood.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 9  The diversity of <a href="/wiki/Gut_microbiota" title="Gut microbiota">gut microbes</a> is reduced compared to healthy controls.<a href="#cite_note-pmid38443223-14">[14]</a> Women with ME/CFS are more likely to experience <a href="/wiki/Endometriosis" title="Endometriosis">endometriosis</a>, <a href="/wiki/Early_menopause" class="mw-redirect" title="Early menopause">early menopause</a>, and other menstrual irregularities compared to women without the condition.<a href="#cite_note-CDC_Clinical2024-11">[11]</a> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=14" title="Edit section: Diagnosis">edit</a>]</div> Diagnosis of ME/CFS is based on symptoms<a href="#cite_note-pmid37226227-7">[7]</a> and involves taking a <a href="/wiki/Medical_history" title="Medical history">medical history</a> and a mental and physical examination.<a href="#cite_note-CDC2020diag-53">[53]</a> No specific lab tests are approved for diagnosis; while physical abnormalities can be found, no single finding is considered sufficient for diagnosis.<a href="#cite_note-Bateman-2021-12">[12]</a><a href="#cite_note-pmid37226227-7">[7]</a> Blood and urine tests are used to rule out other conditions that could be responsible for the symptoms.<a href="#cite_note-CDC2020diag-53">[53]</a> People with ME/CFS often face significant delays in obtaining a diagnosis, and diagnoses may be missed altogether.<a href="#cite_note-NICE2021-2">[2]</a>: 66  Specialists in ME/CFS may be asked to confirm the diagnosis, as primary care physicians often lack a good understanding of the illness.<a href="#cite_note-NICE2021-2">[2]</a>: 68  <div class="mw-heading mw-heading3"><h3 id="Diagnostic_criteria">Diagnostic criteria</h3>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=15" title="Edit section: Diagnostic criteria">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Clinical_descriptions_of_ME/CFS" title="Clinical descriptions of ME/CFS">Clinical descriptions of ME/CFS</a></div> <table class="wikitable floatright"> <caption>ME/CFS symptoms according to five diagnostic criteria<a href="#cite_note-IQWiG-2023-10">[10]</a>: 13 <a href="#cite_note-BMJbest_practice3-27">[27]</a>: 15  </caption> <tbody><tr> <th style="text-align: left; font-weight: normal;">Symptom M: Mandatory O: Optional </th> <th class="nowrap ts-vertical-header" style=""><div style=""><style data-mw-deduplicate="TemplateStyles:r1221560606">@supports(writing-mode:vertical-rl){.mw-parser-output .ts-vertical-header{line-height:1;max-width:1em;padding:0.4em;vertical-align:bottom;width:1em}html.client-js .mw-parser-output .sortable:not(.jquery-tablesorter) .ts-vertical-header:not(.unsortable),html.client-js .mw-parser-output .ts-vertical-header.headerSort{background-position:50%.4em;padding-right:0.4em;padding-top:21px}.mw-parser-output .ts-vertical-header.is-valign-top{vertical-align:top}.mw-parser-output .ts-vertical-header.is-valign-middle{vertical-align:middle}.mw-parser-output .ts-vertical-header.is-normal{font-weight:normal}.mw-parser-output .ts-vertical-header>*{display:inline-block;transform:rotate(180deg);writing-mode:vertical-rl}@supports(writing-mode:sideways-lr){.mw-parser-output .ts-vertical-header>*{transform:none;writing-mode:sideways-lr}}}</style>Fukuda</div> </th> <th class="nowrap ts-vertical-header" style=""><div style=""><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1221560606">CCC</div> </th> <th class="nowrap ts-vertical-header" style=""><div style=""><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1221560606">ICC</div> </th> <th class="nowrap ts-vertical-header" style=""><div style=""><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1221560606">IOM</div> </th> <th class="nowrap ts-vertical-header" style=""><div style=""><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1221560606">NICE</div> </th></tr> <tr> <td>Fatigue </td> <td style="background: #3B7D23; text-align: center;">M </td> <td style="background: #3B7D23; text-align: center;">M </td> <td style="background: #3B7D23; text-align: center;">M </td> <td style="background: #3B7D23; text-align: center;">M </td> <td style="background: #3B7D23; text-align: center;">M </td></tr> <tr> <td>Functional impairment </td> <td style="background: #3B7D23; text-align: center;">M </td> <td style="background: #3B7D23; text-align: center;">M </td> <td style="background: #3B7D23; text-align: center;">M </td> <td style="background: #3B7D23; text-align: center;">M </td> <td style="background: #3B7D23; text-align: center;">M </td></tr> <tr> <td>PEM </td> <td style="background: #8ED973; text-align: center;">O </td> <td style="background: #3B7D23; text-align: center;">M </td> <td style="background: #3B7D23; text-align: center;">M </td> <td style="background: #3B7D23; text-align: center;">M </td> <td style="background: #3B7D23; text-align: center;">M </td></tr> <tr> <td>Sleep problems </td> <td style="background: #8ED973; text-align: center;">O </td> <td style="background: #3B7D23; text-align: center;">M </td> <td style="background: #8ED973; text-align: center;">O </td> <td style="background: #3B7D23; text-align: center;">M </td> <td style="background: #3B7D23; text-align: center;">M </td></tr> <tr> <td>Cognitive issues </td> <td style="background: #8ED973; text-align: center;">O </td> <td style="background: #8ED973; text-align: center;">O </td> <td style="background: #8ED973; text-align: center;">O </td> <td style="background: #8ED973; text-align: center;">O </td> <td style="background: #3B7D23; text-align: center;">M </td></tr> <tr> <td>Pain or headaches </td> <td style="background: #8ED973; text-align: center;">O </td> <td style="background: #3B7D23; text-align: center;">M </td> <td style="background: #8ED973; text-align: center;">O </td> <td> </td> <td> </td></tr> <tr> <td>Orthostatic intolerance </td> <td> </td> <td style="background: #8ED973; text-align: center;">O </td> <td style="background: #8ED973; text-align: center;">O </td> <td style="background: #8ED973; text-align: center;">O </td> <td> </td></tr> <tr> <td>Flu or cold symptoms </td> <td style="background: #8ED973; text-align: center;">O </td> <td style="background: #8ED973; text-align: center;">O </td> <td style="background: #8ED973; text-align: center;">O </td> <td> </td> <td> </td></tr> <tr> <td>Nausea </td> <td> </td> <td style="background: #8ED973; text-align: center;">O </td> <td style="background: #8ED973; text-align: center;">O </td> <td> </td> <td> </td></tr> <tr> <td>Cardiovascular problems </td> <td> </td> <td style="background: #8ED973; text-align: center;">O </td> <td style="background: #8ED973; text-align: center;">O </td> <td> </td> <td> </td></tr> <tr> <td>Hypersensitivities </td> <td> </td> <td style="background: #8ED973; text-align: center;">O </td> <td style="background: #8ED973; text-align: center;">O </td> <td> </td> <td> </td></tr> <tr> <td>Susceptibility to infection </td> <td> </td> <td> </td> <td style="background: #8ED973; text-align: center;">O </td> <td> </td> <td> </td></tr></tbody></table> Multiple research and clinical criteria exist to diagnose ME/CFS. These include the <a href="/wiki/National_Institute_for_Health_and_Care_Excellence" title="National Institute for Health and Care Excellence">NICE</a> guidelines, <a href="/wiki/National_Academy_of_Medicine" title="National Academy of Medicine">Institute of Medicine</a> (IOM) criteria, the International Consensus Criteria (ICC), the Canadian Consensus Criteria (CCC), and <a href="/wiki/Centers_for_Disease_Control_and_Prevention" title="Centers for Disease Control and Prevention">CDC</a> criteria. The criteria sets were all developed based on expert consensus and differ in the required symptoms and which conditions preclude a diagnosis of ME/CFS.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 14  The definitions differ in their conceptualisation of the cause and mechanisms of ME/CFS.<a href="#cite_note-Lim_2020-54">[54]</a> As there is no <a href="/wiki/Biomarker" title="Biomarker">biomarker</a> for ME/CFS, it is not possible to determine which set of criteria is the most accurate. A trade-off must be made between overdiagnosis and missing more diagnoses. The broad Fukuda criteria have a higher risk of overdiagnosis, whereas the strict ICC criteria have a higher risk of missing people. The IOM and NICE criteria fall in the middle.<a href="#cite_note-NICE-2021-D-29">[29]</a>: 47–48  The 1994 CDC criteria, sometimes called the Fukuda criteria, require six months of persistent or relapsing fatigue for diagnosis, as well as the persistent presence of four out of eight other symptoms.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 35  While used frequently, the Fukuda criteria have limitations: PEM and cognitive issues are not mandatory. The large variety of optional symptoms can lead to diagnosis of individuals who differ significantly from each other.<a href="#cite_note-IQWiG-2023-10">[10]</a>: 15  The Canadian Consensus Criteria, another commonly used criteria set, was developed in 2003.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 14  In addition to PEM, fatigue and sleep problems, pain and neurological or cognitive issues are required for diagnosis. Furthermore, three categories of symptoms are defined (orthostatic, thermal instability, and immunological). At least one symptom in two of these categories needs to be present.<a href="#cite_note-IQWiG-2023-10">[10]</a>: 15 <a href="#cite_note-BMJbest_practice3-27">[27]</a>: 34  People diagnosed under the CCC have more severe symptoms compared to those diagnosed under the Fukuda criteria. The 2011 International Consensus Criteria defines ME using symptom clusters and has no minimum duration of symptoms. Similarly to the CCC criteria, ICC is stricter than the Fukuda criteria and selects more severely ill people.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 14  The 2015 IOM criteria share significant similarities with the CCC but were developed to be easy to use for clinicians. Diagnosis requires fatigue, PEM, non-restorative sleep, and either cognitive issues (such as memory impairment) or orthostatic intolerance. Additionally, fatigue must persist for at least six months, substantially impair activities in all areas of life, and have a clearly defined onset.<a href="#cite_note-IQWiG-2023-10">[10]</a>: 16–17  Symptoms must be present at least half of the time, and be of moderate severity or worse; previous criteria just required symptoms to be present.