Chaudhuri Abhijit, Behan Peter O
Division of Clinical Neurosciences, University of Glasgow, Glasgow G51 4TF, UK.
Lancet. 2004 Mar 20;363(9413):978-88. doi: 10.1016/S0140-6736(04)15794-2.
Chronic fatigue is a typical symptom of neurological diseases, and is most disabling in multiple sclerosis, postpoliomyelitis, poststroke, and in chronic fatigue syndrome. Disorders of neuromuscular junction transmission and metabolic diseases cause muscle fatigability, which is characterised by failure to sustain the force of muscle contraction (peripheral fatigue). Fatigue is also seen in diseases that affect the central, peripheral, and autonomic nervous systems (central fatigue). Enhanced perception of effort and limited endurance of sustained physical and mental activities are the main characteristics of central fatigue. Metabolic and structural lesions that disrupt the usual process of activation in pathways interconnecting the basal ganglia, thalamus, limbic system, and higher cortical centre are implicated in the pathophysiological process of central fatigue. A state of pre-existing relative hypocortisolaemia might sensitise the hypothalamic-pituitary-adrenal axis to development of persistent central fatigue after stress. The contributions of physiological, cognitive, and affective changes underlying fatigue are variable, and treatment is largely symptomatic and rehabilitative.
慢性疲劳是神经疾病的典型症状，在多发性硬化症、脊髓灰质炎后综合征、中风后以及慢性疲劳综合征中最为致残。神经肌肉接头传递障碍和代谢疾病会导致肌肉易疲劳，其特征是无法维持肌肉收缩力（外周性疲劳）。在影响中枢、外周和自主神经系统的疾病中也会出现疲劳（中枢性疲劳）。用力感知增强以及持续身心活动的耐力受限是中枢性疲劳的主要特征。破坏基底神经节、丘脑、边缘系统和高级皮质中枢之间通路中正常激活过程的代谢和结构损伤与中枢性疲劳的病理生理过程有关。预先存在的相对低皮质醇血症状态可能会使下丘脑 - 垂体 - 肾上腺轴对应激后持续性中枢性疲劳的发展敏感化。疲劳背后生理、认知和情感变化的作用各不相同，治疗主要是对症和康复治疗。
