磁刺激运动诱发电位检测运动神经元病变的意义  

Motor evoked potential evoked by magnetic stimulation in the detection of motor neuron lesion

作　　者：杨红艳[1] 戴亚美[1] 

机构地区：[1]哈尔滨医科大学第一临床医院神经内科,黑龙江省哈尔滨市150001

出　　处：《中国临床康复》2005年第21期44-45,共2页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:探讨磁刺激运动诱发电位检测对神经系统疾病中运动神经元病变性疾病的评估意义。方法:选择2003-03/12哈尔滨医科大学第一临床医院收治的神经系统病变患者40例,其中14例为多发性硬化,6例为吉兰-巴雷综合征,6例颈椎病,6例运动神经元病,2例亚急性联合变性,3例锥体外系病,3例癔病。所有患者行磁刺激运动诱发电位检测,刺激部位分别选择接受肌肉对侧的手区及同侧的C6,7棘突旁、Erb点、肘部正中神经处,分析时间选择刺激后100ms,带通范围选择20～2000Hz。磁刺激输出量周围神经选择最大输出的70%,中枢输出的80%。每人每刺激点至少重复2次。以哈尔滨医科大学第一临床医院神经科电生理实验室制定的100例正常人磁刺激运动诱发电位结果为正常参考值。结果:按意向处理分析,40例患者均进入结果分析。①14例多发性硬化患者中10例磁刺激运动诱发电位异常,主要表现为中枢传导时间延长,皮质刺激点接收的肌肉复合动作电位波形弥散。②6例吉兰-巴雷综合征患者,5例磁刺激运动诱发电位异常,4例存在运动神经传导速度减慢,1例表现Erb点,肘部刺激复合动作电位波幅低,皮质刺激点及颈部刺激未引出波形。③6例重症脊髓型颈椎病磁刺激运动诱发电位表现均出现异常。④6例运动神经元病3例出现中枢传导时间延长,周围神经传导速度减慢。⑤2例亚急性联合变性患者中枢性运动传导时间延长。⑥3例锥体外系及3例癔病瘫患者磁刺激运动诱发电位未见异常。结论:磁刺激运动诱发电位可以用于评估多种运动神经元病变者的神经传导功能,以便早期发现中枢及周围运动神经传导是否正常。通过中枢运动传导时间延长,揭示临床及亚临床的上运动神经元改变,尤其适用于发现中枢性运动神经元病变的多发性硬化亚临床改变,起到支持辅助诊断作用。AIM:To investigate the significance of motor evoked potential induced by magnetic stimulation for evaluation of motor neuron lesion in nervous system diseases. METHODS:The experiment was conducted in the First Clinical Hospital of Harbin Medical University from March to December 2003.Forty patients were selected,including 14 cases of multiple sclerosises,6 of guillainbarrésyndromes,6 of cervical syndromes,6 of motor neuron diseases,2 of subacute association degenerations, 3 of extrapyramidal diseases and 3 of hysteria. Magnetic stimulation was done at contralateral cheiroarea and same sideway of C6,7 spinous process,Erb points, median nerve of elbow to induce motor evoked potential.The analysis time was 100 ms after stimuation with tape dimension of 20-2 000 Hz.The output of magnet stimulation around nerve was 70%of maximum,and 80%of center output. Each point was stimulated for at least twice. The data of motor evoked potential in 100 healthy cases at the electrophysiological laboratory,the Department of Neurology,the First Clinical Hospital of Harbin Medical University were considered as normal reference.RESULTS:Totally 40 patients were involved in the result analysis according to intentiontotreat analysis.①Among 14 multiple sclerosis patients,abnormal motor evoked potential was found in 10 cases. Mainly changes were an increase in central conduction time,and diffusion of the compound action potential of cortical stimulation.②Five out of six GuillainBarre syndrome patients had abnormal motor evoked potential,including 4 cases of slow down in motor conduction velocity,and 1 case of decrease in amplitude of Erb,elbow stimulation,and without wave for cortex and cervical stimulation.③Motor evoked potential was abnormal in 6 cases of severe cervical spine diseases.④Three out of six motor neuron disease had central and peripheral conduction impairment.⑤Central motor conduction was prolonged in 2 cases of subacute combined degeneration.⑥Three cases of extrapyramidal diseases and 3cases of

关 键 词：冲经系统疾病 诱发电位 运动 磁疗法 

分 类 号：R74[医药卫生—神经病学与精神病学]