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 14  In 2021, NICE revised its criteria based on the IOM criteria. The updated criteria require fatigue, PEM, non-restorative sleep, and cognitive difficulties persisting for at least three months.<a href="#cite_note-IQWiG-2023-10">[10]</a>: 16–17  Separate diagnostic criteria have been developed for children and young people. A diagnosis for children often requires a shorter symptom duration. For example, the CCC definition only requires three months of persistent symptoms in children compared to six months for adults.<a href="#cite_note-IQWiG-2023-10">[10]</a>: 17–18  NICE requires only four weeks of symptoms to suspect ME/CFS in children, compared to six weeks in adults.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 15  Exclusionary diagnoses also differ; for instance, children and teenagers may have <a href="/wiki/School_refusal" title="School refusal">anxiety related to school attendance</a>, which could explain symptoms.<a href="#cite_note-IQWiG-2023-10">[10]</a>: 17–18  <div class="mw-heading mw-heading3"><h3 id="Clinical_assessment">Clinical assessment</h3>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=16" title="Edit section: Clinical assessment">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Could_You_Have_MECFS.webp" class="mw-file-description"><img alt="A leaflet from the CDC describing the Institute of Medicine criteria for ME/CFS." src="//upload.wikimedia.org/wikipedia/commons/thumb/d/d2/Could_You_Have_MECFS.webp/300px-Could_You_Have_MECFS.webp.png" decoding="async" width="300" height="388" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/d/d2/Could_You_Have_MECFS.webp/450px-Could_You_Have_MECFS.webp.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/d/d2/Could_You_Have_MECFS.webp/600px-Could_You_Have_MECFS.webp.png 2x" data-file-width="1275" data-file-height="1651" /></a><figcaption>Could You Have ME/CFS? handout from the US Centers for Disease Control and Prevention</figcaption></figure> Screening can be done using the <a href="/w/index.php?title=DePaul_Symptom_Questionnaire&action=edit&redlink=1" class="new" title="DePaul Symptom Questionnaire (page does not exist)">DePaul Symptom Questionnaire</a>, which assesses the frequency and severity of ME/CFS symptoms.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 24  Individuals may struggle to answer questions related to PEM, if they are unfamiliar with the symptom. To find patterns in symptoms, they may be asked to keep a diary.<a href="#cite_note-Bateman-2021-12">[12]</a> A <a href="/wiki/Physical_exam" class="mw-redirect" title="Physical exam">physical exam</a> may appear completely normal, particularly if the individual has rested substantially before a doctor's visit.<a href="#cite_note-Bateman-2021-12">[12]</a> There may be tenderness in the lymph nodes and abdomen or signs of hypermobility.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 17  Answers to questions may show a temporary difficulty with finding words or other cognitive problems.<a href="#cite_note-pmid37793728-6">[6]</a> <a href="/wiki/Neuropsychological_test" title="Neuropsychological test">Cognitive tests</a> and a two-day cardiopulmonary exercise test (CPET) can be helpful to document aspects of the illness, but they may be risky as they can cause severe PEM. They may be warranted to support a disability claim.<a href="#cite_note-Bateman-2021-12">[12]</a> Orthostatic intolerance can be measured with a tilt table test. If that is unavailable, it can also be assessed with the simpler <a href="/w/index.php?title=NASA_lean_test&action=edit&redlink=1" class="new" title="NASA lean test (page does not exist)">NASA 10-minute lean test</a>, which tests the response to prolonged standing.<a href="#cite_note-pmid37793728-6">[6]</a> Standard laboratory findings are usually normal. Standard tests when suspecting ME/CFS include an HIV test, and blood tests to determine <a href="/wiki/Full_blood_count" class="mw-redirect" title="Full blood count">full blood count</a>, <a href="/wiki/Red_blood_cell_sedimentation_rate" class="mw-redirect" title="Red blood cell sedimentation rate">red blood cell sedimentation rate</a> (ESR), <a href="/wiki/C-reactive_protein" title="C-reactive protein">C-reactive protein</a>, blood glucose and <a href="/wiki/Thyroid-stimulating_hormone" title="Thyroid-stimulating hormone">thyroid-stimulating hormone</a>. Tests for <a href="/wiki/Antinuclear_antibodies" class="mw-redirect" title="Antinuclear antibodies">antinuclear antibodies</a> may come back positive, but below the levels that suggest the individual may have <a href="/wiki/Lupus" title="Lupus">lupus</a>. C-reactive protein levels are often at the high end of normal. <a href="/wiki/Ferritin" title="Ferritin">Serum ferritin</a> levels may be useful to test, as borderline <a href="/wiki/Anemia" title="Anemia">anaemia</a> can make some ME/CFS symptoms worse.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 18  <div class="mw-heading mw-heading3"><h3 id="Differential_diagnosis">Differential diagnosis</h3>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=17" title="Edit section: Differential diagnosis">edit</a>]</div> Some medical conditions have symptoms similar to ME/CFS. Diagnosis often involves clinical evaluation, testing, and specialist referrals to identify the correct condition. During the time other possible diagnoses are explored, advice can be given on symptom management to help prevent the condition from getting worse.<a href="#cite_note-NICE2021-2">[2]</a>: 66–67  Before a diagnosis of ME/CFS is confirmed, a waiting period is used to exclude acute medical conditions or symptoms which may resolve within that time frame.<a href="#cite_note-Bateman-2021-12">[12]</a><a href="#cite_note-55">[55]</a> Possible differential diagnoses span a large set of specialties and depend on the medical history.<a href="#cite_note-Bateman-2021-12">[12]</a> Examples are <a href="/wiki/Infection" title="Infection">infectious diseases</a>, such as Epstein–Barr virus and <a href="/wiki/Lyme_disease" title="Lyme disease">Lyme disease</a>, and neuroendocrine disorders, including <a href="/wiki/Diabetes" title="Diabetes">diabetes</a> and <a href="/wiki/Hypothyroidism" title="Hypothyroidism">hypothyroidism</a>. <a href="/wiki/Hematologic_disease" title="Hematologic disease">Blood disorders</a>, such as <a href="/wiki/Anaemia" class="mw-redirect" title="Anaemia">anaemia</a>, and some cancers may also present similar symptoms.<a href="#cite_note-Bateman-2021-12">[12]</a><a href="#cite_note-NICE-2021-D-29">[29]</a>: 57  Various rheumatological and autoimmune diseases, such as <a href="/wiki/Sj%C3%B6gren%27s_syndrome" class="mw-redirect" title="Sjögren's syndrome">Sjögren's syndrome</a>, lupus, and <a href="/wiki/Arthritis" title="Arthritis">arthritis</a>, may have overlapping symptoms with ME/CFS. Furthermore, it may be necessary to evaluate <a href="/wiki/Mental_disorder" title="Mental disorder">psychiatric diseases</a>, such as depression or <a href="/wiki/Substance_use_disorder" title="Substance use disorder">substance use disorder</a>, as well as neurological disorders, such as <a href="/wiki/Narcolepsy" title="Narcolepsy">narcolepsy</a>, <a href="/wiki/Multiple_sclerosis" title="Multiple sclerosis">multiple sclerosis</a>, and <a href="/wiki/Craniocervical_instability" title="Craniocervical instability">craniocervical instability</a>.<a href="#cite_note-Bateman-2021-12">[12]</a><a href="#cite_note-NICE-2021-D-29">[29]</a>: 57  Finally, sleep disorders, <a href="/wiki/Coeliac_disease" title="Coeliac disease">coeliac disease</a>, and side effects of medications may also explain symptoms.<a href="#cite_note-Bateman-2021-12">[12]</a> Joint and muscle pain without swelling or inflammation is a common feature of ME/CFS, but is more closely associated with <a href="/wiki/Fibromyalgia" title="Fibromyalgia">fibromyalgia</a>. Modern definitions of fibromyalgia not only include widespread pain but also fatigue, sleep disturbances, and cognitive issues. This makes it difficult to distinguish ME/CFS from fibromyalgia<a href="#cite_note-BMJbest_practice-56">[56]</a>: 13, 26  and the two are often co-diagnosed.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 28  Another common condition that often co-occurs with ME/CFS is hypermobile <a href="/wiki/Ehlers_Danlos_syndromes" class="mw-redirect" title="Ehlers Danlos syndromes">Ehlers–Danlos syndrome</a> (EDS).<a href="#cite_note-NICE-2021-D-29">[29]</a>: 57  Unlike ME/CFS, EDS is present from birth. People with ME/CFS are more often <a href="/wiki/Hypermobility_(joints)" title="Hypermobility (joints)">hypermobile</a> compared to the general population.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 28–29  <a href="/wiki/Sleep_apnea" title="Sleep apnea">Sleep apnoea</a> may also co-occur with ME/CFS.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 16  However, many diagnostic criteria require ruling out sleep disorders before confirming a diagnosis of ME/CFS.<a href="#cite_note-IQWiG-2023-10">[10]</a>: 7  Like with other <a href="/wiki/Chronic_condition" title="Chronic condition">chronic illnesses</a>, depression and anxiety co-occur frequently with ME/CFS. Depression may be <a href="/wiki/Differential_diagnosis" title="Differential diagnosis">differentially diagnosed</a> by the presence of feelings of worthlessness, the <a href="/wiki/Anhedonia" title="Anhedonia">inability to feel pleasure</a>, loss of interest, and/or guilt, and the absence of ME/CFS bodily symptoms such as <a href="/wiki/Autonomic_dysfunction" class="mw-redirect" title="Autonomic dysfunction">autonomic dysfunction</a>, pain, migraines, and PEM.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 27  People with chronic fatigue, which is not due to ME/CFS or other chronic illnesses, may be diagnosed with <a href="/wiki/Idiopathic_chronic_fatigue" title="Idiopathic chronic fatigue">idiopathic (unexplained) chronic fatigue</a>.