电生理学检测在特发性面神经麻痹中应用的研究进展

特发性面神经麻痹是门诊常见疾病,临床面神经功能的评定如House-Brackmann分级,对面神经功能状态判断不够客观、具体,对治疗及预后提供信息尚不充足。电生理检查作为辅助诊断神经肌肉疾病的一种手段,多年来各种各样的电生理检测已应用于临床,如神经兴奋性试验(NET)、最大刺激试验(MST)、神经电图(ENoG)和瞬目反射(BR)、肌电图(EMG)等。本文对电生理学检测在特发性面神经麻痹中应用的研究进展作一综述。     

改善微循环对Bell麻痹患者面神经功能恢复的影响

目的:研究改善微循环对Bell麻痹患者面神经传导功能恢复的影响.方法:将14例Bell麻痹患者分为两组:治疗组8例,基础治疗 盐酸丁咯地尔;对照组6例,只作基础治疗.采用瞬目反射(BR)这一客观的神经电生理检查作为观察指标来观察改善微循环的药物盐酸丁咯地尔对Bell麻痹患者面神经传导功能恢复的影响.结果:治疗组Bell麻痹患者的BR的(R1、R2)波潜伏期的恢复优于对照组(P＜0.01).结论:改善微循环可减轻Bell麻痹患者面神经功能的损害.     

儿童周围性面神经炎的电生理检查研究

目的：探讨神经电生理检查对儿童周围性面神经炎的意义.方法：对59例儿童周围性面神经炎患者进行双侧面神经传导和瞬目反射（BR）检测.结果：儿童周围性面神经炎患儿在病程早期健、患侧面神经运动潜伏期、波幅比较差异无统计学意义,而在病程〉7 d比较差异则有统计学意义.面神经炎患儿BR检测患侧刺激时的R1、R2及健侧刺激时的R2′波潜伏期延长或波形消失.结论：面神经传导和BR检查对周围性面神经炎患儿的诊断及预后具有重要价值.     

面神经麻痹30例的瞬目反射和面神经电图检测

面神经麻痹(又称Bell麻痹)是临床常见病,根据病人发病的时间来正确选择电生理检查时机对临床帮助较大。笔者试用瞬目反射(BR)和面神经电图(ENoG)对30例面神经麻痹患者进行测试,现将结果报告如下。1资料和方法临床资料:本组30例患者为2006年12月至2007年6月本院门诊及住院患者,其中男17例,女13例;年龄12~73岁,平均(40±10.2)岁;左侧病变18例,右侧病变12例;病程3天~2年,其中3~7天15例,8~14天9例,15天至2年6例。所有患者无中耳炎、肿瘤、糖尿病及头面部外伤等。检测方法:采用丹麦Keypoint-4型肌电图/诱发电位仪进行检测。BR检测:分别刺激双侧眶上神经三叉神经眶上支,表面电极置于下眼睑中部记录,参考电极置于眼角外侧,手腕置接地电极,受试者眼睛微闭,刺激强度为10~18mA。面神经ENoG检测:记录电极置于患侧眼轮匝肌上方,参考电极置于鼻根部,刺激电极为盘状电极,置于耳根后茎乳孔处,阴极向上,手腕置接地电极。刺激强度以口角轻度抽动为度,且以引出最大和较稳定的负波(向上偏转的正弦波)为准。判断标准:BR主要观察反应的波幅和潜伏期;ENoG观察患侧面神经潜伏期和波幅的变...     

神经电生理检测在Bell麻痹诊断及预后判断中的应用

目的:探讨神经电生理检测在Bell麻痹诊断及预后判断中的应用价值.方法:对15例Bell麻痹患者进行面神经电生理检测,观察面神经电位潜伏期,复合肌肉动作电位(CMAP)波幅的改变,与健侧比较波幅下降比的变化,肌电图(EMG)观察面神经支配肌肉静息时有无失神经电位,轻收缩时运动单位电位时限改变,重收缩时的电位募集等情况.结果:15例患者面神经(额肌、眼轮匝肌、口轮匝肌分别记录)潜伏期相对健侧均有延长,分别为[(4.4±1.1,3.3±1.1,4.0±1.5)]ms;14例患者CMAP波幅减低,分别为[(0.7±0.5,0.8±0.6,1.0±0.9)]mV,1例CMAP波幅正常;患侧波幅下降比分别为[(54.6±27.9),(63.7±22.7),(63.7±19.2)]％;6例患者检测EMG,其中4例异常,见有纤颤波、正尖波等失神经电位.结论:神经电生理检测是Bell麻痹诊断的可靠指标,是目前周围性面瘫比较好的客观定量检查方法.它不仅可以使Bell麻痹的诊断更加客观、量化,而且可对Bell麻痹客观地进行预后判断.神经电生理检测指标中波幅降低的临床意义大于潜伏期延长;失神经电位越多及CMAP波幅下降达70％以上者预后越差.应用神经电生理检测对于Bell麻痹的诊断及预后判断有着重要临床价值.     

