Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke/NIH, 10 Center Drive, Bethesda, MD 20892-1400, USA.
PM R. 2010 May;2(5):399-405. doi: 10.1016/j.pmrj.2010.04.012.
Fatigue is a feature of several chronic diseases of the central and peripheral nervous system. The pathophysiology of central fatigue is complex and often not well-defined. In contrast, peripheral fatigue is more objectively defined and measured. Fatigue can be part of the primary disease process, but there are often contributions from comorbid factors such as depression, sleep disturbance, medication, or deconditioning. Multiple sclerosis (MS) offers an example of central fatigue. More than 40% of MS patients complain of fatigue. Validated questionnaires are used to assess fatigue severity and comorbid factors. Although fatigue is believed to be a primary process in MS, depression and sleep disturbance are often comorbid problems. Magnetic resonance imaging (MRI), positron emission tomography, and functional MRI studies suggest that fatigue is related to gray matter disease, particularly of the cerebral cortex, but also of the thalamus and caudate. Disruption of impulse propagation from demyelination is also a likely factor. It is uncertain if pro-inflammatory cytokines have a specific effect on the genesis of MS fatigue. Several medications have been reported to alleviate fatigue in MS, but controlled studies show contradictory results. Treatment of depression and sleep disturbance, use of exercise programs and rehabilitation therapies as well as treatment of other comorbid conditions is necessary for optimal alleviation of fatigue. Myasthenia gravis (MG) patients exhibit peripheral fatigue. In contrast to MS, the mechanism of weakness and fatigue in MG is well-defined. Antibodies to the postsynaptic acetylcholine receptor at the myoneural junction cause diminution of the force of muscle contractions. This leads to a feeling of fatigue. MG treatments increase the availability of acetylcholine and reduce antibody formation. Evaluation for comorbid conditions, especially thymoma and hyperthyroidism, are mandatory in patients with MG.
疲劳是几种中枢和周围神经系统慢性疾病的特征。中枢疲劳的病理生理学较为复杂，通常定义不明确。相比之下，周围疲劳的定义更为客观，也更容易测量。疲劳可能是原发性疾病过程的一部分，但也常常受到共病因素的影响，如抑郁、睡眠障碍、药物治疗或身体状况不佳。多发性硬化症（MS）就是中枢性疲劳的一个例子。超过 40%的 MS 患者抱怨疲劳。使用经过验证的问卷评估疲劳严重程度和共病因素。尽管疲劳被认为是 MS 的主要发病机制，但抑郁和睡眠障碍往往是共病问题。磁共振成像（MRI）、正电子发射断层扫描和功能性 MRI 研究表明，疲劳与灰质疾病有关，特别是大脑皮层，但也与丘脑和尾状核有关。脱髓鞘引起的冲动传导中断也是一个可能的因素。目前尚不清楚促炎细胞因子是否对 MS 疲劳的发生有特定影响。有报道称几种药物可缓解 MS 患者的疲劳，但对照研究结果相互矛盾。治疗抑郁和睡眠障碍、使用运动方案和康复疗法以及治疗其他共病，对于优化疲劳缓解至关重要。重症肌无力（MG）患者表现出周围性疲劳。与 MS 不同，MG 中肌无力和疲劳的机制明确。位于运动终板的突触后乙酰胆碱受体抗体导致肌肉收缩力减弱。这会导致疲劳感。MG 治疗方法增加了乙酰胆碱的可用性并减少了抗体的形成。评估共病，特别是胸腺瘤和甲状腺功能亢进症，是 MG 患者的必查项目。
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