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 32  <div class="mw-heading mw-heading2"><h2 id="Management">Management</h2>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=18" title="Edit section: Management">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Management_of_ME/CFS" title="Management of ME/CFS">Management of ME/CFS</a></div> There is no approved drug treatment or cure for ME/CFS, although some symptoms can be treated or managed. Care for ME/CFS involved multidisciplinary healthcare professionals. Usually, the primary care clinician plays an important role in coordinating health care, social care and educational support for those still in school. This coordinator can help provide access to community resources such as <a href="/wiki/Occupational_therapy" title="Occupational therapy">occupational therapy</a> and <a href="/wiki/District_nurse" title="District nurse">district nursing</a>. Management may start with treating the most disabling symptom first, and tackle symptoms one by one in further health care visits.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 46  <a href="/wiki/Pacing_(activity_management)" title="Pacing (activity management)">Pacing</a>, or managing one's activities to stay within energy limits, can reduce episodes of <a href="/wiki/Post-exertional_malaise" title="Post-exertional malaise">PEM</a>. Addressing sleep problems with good <a href="/wiki/Sleep_hygiene" title="Sleep hygiene">sleep hygiene</a>, or medication if required, may be beneficial. Chronic pain is common in ME/CFS, and the CDC recommends consulting with a pain management specialist if <a href="/wiki/Over-the-counter" class="mw-redirect" title="Over-the-counter">over-the-counter</a> painkillers are insufficient. For cognitive impairment, adaptations like organisers and calendars may be helpful.<a href="#cite_note-CDC2024manage-8">[8]</a> <a href="/wiki/Comorbid" class="mw-redirect" title="Comorbid">Co-occurring conditions</a> that may interact with and worsen ME/CFS symptoms are common, and treating these may help manage ME/CFS.<a href="#cite_note-Bateman-2021-12">[12]</a> Commonly diagnosed ones include <a href="/wiki/Fibromyalgia" title="Fibromyalgia">fibromyalgia</a>, irritable bowel syndrome, migraines and <a href="/wiki/Mast_cell_activation_syndrome" title="Mast cell activation syndrome">mast cell activation syndrome</a>.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 19  The debilitating nature of ME/CFS can cause depression, <a href="/wiki/Anxiety" title="Anxiety">anxiety</a>, or other psychological problems, which can be treated.<a href="#cite_note-CDC2024manage-8">[8]</a> People with ME/CFS may be unusually sensitive to medications, especially ones that affect the central nervous system.<a href="#cite_note-57">[57]</a> <div class="mw-heading mw-heading3"><h3 id="Pacing_and_energy_management">Pacing and energy management</h3>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=19" title="Edit section: Pacing and energy management">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:FitbitIonicMomentDisplay.jpg" class="mw-file-description"><img alt="A smart watch displaying heart rate on a person's wrist" src="//upload.wikimedia.org/wikipedia/commons/thumb/9/94/FitbitIonicMomentDisplay.jpg/300px-FitbitIonicMomentDisplay.jpg" decoding="async" width="300" height="169" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/94/FitbitIonicMomentDisplay.jpg/450px-FitbitIonicMomentDisplay.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/94/FitbitIonicMomentDisplay.jpg/600px-FitbitIonicMomentDisplay.jpg 2x" data-file-width="4032" data-file-height="2268" /></a><figcaption>A heart rate monitor can be helpful for energy management.</figcaption></figure> <a href="/wiki/Pacing_(activity_management)" title="Pacing (activity management)">Pacing</a>, or activity management, involves balancing periods of rest with periods of activity.<a href="#cite_note-CDC_strategies2024-30">[30]</a> The goal of pacing is to stabilize the illness and avoid triggering PEM.<a href="#cite_note-Hoffmann_2024-58">[58]</a> This involves staying within an individual's available energy envelope to reduce the PEM "payback" caused by overexertion.<a href="#cite_note-Jason2017-59">[59]</a> The technique was developed for ME/CFS in the 1980s.<a href="#cite_note-Goudsmit2011-60">[60]</a> Pacing can involve breaking up large tasks into smaller ones and taking extra breaks, or creating easier ways to do activities. For example, this might include sitting down while doing the laundry. The decision to stop an activity (and rest or change an activity) is determined by self-awareness of a worsening of symptoms. Use of a <a href="/wiki/Heart_rate_monitor" title="Heart rate monitor">heart rate monitor</a> may help some individuals with pacing.<a href="#cite_note-CDC2024manage-8">[8]</a> Research on pacing and energy envelope theory typically shows positive effects.<a href="#cite_note-Jason2017-59">[59]</a><a href="#cite_note-Sanal-Hayes_2023-61">[61]</a> However, these studies have often had a low number of participants and have rarely included methods to check if study participants implemented pacing well.<a href="#cite_note-Sanal-Hayes_2023-61">[61]</a> Pacing is difficult to apply for people with very severe ME/CFS, as the activities that trigger PEM in this group, such as eating, cannot be avoided completely.<a href="#cite_note-Hoffmann_2024-58">[58]</a> Those with a stable illness who understand how to "listen to their body" may be able to carefully and flexibly increase their activity levels.<a href="#cite_note-CDC_strategies2024-30">[30]</a> The goal of an exercise programme would be to increase stamina, while not interfering with everyday tasks or making the illness more severe.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 56  In many chronic illnesses, intense exercise is beneficial, but in ME/CFS it is not recommended. The CDC states:<a href="#cite_note-CDC2024manage-8">[8]</a> <style data-mw-deduplicate="TemplateStyles:r1244412712">.mw-parser-output .templatequote{overflow:hidden;margin:1em 0;padding:0 32px}.mw-parser-output .templatequotecite{line-height:1.5em;text-align:left;margin-top:0}@media(min-width:500px){.mw-parser-output .templatequotecite{padding-left:1.6em}}</style><blockquote class="templatequote">Vigorous aerobic exercise can benefit people with many chronic illnesses. But people with ME/CFS do not tolerate such exercise routines. Standard exercise recommendations for healthy people can be harmful for patients with ME/CFS. However, it is important that patients with ME/CFS undertake activities that they can tolerate.</blockquote> <a href="/wiki/Graded_exercise_therapy" title="Graded exercise therapy">Graded exercise therapy</a> (GET), a proposed treatment for ME/CFS that assumes deconditioning and a fear of activity play important roles in maintaining the illness, is no longer recommended for people with ME/CFS.<a href="#cite_note-pmid37793728-6">[6]</a><a href="#cite_note-BMJbest_practice3-27">[27]</a>: 38  Reviews of GET either see weak evidence of a small to moderate effect<a href="#cite_note-Chou_2022-62">[62]</a><a href="#cite_note-Lar20192-63">[63]</a> or no evidence of effectiveness.<a href="#cite_note-Geraghty_2019-64">[64]</a><a href="#cite_note-Ahmed_2020-65">[65]</a> GET can have serious adverse effects.<a href="#cite_note-Hoffmann_2024-58">[58]</a> Similarly, a form of <a href="/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">cognitive behavioural therapy</a> (CBT) that assumed the illness is maintained by unhelpful beliefs about the illness and avoidance of activity is no longer recommended.<a href="#cite_note-Bateman-2021-12">[12]</a> <div class="mw-heading mw-heading3"><h3 id="Symptom_relief">Symptom relief</h3>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=20" title="Edit section: Symptom relief">edit</a>]</div> The first management step for sleep problems in ME/CFS is improving sleep habits. If sleep problems remain after implementing sleep hygiene routines, <a href="/wiki/Cognitive_behavioural_therapy_for_insomnia" class="mw-redirect" title="Cognitive behavioural therapy for insomnia">cognitive behavioural therapy for insomnia</a> can be offered. Avoiding naps during the day can further improve sleep,<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 41  but there may be a trade-off with needed rest during the day.<a href="#cite_note-NICE2021-2">[2]</a>: 36  Drugs that help with insomnia in fibromyalgia, such as <a href="/wiki/Trazodone" title="Trazodone">trazodone</a> or <a href="/wiki/Suvorexant" title="Suvorexant">suvorexant</a>, may help in ME/CFS too.<a href="#cite_note-pmid37793728-6">[6]</a> Pain is initially managed with over-the-counter pain medication, such as <a href="/wiki/Ibuprofen" title="Ibuprofen">ibuprofen</a> or <a href="/wiki/Paracetamol" title="Paracetamol">paracetamol</a>. If this is insufficient, referral to a pain specialist or counselling on pain management can be the next step. Heat treatment, <a href="/wiki/Hydrotherapy" title="Hydrotherapy">hydrotherapy</a> and gentle massage can sometimes help. In addition, stretching and exercise may help with pain, but a balance must be struck, as they can trigger PEM.<a href="#cite_note-CDC_strategies2024-30">[30]</a> While there is lack of evidence on pharmaceutical options for pain management in ME/CFS, medication that works for fibromyalgia may be tried, such as <a href="/wiki/Pregabalin" title="Pregabalin">pregabalin</a>.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 42 <a href="#cite_note-pmid37793728-6">[6]</a> Like in other chronic illnesses, those with ME/CFS often experience mental health issues like anxiety and depression.<a href="#cite_note-Bateman-2021-12">[12]</a> <a href="/wiki/Psychotherapy" title="Psychotherapy">Psychotherapy</a>, such as CBT may help manage the stress of being ill and teach self-management strategies.<a href="#cite_note-NICE2021-2">[2]</a>: 42  Family sessions may be useful to educate people close to those with ME/CFS about the severity of the illness.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 41  <a href="/wiki/Antidepressant" title="Antidepressant">Antidepressants</a> can be useful, but there may be more side effects than in the general population. For instance, it may be difficult to stop weight gain due to exercise intolerance.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 52  Bowel issues are a common symptom of ME/CFS. For some, eliminating specific foods, such as <a href="/wiki/Caffeine" title="Caffeine">caffeine</a>, <a href="/wiki/Alcohol_and_health" title="Alcohol and health">alcohol</a>, <a href="/wiki/Gluten" title="Gluten">gluten</a>, or dairy, can alleviate symptoms.<a href="#cite_note-Bateman-2021-12">[12]</a> Those with orthostatic intolerance can benefit from increased salt and fluid intake.