咀嚼肌经颅电刺激运动诱发电位在肌萎缩侧索硬化诊断中的价值  

Motor evoked potentials by transcranial electric stimulation in masseter muscles in amyotrophic lateral sclerosis

作　　者：张俊[1] 樊东升[1] 郑菊阳[1] 康德[1] 

机构地区：[1]北京大学第三医院神经科,100083

出　　处：《中华神经科杂志》2003年第6期422-424,共3页Chinese Journal of Neurology

基　　金：国家 8 63基金资助项目 (2 0 0 1AA2 17161)

摘　　要：目的　对肌萎缩侧索硬化 (ALS)患者进行经颅电刺激咀嚼肌诱发电位的研究 ,建立评估ALS头区皮质脑干束的检查方法。方法　对 2 0例ALS患者和 30名健康志愿者进行双侧咀嚼肌经颅电刺激 ,双侧同时接受 ,分别记录同侧的根运动诱发电位 (R MEP)和对侧的皮层运动诱发电位(C MEP)的潜伏期、波幅 ,计算中枢运动传导时间 (CMCT)。结果　R MEP可在所有ALS患者中引出。R MEP的潜伏期 [(3 4 4± 0 5 3)ms]、波幅 [(2 79± 2 19)mV]与健康对照组比较差异无显著意义 ;而C MEP有 12例ALS患者不正常 ,C MEP的潜伏期 [(7 6 9± 1 5 8)ms]与健康对照组 [(5 83±1 4 0 )ms]比较差异有显著意义 ,CMCT显著延长 (P <0 0 1)。结论　C MEP为一种非创伤性评估ALS头区上运动神经元受损的较敏感方法。Objective To study the motor evoked potential (MEP) evoked by transcranial electric stimulation in the masseter muscles of patients with amyotrophic lateral sclerosis (ALS), and to compare the results obtained from a control population, so as to establishe a method to evaluating the impairment of corticobulbar projections in ALS.Method Transcranial electrical stimulation was used in 20 patients with ALS and 30 matched normal control.Central motor conduction time (CMCT) was calculated.Results Responses to direct activation of the trigeminal motor root (R-MEP) were able to be recorded in all ALS.The latency and amplitude of R-MEP was (3.44±0.53) ms and (2.79±2.19) mV respectively.They had nonsignificant differences as compared to the controls.Responses to activation of corticobulbar descending fibers (C-MEP) were absent or delayed in 12 ALS patients, and CMCT was significantly prolonged ( P <0.01).Conclusion MEPs recorded from the masseter muscles by transcranial electric stimulation might show a higher sensitivity in detecting upper motor neuron involvement in ALS especially for those without any clinical evidence of bulbar lesion.

关 键 词：咀嚼肌 电刺激 运动诱发电位 肌萎缩侧索硬化 诊断 运动神经元 

分 类 号：R744[医药卫生—神经病学与精神病学]