经颅磁刺激运动诱发电位和体感诱发电位对遗传性运动感觉性神经病的诊断

目的 了解遗传性运动感觉性神经病（HMSN）的经颅磁刺激运动诱发电位（MEP）和体感诱发电位（SEP）的变化。方法 对一家三代HMSN的12例患和1例无症状进行检查。结果 MEP和SEP的异常率分别为84．6％和92．3％。结论 绝大多数HMSN患的MEP和SEP均异常。     

脑卒中后肢体运动功能障碍的生物学评估指标分析

目的 探讨弥散张量成像（DTI）及运动诱发电位（MEP）能否作为评估脑卒中后肢体运动能障碍程度的生物学指标。 方法 选取60例脑卒中偏瘫患者并给予简式Fugl-Meyer运动功能（FMA）评定,同时进行DTI及MEP检查,分析DTI、MEP参数与肢体FMA评分间的相关性,并利用受试者工作特征曲线（ROC）明确其在评定重度运动功能障碍时的检验效能。 结果 ①DTI参数大脑脚部分各向异性不对称系数（aFA）与患侧上、下肢FMA评分均具有负相关性（P<0.05）;内囊后肢aFA值与患侧上肢FMA评分具有负相关性（P<0.05）,与患侧下肢FMA评分无明显相关性（P>0.05）;MEP参数中枢运动传导时间（CMCT）、运动阈值（MT）异常程度均与该侧肢体FMA评分具有负相关性（P<0.05）;②ROC曲线显示内囊后肢aFA值为评定上肢重度运动功能障碍的最佳指标,分界值为0.167,具有较好的检验效能;MEP波形缺失作为重度运动功能障碍的评定标准,其灵敏度较高,但特异度较低;③联合DTI及MEP进行系列检查,可提高识别上肢重度运动功能障碍的特异度。 结论 DTI及MEP相关参数可作为评估脑卒中后肢体运动功能障碍的生物学指标,且对评定上肢重度运动功能障碍具有较好效能。     

多项诱发电位对职业中毒神经损害的初步研究

目的研究多项诱发电位评估职业中毒神经损伤的临床价值。方法对27例职业中毒患者进行运动诱发电位(MEP)、体感诱发电位(SEP)、肋间体感诱发电位(ISEP)、肌电图(EMG)检测,同期作相关检查。结果职业中毒男性患者MEP上下肢皮层脊髓和女性左上肢、右下肢皮层和左下肢脊髓潜伏期（PL）较正常人有显著改变（P均<0.05）,尿中重金属浓度与诱发电位(EP)异常显著相关（γ="0.284;P<"0.05）。结论诱发电位技术是评估职业中毒伴中枢及周围神经中枢损害的一种较好方法。     

低频重复经颅磁刺激对帕金森病患者运动功能及皮质兴奋性的影响

目的从运动功能、电生理检测方面观察低频重复经颅磁刺激（rTMS）对帕金森病（PD）患者的治疗作用,并从电生理角度进一步探索PD 的发病机制。 方法采用低频rTMS技术治疗28例PD患者（患者组）,刺激部位为入选者双侧的第一运动皮质手代表区M1Hand,频率为1 Hz,磁场强度为120％静息阈值,每日1次,共15 d。另选择30名健康者作为对照组。采用统一帕金森病评定量表（UPDRS）评分、运动诱发电位（MEP）作为评定指标。 结果PD患者MEP的静息态阈值（RMT）、中枢传导时间（CMCT）明显低于对照组,而波幅（Amp）比较,差异无统计学意义。经rTMS治疗后,PD患者运动功能有改善,RMT增加,CMCT延长,强直型患者症状改善更为明显。 结论PD 患者存在运动功能障碍,大脑皮质兴奋性提高,低频rTMS可部分抑制这种改变。     

