高同型半胱氨酸血症对大鼠周围神经结构和功能的影响

目的 观察高同型半胱氨酸血症(hyperhomocysteinemia,Hhcy)对大鼠周围神经组织结构和传导功能的影响.方法 通过高蛋氨酸饮食建立Hhcy大鼠模型.应用电生理技术检测大鼠尾神经传导功能;光镜下计数大鼠腓肠神经单位面积有髓神经纤维密度(fiber density,FD)、平均髓鞘面积(mean myelin area,MMA);免疫组化方法分析腓肠神经髓鞘碱性蛋白(myelin basic protein,MBP)、神经丝蛋白(neurofilament protein,NF)表达;电镜观察腓肠神经超微结构.结果 Hhcy组大鼠尾神经运动神经传导速度(motor nerve conduction velocity,MCV)、感觉神经传导速度(sensory nerve conduction velocity,SCV)与复合肌肉动作电位(compound muscle action potential,CMAP)、感觉神经动作电位(sensory nerve action potential,SNAP)波幅均较对照组减慢和下降(均P＜0.05);Hhcy组大鼠腓肠神经FD、MMA与MBP、NF积分光密度均较对照组减小(均P＜0.05);Hhcy组大鼠有髓神经纤维出现了髓鞘脱失、轴突肿胀、间质水肿等超微结构改变.结论 Hhcy可造成大鼠周围神经组织结构与传导功能的损害.     

吉兰-巴雷综合征患者的神经电生理特点

目的 探讨吉兰-巴雷综合征(GBS)患者的神经电生理特点.方法 对20例吉兰-巴雷综合征患者进行肌电图(EMG)、运动神经传导速度(MCV)、F波及感觉神经传导速度(SCV)检测,共检测160条运动神经、120条感觉神经及60块肌肉,并对结果进行分析.结果 上、下肢神经远端潜伏期延长占54.4%,MCV减慢占68.8%,F波异常占95.0%,SCV减慢占70.8%,EMG提示神经源性损害占70.0%.结论 GBS为广泛的周围神经损害,存在以脱髓鞘为主伴有轴索变性的神经电生理改变.神经电生理检测对GBS的诊断具有极为重要的诊断价值.     

200例2型糖尿病患者神经传导速度检测分析

目的:探讨2型糖尿病(DM)患者周围神经病变的客观神经电生理特点。方法:分别对200例DM患者,其中有周围神经损害临床表现组(DM-I)100例和无周围神经损害临床表现组(DM-Ⅱ)100例,与50例正常成人进行运动神经传导速度(MCV)、感觉神经传导速度(SCV)、复合肌肉动作电位(CMAP)、感觉神经动作电位(SNAP)进行测定。结果:两组患者所测的MCV、SCV、CMAP、SNAP与正常对照组比较有显著差异,而DM-I组与DM-II所测的MCV、SCW、CMAP、SNAP比较亦有显著差异,下肢神经的4个参数总异常率高于上肢。结论:(1)神经传导速度的检测有助于糖尿病周围神经病的早期诊断。(2)DM并发周围神经损害在临床症状出现之前已有神经传导速度的改变。(3)下肢神经的总异常率高于上肢。     

神经电生理对外伤性臂丛神经损害的诊断

目的探讨神经电生理对外伤性臂丛神经损害的诊断价值。方法对47例有周围神经临床症状的患者行针极肌电图(EMG)、运动神经传导速度(MCV)和感觉神经传导速度(SCV)的检测,并与实验室正常值对比。结果全臂丛神经损害17例,根性损伤12例,上、中干损伤11例,中、下干损伤7例。结论神经电生理是外伤性臂丛神经损害的客观检查方法。     

