Tankisi, Hatice, Versace, Viviana, Kuppuswamy, Annapoorna et al. · Clinical neurophysiology practice · 2024 · DOI
This review article explains how doctors and researchers can better understand fatigue and 'fatigability'—the reduced ability to sustain physical or mental effort. The authors describe different types of tests that can measure these problems objectively by looking at how the brain, nerves, and muscles work, rather than relying only on what patients report. These specialized tests may help identify the actual cause of fatigue in different conditions, including long COVID and ME/CFS.
For ME/CFS patients, this framework is crucial because fatigue and post-exertional malaise represent the core diagnostic features, yet objective biomarkers remain poorly defined. This review provides clinicians and researchers with practical guidance on which neurophysiological tests may help distinguish ME/CFS-specific mechanisms (potentially central or muscle-based) from other causes of fatigue, potentially enabling better diagnosis and targeted treatment.
This review does not provide original evidence that specific neurophysiological tests definitively diagnose ME/CFS or demonstrate which tests are most sensitive/specific in ME/CFS populations specifically. It also does not prove that any single biomarker can fully explain ME/CFS fatigue; the condition likely involves multiple biological systems whose interactions remain unclear.
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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