早期康复对急性脑梗死患者功能恢复的影响及运动诱发电位对其评定价值

目的 探讨早期康复对急性脑梗死患者功能恢复的影响，及运动诱发电位（MEP）在评价患者运动功能及预后中的应用价值。方法 选择80例急性脑梗死患者，分为对照组和早期康复组，每组40例。早期康复组采用Bobath法和运动再学习法等进行康复训练，对照组只接受神经内科药物治疗。2组均于治疗前和治疗3个月后，采用简式Fugl-Meyer运动功能评分法（FMA）和MEP进行评定。结果 入选时2组FMA评分和MEP潜伏期及中枢运动传导时间比较，差异均无统计学意义（P〉0．05）；治疗3个月后，早期康复组与对照组FMA评分比较，差异有统计学意义，早期康复组改善明显（P〈0．05）；且MEP检测结果与FMA评分结果相符。结论 早期康复训练可明显改善急性脑梗死患者的神经功能，而MEP可能作为偏瘫患者运动功能障碍及预后情况的定量分析指标。     

体感及运动诱发电位对脑梗死患者感觉和运动功能恢复的评估

目的:探讨体感诱发电位(somatosensoryevokedpotentials,SEP)及运动诱发电位(motorevokedpotentials,MEP)对脑梗死患者感觉和运动功能恢复的评估价值。方法:将138例首次发病脑梗死患者按肢体肌力≤3级和>3级进行研究,检查健、患侧的SEP,MEP,统计两组异常率。结果:SEP,MEP异常程度与病情严重程度有关,且MEP更为灵敏(SEPχ2=19.551,MEPχ2=79.934,P<0.001)。SEP,MEP与治疗效果有关联,SEP缺失、延长、正常组未愈分别为12,14,7例;MEP缺失、延长、正常组治愈分别为20,12,1例。MEP,SEP检查3组间治疗效果比较,差异有显著性意义(χ2=8.433,P<0.05;χ2=14.328,P<0.01)。结论:SEP,MEP客观反映脑梗死患者中枢感觉运动传导通路功能受损情况,并帮助预测其预后。     

功能性电刺激对健康人运动诱发电位影响的自身对照研究

目的：观察功能性电刺激(FES)对健康年轻人运动诱发电位（MEP）的影响。方法：13例健康年轻志愿者参与了研究,其中男9例,女4例;年龄（24.9±3.1）岁。分别接受30min FES和安慰刺激。采用经颅磁刺激仪(TMS)与肌电图仪（EMG）在FES前、后,安慰刺激后分别检测每一对象的MEP,计算潜伏期、波幅和中枢运动传导时间。结果：健康年轻人在FES后MEP值潜伏期缩短,波幅增高,中枢运动传导时间无明显变化;而安慰刺激后MEP的个参数均无明显变化。结论：MEP值可以反映FES后健康年轻人大脑兴奋性的改变趋势。     

经颅磁刺激运动诱发电位和体感诱发电位对遗传性运动感觉性神经病的诊断

目的了解遗传性运动感觉性神经病(HMSN)的经颅磁刺激运动诱发电位(MEP)和体感诱发电位(SEP)的变化。方法对一家三代HMSN的12例患者和1例无症状者进行检查。结果MEP和SEP的异常率分别为84.6%,92.3%。结论绝大多数HMSN患者的MEP和SEP均异常。     

经颅磁刺激在急性脑梗死运动功能康复中的作用

目的 研究经颅磁刺激对运动传导通路的易化作用及其脑卒中运动功能康复中的作用。资料与方法 选取65例住院的急性脑梗死患者,在基本治疗相同的情况下,治疗组给予14天的经颅磁刺激治疗。比较第1天和第14天的MEP（运动诱发电位）、CMCT（中枢运动传导时间）、肌力和Fugl-Meyer运动功能评分。结果 在Gug-Meyer运动功能评分、肌力和CMCT等方面：治疗前,两组无显著性差异;治疗后,两组分别与治疗前相比,均有非常显著性差异,治疗组的运动功能恢复明显优于对照组。治疗前后,两组之间的MEP潜伏期无显著性差异。结论 脑卒中急性期进行经颅磁刺激治疗,可明显缩短CMCT,有利于运动功能的恢复。     

