Comi G, Leocani L, Rossi P, Colombo B
University of Milan, Department of Neuroscience, Scientific Institute H. San Raffaele, Via Olgettina 60, 20132 Milan, Italy.
J Neurol. 2001 Mar;248(3):174-9. doi: 10.1007/s004150170222.
Fatigue is a common symptom of patients with multiple sclerosis (MS). It is reported by about one-third of patients, and for many fatigue is the most disabling symptom. Fatigue may be associated with motor disturbances and/or mood disorders, which makes it very difficult to determine whether the fatigue is an aspect of these features or a result per se of the disease. Although peripheral mechanisms have some role in the pathogenesis of fatigue, in MS there are clear indications that the more important role is played by "central" abnormalities. Neurophysiological studies have shown that fatigue does not depend on involvement of the pyramidal tracts and implicate impairment of volitional drive of the descending motor pathways as a physiopathological mechanism. Metabolic abnormalities of the frontal cortex and basal ganglia revealed by positron-emission tomography and correlations between fatigue and magnetic resonance imaging lesion burden support this hypothesis. Some recent studies also suggest that pro-inflammatory cytokines contribute to the sense of tiredness. No specific treatments are available. Management strategies include medications, exercise, and behavioural therapy; in most cases a combined approach is appropriate.
疲劳是多发性硬化症（MS）患者的常见症状。约三分之一的患者报告有疲劳症状，对许多人来说，疲劳是最致残的症状。疲劳可能与运动障碍和/或情绪障碍有关，这使得很难确定疲劳是这些特征的一个方面还是疾病本身的结果。虽然外周机制在疲劳的发病机制中起一定作用，但在MS中，有明确迹象表明“中枢”异常起更重要的作用。神经生理学研究表明，疲劳并不取决于锥体束的受累情况，并暗示下行运动通路的意志驱动受损是一种病理生理机制。正电子发射断层扫描显示的额叶皮质和基底神经节的代谢异常以及疲劳与磁共振成像病变负荷之间的相关性支持了这一假设。最近的一些研究还表明，促炎细胞因子会导致疲劳感。目前尚无特效治疗方法。管理策略包括药物治疗、运动和行为疗法；在大多数情况下，综合方法是合适的。