<a href="#cite_note-Bateman-2021-12">[12]</a> <a href="/wiki/Compression_stockings" title="Compression stockings">Compression stockings</a> can help with orthostatic intolerance.<a href="#cite_note-Bateman-2021-12">[12]</a> <div class="mw-heading mw-heading3"><h3 id="Severe_ME/CFS">Severe ME/CFS</h3>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=21" title="Edit section: Severe ME/CFS">edit</a>]</div> People with moderate to severe ME/CFS may benefit from home adaptations and mobility aids, such as <a href="/wiki/Wheelchair" title="Wheelchair">wheelchairs</a>, disability parking, <a href="/wiki/Transfer_bench" title="Transfer bench">shower chairs</a>, or <a href="/wiki/Stair_lift" title="Stair lift">stair lifts</a>. To manage sensitivities to environmental stimuli, these stimuli can be limited. For instance, the surroundings can be made perfume-free, or an <a href="/wiki/Sleep_mask" class="mw-redirect" title="Sleep mask">eye mask</a> or <a href="/wiki/Earplug" title="Earplug">earplugs</a> can be used.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 39–40  Those with severe ME/CFS may have significant trouble getting nutrition. <a href="/wiki/Parenteral_nutrition" title="Parenteral nutrition">Intravenous feeding</a> (via blood) or <a href="/wiki/Feeding_tube" title="Feeding tube">tube feeding</a> may be necessary to address this or to address <a href="/wiki/Electrolyte_imbalance" title="Electrolyte imbalance">electrolyte imbalances</a>.<a href="#cite_note-pmid37793728-6">[6]</a> Patients who cannot move easily in bed may need help to prevent <a href="/wiki/Pressure_ulcer" title="Pressure ulcer">pressure sores</a>. Regular repositioning is important to keep their joints flexible and prevent <a href="/wiki/Contracture" title="Contracture">contractures</a> and stiffness. <a href="/wiki/Osteoporosis" title="Osteoporosis">Osteoporosis</a> may pose a risk over the long term.<a href="#cite_note-66">[66]</a> Symptoms of severe ME/CFS may be misunderstood as neglect or abuse during well-being evaluations, and NICE recommends that professionals with experience in ME/CFS should be involved in any type of assessment for <a href="/wiki/Safeguarding" title="Safeguarding">safeguarding</a>.<a href="#cite_note-NICE2021-2">[2]</a>: 22  <div class="mw-heading mw-heading2"><h2 id="Prognosis">Prognosis</h2>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=22" title="Edit section: Prognosis">edit</a>]</div> Information on the <a href="/wiki/Prognosis" title="Prognosis">prognosis</a> of ME/CFS is limited. Complete recovery, partial improvement, and worsening are all possible,<a href="#cite_note-CDC_Clinical2024-11">[11]</a> but full recovery is uncommon.<a href="#cite_note-IQWiG-2023-10">[10]</a>: 11  Symptoms generally fluctuate over days, weeks, or longer periods, and some people may experience periods of remission. Overall, many will have to adjust to life with ME/CFS.<a href="#cite_note-NICE2021-2">[2]</a>: 20  An early diagnosis may improve care and prognosis.<a href="#cite_note-NICE-2021-D-29">[29]</a> Factors that may make the disease worse over days, but also over longer periods, are physical and mental exertion, a new infection, sleep deprivation, and emotional stress.<a href="#cite_note-IQWiG-2023-10">[10]</a>: 11  Some people who improve need to manage their activities to prevent a relapse.<a href="#cite_note-CDC_Clinical2024-11">[11]</a> Children and teenagers are more likely to recover or improve than adults.<a href="#cite_note-CDC_Clinical2024-11">[11]</a><a href="#cite_note-NICE2021-2">[2]</a>: 20  For instance, a study in Australia among 6- to 18-year-olds found that two-thirds reported recovery after ten years and that the typical duration of illness was five years.<a href="#cite_note-IQWiG-2023-10">[10]</a>: 11  The effect of ME/CFS on <a href="/wiki/Life_expectancy" title="Life expectancy">life expectancy</a> is poorly studied, and the evidence is mixed. One large retrospective study on the topic found no increase in all-cause mortality due to ME/CFS. Death from suicide was, however, significantly higher among those with ME/CFS.<a href="#cite_note-BMJbest_practice3-27">[27]</a>: 59  In extreme cases, people can die from the illness.<a href="#cite_note-Hoffmann_2024-58">[58]</a> <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=23" title="Edit section: Epidemiology">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:ME-CFS_Incidence_Rate_by_Age.png" class="mw-file-description"><img alt="Graph showing that females have two incidence peaks (teenagers and 30–39 years old), and males' incidence peaks in the teenager years." src="//upload.wikimedia.org/wikipedia/commons/thumb/1/1d/ME-CFS_Incidence_Rate_by_Age.png/300px-ME-CFS_Incidence_Rate_by_Age.png" decoding="async" width="300" height="204" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/1/1d/ME-CFS_Incidence_Rate_by_Age.png/450px-ME-CFS_Incidence_Rate_by_Age.png 1.5x, //upload.wikimedia.org/wikipedia/commons/1/1d/ME-CFS_Incidence_Rate_by_Age.png 2x" data-file-width="494" data-file-height="336" /></a><figcaption>Incidence rates by age and sex, from a 2014 study in Norway</figcaption></figure> Reported prevalence rates vary widely depending on how ME/CFS is defined and diagnosed. Overall, around 1 in 150 people have ME/CFS. Based on the 1994 CDC diagnostic criteria, the global prevalence rate for CFS is 0.89%. In comparison, estimates using the stricter 1988 CDC criteria or the 2003 Canadian Consensus Criteria for ME/CFS produced a prevalence rate of only 0.17%.<a href="#cite_note-Lim2020-9">[9]</a> In England and Wales, over 250,000 people are estimated to be affected.<a href="#cite_note-NICE2021-2">[2]</a>: 92  These estimates are based on data before the <a href="/wiki/COVID-19_pandemic" title="COVID-19 pandemic">COVID-19 pandemic</a>. It is likely that numbers have increased as a large share of people with <a href="/wiki/Long_COVID" title="Long COVID">long COVID</a> meet the diagnostic criteria of ME/CFS.<a href="#cite_note-IQWiG-2023-10">[10]</a>: 228  A 2021–2022 <a href="/wiki/National_Health_Interview_Survey" title="National Health Interview Survey">CDC survey</a> found that 1.3% of adults in the United States, or 3.3 million, had ME/CFS.<a href="#cite_note-67">[67]</a> Women are diagnosed about 1.5 to 4 times more often with ME/CFS than men.<a href="#cite_note-Lim2020-9">[9]</a><a href="#cite_note-CDCEpide2023-17">[17]</a> The prevalence in children and adolescents is slightly lower than in adults,<a href="#cite_note-Lim2020-9">[9]</a> and children have it less than adolescents.<a href="#cite_note-68">[68]</a> The <a href="/wiki/Incidence_(epidemiology)" title="Incidence (epidemiology)">incidence</a> rate (the onset of ME/CFS) has two peaks, one at 10–19 and another at 30–39 years,<a href="#cite_note-pmid31379194-4">[4]</a> and the <a href="/wiki/Prevalence" title="Prevalence">prevalence</a> is highest in <a href="/wiki/Middle_age" title="Middle age">middle age</a>.<a href="#cite_note-:0-34">[34]</a> <div class="mw-heading mw-heading2"><h2 id="History">History</h2>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=24" title="Edit section: History">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/History_of_ME/CFS" title="History of ME/CFS">History of ME/CFS</a></div>From 1934 onwards, there were multiple outbreaks globally of an unfamiliar illness, initially mistaken for <a href="/wiki/Polio" title="Polio">polio</a>. A 1950s outbreak at London's <a href="/wiki/Royal_Free_Hospital" title="Royal Free Hospital">Royal Free Hospital</a> led to the term "benign myalgic encephalomyelitis" (ME). Those affected displayed symptoms such as malaise, <a href="/wiki/Sore_throat" title="Sore throat">sore throat</a>, <a href="/wiki/Pain" title="Pain">pain</a>, and signs of <a href="/wiki/Encephalomyelitis" title="Encephalomyelitis">nervous system inflammation</a>. While its infectious nature was suspected, the exact cause remained elusive.<a href="#cite_note-IOM2015-1">[1]</a>: 28–29  The syndrome appeared in sporadic as well as epidemic cases.<a href="#cite_note-69">[69]</a> In 1970, two UK psychiatrists proposed that these ME outbreaks were <a href="/wiki/Psychosocial" title="Psychosocial">psychosocial</a> phenomena, suggesting <a href="/wiki/Mass_hysteria" class="mw-redirect" title="Mass hysteria">mass hysteria</a> or altered medical perception as potential causes. This theory, though challenged, sparked controversy and cast doubt on ME's legitimacy in the medical community.<a href="#cite_note-IOM2015-1">[1]</a>: 28–29  <a href="/wiki/Melvin_Ramsay" title="Melvin Ramsay">Melvin Ramsay</a>'s later research highlighted ME's disabling nature, prompting the removal of "benign" from the name and the creation of diagnostic criteria in 1986. These criteria included the tendency of muscles to tire after minor effort and take multiple days to recover, high symptom variability, and chronicity. Despite Ramsay's work and a UK report affirming that ME was not a psychological condition, scepticism persisted within the medical field, leading to limited research.<a href="#cite_note-IOM2015-1">[1]</a>: 28–29  In the United States, Nevada and New York State saw outbreaks of what appeared similar to <a href="/wiki/Infectious_mononucleosis" title="Infectious mononucleosis">mononucleosis</a> in the middle of the 1980s. People suffered from "chronic or recurrent fatigue", among a large number of other symptoms.<a href="#cite_note-IOM2015-1">[1]</a>: 28–29  The initial link between elevated antibodies and the Epstein–Barr virus led to the name "chronic Epstein–Barr virus syndrome". The CDC renamed it chronic fatigue syndrome (CFS), as a viral cause could not be confirmed in studies.<a href="#cite_note-Packard_2004-70">[70]</a>: 155–158  An initial case definition of CFS was outlined in 1988;<a href="#cite_note-IOM2015-1">[1]</a>: 28–29  the CDC published new <a href="/wiki/Diagnostic_criteria" class="mw-redirect" title="Diagnostic criteria">diagnostic criteria</a> in 1994, which became widely referenced.<a href="#cite_note-Brurberg2014rev-71">[71]</a> In the 2010s, ME/CFS began to gain more recognition from health professionals and the public. Two reports proved key in this shift. In 2015, the US <a href="/wiki/National_Academy_of_Medicine" title="National Academy of Medicine">Institute of Medicine</a> produced a report with new diagnostic criteria that described ME/CFS as a "serious, chronic, complex systemic disease". Following this, the US <a href="/wiki/National_Institutes_of_Health" title="National Institutes of Health">National Institutes of Health</a> published their Pathways to Prevention report, which gave recommendations on research priorities.