Sonya Marshall-Gradisnik

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Sonya M. Marshall-Gradisnik, BSc (Hons), PhD, is co-director (alongside Professor Donald Staines) of the National Centre for Neuroimmunology and Emerging Diseases (NCNED) at Griffith University in Australia. Her expertise is in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis with particular focus on Natural Killer Cell function and signalling pathways, T regulatory and B cell phenotypes and cytokine production, and transcriptional profiling and gene expression.[1] In her studies, she compares the changes of the different cells of the immune system in relation to the severity of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis. Professor Marshall-Gradisnik established the first Australian CFS/ME research/medical clinic at Griffith University, which was developed in conjunction with Queensland Health and CFS public health programs and provides clinical support for patients and carers at Gold Cost University Hospital, Griffith University. Later she established a mobile CFS research clinic to ensure the most severely affected CFS patients are able to have medical attention as well as participate in research.[2]

Awards[edit | edit source]

  • Queensland Women in Technology Research Award Rising Star Award for her research into immunological biomarkers for CFS or ME in 2010[3]
  • National Award as Best Young Science Investigator at the Australian Conference for Science and Medicine for her studies into natural killer cell function and genotyping[3]
  • Finalist in Young Australian of the Year Award Science and Technology Category[3]

Committees and writing boards[edit | edit source]

International Consensus Criteria[edit | edit source]

2011 - Marshall-Gradisnik co-authored the 2011 case definition, International Consensus Criteria.[4]

International Association for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis[edit | edit source]

Marshall-Gradisnik serves on the Board of Directors of the International Association for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (IACFS/ME).[2]

Marshall-Gradisnik serves on the editorial board of the journal, Fatigue: Biomedicine, Health & Behavior, published on behalf of the IACFS/ME.[5]

Austrialia National Health and Medical Research Council's ME and CFS advisory committee[edit | edit source]

2018 - Prof Marshall-Gradisnik serves on the Australian government's National Health and Medical Research Council's ME and CFS advisory committee.[6]

Biomarker Patent[edit | edit source]

In 2016, Griffith University filed for a patent for a biological marker (Patent Publication number WO2016023077 A1)[7] for the diagnosis and management of ME and CFS. Sonya Marshall-Gradisnik and Ekua Brenu are listed as the inventors. The application states: "The present invention resides broadly in the use of at least one miRNA as a biological marker for identifying or diagnosing a subject having CFS and/or ME."[8]

Notable studies[edit | edit source]

Advocacy[edit | edit source]

Open Letter to The Lancet[edit | edit source]

Three open letters to the editor of The Lancet urged the editor to commission a fully independent review of the PACE trial, which the journal had published in 2011. In 2016, Dr. Marshall-Gradisnik, along with 41 colleagues in the ME/CFS field, signed the second letter. In June 2018, Dr. Marshall-Gradisnik signed the third letter, along with approximately 100 colleagues.

Clinic location[edit | edit source]

National Centre for Neuroimmunology and Emerging Diseases (NCNED) is located at Griffith University on the Gold Coast, Queensland, Australia.

Talks and interviews[edit | edit source]

Online presence[edit | edit source]

See also[edit | edit source]

Learn more[edit | edit source]

References[edit | edit source]