高频超声联合神经电生理检查在尺神经肘管卡压中的应用价值

目的探讨高频神经超声联合神经电生理检查在尺神经肘管卡压中的应用价值。方法回顾性分析186例尺神经肘管卡压病人的临床资料,其中Mc GowanⅠ级96例,Ⅱ级68例,Ⅲ级22例;均进行尺神经皮下前置减压手术。所有病人随访2年,手术前后检测尺神经横截面积(cross section area,CSA)、运动传导速度(motor conduction velocity,MCV)、感觉传导速度(sensory conduction velocity,SCV)和神经动作电位(nerve action potential,NAP)作为诊断和疗效评估指标。结果 Mc GowanⅠ、Ⅱ、Ⅲ级皮下前置术后的优良率分别为87.5%、72.1%、63.6%。术前Mc GowanⅠ级健侧与病侧CSA、MCV、SCV、NAP差异均有统计学意义(P 0.05);术前Mc GowanⅠ、Ⅱ、Ⅲ级间CSA、MCV、SCV、NAP差异均有统计学意义(P 0.05);Mc GowanⅠ、Ⅱ、Ⅲ级术后2年的CSA、MCV、SCV、NAP均较术前显著改善(P 0.05)。结论高频神经超声联合神经电生理检查可应用于尺神经肘管卡压的临床诊断和手术疗效评价。     

糖尿病周围神经病病情分级与电生理的相关性

目的探讨糖尿病周围神经病病情分级与电生理的相关性。方法依据糖尿病性周围神经病的诊断标准确定入选对象;依据糖尿病周围神经病病情分级对入选对象进行临床分级;应用丹麦产DANTEC CANTATA型肌电图仪,进行运动神经和感觉神经传导功能检查。结果腓肠神经、正中神经诱发感觉动作电位波幅(SNAP)和腓总神经复合肌肉动作电位波幅(CMAP)随病情分级的升高而明显减低(P<0.05);腓肠神经、正中神经感觉传导速度(SCV)和腓总神经、正中神经运动传导速度(MCV)3级与1、2两级比较显著减慢(P<0.05)。结论神经电生理改变,尤其感觉神经电生理改变,易此作为糖尿病周围神经病情程度评定的指标。     

138例糖尿病患者神经电图分析

目的探讨2型糖尿病患者周围神经病变(DPN)的神经电生理特点及其与病程的关系。方法连续记录138例血糖控制良好的糖尿病患者神经电图(包括感觉神经传导速度SCV和运动神经传导速度MCV)的检测结果,并根据糖尿病病程将其分组进行比较。结果共检测周围神经1669条,异常神经313条(18.75%),下肢异常率(132/530,24.9%)明显高于上肢(59/517,11.4%)(P<0.0001),感觉神经(122/622,19.6%)与运动神经(191/1047,18.2%)受累无差异(P=0.5665);糖尿病病程10年以上者运动、感觉神经异常率(24.3%,33%)明显高于病程小于10年组(14.2%,14%)(P<0.001)。病程大于10年组神经传导速度均较病程小于10年组减慢,正中神经、胫后神经运动传导速度和尺神经、腓肠神经感觉传导速度有统计学意义(P<0.05);除尺神经外所查运动神经近远端复合肌肉动作电位波幅(CAMP)病程≥10年组均明显低于病程<10年组。结论尽管受检时血糖控制良好,但依然有周围神经电生理异常变化。2型糖尿病患者下肢神经传导异常率高于上肢,尤以运动神经明显。病程是糖尿病周围神经损害的危险因素,随着病程增加神经传导异常率和损伤严重程度增高。     

糖尿病周围神经病电生理特点及与血糖水平的关系

目的研究糖尿病周围神经病的神经电生理特点以及与血糖水平的关系。方法分析2013年3月~2014年3月于本院神经内科住院的108例糖尿病周围神经病患者,测定其正中、尺、胫、腓总神经的运动传导速度(MCV)和复合肌肉动作电位波幅(CMAP),以及正中、尺、腓肠神经、腓浅神经的感觉传导速度(SCV)和感觉神经动作电位波幅(SNAP),比较上、下肢和运动、感觉神经异常情况,分析糖化血红蛋白(HbA1C)、餐后2 h血糖对神经传导速度(NCV)的影响。结果糖尿病患者下肢运动神经病变重于上肢,且差异明显(P<0.05)。感觉神经损害重于运动神经,且差异明显(P     

神经电生理对周围神经损伤的评估价值探讨

目的探讨神经电生理对周围神经损伤的诊断价值。方法对160例有周围神经临床症状的患者行针极肌电图(EMG)、运动神经传导速度(MCV)和感觉神经传导速度(SCV)的检测,并与本实验室正常值对比。结果未见神经损伤者16例,轻度神经损伤者47例,中重度神经损伤者66例。完全性神经损伤者31例。结论神经电生理是周围神经损伤部位、程度、范围和预后的客观检查方法。     