<a href="#cite_note-72">[72]</a> <div class="mw-heading mw-heading2"><h2 id="Society_and_culture">Society and culture</h2>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=25" title="Edit section: Society and culture">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Petition_presentation_by_M.E_Support_in_Glamorgan.jpg" class="mw-file-description"><img alt="a group of people offering a petition. The group includes a person on a camp bed holding up a placard that says she is in bed 23 hours a day." src="//upload.wikimedia.org/wikipedia/commons/thumb/b/b9/Petition_presentation_by_M.E_Support_in_Glamorgan.jpg/300px-Petition_presentation_by_M.E_Support_in_Glamorgan.jpg" decoding="async" width="300" height="200" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/b/b9/Petition_presentation_by_M.E_Support_in_Glamorgan.jpg/450px-Petition_presentation_by_M.E_Support_in_Glamorgan.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/b/b9/Petition_presentation_by_M.E_Support_in_Glamorgan.jpg/600px-Petition_presentation_by_M.E_Support_in_Glamorgan.jpg 2x" data-file-width="4426" data-file-height="2951" /></a><figcaption>Presentation of a petition to the <a href="/wiki/National_Assembly_for_Wales" class="mw-redirect" title="National Assembly for Wales">National Assembly for Wales</a> relating to ME support in South East Wales</figcaption></figure> <div class="mw-heading mw-heading3"><h3 id="Controversy">Controversy</h3>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=26" title="Edit section: Controversy">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Controversies_related_to_ME/CFS" title="Controversies related to ME/CFS">Controversies related to ME/CFS</a></div> ME/CFS is a contested illness, with debates mainly revolving around the cause of the illness and treatments.<a href="#cite_note-pmid29971693-73">[73]</a> Historically, there was a heated discussion about whether the condition was psychological or neurological.<a href="#cite_note-Lim_2020-54">[54]</a> Professionals who subscribed to the psychological model had frequent conflicts with patients, who believed their illness to be organic.<a href="#cite_note-pmid32601171-74">[74]</a> While ME/CFS is now generally believed to be a multisystem neuroimmune condition,<a href="#cite_note-Lim_2020-54">[54]</a> a subset of professionals still see the condition as <a href="/wiki/Psychosomatic_medicine" title="Psychosomatic medicine">psychosomatic</a>, or an "illness-without-disease".<a href="#cite_note-pmid32601171-74">[74]</a><a href="#cite_note-75">[75]</a> The possible role of chronic viral infection in ME/CFS has been a subject of disagreement. One study caused considerable controversy by establishing a causal relationship between ME/CFS and a <a href="/wiki/Retrovirus" title="Retrovirus">retrovirus</a> called <a href="/wiki/Xenotropic_murine_leukemia_virus%E2%80%93related_virus" title="Xenotropic murine leukemia virus–related virus">XMRV</a>. Some with the illness began taking <a href="/wiki/Antiretroviral_drug" class="mw-redirect" title="Antiretroviral drug">antiretroviral drugs</a> targeted specifically for <a href="/wiki/HIV/AIDS" title="HIV/AIDS">HIV/AIDS</a>, another retrovirus,<a href="#cite_note-76">[76]</a> and national blood supplies were suspected to be tainted with the retrovirus. After several years of study, the XMRV findings were determined to be the result of contamination of the testing materials.<a href="#cite_note-pmid27358491-77">[77]</a> Treatments based on behavioural and psychological models of the illness have also been the subject of much contention. The largest clinical trial on behavioural interventions, the 2011 <a href="/wiki/PACE_trial" title="PACE trial">PACE trial</a>, concluded that graded exercise therapy and <a href="/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">CBT</a> are moderately effective. The trial drew heavy criticism.<a href="#cite_note-pmid29971693-73">[73]</a> The study authors <a href="/wiki/Outcome_switching" title="Outcome switching">weakened their definition of recovery</a> during the trial: some participants now met a key criterion for recovery before the trial started. A reanalysis under the original <a href="/wiki/Clinical_trial_protocol" class="mw-redirect" title="Clinical trial protocol">clinical trial protocol</a> showed no significant difference in recovery rate between treatment groups and the controls receiving standard care.<a href="#cite_note-pmid28805517-78">[78]</a><a href="#cite_note-pmid31637650-79">[79]</a> <div class="mw-heading mw-heading3"><h3 id="Doctor–patient_relations">Doctor–patient relations</h3>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=27" title="Edit section: Doctor–patient relations">edit</a>]</div> People with ME/CFS often face stigma in healthcare settings,<a href="#cite_note-Hussein-2024-19">[19]</a> and the majority of individuals report negative healthcare experiences. They may feel that their doctor inappropriately calls their illness psychological or doubts the severity of their symptoms.<a href="#cite_note-McManimen-2019-80">[80]</a> They may also feel forced to prove that they are legitimately ill.<a href="#cite_note-pmid16085344-81">[81]</a> Some may be given outdated treatments that provoke symptoms or assume their illness is due to unhelpful thoughts and deconditioning.<a href="#cite_note-Bateman-2021-12">[12]</a>: 2871 <a href="#cite_note-Davis-2023-16">[16]</a> Clinicians may be unfamiliar with ME/CFS, as it is often not fully covered in medical school.<a href="#cite_note-Davis-2023-16">[16]</a> Due to this unfamiliarity, people may go undiagnosed for years<a href="#cite_note-Bateman-2021-12">[12]</a> or be misdiagnosed with mental health conditions.<a href="#cite_note-Davis-2023-16">[16]</a> As individuals gain knowledge about their illness over time, their relationship with treating physicians changes. They may feel on a more equal footing with their doctors and able to work in partnership. At times, relationships may deteriorate instead as the previous asymmetry of knowledge breaks down.<a href="#cite_note-Shortland_2024-82">[82]</a> <div class="mw-heading mw-heading3"><h3 id="Economic_and_social_impact">Economic and social impact</h3>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=28" title="Edit section: Economic and social impact">edit</a>]</div> ME/CFS negatively impacts people's social lives and relationships. Stress can be compounded by disbelief in the illness from the support network, who can be sceptical due to the subjective nature of diagnosis. Many people with the illness feel <a href="/wiki/Social_isolation" title="Social isolation">socially isolated</a>, and <a href="/wiki/Suicidal_ideation" title="Suicidal ideation">thoughts of suicide</a> are high, especially in those without a supportive care network.<a href="#cite_note-Shortland_2024-82">[82]</a> ME/CFS interrupts <a href="/wiki/Child_development" title="Child development">normal development</a> in children, making them more dependent on their family for assistance instead of gaining independence as they age.<a href="#cite_note-pmid28087544-83">[83]</a> Caring for somebody with ME/CFS can be a full-time role, and the stress of caregiving is made worse by the lack of effective treatments.<a href="#cite_note-84">[84]</a> Economic costs due to ME/CFS are significant.<a href="#cite_note-85">[85]</a> In the United States, estimates range from $36 to $51 billion per year, considering both lost wages and healthcare costs.<a href="#cite_note-86">[86]</a> A 2017 estimate for the annual economic burden in the United Kingdom was £3.3 billion.<a href="#cite_note-Dibble_McGrath_Ponting_2020_p.-13">[13]</a> <div class="mw-heading mw-heading3"><h3 id="Advocacy">Advocacy</h3>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=29" title="Edit section: Advocacy">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Blue_awareness_ribbon_icon_with_outline.svg" class="mw-file-description"><img alt="see caption" src="//upload.wikimedia.org/wikipedia/commons/thumb/a/a4/Blue_awareness_ribbon_icon_with_outline.svg/220px-Blue_awareness_ribbon_icon_with_outline.svg.png" decoding="async" width="220" height="156" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/a/a4/Blue_awareness_ribbon_icon_with_outline.svg/330px-Blue_awareness_ribbon_icon_with_outline.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/a/a4/Blue_awareness_ribbon_icon_with_outline.svg/440px-Blue_awareness_ribbon_icon_with_outline.svg.png 2x" data-file-width="512" data-file-height="362" /></a><figcaption>The blue ribbon is used for ME/CFS awareness.</figcaption></figure> Patient organisations have aimed to involve researchers via activism but also by publishing research themselves—similarly to <a href="/wiki/HIV/AIDS_activism" title="HIV/AIDS activism">AIDS activism</a> in the 1980s, which also sought to combat underfunding and stigma. <a href="/wiki/Citizen_science" title="Citizen science">Citizen scientists</a>, for example, helped start discussions about weaknesses in trials of psychological treatments.<a href="#cite_note-pmid29971693-73">[73]</a> <a href="/wiki/International_May_12th_Awareness_Day" title="International May 12th Awareness Day">ME/CFS International Awareness Day</a> takes place on 12 May.<a href="#cite_note-CDC_Awareness-87">[87]</a> The goal of the day is to raise awareness among the public and health care workers about the diagnosis and treatment of ME/CFS.<a href="#cite_note-NIH_Awareness-88">[88]</a> The date was chosen because it is the birthday of <a href="/wiki/Florence_Nightingale" title="Florence Nightingale">Florence Nightingale</a>, who had an unidentified illness similar to ME/CFS.<a href="#cite_note-CDC_Awareness-87">[87]</a> <div class="mw-heading mw-heading2"><h2 id="Research">Research</h2>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=30" title="Edit section: Research">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:ME-CFS_Papers_by_Year.svg" class="mw-file-description"><img alt="Graph of ME/CFS papers published by year, showing an increasing trend since about 1985" src="//upload.wikimedia.org/wikipedia/commons/thumb/c/cf/ME-CFS_Papers_by_Year.svg/300px-ME-CFS_Papers_by_Year.svg.png" decoding="async" width="300" height="236" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/cf/ME-CFS_Papers_by_Year.svg/450px-ME-CFS_Papers_by_Year.