正常学龄儿童瞬目反射的初步研究

应用电刺激法研究４０例正常学龄儿童的瞬目反射。通常能诱发出刺激侧快反应（Ｒ１）、迟反应（Ｒ２）及对侧迟反应（Ｒ２＇）。分析Ｒ１的形态、各波的潜伏期、时程、波幅，制定出正常值。瞬目反对的检查结果可作为诊断多种脑干障碍和三叉神经、面神经病变的方法。     

瞬目反射与神经电图对Bell麻痹的诊断价值

目的：研究瞬目反射（BR）与面神经的神经电图（electroneurogram,ENG）对Bell麻痹（特发性面神经麻痹）的诊断价值。方法：对246例Bell麻痹患者在发病后10d内行BR和ENG检查。结果：BR检测阳性率为100％,ENG检测阳性率为63．8％（P〈0．01）。结论：BR与ENG均能反映面神经损害的严重程度、部位及预后,其中BR在早期诊断中更为敏感,两者结合的临床价值更大。     

瞬目反射R_1波对面神经麻痹诊断价值的研究

对３４例面神经麻痹患者进行Ｒ_１波、Ｍ波及ＥＭＧ检测综合分析，可客观地评价面神经损害程度及部位是在茎乳孔内或外。结果表明Ｒ_１波、Ｍ波是定位诊断的敏感指标，Ｒ_１波传导时间延长对茎乳孔内病变有较高诊断价值。面神经麻痹患者Ｒ_１波消失经１个月未恢复者提示预后不良。     

面神经炎病人神经电生理检查和面肌运动评分的相关性

目的：探讨神经电生理检查和面肌运动功能评分在面神经炎诊断和面肌功能评估中的相关性。方法：选取符合入选标准的面神经炎病人37例,在发病第7、28天分别予以神经电生理检查和面肌运动功能评分。神经电生理检查选用瞬目反射和面神经电图;面肌运动功能评分采用House Brackmann分级量表（HB）评分和Nottingham面神经分级量表评分（选用VMG指数）,比较不同评分标准对面神经炎评估的异同,并应用Pearson相关分析法探讨不同评分标准之间的相关性。结果：与神经电图评分法相比较,瞬目反射评分法和HB评分法更为一致。Pearson相关性分析结果显示VMG指数与HB评分法相关性最强（r=-0．925）,神经电图评分法和HB评分法相关性相对较差。结论：针对面神经炎病人的评估应将面神经运动功能评估和神经电生理学评估结合起来,才能达到最好的客观性和准确性。HB评分、VMG指数联合以瞬目反射为最优指标的神经电生理检测是较为理想、科学的面神经炎的诊断和评估方法,可以较为可信地应用到临床诊治和科学研究工作中。     

面神经炎的电生理学诊断研究

目的：探讨神经电生理学检测对面神经炎（双称Bell麻痹）的诊断价值。方法：对75例面神经炎患者主要施行了瞬目反射（Blink—Reflex）和强度-时间曲线测定。结果：瞬目反射（Blink—Reflex）测定和强度-时间曲线测定在疾病的不同时期可有电生理的异常特征。结论：瞬目反射（Blink—Reflex）测定和强度-时间曲线测定有助于疾病的诊断及预后的判断。     

Inadequacy of transcranial magnetic stimulation in the neurophysiologic assessment of Bell's palsy.