功能性电刺激对健康青年受试者体感及运动诱发电位影响的对照研究

目的：观察功能性电刺激（FES）对健康青年体感诱发电位（SEP）及运动诱发电位（MEP）的影响。方法：采用经颅磁刺激仪（TMS）及肌电图仪,分别测量15例健康青年,其中男10例,女5例,平均年龄（22.9±0.7）岁。单次FES前、后检测SEP值及MEP值,其中11例完成两周FES（每天1次,每次30min）,并再次接受SEP及MEP检测。结果：健康青年者单次及2周FES后SEP及MEP值的潜伏期缩短,波幅增高,与FES前比较,差异有显著性意义;非FES侧变化不明显。结论：健康青年者FES前后SEP及MEP值均有变化,尤以波幅明显。     

骨髓间充质干细胞移植脊髓全横断模型大鼠运动和体感诱发电位的评价

背景：临床常用皮质运动诱发电位和皮质体感诱发电位来分别评价脊髓损伤后运动传导路和感觉传导路的损伤或修复情况。目的：以脊髓诱导电位监测骨髓间充质干细胞移植后急性脊髓完全性损伤大鼠下肢神经功能的变化。方法：选取健康Wistar大鼠50只,分成5组,即生理盐水组、骨髓间充质干细胞移植组、脑源性神经营养因子修饰组、神经营养素3＋骨髓间充质干细胞移植组和假手术组。除假手术组外,其余各组均制作Allen’s脊髓完全性损伤动物模型,造模后各组均行相应治疗。治疗后4,8和12周行大鼠后肢运动功能评分,并于造模后24h,3,7,14d行运动和体感诱发电位检测。结果与结论：运动诱发电位检测结果提示,各治疗组的运动功能均有不同程度的恢复,与生理盐水组间差异均有显著性意义（P〈0.05）,大鼠后肢BBB评分也证实了各治疗组后肢运动功能明显优于生理盐水组（P〈0.05）。提示经脑源性神经营养因子修饰的骨髓间充质干细胞可移植到脊髓损伤处,可改善大鼠的后肢运动,神经营养素3蛋白有可能提高骨髓间充质干细胞在体内的生存率,促进受损脊髓的轴突再生。     

Electrophysiolgical diagnosis for multiple sclerosis

Evoked potentials(EPs) in daily practice contain brainstem auditory evoked potentials (BAEPs), short-latency somatosensory evoked potentials(SSEPs), pattern-reversal visual evoked potentials(PVEPs) and motor evoked potentials(MEPs) with transcranial magnetic stimulation(TMS). In this review, we summarize the EP findings in Caucasian and Japanese MS. EPs can confirm the presence of lesions in patients with suspected involvement, and document the presence of clinically unsuspected lesions. In addition, the combined use of these EPs in each patients, so-called multimodality EPs, enables us to evaluate multiple aspects of sensory and motor systems. In 73 Japanese MS, the abnormality rates were 10.3% in median nerve SSEP, 37.1% in posterior tibial nerve SSEP, 35.6% in upper limb MEP, 56.1% in lower limb MEP, 39.3% in PVEP and 34.3% in BAEP. The frequency of clinically unsuspected lesions was about 30% in each EP. These findings are in good agreement with the recent fact that conventional MS have been increased in Japan. Other electrophysiological methods such as multimodality VEPs, pain-related SEPs, paired TMS and event related potentials(P300) may be useful for the diagnosis or evaluation of MS.     

Transcranial magnetic stimulation for detection of preclinical cervical spondylotic myelopathy.

Twenty-three patients, mean age 50.4 years, with cervical radiculopathy at C7 or more rostrally, were studied with electromyography, CT scans (in 16 cases) and transcranial magnetic stimulation. None had overt evidence of myelopathy. Motor evoked potentials (MEPs) were recorded from the hand muscles (C8/T1), and latency, amplitude, and the MEP/CMAP ratio and central motor delay between the hand motor cortex and the lower cervical spine were measured. One or more of these were abnormal in 15 of 23 cases (65%). The most common abnormality was a reduced MEP/CMAP ratio. The findings indicate that physiologic dysfunction of the spinal cord, caudal to a radiculopathy, frequently accompanies a radiculopathy and may antedate overt cervical spondylotic myelopathy. This may be valuable in directing more timely surgical intervention.     