  1. https://www.griffith.edu.au/health/school-medical-science/staff/professor-sonya-marshall-gradisnik
  2. 2.02.1 "Board Member-Sonya Marshall-Gradisnik, PhD". iacfsme.org. Retrieved Dec 7, 2018. 
  3. 3.03.13.2 "Editor - Sonya Marshall-Gradisnik | Bond University | 5340". www.omicsonline.org. Retrieved Dec 7, 2018. 
  4. Carruthers, Bruce M.; van de Sande, Marjorie I.; De Meirleir, Kenny L.; Klimas, Nancy G.; Broderick, Gordon; Mitchell, Terry; Staines, Donald; Powles, A. C. Peter; Speight, Nigel; Vallings, Rosamund; Bateman, Lucinda; Baumgarten-Austrheim, Barbara; Bell, David; Carlo-Stella, Nicoletta; Chia, John; Darragh, Austin; Jo, Daehyun; Lewis, Donald; Light, Alan; Marshall-Gradisnik, Sonya; Mena, Ismael; Mikovits, Judy; Miwa, Kunihisa; Murovska, Modra; Pall, Martin; Stevens, Staci (Aug 22, 2011). "Myalgic encephalomyelitis: International Consensus Criteria". Journal of Internal Medicine. 270 (4): 327–338. doi:10.1111/j.1365-2796.2011.02428.x. ISSN 0954-6820. PMC 3427890Freely accessible. PMID 21777306. 
  5. "Fatigue: Biomedicine, Health & Behavior". www.tandfonline.com. Retrieved Nov 1, 2019. 
  6. "Myalgic Encephalomyelitis and Chronic Fatigue Syndrome | NHMRC". nhmrc.gov.au. Retrieved Dec 6, 2018. 
  7. Biological markers, retrieved Sep 1, 2019 
  8. Biological markers, retrieved Sep 1, 2019 
  9. Brenu, Ekua W; van Driel, Mieke L; Staines, Don R; Ashton, Kevin J; Ramos, Sandra B; Keane, James; Klimas, Nancy G; Marshall-Gradisnik, Sonya M (2011). "Immunological abnormalities as potential biomarkers in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis". Journal of Translational Medicine. 9 (1): 81. doi:10.1186/1479-5876-9-81. ISSN 1479-5876. PMC 3120691Freely accessible. PMID 21619669. 
  10. Brenu, Ekua W; van Driel, Mieke L; Staines, Donald R; Kreijkamp-Kaspers, Sanne; Hardcastle, Sharni L; Marshall-Gradisnik, Sonya M (2012), "The Effects of Influenza Vaccination on Immune Function in Patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis" (PDF), International Journal of Clinical Medicine, 3 (6): 544-551, doi:10.4236/ijcm.2012.36098 
  11. Johnston, S.C.; Brenu, E.W.; Staines, D.R.; Marshall-Gradisnik, S.M. (2013), "The role of clinical guidelines for chronic fatigue syndrome/myalgic encephalomyelitis in research settings.", Fatigue: Biomedicine, Health & Behavior, 2 (1): 28-39, doi:10.1080/21641846.2013.860779 
  12. Huth, Teilah K.; Brenu, Ekua; Nguyen, Thao; Hardcastle, Sharni L.; Johnston, Samantha; Ramos, Sandra; Staines, Donald R.; Marshall-Gradisnik, Sonya M. (2014), "Characterization of Natural Killer Cell Phenotypes in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis", Journal of Clinical & Cellular Immunology, 5 (3), doi:10.4172/2155-9899.1000223 
  13. Brenu, EW; Huth, TK; Hardcastle, SL; Fuller, K; Kaur, M; Johnston, S; Ramos, S; Staines, D; Marshall-Gradisnik, S (2014), "The Role of adaptive and innate immune cells in chronic fatigue syndrome/myalgic encephalomyelitis",  International Immunology, 26 (4): 233-42, doi:10.1093/intimm/dxt068, PMID 24343819 
  14. Hardcastle, Sharni L.; Brenu, Ekua W.; Johnston, Samantha; Nguyen, Thao; Huth, Teilah K.; Kaur, Manprit; Ramos, Sandra; Salajegheh, Ali; Staines, Donald R.; Marshall-Gradisnik, Sonya (2014), "Analysis of the Relationship between Immune Dysfunction and Symptom Severity in Patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME)", Journal of Clinical & Cellular Immunology, 5 (190), doi:10.4172/2155-9899.1000190 
  15. Wong, Naomi; Nguyen, Thao; Brenu, Ekua Weba; Broadley, Simon; Staines, Donald; Marshall-Gradisnik, Sonya (2015), "A Comparison of Cytokine Profiles of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis and Multiple Sclerosis Patients", International Journal of Clinical Medicine, 6 (10): 769-783, doi:10.4236/ijcm.2015.610103 
  16. Peterson, D; Brenu, EW; Gottschalk, G; Ramos, Sandra B; Nguyen, T; Staines, D; Marshall-Gradisnik, S (2015), "Cytokines in the Cerebrospinal Fluids of Patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis", Mediators of Inflammation, 2015, doi:10.1155/2015/929720 
  17. Hardcastle, SL; Brenu, EW; Johnston, S; Nguyen, T; Huth, T; Wong, N; Ramos, S; Staines, DR; Marshall-Gradisnik, SM (2015), "Serum Immune Proteins in Moderate and Severe Chronic Fatigue Syndrome/Myalgic Encephalomyelitis Patients", International Journal of Medical Sciences, 12 (10): 764-772, doi:10.7150/ijms.12399 
  18. Hardcastle, Sharni Lee; Brenu, Ekua Weba; Johnston, Samantha; Nguyen, Thao; Huth, Teilah; Ramos, Sandra; Staines, Donald; Marshall-Gradisnik, Sonya (2015), "Longitudinal analysis of immune abnormalities in varying severities of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis patients", Journal of Translational Medicine, 13 (299), doi:10.1186/s12967-015-0653-3 
