长病程帕金森病患者的运动诱发电位研究  

Study on motor evoked potentials in long-term Parkinson's disease

作　　者：邹扬[1] 胡勇博 高颖[1] 张月琪[1] 陈生弟[1] 王刚[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院神经内科神经病学研究所,上海200025

出　　处：《诊断学理论与实践》2016年第2期124-127,共4页Journal of Diagnostics Concepts & Practice

摘　　要：目的 :采用经颅磁刺激(transcranial magnetic stimulation,TMS)法评估长病程随访和初诊原发性帕金森病(Parkinson′s disease,PD)患者的运动诱发电位(motor-evoked potentials,MEP),探究长期PD病理改变对大脑皮层兴奋性和中枢神经传导的影响。方法:选择病程>8年的PD患者和初诊未服药的PD患者各7例,采用统一帕金森病评定量表运动部分(Unified Parkinson′s Disease Rating ScaleⅢ,UPDRS-Ⅲ)评估其运动功能,并用简易精神状态量表评估其认知功能,通过TMS检测其双侧静息运动阈值(resting motor threshold,RMT)、活动运动阈值(active motor threshold,AMT)、MEP波幅和中枢传导时间(central motor conduction time,CMCT),根据每位患者症状重侧和轻侧进行双侧对比和组间比较。结果:RMT、AMT、MEP波幅及CMCT在长病程PD患者与初诊PD患者间,以及在每位患者症状重侧与症状轻侧之间的差异均无统计学意义(P>0.05)。全体PD患者症状轻侧的CMCT与其UPDRS-Ⅲ总分及症状轻侧得分呈正相关(P<0.05);而在长病程组中,患者症状重侧的CMCT与症状重侧的UPDRS-Ⅲ得分间呈正相关(P<0.05)。结论:长病程PD并不改变患者的皮层兴奋性,但其中枢传导速度可能随疾病发展而降低。Objective To assess the motor-evoked potentials （MEP）by transcranial magnetic stimulation （TMS）in patients with newly diagnosed Parkinson＇s disease （PD） and with long-term PD, and to investigate the effect of long-term pathological changes of PD on motor cortical excitability and central motor conduction. Methods Seven PD patients diagnosed for more than 8 years （long-term follow-up group） and 7 newly diagnosed drug-naive PD patients were enrolled. UPDRS-Ⅲ （Unified Parkinson＇s Disease Rating Scale） and MMSE （Minimum Mental State Examination） were used to evaluate the motor and cognitive function of the patients. MEP induced by TMS were recorded. Resting motor threshold （RMT）, active motor threshold （AMT）, MEP amplitude and central motor conduction time （CMCT） were measured. The above mentioned indices were compared between the more affected （MA） and less affected （LA） side in each patient,as well as between long-term and newly diagnosed PD patients. Results There were no significant differences in RMT, AMT, MEP amplitude or CMCT between the follow-up group and newly diagnosed group.There were also no differences in these measurements between the MA and LA sides for each patient. CMCT on LA side correlated with total UPDRS-Ⅲ score and UPDRS-Ⅲ score measured on the corresponding side in all patients. CMCT on MA side correlated with UPDRS-Ⅲ score measured on MA side in follow-up patients. Conclusions Long-term duration of disease in PD may not change the motor cortical excitability, and central motor conduction may decrease with the disease progression in PD patients.

关 键 词：运动诱发电位 经颅磁刺激 帕金森病 运动皮质 

分 类 号：R742.5[医药卫生—神经病学与精神病学]