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/c/cf/ME-CFS_Papers_by_Year.svg/600px-ME-CFS_Papers_by_Year.svg.png 2x" data-file-width="800" data-file-height="630" /></a><figcaption>Graph of ME/CFS papers published by year:<style data-mw-deduplicate="TemplateStyles:r981673959">.mw-parser-output .legend{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .legend-color{display:inline-block;min-width:1.25em;height:1.25em;line-height:1.25;margin:1px 0;text-align:center;border:1px solid black;background-color:transparent;color:black}.mw-parser-output .legend-text{}</style><div class="legend">  Papers mentioning ME or CFS</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend">  Papers whose title mentions ME/CFS</div></figcaption></figure> Research into ME/CFS seeks to find a better understanding of the disease's causes, biomarkers to aid in diagnosis, and treatments to relieve symptoms.<a href="#cite_note-IOM2015-1">[1]</a>: 10  The emergence of long COVID has sparked increased interest in ME/CFS, as the two conditions may share pathology and treatment for one may treat the other.<a href="#cite_note-Marshall-Gradisnik_2022-23">[23]</a><a href="#cite_note-pmid38443223-14">[14]</a> <div class="mw-heading mw-heading3"><h3 id="Funding">Funding</h3>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=31" title="Edit section: Funding">edit</a>]</div> Historical research funding for ME/CFS has been far below that of comparable diseases.<a href="#cite_note-Tyson_2022-20">[20]</a><a href="#cite_note-meresearch_funding_2016-89">[89]</a> In a 2015 report, the US National Academy of Sciences said that "remarkably little research funding" had been dedicated to causes, mechanisms, and treatment.<a href="#cite_note-IOM2015-1">[1]</a>: 9  Lower funding levels have led to a smaller number and size of studies.<a href="#cite_note-90">[90]</a> In addition, drug companies have invested very little in the disease.<a href="#cite_note-pmid33529750-91">[91]</a> The US National Institutes of Health (NIH) is the largest biomedical funder worldwide.<a href="#cite_note-92">[92]</a> Using rough estimates of disease burden, a study found NIH funding for ME/CFS was only 3% to 7% of the average disease per <a href="/wiki/Disability-adjusted_life_year" title="Disability-adjusted life year">healthy life year lost</a> between 2015 and 2019.<a href="#cite_note-Mirin_2021-93">[93]</a> Worldwide, <a href="/wiki/Multiple_sclerosis" title="Multiple sclerosis">multiple sclerosis</a>, which affects fewer people and results in disability no worse than ME/CFS, received 20 times as much funding between 2007 and 2015.<a href="#cite_note-meresearch_funding_2016-89">[89]</a><a href="#cite_note-Tyson_2022-20">[20]</a> Multiple reasons have been proposed for the low funding levels. Diseases for which society "blames the victim" are frequently underfunded. This may explain why <a href="/wiki/Chronic_obstructive_pulmonary_disease" title="Chronic obstructive pulmonary disease">COPD</a>, a severe lung disease often caused by smoking, receives low funding per healthy life year lost.<a href="#cite_note-94">[94]</a> Similarly, for ME/CFS, the historical belief that it is caused by psychological factors may have contributed to lower funding. <a href="/wiki/Gender_disparities_in_health" title="Gender disparities in health">Gender bias</a> may also play a role; the NIH spends less on diseases that predominantly affect women in relation to disease burden. Less well-funded research areas may also struggle to compete with more mature areas of medicine for the same grants.<a href="#cite_note-Mirin_2021-93">[93]</a> <div class="mw-heading mw-heading3"><h3 id="Directions">Directions</h3>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=32" title="Edit section: Directions">edit</a>]</div> Many biomarkers for ME/CFS have been proposed. Studies on biomarkers have often been too small to draw robust conclusions. Natural killer cells have been identified as an area of interest for biomarker research as they show consistent abnormalities.<a href="#cite_note-pmid37226227-7">[7]</a> Other proposed markers include <a href="/wiki/Electrical_impedance" title="Electrical impedance">electrical measurements</a> of blood cells and <a href="/wiki/Raman_microscope" title="Raman microscope">Raman microscopy</a> of immune cells.<a href="#cite_note-pmid38443223-14">[14]</a> Several small studies have investigated the genetics of ME/CFS, but none of their findings have been replicated.<a href="#cite_note-Dibble_McGrath_Ponting_2020_p.-13">[13]</a> A larger study, <a href="/wiki/DecodeME" title="DecodeME">DecodeME</a>, is currently underway in the United Kingdom.<a href="#cite_note-95">[95]</a> Various drug treatments for ME/CFS are being explored. Drugs under investigation often target the nervous system, the immune system, autoimmunity, or pain directly. More recently, there has been a growing interest in drugs targeting energy metabolism.<a href="#cite_note-pmid33529750-91">[91]</a> In several clinical trials of ME/CFS, <a href="/wiki/Rintatolimod" title="Rintatolimod">rintatolimod</a> showed a small reduction in symptoms, but improvements were not sustained after discontinuation.<a href="#cite_note-Richman2019-96">[96]</a><a href="#cite_note-pmid33529750-91">[91]</a> Rintatolimod has been approved in Argentina.<a href="#cite_note-ADVINAT2019-97">[97]</a> <a href="/wiki/Rituximab" title="Rituximab">Rituximab</a>, a drug that depletes <a href="/wiki/B_cell" title="B cell">B cells</a>, was studied and found to be ineffective.<a href="#cite_note-pmid38443223-14">[14]</a> Another option targeting autoimmunity is <a href="/wiki/Immunoadsorption" title="Immunoadsorption">immune adsorption</a>, which removes a large set of (auto)antibodies from the blood.<a href="#cite_note-pmid33529750-91">[91]</a> <div class="mw-heading mw-heading3"><h3 id="Challenges">Challenges</h3>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=33" title="Edit section: Challenges">edit</a>]</div> Symptoms and their severity can widely differ among people with ME/CFS. This poses a challenge for research into the cause and progression of the disease. Dividing people into subtypes may help manage this heterogeneity.<a href="#cite_note-pmid38443223-14">[14]</a> The existence of multiple diagnostic criteria and variations in how scientists apply them complicate comparisons between studies.<a href="#cite_note-IOM2015-1">[1]</a>: 53  Definitions also vary in which co-occurring conditions preclude a diagnosis of ME/CFS.<a href="#cite_note-IOM2015-1">[1]</a>: 52  <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=34" title="Edit section: See also">edit</a>]</div> <ul><li><a href="/wiki/List_of_people_with_ME/CFS" title="List of people with ME/CFS">List of people with ME/CFS</a></li> <li><a href="/wiki/History_of_ME/CFS" title="History of ME/CFS">History of ME/CFS</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=35" title="Edit section: References">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-IOM2015-1">^ <a href="#cite_ref-IOM2015_1-0">a</a> <a href="#cite_ref-IOM2015_1-1">b</a> <a href="#cite_ref-IOM2015_1-2">c</a> <a href="#cite_ref-IOM2015_1-3">d</a> <a href="#cite_ref-IOM2015_1-4">e</a> <a href="#cite_ref-IOM2015_1-5">f</a> <a href="#cite_ref-IOM2015_1-6">g</a> <a href="#cite_ref-IOM2015_1-7">h</a> <a href="#cite_ref-IOM2015_1-8">i</a> <a href="#cite_ref-IOM2015_1-9">j</a> <a href="#cite_ref-IOM2015_1-10">k</a> <a href="#cite_ref-IOM2015_1-11">l</a> <a href="#cite_ref-IOM2015_1-12">m</a> <style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite 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Retrieved 20 January 2023.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BBC+News&rft.atitle=Experts+Launch+World%27s+Largest+Genetic+Study+of+ME&rft.date=2022-09-12&rft_id=https%3A%2F%2Fwww.bbc.com%2Fnews%2Fuk-scotland-edinburgh-east-fife-62876472&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMyalgic+encephalomyelitis%2Fchronic+fatigue+syndrome" class="Z3988"> </li> <li id="cite_note-Richman2019-96"><a href="#cite_ref-Richman2019_96-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFRichmanMorrisBroderickCraddock2019" class="citation journal cs1">Richman S, Morris MC, Broderick G, Craddock TJ, Klimas NG, Fletcher MA (May 2019). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6543846">"Pharmaceutical Interventions in Chronic Fatigue Syndrome: A Literature-Based Commentary"</a>. Clinical Therapeutics. 41 (5): 798–805. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.clinthera.2019.02.011">10.1016/j.clinthera.2019.02.011</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6543846">6543846</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/30871727">30871727</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+Therapeutics&rft.atitle=Pharmaceutical+Interventions+in+Chronic+Fatigue+Syndrome%3A+A+Literature-Based+Commentary&rft.volume=41&rft.issue=5&rft.pages=798-805&rft.date=2019-05&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC6543846%23id-name%3DPMC&rft_id=info%3Apmid%2F30871727&rft_id=info%3Adoi%2F10.1016%2Fj.clinthera.2019.02.011&rft.aulast=Richman&rft.aufirst=S&rft.au=Morris%2C+MC&rft.au=Broderick%2C+G&rft.au=Craddock%2C+TJ&rft.au=Klimas%2C+NG&rft.au=Fletcher%2C+MA&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC6543846&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMyalgic+encephalomyelitis%2Fchronic+fatigue+syndrome" class="Z3988"> </li> <li id="cite_note-ADVINAT2019-97"><a href="#cite_ref-ADVINAT2019_97-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFAgrawalKandimalla2019" class="citation book cs1">Agrawal S, Kandimalla ER (February 2019). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=HsCrDwAAQBAJ&q=Rintatolimod+argentina&pg=PA310">"Chapter 14: Synthetic agonists of Toll-like receptors and therapeutic applications."</a>. In Agrawal S, Gait MJ (eds.). Advances in Nucleic Acid Therapeutics. <a href="/wiki/Royal_Society_of_Chemistry" title="Royal Society of Chemistry">Royal Society of Chemistry</a>. pp. 306–338 (310). <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-78801-732-9" title="Special:BookSources/978-1-78801-732-9"><bdi>978-1-78801-732-9</bdi></a>. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20220514015202/https://books.google.com/books?id=HsCrDwAAQBAJ&q=Rintatolimod+argentina&pg=PA310">Archived</a> from the original on 14 May 2022. Retrieved 20 October 2021. <q>14.2: Agonists of TLR3</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+14%3A+Synthetic+agonists+of+Toll-like+receptors+and+therapeutic+applications.&rft.btitle=Advances+in+Nucleic+Acid+Therapeutics&rft.pages=306-338+%28310%29&rft.pub=Royal+Society+of+Chemistry&rft.date=2019-02&rft.isbn=978-1-78801-732-9&rft.aulast=Agrawal&rft.aufirst=S&rft.au=Kandimalla%2C+ER&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DHsCrDwAAQBAJ%26q%3DRintatolimod%2Bargentina%26pg%3DPA310&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMyalgic+encephalomyelitis%2Fchronic+fatigue+syndrome" class="Z3988"> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2>[<a href="/w/index.php?title=Myalgic_encephalomyelitis/chronic_fatigue_syndrome&action=edit&section=36" title="Edit section: External links">edit</a>]</div> <style 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style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q209733" class="extiw" title="d:Q209733">D</a></div><div class="hlist" style="text-align:left;"><ul><li><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-11" title="ICD-11">11</a>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse/latest-release/mms/en#569175314">8E49</a></li><li><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/G93.3">G93.3</a></li><li><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10-CM" title="ICD-10-CM">10-CM</a>: <a rel="nofollow" class="external text" href="https://icd10cmtool.cdc.gov/?fy=FY2024&query=G93.32">G93.32</a></li><li><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=323.9">323.9</a> <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=780.71">780.71</a></li><li><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D015673">D015673</a></li><li><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb1645.htm">1645</a></li><li><a href="/wiki/SNOMED_CT" title="SNOMED CT">SNOMED CT</a>: <a rel="nofollow" class="external text" href="http://snomed.info/id/52702003">52702003</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/001244.htm">001244</a></li><li><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a>: <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/med/3392-overview">med/3392</a> <a rel="nofollow" class="external text" href="https://www.emedicine.com/ped/topic2795.htm#">ped/2795</a></li><li><a href="/wiki/Patient_UK" title="Patient UK">Patient UK</a>: <a rel="nofollow" class="external text" href="https://patient.info/doctor/myalgic-encephalomyelitischronic-fatigue-syndrome-mecfs-pro">Myalgic encephalomyelitis/chronic fatigue syndrome</a></li><li><a href="/wiki/Radiopaedia" title="Radiopaedia">Radiopaedia</a>: <a rel="nofollow" class="external text" href="https://radiopaedia.org/articles/74341">74341</a></li><li>Scholia: <a class="external text" href="https://tools.wmflabs.org/scholia/topic/Q209733">Q209733</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Myalgic_encephalomyelitis/chronic_fatigue_syndrome" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Chronic_fatigue_syndrome" title="Template:Chronic fatigue syndrome"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Chronic_fatigue_syndrome" title="Template talk:Chronic fatigue syndrome"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Chronic_fatigue_syndrome" title="Special:EditPage/Template:Chronic fatigue syndrome"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Myalgic_encephalomyelitis/chronic_fatigue_syndrome" style="font-size:114%;margin:0 4em"><a class="mw-selflink selflink">Myalgic encephalomyelitis/chronic fatigue syndrome</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Medical issues</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Clinical_descriptions_of_ME/CFS" title="Clinical descriptions of ME/CFS">Clinical descriptions</a></li> <li><a href="/wiki/ME/CFS_treatment" class="mw-redirect" title="ME/CFS treatment">Treatment</a></li> <li><a href="/wiki/Post-exertional_malaise" title="Post-exertional malaise">Post-exertional malaise</a></li> <li><a href="/wiki/2-day_CPET" title="2-day CPET">2-day CPET</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Research</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/DecodeME" title="DecodeME">DecodeME</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Society and history</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/History_of_ME/CFS" title="History of ME/CFS">History</a></li> <li><a href="/wiki/Controversies_related_to_ME/CFS" title="Controversies related to ME/CFS">Controversies</a></li> <li><a href="/wiki/List_of_people_with_ME/CFS" title="List of people with ME/CFS">Notable patients</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Organizations</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Action_for_ME" title="Action for ME">Action for ME</a></li> <li><a href="/wiki/ME_Association" title="ME Association">ME Association</a></li> <li><a href="/wiki/ME_Research_UK" title="ME Research UK">ME Research UK</a></li> <li><a href="/wiki/Open_Medicine_Foundation" title="Open Medicine Foundation">Open Medicine Foundation</a></li> <li><a href="/wiki/Solve_ME/CFS_Initiative" title="Solve ME/CFS Initiative">Solve ME/CFS Initiative</a></li> <li><a href="/wiki/Whittemore_Peterson_Institute" title="Whittemore Peterson Institute">Whittemore Peterson Institute</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Diseases_of_the_nervous_system,_primarily_CNS" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Central_nervous_system_disease" title="Template:Central nervous system disease"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Central_nervous_system_disease" title="Template talk:Central nervous system disease"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Central_nervous_system_disease" title="Special:EditPage/Template:Central nervous system disease"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Diseases_of_the_nervous_system,_primarily_CNS" style="font-size:114%;margin:0 4em">Diseases of the <a href="/wiki/Nervous_system" title="Nervous system">nervous system</a>, primarily <a href="/wiki/Central_nervous_system_disease" title="Central nervous system disease">CNS</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Inflammation" title="Inflammation">Inflammation</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Brain" scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_brain" title="Human brain">Brain</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Encephalitis" title="Encephalitis">Encephalitis</a> <ul><li><a href="/wiki/Viral_encephalitis" title="Viral encephalitis">Viral encephalitis</a></li> <li><a href="/wiki/Herpesviral_encephalitis" class="mw-redirect" title="Herpesviral encephalitis">Herpesviral encephalitis</a></li> <li><a href="/wiki/Limbic_encephalitis" title="Limbic encephalitis">Limbic encephalitis</a></li> <li><a href="/wiki/Encephalitis_lethargica" title="Encephalitis lethargica">Encephalitis lethargica</a></li></ul></li> <li><a href="/wiki/Cavernous_sinus_thrombosis" title="Cavernous sinus thrombosis">Cavernous sinus thrombosis</a></li> <li><a href="/wiki/Brain_abscess" title="Brain abscess">Brain abscess</a> <ul><li><a href="/wiki/Amoebic_brain_abscess" title="Amoebic brain abscess">Amoebic</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Brain and <a href="/wiki/Spinal_cord" title="Spinal cord">spinal cord</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Encephalomyelitis" title="Encephalomyelitis">Encephalomyelitis</a> <ul><li><a href="/wiki/Acute_disseminated_encephalomyelitis" title="Acute disseminated encephalomyelitis">Acute disseminated</a></li></ul></li> <li><a href="/wiki/Meningitis" title="Meningitis">Meningitis</a></li> <li><a href="/wiki/Meningoencephalitis" title="Meningoencephalitis">Meningoencephalitis</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_brain" title="Human brain">Brain</a>/ <a href="/wiki/Encephalopathy" title="Encephalopathy">encephalopathy</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Neurodegenerative_disease" title="Neurodegenerative disease">Degenerative</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Extrapyramidal_system" title="Extrapyramidal system">Extrapyramidal</a> and <a href="/wiki/Movement_disorders" class="mw-redirect" title="Movement disorders">movement disorders</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Basal_ganglia_disease" title="Basal ganglia disease">Basal ganglia disease</a> <ul><li><a href="/wiki/Parkinsonism" title="Parkinsonism">Parkinsonism</a> <ul><li><a href="/wiki/Parkinson%27s_disease" title="Parkinson's disease">PD</a></li> <li><a href="/wiki/Postencephalitic_parkinsonism" class="mw-redirect" title="Postencephalitic parkinsonism">Postencephalitic</a></li> <li><a href="/wiki/Neuroleptic_malignant_syndrome" title="Neuroleptic malignant syndrome">NMS</a></li></ul></li> <li><a href="/wiki/Neurodegeneration_with_brain_iron_accumulation" title="Neurodegeneration with brain iron accumulation">NBIA</a> <ul><li><a href="/wiki/Pantothenate_kinase-associated_neurodegeneration" title="Pantothenate kinase-associated neurodegeneration">PKAN</a></li></ul></li> <li><a href="/wiki/Tauopathy" title="Tauopathy">Tauopathy</a> <ul><li><a href="/wiki/Progressive_supranuclear_palsy" title="Progressive supranuclear palsy">PSP</a></li></ul></li> <li><a href="/wiki/Multiple_system_atrophy" title="Multiple system atrophy">Striatonigral degeneration</a></li> <li><a href="/wiki/Hemiballismus" title="Hemiballismus">Hemiballismus</a></li> <li><a href="/wiki/Huntington%27s_disease" title="Huntington's disease">HD</a></li> <li><a href="/wiki/Olivopontocerebellar_atrophy" class="mw-redirect" title="Olivopontocerebellar atrophy">OA</a></li></ul></li></ul> <ul><li><a href="/wiki/Dyskinesia" title="Dyskinesia">Dyskinesia</a> <ul><li><a href="/wiki/Dystonia" title="Dystonia">Dystonia</a> <ul><li><a href="/wiki/Status_dystonicus" title="Status dystonicus">Status dystonicus</a></li> <li><a href="/wiki/Spasmodic_torticollis" title="Spasmodic torticollis">Spasmodic torticollis</a></li> <li><a href="/wiki/Meige%27s_syndrome" title="Meige's syndrome">Meige's</a></li> <li><a href="/wiki/Blepharospasm" title="Blepharospasm">Blepharospasm</a></li></ul></li> <li><a href="/wiki/Athetosis" title="Athetosis">Athetosis</a></li> <li><a