骨髓间充质干细胞移植脊髓全横断模型大鼠运动和体感诱发电位的评价

背景:临床常用皮质运动诱发电位和皮质体感诱发电位来分别评价脊髓损伤后运动传导路和感觉传导路的损伤或修复情况。目的:以脊髓诱导电位监测骨髓间充质干细胞移植后急性脊髓完全性损伤大鼠下肢神经功能的变化。方法:选取健康Wistar大鼠50只,分成5组,即生理盐水组、骨髓间充质干细胞移植组、脑源性神经营养因子修饰组、神经营养素3+骨髓间充质干细胞移植组和假手术组。除假手术组外,其余各组均制作Allen’s脊髓完全性损伤动物模型,造模后各组均行相应治疗。治疗后4,8和12周行大鼠后肢运动功能评分,并于造模后24h,3,7,14d行运动和体感诱发电位检测。结果与结论:运动诱发电位检测结果提示,各治疗组的运动功能均有不同程度的恢复,与生理盐水组间差异均有显著性意义(P<0.05),大鼠后肢BBB评分也证实了各治疗组后肢运动功能明显优于生理盐水组(P<0.05)。提示经脑源性神经营养因子修饰的骨髓间充质干细胞可移植到脊髓损伤处,可改善大鼠的后肢运动,神经营养素3蛋白有可能提高骨髓间充质干细胞在体内的生存率,促进受损脊髓的轴突再生。     

Changes in corticospinal excitability with short-duration high-frequency electrical muscle stimulation: a transcranial magnetic stimulation study

[Purpose] Afferent input caused by electrical stimulation of a peripheral nerve or a muscle modulates corticospinal excitability. However, a long duration of stimulation is required to induce these effects. The purpose of this study was to investigate the effect of short-duration high-frequency electrical muscle stimulation (EMS) on corticospinal excitability through the measurement of motor evoked potentials (MEP) in young healthy subjects. [Subjects] Eleven healthy right-handed subjects participated in this study. [Methods] EMS was applied to the abductor pollicis brevis (APB) muscle at 100 Hz with a pulse width of 100 μs for 120 s. The intensity of stimulation was just below the motor threshold. Transcranial magnetic stimulation was applied over the motor cortex, and MEP were recorded from the APB before, and immediately, 10, and 20 min after EMS. [Results] In the APB muscle, the MEP amplitude significantly decreased after EMS, and this effect lasted for 20 min. [Conclusion] The excitability of the corticospinal tract decreased after short-duration high-frequency EMS, and the effect lasted for 20 min. These results suggest that even short duration EMS can change the excitability of the corticospinal tract.Key words: Electrical muscle stimulation, Transcranial magnetic stimulation, Corticospinal excitability     

不同侧小脑半球Theta爆发式经颅磁刺激对健康受试者吞咽调节效应的影响

目的观察间歇性Theta爆发式经颅磁刺激(iTBS)对健康受试者大脑吞咽运动皮质和小脑吞咽运动区兴奋性的影响, 并探讨小脑iTBS调节吞咽功能的机制。方法采用随机数字表法将44例右利手健康受试者分为优势侧小脑组(15例)、非优势侧小脑组(15例)、对照组(14例)。优势侧小脑组给予优势侧小脑iTBS干预和非优势侧小脑假刺激, 非优势侧小脑组给予优势侧小脑假刺激和非优势侧小脑iTBS干预, 对照组给予双侧小脑假刺激。iTBS干预前后, 分别对受试者双侧大脑和双侧小脑的舌骨上肌群代表区进行单脉冲经颅磁刺激(TMS)测定, 观察受试者运动诱发电位(MEP)波幅和潜伏期的变化。结果与组内干预前比较, 非优势侧小脑组干预后双侧大脑吞咽皮质和刺激同侧小脑的MEP波幅升高(P<0.05);优势侧小脑组干预后仅刺激同侧小脑的MEP波幅升高(P<0.05)。在MEP波幅与基线相比的百分比变化方面, 与对照组干预后同指标比较, 非优势侧小脑组刺激双侧大脑皮质和刺激同侧小脑的数值较高(P<0.05);与非优势侧小脑组干预后同指标比较, 优势侧小脑组刺激双侧大脑皮质的数值较低(P<0....     

