Brola Waldemar, Ziomek Małgorzata, Czernicki Jan
Oddział Neurologiczny, Szpital Specjalistyczny w Końskich.
Neurol Neurochir Pol. 2007 Jul-Aug;41(4):340-9.
Fatigue without coincident depression may accompany many neurological disorders, including multiple sclerosis, Parkinson's disease, motor neuron disease, stroke and post-polio syndrome, and is frequently reported by patients as a predominant complaint. The pathophysiology of fatigue is unknown. The role of various mechanisms has been suggested, including the effect of proinflammatory cytokines (TNF-alpha, IL-1beta and IL-6) on glutaminergic transmission, hypothalamo-pituitary-adrenal (HPA) axis dysfunction, disturbances of astroglia metabolism and decreased levels of the neurotransmitters noradrenaline and serotonin. The diagnosis of fatigue syndrome is based on exclusion of depression and additional organic conditions (anaemia, cardiovascular disorders, kidney diseases or hypothyroidism). The treatment of fatigue syndrome is complex. Physical activity, rehabilitation, psychotherapy and avoidance of factors which may increase fatigue, such as fever, anxiety, depression, pain, sleep disturbances, as well as some drugs like opioids and benzodiazepines, are important. Pharmacological treatment leads to slight improvement. Amantadine, modafinil and pemoline are administered to such patients.
无并发抑郁症的疲劳可能伴随多种神经系统疾病，包括多发性硬化症、帕金森病、运动神经元病、中风和小儿麻痹后遗症，且患者常将其作为主要诉求。疲劳的病理生理学尚不清楚。人们提出了多种机制的作用，包括促炎细胞因子（肿瘤坏死因子-α、白细胞介素-1β和白细胞介素-6）对谷氨酸能传递的影响、下丘脑-垂体-肾上腺（HPA）轴功能障碍、星形胶质细胞代谢紊乱以及神经递质去甲肾上腺素和血清素水平降低。疲劳综合征的诊断基于排除抑郁症和其他器质性疾病（贫血、心血管疾病、肾脏疾病或甲状腺功能减退）。疲劳综合征的治疗很复杂。体育活动、康复治疗、心理治疗以及避免可能增加疲劳的因素，如发热、焦虑、抑郁、疼痛、睡眠障碍，以及一些药物，如阿片类药物和苯二氮䓬类药物，都很重要。药物治疗只能带来轻微改善。金刚烷胺、莫达非尼和匹莫林可用于此类患者。
