颈神经根刺激的第Ⅱ部分:原发脱髓鞘性神经病变与运动神经元病的结果  

Cervical nerve root stimulation.Part II:Findings in primary demyelinating neuropathies and motor neuron disease

作　　者：Vucic S. Black K. Siao Tick Chong P. Cros D. 袁海峰 

机构地区：[1]Department of Neurology, Massachusetts General Hospital, Bigelow 1256, 55 Fruit Street, Boston, MA 02114, United States

出　　处：《世界核心医学期刊文摘（神经病学分册）》2006年第6期24-25,共2页Digest of the World Core Medical Journals:Clinical Neurology

摘　　要：Objective: Cervical nerve root stimulation (CRS) allows the assessment of conduction in the proximal segments of motor fibers destined to the upper extremities, which are not evaluated by routine nerve conduction studies (NCS). Since many primary demyelinating polyneuropathies (PDP) are multifocal lesions may be confined to the proximal nerve segments. CRS may therefore increase the yield of neurophysiologic studies in diagnosing PDP. Methods: We reviewed clinical and neurophysiologic data from 38 PDP patients and compared them to 35 patients with motor neuron disease (MND), and 21 healthy controls (HC). Results: Mean onset-latency was significantly prolonged in PDP patients. The optimal onset-latency cutoff necessary to distinguish PDP from MND and controls was 17.5 ms for the abductor pollicis brevis (APB) and abductor digiti minimi (ADM), and 7 ms for Biceps and Triceps. Mean reduction in proximal to distal CMAP amplitude to APB and ADM was significantly greater in PDP patients, with an optimal cutoff in proximal to distal CMAP amplitude reduction necessary to distinguish PDP from MND and HC being 45%. Conclusions: CRS is effective in distinguishing PDP from MND and HC based on prolonged onset latency and conduction block criteria. Significance: CRS may increase the diagnostic yield in cases where demyelinating lesions are confined to the proximal peripheral neuraxis.Objective： Cervical nerve root stimulation （CRS） allows the assessment of conduction in the proximal segments of motor fibers destined to the upper extremities, which are not evaluated by routine nerve conduction studies （NCS）. Since many primary demyelinating polyneuropathies （PDP） are multifocal lesions may be confined to the proximal nerve segments. CRS may therefore increase the yield of neurophysiologic studies in diagnosing PDP. Methods： We reviewed clinical and neurophysiologic data from 38 PDP patients and compared them to 35 patients with motor neuron disease （MND）, and 21 healthy controls （HC） . Results： Mean onset-latency was significantly prolonged in PDP patients. The optimal onset-latency cutoff necessary to distinguish PDP from MND and controls was 17.5 ms for the abductor pollicis brevis （APB） and abductor digiti minimi （ADM）, and 7 ms for Biceps and Triceps. Mean reduction in proximal to distal CMAP amplitude to APB and ADM was significantly greater in PDP patients, with an optimal cutoff in proximal to distal CMAP amplitude reduction necessary to distinguish PDP from MND and HC being 45%. Conclusions： CRS is effective in distinguishing PDP from MND and HC based on prolonged onset latency and conduction block criteria. Significance： CRS may increase the diagnostic yield in cases where demyelinating lesions are confined to the proximal peripheral neuraxis.

关 键 词：运动神经元病 多发性神经病变 颈神经根刺激 脱髓鞘性 神经传导检查 神经生理学 最佳临界值 脱髓鞘损害 原发 小指展肌 

分 类 号：R744.8[医药卫生—神经病学与精神病学] R59[医药卫生—临床医学]