Ziemssen Tjalf
MS Center, Neurological University Clinic, Dresden, Germany.
J Neurol Sci. 2009 Feb 1;277 Suppl 1:S37-41. doi: 10.1016/S0022-510X(09)70011-5.
Depression and fatigue are common symptoms of multiple sclerosis and are the primary determinants of impaired quality of life in this demyelinating neurological disease. The twelve-month prevalence of major depression in patients with multiple sclerosis is around 15%. Untreated depression is associated with suicidal ideation, impaired cognitive function and poor adherence to immunomodulatory treatment. For these reasons, systematic screening and management of depressive symptoms is recommended for all patients with multiple sclerosis. There is some evidence that interferon-beta treatment may exacerbate depressive symptoms and a switch to glatiramer acetate can be envisaged in patients treated with an interferon-beta in whom depressive symptoms become an issue. Fatigue is present in over three-quarters of patients with multiple sclerosis. It is considered the most debilitating symptom of the disease and is a major reason for work absenteeism. There is growing evidence that immunomodulatory treatments, in particular glatiramer acetate, improve fatigue symptoms in patients with multiple sclerosis.
抑郁和疲劳是多发性硬化症的常见症状，也是这种脱髓鞘性神经疾病中生活质量受损的主要决定因素。多发性硬化症患者中重度抑郁症的12个月患病率约为15%。未经治疗的抑郁症与自杀意念、认知功能受损以及免疫调节治疗依从性差有关。出于这些原因，建议对所有多发性硬化症患者进行抑郁症状的系统筛查和管理。有一些证据表明，β-干扰素治疗可能会加重抑郁症状，对于使用β-干扰素治疗且抑郁症状成为问题的患者，可以考虑改用醋酸格拉替雷。超过四分之三的多发性硬化症患者存在疲劳症状。它被认为是该疾病最使人衰弱的症状，也是旷工的主要原因。越来越多的证据表明，免疫调节治疗，特别是醋酸格拉替雷，可改善多发性硬化症患者的疲劳症状。
