Berger, Joseph R, Pocoski, Jennifer, Preblick, Ronald et al. · Multiple sclerosis (Houndmills, Basingstoke, England) · 2013 · DOI
This study looked at medical records to see how often fatigue appears before someone is diagnosed with multiple sclerosis (MS). Researchers found that about 29% of newly diagnosed MS patients had been labeled with fatigue in the 3 years before their MS diagnosis, often 1–2 years earlier. The findings suggest that persistent fatigue might be an early warning sign of MS, and doctors should carefully evaluate people with unexplained fatigue for possible neurological causes.
This study highlights that fatigue—a cardinal symptom in ME/CFS—can precede serious neurological diagnoses by months to years. For ME/CFS patients and clinicians, it underscores the importance of rigorous differential diagnosis, since persistent fatigue warrants investigation for demyelinating and other systemic diseases that may coexist with or masquerade as ME/CFS.
This study does not prove that fatigue *causes* MS or that all fatigue is a sign of future MS; the findings are correlational. It does not establish whether the fatigue codes represent the same pathophysiology in MS patients as in primary fatigue disorders like ME/CFS. The study cannot determine temporal causality or rule out confounding from surveillance bias (more intensive medical evaluation in symptomatic patients).
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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