The many faces of asthenia: a literature review and case series

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Abstract

The study and management of asthenic disorders remain significant challenges for clinicians across multiple medical specialties, including neurology and pediatrics. Asthenia is a nonspecific syndrome that may manifest in a range of neuropsychiatric and somatic conditions during childhood. This article provides a comprehensive review of scientific literature addressing asthenic disorders in pediatric populations. Particular attention is given to somatic and neurological symptoms prompting consultation with neurologists and pediatricians, such as abnormal fatigue, irritability, reduced performance, shortened nocturnal sleep, and impaired sleep quality. Effective treatment of asthenic disorders requires a multidisciplinary approach that incorporates a balanced sleep-wake schedule, dietary modifications, psychotherapy, and evidence-based pharmacotherapy. The article also presents clinical cases of psychogenic, cerebrogenic, and somatic asthenia in children, including an evaluation of the efficacy of citrulline malate (Stimol®).

Clinical case 1: A 15-year-old patient diagnosed with moderate psychogenic asthenia, characterized by increased fatigue, daytime sleepiness, emotional lability, heightened anxiety, and reduced performance.

Clinical case 2: A 9-year-old patient was diagnosed with cerebrogenic asthenia, presenting with attention deficits, impaired attention switching, emotional-volitional disturbances, increased mental fatigability, and emotional lability.

Clinical case 3: A 12-year-old patient with a history of closed traumatic brain injury three months prior to treatment, diagnosed with asthenic-neurotic syndrome and cerebrogenic asthenia. The patient exhibited persistent fatigue, declining attention and memory, and a progressive decrease in overall performance.

Clinical case 4: an 8-year-old patient diagnosed with postinfectious asthenia with persistent fatigue, drowsiness, and decreased performance.

All patients received a course of Stimol® at a dosage of 2 g per day [one sachet (1 g) twice daily for 12 days]. Following treatment, patients reported symptomatic improvement and a reduction in asthenic manifestations.

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About the authors

Leonid S. Chutko

Bekhtereva Institute of the Human Brain; Saint Petersburg State Pediatric Medical University; Clinical Center “Doctrine”

Author for correspondence.
Email: chutko5@mail.ru
ORCID iD: 0000-0002-1065-9859

D. Sci. (Med.), Prof.

Russian Federation, Saint Petersburg; Saint Petersburg; Saint Petersburg

Svetlana Yu. Surushkina

Bekhtereva Institute of the Human Brain

Email: chutko5@mail.ru
ORCID iD: 0000-0001-9510-7182

Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Elena A. Yakovenko

Bekhtereva Institute of the Human Brain

Email: chutko5@mail.ru
ORCID iD: 0000-0001-7249-3332

Cand. Sci. (Biol.)

Russian Federation, Saint Petersburg

Larisa V. Shcheglova

Saint Petersburg State Pediatric Medical University

Email: chutko5@mail.ru
ORCID iD: 0000-0002-1059-4610

D. Sci. (Med.), Prof.

Russian Federation, Saint Petersburg

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2. Fig. 1. Clinical case 1. TOVA test results before and after treatment with Stimol®.

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3. Fig. 2. Clinical case 2. TOVA test results before and after treatment with Stimol®.

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4. Fig. 3. Clinical case 3. TOVA test results before and after treatment with Stimol®.

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