36例手足口病合并急性弛缓性麻痹患儿的肌电图分析

目的:探讨神经电生理检查在手足口病(HFMD)合并急性迟缓性麻痹(AFP)患儿的特点及应用价值.方法:对36例手足口病合并急性迟缓性麻痹患儿进行运动神经传导速度(MCV)、感觉神经传导速度(SCV)、F波及肌电图(EMG)检查,共检测176条运动神经、88条感觉神经、98条神经的F波及285块肌肉,并对结果进行分析.结果:运动神经传导异常率为52.8%,其中运动传导波幅下降占81%,未引出反应波者为15%,MCV减慢或潜伏期延长者为4%,感觉传导异常率为6%,F波异常率为10%,EMG出现自发电位者为28.4%,出现高大运动单位电位(MUP)者为48.1%,募集相减少63.9%.结论:HFMD合并AFP患儿有神经原性损害,以轴突损害电生理改变为主,多累及近端神经,以运动神经受累为主.神经电生理检查对HFMD合并AFP患儿的诊断治疗及判断预后有重要价值.     

多发性硬化周围神经病变的电生理评价

目的研究多发性硬化(MS)患者的周围神经病变，并评价神经电生理技术的应用价值。方法采用神经传导速度(NCV)技术检测MS患者周围神经的运动传导速度(MCV)、感觉传导速度(SCV)及其潜伏期；采用运动诱发电位(MEP)检测正中神经和胫神经的潜伏期；采用F波检测正中神经的出现率和传导速度。结果MS患者NCV均不同程度地减慢，MCV的异常率高于SCV，NCV结果提示轴突损害比脱髓鞘显著。MEP测得肘点和腰4点的潜伏期延长，提示正中神经远端和腰骶神经根功能的损害。部分患者F波的出现率降低．提示周围神经根功能异常。结论MS患者存在周围神经病变；综合运用电生理技术可以全面地评价MS周围神经功能。     

Subclinical lesions of peripheral nervous system in multiple sclerosis patients

BACKGROUND AND PURPOSE: In the last years the presence of peripheral nervous system (PNS) lesions has been noted in patients with multiple sclerosis (MS). The frequency and degree of PNS damage reported by many authors differ among publications, so does the type of PNS lesions. The aim of our study was to perform an electrophysiological evaluation of the peripheral nervous system in patients with a definite diagnosis of multiple sclerosis and without any clinical signs of peripheral neuropathy. MATERIAL AND METHODS: 110 patients were included in the study, comprising 70 people with a definite diagnosis of multiple sclerosis and 40 people without any symptoms of organic nervous system lesion serving as a control group. During neurologic examination of MS patients the degree of disability measured by EDSS scale, the duration of the disease as well as number of relapses were assessed. A "disease progression factor" was calculated by dividing a number of relapses by disease duration in years. Patients with common etiologies for peripheral neuropathy such as diabetes, renal insufficiency, thyroid gland dysfunction, proliferative disorders etc. were excluded from the study. Orthodromic motor conduction and late responses (F wave) in median, ulnar, peroneal and tibial nerves as well as sensory conduction in median, ulnar (orthodromic) and sural (antidromic) nerves were evaluated. RESULTS: There was electrophysiological evidence of peripheral nervous system lesions in at least one nerve in 52 (74.2%) MS patients. In 30 patients (42.8%) more than one peripheral nerve was lesioned. There were more significant differences noted during the examination of sensory nerves. Sensory amplitudes in all of the sensory nerves examined were significantly lower than in control group. Furthermore we observed slow sensory conduction velocities and prolonged sensory latencies in ulnar and sural nerves. There were significant differences between the two groups of patients concerning motor conduction too: prolonged distal latency in tibial and sural nerves, prolonged F wave latency in median, peroneal and tibial nerves, low motor amplitude in ulnar and peroneal nerves, low motor conduction velocity in ulnar nerve -- all noted in MS patients. We found no correlation between conduction parameters and the patients' age, disease duration, number of relapses and disease progression degree. CONCLUSIONS: We found out that subclinical peripheral nervous system abnormalities are very frequent in MS patients. We noted both sensory and motor nerve lesions of a demyelinating-axonal character. Sensory abnormalities were more pronounced than motor ones. There was no correlation between the degree of PNS lesions and the patients' age and/or progression of multiple sclerosis.     