Transcranial magnetic stimulation is a non-invasive procedure which to stimulate the brain cortex and the peripheral nerve pathways. A new technique was recently introduced to record the muscle action potential of facial muscles by means of transcranial magnetic stimulation of the facial nerve. The experimental data that was obtained indicate that this technique allows to stimulate the facial nerve above the stylomastoid foramen: a greater tract of the nerve can therefore be explored than what was possible with the traditional electrical stimulation at the mastoid. Until now no comparison data was available on the clinical usefulness of the two methods. We decided to study 14 normal controls and 26 patients suffering from unilateral idiopathic facial palsy (Bell's palsy) and to submit these two groups to magnetic transcranial stimulation and electrical stimulation of the facial nerve in the mastoid region, to the purpose of observing where the nerve is stimulated by the magnetic impulse and which of the two techniques can be of accurate prognostic value in the study of the evolution of the clinical lesion. The electromyographic responses were elicited by the electrical stimulation at the mastoid and by transcranial stimulation after positioning the coil on the parieto-occipital scalp. A recording was taken from the ipsilateral orhicularis oculi muscle utilising two cupped electrodes. The latency and the amplitude of the compound muscle action potential were measured bilaterally in order to compare the results obtained on both the affected and the healthy sides. The patients were scheduled to two neurophysiological and clinical evaluations at about 30 days interval one from the other: the first test was not carried out before 20 days from the onset of the deficit; further clinical examination was carried out only 6 months later. The analysis of the results obtained in the normal controls submitted to transcranial magnetic stimulation indicate that the nerve is activated at the point where it originates from the brainstem. The study carried out showed that transcranial magnetic stimulation of the facial nerve, does not provide data which can be correlated to the clinical situation observed at the time of the study; furthermore, transcranial magnetic stimulation does not supply any prognostic data on the clinical evolution of the lesion.     

面瘫患者面神经电图和瞬目反射的应用比较

目的:比较面瘫患者瞬目反射和面神经电图的应用价值。方法:这些面瘫患者经过四周基础治疗和(或)针灸治疗后,进行健、患侧瞬目反射(207例)和面神经电图(205例)检查比较。结果:瞬目反射治疗前健、患侧R1值的差异有极显著意义(P<0．01);治疗后健、患侧R1值的差异无显著意义 (P>0．05)。面神经电图患侧潜伏期延长者于治疗后均有所好转(P<0．05),波幅降低者治疗后无明显改善(P>0．05)。结论:面瘫患者治疗后瞬目反射改善非常明显,而面神经电图恢复存在明显的滞后现象,早期诊断(发病第一周)瞬目反射检查优于面神经电图,中后期面神经电图检查优于瞬目反射。     

Correlation between MRI and operative findings in Bell's palsy and Ramsay Hunt syndrome

PURPOSE: To investigate the correlation between gadolinium enhanced magnetic resonance image (MRI) results and surgical findings of facial nerves in Bell's palsy and Ramsay Hunt syndrome. MATERIALS AND METHODS: From 1995 to 2004, MRI was performed on 13 patients with Bell's palsy or Ramsay Hunt syndrome, who were offered with surgical decompression of the facial nerve through the middle cranial fossa approach. Gadolinium enhanced MRI was performed on all patients and the enhancement of the facial nerve was evaluated by radiology specialists. Operative findings including the degree of the facial nerve segment swelling were examined. Furthermore, the time interval from the onset of palsy to surgery was evaluated. RESULTS: Swelling of facial nerve segments was found in patients with enhanced facial nerves from MRI. The swelling of the facial nerve in the labyrinthine segment in particular was identified in all patients with enhanced labyrinthine segments in MRI. The intraoperative swelling of geniculate ganglion of facial nerve was found in 78% of patients with enhanced facial segment in MRI (p=0.01). The intraoperative swelling of tympanic segment was observed from fourth to ninth weeks after the onset of palsy. CONCLUSION: MRI enhancement of facial nerves in Bell's palsy and Ramsay Hunt syndrome is associated with the extent of intratemporal lesions of facial nerves, especially in the labyrinthine segment.     

面神经逆行诱发电位的临床初探

目的探讨人体面神经逆行诱发电位（ＦＮＡＥＰ）的特点及其临床应用价值。方法采用极性交替的恒流刺激电信号经皮电刺激茎乳孔面神经，在正常人鼓膜（１５耳）及鼓室（９耳）记录ＦＮＡＥＰ。结果都能记录到ＦＮＡＥＰ，且其波幅随刺激强度的增大而增大，当刺激强度为阈强度的２倍时，ＦＮＡＥＰ达到最大；急性颞骨内面瘫后ＦＮＡＥＰ波幅减小、峰潜伏期延长，并随面瘫的好转，ＦＮＡＥＰ逐渐恢复正常。结论ＦＮＡＥＰ可作为早期诊断急性颞骨内面瘫的一种新方法。     

偏头痛患者发作期脑干听觉诱发电位和瞬目反射检测

目的：观察偏头痛患者发作期脑干听觉诱发电位(BAEP)和瞬目反射(BR)改变。方法：对45例偏头痛发作期患者进行BAEP、BR检测。结果：BR和BAEP联合检测提示脑干病变者31例，占69％；BAEP、BR检测提示听神经、三叉神经传入通路功能障碍和面神经传出通路功能障碍共26例，占58％，其中三叉神经传入通路障碍21例，占81％。结论：偏头痛发作期存在着以脑干和三叉神经为主的神经功能障碍．与血管舒缩功能障碍很可能互为因果、相互影响。     