Monitoring of motor evoked potentials with high intensity repetitive transcranial electrical stimulation during spinal surgery

Objective.Clinical utility of high voltage repetitive transcranial electrical stimulation (TES) was investigated in 46 patients undergoing spine surgery. Methods.During spinal surgery, motor evoked potentials (MEPs) were recorded from upper or lower limb muscles following high voltage repetitive TES of motor cortex under propofol and opioid/N₂O anesthesia. Results.The number of responses evoked by the double pulse stimulation was significantly higher than the single pulse stimulation. A similar finding was obtained when repetitive and single pulse stimulation was compared. Compound muscle action potentials (CMAPs) were recorded from upper and lower limbs in 4 patients with cervical spine myelopathy. The CMAP was absent on the affected side in 1 patient, which improved slightly after decompression. Radiculopathy was clinically present in 6 patients undergoing posterior lumbar decompression and fusion. No improvement of MEP was noted intraoperatively after spinal decompression and instrumentation. Conclusion.The findings suggest that intraoperative MEP monitoring is feasible method, however, its immediate prognostic value for adequacy of neuronal decompression and improvement requires further studies with larger patient population.     

磁刺激运动诱发电位量化慢性神经根损伤程度的实验研究

目的 研究神经根在慢性嵌压性损伤中，不同损伤程度的神经病理组织学改变与运动诱发电位(MEP)表现形式之间的对应关系。方法 建立神经根慢性嵌压伤的病理模型，用表面磁刺激MEP对损伤神经做动态观察，结合不同损伤程度的神经病理组织学改变情况，研究两者间的相关性。结果 神经的病理形态学改变在有髓神经首先出现髓鞘的变性。此时的MEP表现为潜伏期延长和波形离散。继而脱髓鞘的神经轴突发生变性、断裂及远侧的瓦勒氏变性。MEP则表现为在潜伏期延长的同时伴有波幅降低，且MEP在不同程度的神经病理损伤中具有相应的特征性表现形式。结论 磁刺激MEP的检查指标与神经根慢性嵌压性损伤的程度具有相关性，其表现形式可作为判断神经病理损伤程度的量化指标。     

运动诱发电位用于鉴别诊断原发性帕金森病和多系统萎缩的临床研究

目的：研究原发性帕金森病（Parkinson′s disease, PD）与多系统萎缩（multiple system atrophy,MSA）患者间的运动诱发电位（Motor evoked potentials,MEP）差异,探索其在两者鉴别诊断中的价值。方法：对12例MSA患者和12例性别、年龄匹配的初诊未服药原发性PD患者进行单脉冲经颅磁刺激-MEP检查,比较2组患者的MEP指标,通过绘制受试者工作特征曲线选取适用于鉴别诊断的指标。结果：运动阈值、MEP波幅和中枢运动传导时间（central motor conduction time, CMCT）在MSA与初诊原发性PD患者间差异无统计学意义（P>0.05）,而MEP波形在2组间的差异存在统计学意义（P<0.05）;MSA患者的MEP时长较初诊PD患者存在延长的趋势,但差异尚无统计学意义（P>0.05）。结论：对MEP波形评级和MEP时长的检测有助于MSA与原发性PD间的鉴别诊断。     

Neurologic diagnosis of spinal diseases

The clinical assessment of neurological deficits using a standardized protocol in spinal cord disorders is most important for indicating further neuroradiological, neurophysiological and orthopedic examinations. By neurophysiological technics the clinical examinations can be supplemented not only in patients, who are not able to cooperate. Furthermore the latter technics are able to assess in how far findings in neuroradiological examinations can be related to clinically complained symptoms. The clinical examination should define the spinal level of lesion for motor and sensory function separately and use a semiquantitative scoring system of neurological deficits, which is most relevant for follow-up examinations. Performing motor evoked potentials (MEP), somato-sensory evoked potentials (SSEP) and electromyographic recordings allows to distinguish between lesions of the central and peripheral nervous system and to assess disturbances of spinal cord function.