腕管综合征高频超声检测所见与电生理检查结果相关性研究

目的：探讨腕管综合征（CTS）患者高频超声检查正中神经结构改变与电生理结果的相关性，以作拟定临床治疗的参考。方法：对上肢麻木患者进行电生理检查，诊断为CTS后再进行高频彩超检查，重点测定受压正中神经最细处、最粗处的前后径，并计算最细处与最粗处之比。电生理主要检查正中神经运动传导末端潜伏期、波幅及感觉传导速度（SCV ）及波幅，对超声检查结果及电生理结果进行相关性分析。结果：SCV与直径的 Pearson相关性为0．850，呈高度相关性；运动末端潜伏期与直径的Pearson相关性为0．419，呈中度相关性；感觉传导波幅与超声所测直径的 Pearson相关性为0．220，为弱相关性；运动传导波幅与超声所测直径的 Pearson相关性为0．256，为极弱相关或无相关性；所有电生理数据与神经细粗比的 Pearson数据均低于0．2，为极弱相关或无相关性。结论：正中神经SCV与最细处直径呈高度负相关，运动末端潜伏期与最细处直径呈中度负相关，与正中神经解剖改变有关。     

Guillain-Barré syndrome. A clinical electrophysiological and biochemical study

Fifty-six consecutive patients with Guillain-Barré syndrome representing 49% of all cases of peripheral neuropathy (except those due to diabetes mellitus and leprosy) admitted to the Postgraduate Institute of Medical Education and Research, Chandigarh over a period of three years were studied. All patients developed weakness of limbs within one day to three weeks. Attenuation of deep tendon jerks (98%) paresthesia (66%), cranial nerve involvement (41%) and antecedent infection (32%) were the common clinical features. The common patterns of motor weakness were predominantly proximal in all the four limbs (45%) or predominantly proximal in lower limbs along with distal muscles in upper limbs (29%). Electrodiagnostic studies revealed prolonged distal (motor) latency (82%), reduced motor nerve conduction velocity (74%), sensory nerve conduction abnormality (85%) and evidence of denervation (41%). Evoked motor response of median, ulnar, common peroneal and tibial nerves exhibited significant increase in duration and reduction in amplitude. The maximum incidence of electrophysiological abnormality occurred between four to 12 weeks after the onset of neurological symptoms. Four patients died and 11 showed poor recovery. Long intervals (greater than 3 weeks) between peak deficit and onset of recovery and coexistence of reduced motor nerve conduction velocity with evidence of denervation on EMG were found to be associated with poor recovery.     

周围髓鞘蛋白22基因重复突变致夏科-马里-图斯病1A亚型的临床和神经电生理特征

目的探讨周围髓鞘蛋白22(PMP22)基因重复突变阳性的夏科-马里-图斯病(CMT)lA亚型患者临床和神经电生理改变特点。方法总结21例PMP22基因重复突变阳性的CMTlA患者的临床特点,并分析其神经电生理特征。结果 21例患者中,10例临床特征符合四肢远端萎缩无力的典型CMTl型表现,另外11例呈不典型性,如仅有头晕、合并听力障碍、上肢姿势性震颤、反复发作性肢体无力、伴有小脑性共济失调及癫疒间等。10例患者肌电图出现纤颤电位和(或)正锐波,15例患者运动单位电位时限延长。神经传导存在广泛异常,所有患者被检的运动或感觉神经传导速度存在不同程度的减慢或消失。结论 PMP22重复突变阳性的CMTlA患者具有较高的临床异质性,其电生理特点为肌电图呈神经源性损害,感觉神经病变重于运动神经,下肢受累程度重于上肢,神经电生理检查对CMT1A的诊断很重要。     