Electrophysiological findings of acute peripheral facial palsy in diabetic and non-diabetic patients

The aim of this study is to investigate the role of diabetes mellitus on the clinical and electrophysiological findings of peripheral facial palsy (PFP), the effect of the diabetes duration and polyneuropathy on the electrophysiological parameters. A total of 32 diabetic and 40 non-diabetic patients with peripheral facial palsy were included. All patients were divided into two subgroups based on the time of electrophysiological examinations: within the first 15 days versus within 16–30 days. Neuropathy symptoms and the results of neurological examinations and electrophysiological findings were recorded. The findings of electroneurography (EnoG), blink reflex (BR) evaluation, and needle electromyography (EMG) indicated statistically significant blink reflex abnormalities in diabetic patients compared to non-diabetics. Delay in the latency was more remarkable in the R2 component than in the R1 (p < 0.001). The delay in the R1 latency was also observed in the non-affected side for diabetic patients. The longer duration of the diabetes caused significant delay on the blink reflex latency on both the affected and non-affected sides for R1 component (p = 0.019, p = 0.041, respectively). In contrary, neither the diabetes duration nor the age of the patients correlated with the clinical severity of facial palsy, fiber loss, fibular nerve compound muscle action potential amplitudes, and the nerve conduction velocities.     

颞骨内面神经垂直段的显微解剖及其临床意义

目的：研究颞骨内面神经垂直段及其毗邻结构的显微解剖,为临床应用提供解剖学资料。方法：通过模拟临床经乳突入路的方法,分层解剖20个成人湿性头颅标本（40侧颞骨）,显露并观测颞骨内面神经垂直段及其毗邻结构。结果：面神经垂直段的长度为（17.39±1.78）mm、直径为（2.13±0.13）mm,面神经垂直段与水平段的夹角（向前）为（115.5±6.89）°,面神经垂直段近端至外半规管隆突距离为（2.86±0.31）mm,鼓索神经自面神经发出点至茎乳孔距离为（5.99±0.74）mm,面神经垂直段与鼓索神经的夹角（向上）为（38.6±1.99）°,锥隆起尖到面神经垂直段垂直距离为（2.05±0.65）mm,后半规管至面神经垂直段最短距离为（2.89±0.36）mm。有5%（2/40侧）的面神经垂直段的近端位于外半规管隆突外侧。结论：外半规管、鼓索神经、茎乳孔、锥隆起、后半规管是手术中确定面神经垂直段的重要标志。熟悉颞骨内面神经垂直段与其周围结构的毗邻关系,有利于面神经垂直段相关手术的顺利进行。     

三叉神经诱发电位与瞬目反射在特发性三叉神经痛中的应用比较

目的：探讨三叉神经诱发电位（TSEP）与瞬目反射（BR）检查在特发性三叉神经痛（ITN）中的临床应用比较.方法：采用丹麦产Dantic keypoint多道肌电图-诱发电位仪,对168例ITN患者进行患侧与健侧的TSEP与BR检查,并对其结果进行对比分析. 结果： TSEP提示患侧三叉神经的短潜伏期延长、波幅降低,与健侧比较差异有显著意义（P〈0.01） TSEP的变化与ITN的病程长短及临床表现严重程度有关.而BR提示三叉神经潜伏期与健侧比较差异无显著意义（P〉0.05）,说明患者ITN三叉神经第一支受损较少.TSEP的异常率明显高于BR,是因为TSEP刺激为上颌神经与BR刺激为眼神经的刺激点不同,所以在三叉神经周围结构病变中不具有可比性.结论：TSEP与BR检查是评价三叉神经周围结构和脑干中枢传导通路生理功能的重要方法,有助于对ITN的定性及定量诊断.但因TSEP和BR的波型不稳定、干扰成分大、刺激与记录方法有待标准化、神经解剖与神经电生理基础还有待于进一步明确.     

人面神经管和面神经的发生

本文对229侧胚胎儿周至出生后1年颞骨组织切片连续观测。结果表明,面神经管由膜性化骨和软骨化骨共同形成。面神经管水平段外侧壁、下壁和迷路段上壁为膜性化骨,膜性化骨顺序有一定规律性;其余部分为软骨化骨。面神经发育随胎龄的增长而递增,出生前渐近高峰;不同部位面神经在面神经管内保持相对恒定的截面积空间比。面神经在面神经管迷路段远侧端所占截面积空间比最大,在茎乳孔处所占截面积空间比最小。本文并提出,胚胎发育后期膜性化骨不全、乳突气化过度是导致面神经管缺损的主要原因。