  19. Hardcastle, SL; Brenu, EW; Johnston, S; Nguyen, T; Huth, T; Wong, N; Ramos, S; Staines, DR; Marshall-Gradisnik, SM (2015), "Characterisation of cell functions and receptors in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME)", BMC Immunology, 16 (35), doi:10.1186/s12865-015-0101-4 
  20. Marshall-Gradisnik, Sonya M.; Smith, Peter; Brenu, Ekua W.; Nilius, Bernd; Ramos, Sandra B.; Staines, Donald R. (2015), "Examination of Single Nucleotide Polymorphisms (SNPs) in Transient Receptor Potential (TRP) Ion Channels in Chronic Fatigue Syndrome Patients", Immunology and Immunogenetics Insights, 2015 (7): 1-6, doi:10.4137/III.S25147 
  21. Collatz, Ansel; Johnston, Samantha C.; Staines, Donald R.; Marshall-Gradisnik, Sonya M. (2016), "A Systematic Review of Drug Therapies for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis", Clinical Therapeutics, 38 (6): 1263-1271.e9, doi:10.1016/j.clinthera.2016.04.038, PMID 27229907 
  22. Shan, Zack Y.; Kwiatek, Richard; Burnet, Richard; Del Fante, Peter; Staines, Donald R.; Marshall‐Gradisnik, Sonya; Barnden, Leighton R. (2016), "Progressive brain changes in patients with chronic fatigue syndrome: A longitudinal MRI study", Journal of Magnetic Resonance Imaging, 44: 1301–1311, doi:10.1002/jmri.25283 
  23. Ramos, S; Brenu, E; Broadley, S; Kwiatek, R; Ng, J; Nguyen, T; Freeman, S; Staines, D; Marshall-Gradisnik, S (Mar 20, 2016), "Regulatory T, natural killer T and γδ T cells in multiple sclerosis and chronic fatigue syndrome/myalgic encephalomyelitis: a comparison" (PDF), Asian Pac J Allergy Immunol, 2016 (34): 300-305, doi:10.12932/AP0733 
  24. Huth, T.K.; Brenu, E.W.; Staines, D.R.; Marshall-Gradisnik, S.M. (2016), "Killer Cell Immunoglobulin-like Receptor Genotype and Haplotype Investigation of Natural Killer Cells from an Australian Population of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis Patients", Gene Regulation and Systems Biology, 10: 43–49, doi:10.4137/GRSB.S39861 
  25. Huth, Teilah K.; Staines, Donald; Marshall-Gradisnik, Sonya (2016), "ERK1/2, MEK1/2 and p38 downstream signalling molecules impaired in CD56dimCD16+ and CD56brightCD16dim/− natural killer cells in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis patients", Journal of Translational Medicine, 14 (97), doi:10.1186/s12967-016-0859-z 
  26. Marshall-Gradisnik, Sonya M.; Huth, Teilah; Chacko, Anu; Johnston, Samantha; Smith, Peter; Staines, Donald R. (2016), "Natural killer cells and single nucleotide polymorphisms of specific ion channels and receptor genes in myalgic encephalomyelitis/chronic fatigue syndrome", The Application of Clinical Genetics, 9: 39—47, doi:10.2147/TACG.S99405 
  27. Campagnolo, N.; Johnston, S.; Collatz, A.; Staines, D.; Marshall-Gradisnik, S. (Jan 22, 2017). "Dietary and nutrition interventions for the therapeutic treatment of chronic fatigue syndrome/myalgic encephalomyelitis: a systematic review". Journal of Human Nutrition and Dietetics. 30 (3): 247–259. doi:10.1111/jhn.12435. ISSN 0952-3871. PMID 28111818. 
  28. Nguyen, T.; Hardcastle, S.; Clarke, L.; Smith, P.; Staines, D.; Marshall-Gradisnik, S. (2017), "Impaired calcium mobilization in natural killer cells from chronic fatigue syndrome/myalgic encephalomyelitis patients is associated with transient receptor potential melastatin 3 ion channels", Clinical and Experimental Immunology, 187 (2): 284–293, doi:10.1111/cei.12882 
  29. Nguyen, T.; Johnston, S.; Chacko, A.; Gibson, D.; Cepon, J.; Smith, D.; Staines, D.; Marshall-Gradisnik, S. (2017), "Novel characterisation of mast cell phenotypes from peripheral blood mononuclear cells in chronic fatigue syndrome/myalgic encephalomyelitis patients", Asian Pac J Allergy Immunol, 35 (2): 75-81, doi:10.12932/AP0771 
  30. Marshall-Gradisnik, Sonya; Fretel, Marshall; Eaton, Natalie; Cabanas, Helene; Balinas, Cassandra; Gopalan, Vinod; Petersen, Daniel; Passmore, Rachel; Tang, Kevin; Haque, Mazhar; Lam, Alfred; Staines, Donald (May 31, 2018). "Decreased Expression of TRPM3 and mAChRM3 in the Small Intestine in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis". International Journal of Clinical Medicine. 09 (05): 467. doi:10.4236/ijcm.2018.95040. 
  31. Shan, Zack Y.; Finegan, Kevin; Bhuta, Sandeep; Ireland, Timothy; Staines, Donald R.; Marshall‐Gradisnik, Sonya; Barnden, Leighton R. (2018), "Brain function characteristics of chronic fatigue syndrome: A task fMRI study", NeuroImage: Clinical, 19: 279-286, doi:10.1016/j.nicl.2018.04.025 
