부산대학교 도서관

Fatigue is common in neurological disease and associated with substantial disability. Aetiology is generally multifactorial, meaning an individualized, patient-specific understanding of relevant contributors is central to effective management. Primary factors may include brain injury, endocrine changes, or inflammation; medications, deconditioning, psychiatric disorders, pain, and unhelpful beliefs about activity are potential secondary factors. Heterogeneity of causation makes a unifying theory of fatigue elusive, but convergent data across neurological conditions suggest dysfunction in the striatal-thalamic-frontal system is important. Computational neuroscience models suggest fatigue could arise from metacognitive recognition of failure of homeostatic process, then perpetuated by fatigue expectation altering neurocomputational processes during preparation and monitoring of effortful activity. Treatment is guided by biopsychosocial formulation, with emphasis on maintaining factors. Exercise has best evidence, ideally delivered through individually tailored exercise programmes. Cognitive behavioural therapy (CBT) can be helpful in more cognitively able patients. Evidence for pharmacological treatments is weak, though amantadine is generally first choice.