href="/wiki/Chorea" title="Chorea">Chorea</a> <ul><li><a href="/wiki/Choreoathetosis" title="Choreoathetosis">Choreoathetosis</a></li></ul></li> <li><a href="/wiki/Myoclonus" title="Myoclonus">Myoclonus</a> <ul><li><a href="/wiki/Myoclonic_epilepsy" title="Myoclonic epilepsy">Myoclonic epilepsy</a></li></ul></li> <li><a href="/wiki/Akathisia" title="Akathisia">Akathisia</a></li></ul></li></ul> <ul><li><a href="/wiki/Tremor" title="Tremor">Tremor</a> <ul><li><a href="/wiki/Essential_tremor" title="Essential tremor">Essential tremor</a></li> <li><a href="/wiki/Intention_tremor" title="Intention tremor">Intention tremor</a></li></ul></li> <li><a href="/wiki/Restless_legs_syndrome" title="Restless legs syndrome">Restless legs</a></li> <li><a href="/wiki/Stiff-person_syndrome" title="Stiff-person syndrome">Stiff-person</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Dementia" title="Dementia">Dementia</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Tauopathy" title="Tauopathy">Tauopathy</a> <ul><li><a href="/wiki/Alzheimer%27s_disease" title="Alzheimer's disease">Alzheimer's</a> <ul><li><a href="/wiki/Early-onset_Alzheimer%27s_disease" title="Early-onset Alzheimer's disease">Early-onset</a></li></ul></li> <li><a href="/wiki/Primary_progressive_aphasia" title="Primary progressive aphasia">Primary progressive aphasia</a></li></ul></li> <li><a href="/wiki/Frontotemporal_dementia" title="Frontotemporal dementia">Frontotemporal dementia</a>/<a href="/wiki/Frontotemporal_lobar_degeneration" title="Frontotemporal lobar degeneration">Frontotemporal lobar degeneration</a> <ul><li><a href="/wiki/Pick%27s_disease" class="mw-redirect" title="Pick's disease">Pick's</a></li></ul></li> <li><a href="/wiki/Lewy_bodies_dementia" class="mw-redirect" title="Lewy bodies dementia">Lewy bodies dementia</a></li> <li><a href="/wiki/Posterior_cortical_atrophy" title="Posterior cortical atrophy">Posterior cortical atrophy</a></li></ul> <a href="/wiki/Creutzfeldt%E2%80%93Jakob_disease" title="Creutzfeldt–Jakob disease">Creutzfeldt–Jakob disease</a> <ul><li><a href="/wiki/Vascular_dementia" title="Vascular dementia">Vascular dementia</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Mitochondrial_disease" title="Mitochondrial disease">Mitochondrial disease</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Leigh_syndrome" title="Leigh syndrome">Leigh syndrome</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Demyelinating_disease" title="Demyelinating disease">Demyelinating</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/CNS_demyelinating_autoimmune_diseases" title="CNS demyelinating autoimmune diseases">Autoimmune</a></li> <li><a href="/wiki/Inflammatory_demyelinating_diseases_of_the_central_nervous_system" title="Inflammatory demyelinating diseases of the central nervous system">Inflammatory</a></li> <li><a href="/wiki/Multiple_sclerosis" title="Multiple sclerosis">Multiple sclerosis</a></li> <li>For more detailed coverage, see <a href="/wiki/Template:Demyelinating_diseases_of_CNS" title="Template:Demyelinating diseases of CNS">Template:Demyelinating diseases of CNS</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Episodic/ <a href="/wiki/Paroxysmal_attack" title="Paroxysmal attack">paroxysmal</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Epileptic_seizure" class="mw-redirect" title="Epileptic seizure">Seizures</a> and <a href="/wiki/Epilepsy" title="Epilepsy">epilepsy</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Focal_seizure" title="Focal seizure">Focal</a></li> <li><a href="/wiki/Generalized_epilepsy" title="Generalized epilepsy">Generalised</a></li> <li><a href="/wiki/Status_epilepticus" title="Status epilepticus">Status epilepticus</a></li> <li>For more detailed coverage, see <a href="/wiki/Template:Epilepsy" class="mw-redirect" title="Template:Epilepsy">Template:Epilepsy</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Headache" title="Headache">Headache</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Migraine" title="Migraine">Migraine</a></li> <li><a href="/wiki/Cluster_headache" title="Cluster headache">Cluster</a></li> <li><a href="/wiki/Tension_headache" title="Tension headache">Tension</a></li> <li>For more detailed coverage, see <a href="/wiki/Template:Headache" title="Template:Headache">Template:Headache</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Cerebrovascular_disease" title="Cerebrovascular disease">Cerebrovascular</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Transient_ischemic_attack" title="Transient ischemic attack">TIA</a></li> <li><a href="/wiki/Stroke" title="Stroke">Stroke</a></li> <li>For more detailed coverage, see <a href="/wiki/Template:Cerebrovascular_diseases" title="Template:Cerebrovascular diseases">Template:Cerebrovascular diseases</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Sleep_disorders" class="mw-redirect" title="Sleep disorders">Sleep disorders</a> <ul><li>For more detailed coverage, see <a href="/wiki/Template:Sleep" title="Template:Sleep">Template:Sleep</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Cerebrospinal_fluid" title="Cerebrospinal fluid">CSF</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Intracranial_pressure" title="Intracranial pressure">Intracranial hypertension</a> <ul><li><a href="/wiki/Hydrocephalus" title="Hydrocephalus">Hydrocephalus</a></li> <li><a href="/wiki/Normal_pressure_hydrocephalus" title="Normal pressure hydrocephalus">Normal pressure hydrocephalus</a></li> <li><a href="/wiki/Choroid_plexus_papilloma" title="Choroid plexus papilloma">Choroid plexus papilloma</a></li> <li><a href="/wiki/Idiopathic_intracranial_hypertension" title="Idiopathic intracranial hypertension">Idiopathic intracranial hypertension</a></li></ul></li> <li><a href="/wiki/Cerebral_edema" title="Cerebral edema">Cerebral edema</a></li> <li><a href="/wiki/Spontaneous_cerebrospinal_fluid_leak" class="mw-redirect" title="Spontaneous cerebrospinal fluid leak">Intracranial hypotension</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Brain_herniation" title="Brain herniation">Brain herniation</a></li> <li><a href="/wiki/Reye_syndrome" title="Reye syndrome">Reye syndrome</a></li> <li><a href="/wiki/Hepatic_encephalopathy" title="Hepatic encephalopathy">Hepatic encephalopathy</a></li> <li><a href="/wiki/Toxic_encephalopathy" title="Toxic encephalopathy">Toxic encephalopathy</a></li> <li><a href="/wiki/Hashimoto%27s_encephalopathy" title="Hashimoto's encephalopathy">Hashimoto's encephalopathy</a></li> <li><a href="/wiki/Fetal_alcohol_spectrum_disorder" title="Fetal alcohol spectrum disorder">Static encephalopathy</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Both/either</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Degenerative" scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Neurodegenerative_disease" title="Neurodegenerative disease">Degenerative</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Spinocerebellar_ataxia" title="Spinocerebellar ataxia">SA</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Friedreich%27s_ataxia" title="Friedreich's ataxia">Friedreich's ataxia</a></li> <li><a href="/wiki/Ataxia%E2%80%93telangiectasia" title="Ataxia–telangiectasia">Ataxia–telangiectasia</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Motor_neuron_diseases" title="Motor neuron diseases">MND</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Upper_motor_neuron" title="Upper motor neuron">UMN</a> only: <ul><li><a href="/wiki/Primary_lateral_sclerosis" title="Primary lateral sclerosis">Primary lateral sclerosis</a></li> <li><a href="/wiki/Pseudobulbar_palsy" title="Pseudobulbar palsy">Pseudobulbar palsy</a></li> <li><a href="/wiki/Hereditary_spastic_paraplegia" title="Hereditary spastic paraplegia">Hereditary spastic paraplegia</a></li></ul></li></ul> <ul><li><a href="/wiki/Lower_motor_neuron" title="Lower motor neuron">LMN</a> only: <ul><li><a href="/wiki/Distal_hereditary_motor_neuronopathies" title="Distal hereditary motor neuronopathies">Distal hereditary motor neuronopathies</a></li> <li><a href="/wiki/Spinal_muscular_atrophies" title="Spinal muscular atrophies">Spinal muscular atrophies</a> <ul><li><a href="/wiki/Spinal_muscular_atrophy" title="Spinal muscular atrophy">SMA</a></li> <li><a href="/wiki/Spinal_and_bulbar_muscular_atrophy" title="Spinal and bulbar muscular atrophy">SMAX1</a></li> <li><a href="/wiki/X-linked_spinal_muscular_atrophy_type_2" title="X-linked spinal muscular atrophy type 2">SMAX2</a></li> <li><a href="/wiki/Distal_spinal_muscular_atrophy_type_1" title="Distal spinal muscular atrophy type 1">DSMA1</a></li> <li><a href="/wiki/Congenital_distal_spinal_muscular_atrophy" title="Congenital distal spinal muscular atrophy">Congenital DSMA</a></li> <li>Spinal muscular atrophy with lower extremity predominance (SMALED) <ul><li><a href="/wiki/Spinal_muscular_atrophy_with_lower_extremity_predominance_1" title="Spinal muscular atrophy with lower extremity predominance 1">SMALED1</a></li> <li><a href="/wiki/Spinal_muscular_atrophy_with_lower_extremity_predominance_2A" title="Spinal muscular atrophy with lower extremity predominance 2A">SMALED2A</a></li> <li><a href="/wiki/Spinal_muscular_atrophy_with_lower_extremity_predominance_2B" title="Spinal muscular atrophy with lower extremity predominance 2B">SMALED2B</a></li></ul></li> <li><a href="/wiki/Pontocerebellar_hypoplasia" title="Pontocerebellar hypoplasia">SMA-PCH</a></li> <li><a href="/wiki/Spinal_muscular_atrophy_with_progressive_myoclonic_epilepsy" title="Spinal muscular atrophy with progressive myoclonic epilepsy">SMA-PME</a></li></ul></li> <li><a href="/wiki/Progressive_muscular_atrophy" title="Progressive muscular atrophy">Progressive muscular atrophy</a></li> <li><a href="/wiki/Progressive_bulbar_palsy" title="Progressive bulbar palsy">Progressive bulbar palsy</a> <ul><li><a href="/wiki/Fazio%E2%80%93Londe_disease" title="Fazio–Londe disease">Fazio–Londe</a></li> <li><a href="/wiki/Infantile_progressive_bulbar_palsy" title="Infantile progressive bulbar palsy">Infantile progressive bulbar palsy</a></li></ul></li></ul></li></ul> <ul><li>both: <ul><li><a href="/wiki/Amyotrophic_lateral_sclerosis" class="mw-redirect" title="Amyotrophic lateral sclerosis">Amyotrophic lateral sclerosis</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr></tbody></table></div> <style 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