A current problem regarding Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is the large proportion of doctors that are either not trained or refuse to recognize ME/CFS as a genuine clinical entity, and as a result do not diagnose it. An additional problem is that most of the clinical and research studies currently available on ME are focused on patients who are ambulant and able to attend clinics and there is very limited data on patients who are very severe (housebound or bedbound), despite the fact that they constitute an estimated 25% of all ME/CFS cases. This author has personal experience of managing and advising on numerous cases of severe paediatric ME, and offers a series of case reports of individual cases as a means of illustrating various points regarding clinical presentation, together with general principles of appropriate management.
Keywords: Chronic Fatigue Syndrome (CFS); Cognitive Behavioural Therapy; Fabricated and Induced Illness; Graded Exercise Therapy; Myalgic Encephalomyelitis (ME); Pervasive Refusal Syndrome; Post-Exertional Malaise (PEM); Severe ME; Very Severe ME; immunoglobulin.