  32. Corbitt, M; Campagnolo, N; Staines, D; Marshall-Gradisnik, S (2018), "A Systematic Review of Probiotic Interventions for Gastrointestinal Symptoms and Irritable Bowel Syndrome in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME)", Probiotics Antimicrob Proteins, doi:10.1007/s12602-018-9397-8 
  33. Du Preez, S.; Corbitt, M.; Cabanas, H.; Eaton, N.; Staines, D.; Marshall-Gradisnik, S. (Dec 20, 2018). "A systematic review of enteric dysbiosis in chronic fatigue syndrome/myalgic encephalomyelitis". Systematic Reviews. 7 (1): 241. doi:10.1186/s13643-018-0909-0. ISSN 2046-4053. PMID 30572962. 
  34. Eaton, Natalie; Cabanas, Hélène; Balinas, Cassandra; Klein, Anne; Staines, Donald; Marshall-Gradisnik, Sonya (Dec 2018). "Rituximab impedes natural killer cell function in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis patients: A pilot in vitro investigation". BMC Pharmacology and Toxicology. 19 (1): 12. doi:10.1186/s40360-018-0203-8. ISSN 2050-6511. PMC 5870391Freely accessible. PMID 29587879. 
  35. Nguyen, T.; Staines, D.; Johnston, S.; Marshall-Gradisnik, S. (Jul 2018), "Reduced glycolytic reserve in isolated natural killer cells from Myalgic encephalomyelitis/chronic fatigue syndrome patients: A preliminary investigation", Asian Pac J Allergy Immunol, doi:10.12932/AP-011117-0188 
  36. Barnden, Leighton R.; Shan, Zack Y.; Staines, Donald R.; Marshall-Gradisnik, Sonya; Finegan, Kevin; Ireland, Timothy; Bhuta, Sandeep (2018). "Hyperintense sensorimotor T1 spin echo MRI is associated with brainstem abnormality in chronic fatigue syndrome". NeuroImage: Clinical. 20: 102–109. doi:10.1016/j.nicl.2018.07.011. 
  37. Cabanas, Hélène; Muraki, Katsuhiko; Eaton, Natalie; Balinas, Cassandra; Staines, Donald; Marshall-Gradisnik, Sonya (Aug 14, 2018). "Loss of Transient Receptor Potential Melastatin 3 ion channel function in natural killer cells from Chronic Fatigue Syndrome/Myalgic Encephalomyelitis patients". Molecular Medicine. 24 (1). doi:10.1186/s10020-018-0046-1. ISSN 1076-1551. 
  38. Shan, Zack Y.; Finegan, Kevin; Bhuta, Sandeep; Ireland, Timothy; Staines, Donald R.; Marshall-Gradisnik, Sonya M.; Barnden, Leighton R. (Feb 2018). "Decreased Connectivity and Increased Blood Oxygenation Level Dependent Complexity in the Default Mode Network in Individuals with Chronic Fatigue Syndrome". Brain Connectivity. 8 (1). doi:10.1089/brain.2017.0549. 
  39. Knight, Sarah; Elders, Shane; Rodda, Jill; Harvey, Adrienne; Lubitz, Lionel; Rowe, Kathy; Reveley, Colette; Hennel, Sabine; Towns, Susan; Kozlowska, Kasia; Payne, Donald N; Marshall-Gradisnik, Sonya; Scheinberg, Adam (Feb 23, 2019). "Epidemiology of paediatric chronic fatigue syndrome in Australia". Archives of Disease in Childhood: archdischild–2018–316450. doi:10.1136/archdischild-2018-316450. ISSN 0003-9888. 
  40. Słomko, Joanna; Newton, Julia L; Kujawski, Sławomir; Tafil-Klawe, Małgorzata; Klawe, Jacek; Staines, Donald; Marshall-Gradisnik, Sonya; Zalewski, Pawel (Mar 2019). "Prevalence and characteristics of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) in Poland: a cross-sectional study". BMJ Open. 9 (3): e023955. doi:10.1136/bmjopen-2018-023955. ISSN 2044-6055. PMID 30850404. 
  41. Cabanas, H.; Muraki, K.; Balinas, C.; Eaton-Fitch, N.; Staines, D.; Marshall-Gradisnik, S. (Dec 2019). "Validation of impaired Transient Receptor Potential Melastatin 3 ion channel activity in natural killer cells from Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis patients". Molecular Medicine. 25 (1). doi:10.1186/s10020-019-0083-4. ISSN 1076-1551. 
  42. Corbitt, Matthew; Eaton-Fitch, Natalie; Staines, Donald; Cabanas, Hélène; Marshall-Gradisnik, Sonya (Dec 2019). "A systematic review of cytokines in chronic fatigue syndrome/myalgic encephalomyelitis/systemic exertion intolerance disease (CFS/ME/SEID)". BMC Neurology. 19 (1). doi:10.1186/s12883-019-1433-0. ISSN 1471-2377. PMID 31445522. 
  43. Cabanas, Helene; Muraki, Katsuhiko; Staines, Donald; Marshall-Gradisnik, Sonya (Oct 14, 2019). "Naltrexone restores impaired transient receptor potential melastatin 3 ion channel function in natural killer cells from myalgic encephalomyelitis/chronic fatigue syndrome patients". Frontiers in Immunology. doi:10.3389/fimmu.2019.02545. 
  44. Barnden, Leighton R; Shan, Zack Y; Staines, Donald R; Marshall-Gradisnik, Sonya; Finegan, Kevin; Ireland, Timothy; Bhuta, Sandeep (2019). "Intra brainstem connectivity is impaired in chronic fatigue syndrome". NeuroImage: Clinical. 24: 102045. doi:10.1016/j.nicl.2019.102045. 

Myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

Myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

serum - the clear yellowish fluid that remains from blood plasma after clotting factors have been removed by clot formation

Single nucleotide polymorphism (SNP) - A single nucleotide polymorphism (SNP, pronounced "snip") is a potential genetic mutation that occurs in a single spot in the human genome; a difference in a single DNA building block. SNPs are often represented by an "rs" number, such as "rs53576".

Antibody - Antibodies or immunoglobulin refers to any of a large number of specific proteins produced by B cells that act against an antigen in an immune response.

Single nucleotide polymorphism (SNP) - A single nucleotide polymorphism (SNP, pronounced "snip") is a potential genetic mutation that occurs in a single spot in the human genome; a difference in a single DNA building block. SNPs are often represented by an "rs" number, such as "rs53576".

Myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

Systemic exertion intolerance disease (SEID) - A term for ME/CFS that aims to avoid the stigma associated with the term "chronic fatigue syndrome", while emphasizing the defining characteristic of post-exertional malaise (PEM). SEID was defined as part of the diagnostic criteria put together by the Institute of Medicine (IOM) report of 10 February 2015.

Systemic exertion intolerance disease (SEID) - A term for ME/CFS that aims to avoid the stigma associated with the term "chronic fatigue syndrome", while emphasizing the defining characteristic of post-exertional malaise (PEM). SEID was defined as part of the diagnostic criteria put together by the Institute of Medicine (IOM) report of 10 February 2015.

Myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

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From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history.