Reduced sensory and motor conduction velocity in 25-week-old diabetic [ ] mice

Motor and sensory conduction velocities were measured in sural and tibial nerves of 25-week-old genetically diabetic ( ) mice and their nondiabetic littermates. For motor conduction velocity determination, the sciatic nerve was stimulated at the hip and the tibial nerve subsequently stimulated at the ankle while recording interosseous muscle potentials from needle electrodes placed in the foot. Sensory conduction velocities were determined by recording compound action potentials directly from sural and tibial nerves at the ankle after sciatic nerve stimulation. Control and diabetic conduction velocities were compared by Student's t test. The motor conduction velocity was reduced by approximately 20% from the control, and the distal motor latency was increased in mice by 22% more than the control latency. Conduction velocity was also reduced in some sensory fibers, an observation not previously reported in the mouse. Sensory fibers most severely affected were the faster-conducting fibers of the sural nerve, whose conduction velocity was decreased by 18% from the control. Slower-conducting sensory fibers in sural and tibial nerves were only midly affected, whereas fast-conducting sensory fibers of the tibial nerve appeared to remain normal. These data suggest that not all nerve fibers react alike to the diabetic state in the genetically diabetic ( ) mouse.     

Somatosensory evoked potentials in chronic acquired demyelinating peripheral neuropathy

We recorded somatosensory evoked potentials (SEPs) over the scalp in eight patients with chronic acquired demyelinating peripheral neuropathy. They were obtained from 15 nerves in which sensory nerve action potentials (SNAPs) were absent or not more than 1 microV, but from which motor responses could be elicited. Motor and sensory (SEP-derived) conduction velocity was determined from the difference in response latency with wrist and elbow stimulation. In 11 nerves, afferent conduction velocity was slowed. In 10, there was relatively equal slowing in sensory and motor axons, whereas in 1 there was disproportionate slowing in afferent fibers. In four nerves, afferent conduction velocity was within the normal range despite slowing of motor conduction. We conclude that SEPs may be useful in evaluating peripheral sensory conduction in the absence of SNAPs, but can provide misleadingly normal data, presumably because of central amplification of an attenuated response arising from a few axons that conduct normally.     

Electrophysiological features of patients with POEMS syndrome.

OBJECTIVE: Polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes (POEMS) syndrome is a rare cause of polyneuropathy. Although the polyneuropathy component is essential for the diagnosis of the disease, the pattern of associated electrodiagnostic abnormalities has not been characterized in detail. The purpose of this study was to elucidate the features of nerve conduction abnormalities in POEMS syndrome. METHODS: We reviewed the medical records and nerve conduction studies (NCS) of 12 consecutive patients with POEMS. RESULTS: A total of 68 motor and 46 sensory nerves were examined. Compound muscle action potentials (CMAPs) and sensory nerve action potentials (SNAPs) were not elicited in lower limbs more frequently compared with in upper limbs (P<0.05, in both motor and sensory nerves), and the CMAP amplitude was more attenuated in lower limbs than in upper limbs (P<0.05). Abnormal conduction slowing was frequently observed in motor (95%) and sensory (76%) nerves. Distal motor latencies were abnormally prolonged in 75% of the motor nerves, and terminal latency indices were significantly higher in patients than in normal controls (P<0.05). CONCLUSIONS: NCS in POEMS syndrome showed characteristic patterns, in which conduction abnormalities were more frequently and severely affected in the lower limbs, and more predominantly in the intermediate nerve segments than in the distal portions. SIGNIFICANCE: The recognition of these characteristic patterns may be helpful for the early diagnosis of polyneuropathy in POEMS syndrome.     

Determination of nerve conduction abnormalities in patients with impaired glucose tolerance

Recent studies have shown that impaired glucose tolerance (IGT) is associated with dysfunction in the peripheral and autonomic nerves. The aim of this study was to determine the electrophysiological abnormalities of IGT. To determine electrophysiological abnormality in the large sensorimotor and sudomotor autonomic nerves with IGT patients, 43 patients and 34 healthy subjects have been studied. Subjective neuropathy symptoms, neurological examination and the electrophysiological findings were evaluated. When conduction of large somatic fibers only was evaluated, the ratio of electrophysiological abnormality was found to be 21%. In addition, where sympathetic skin response was evaluated the sudomotor autonomic abnormality ratio was 28% in upper extremities, 53% in lower extremities, and 16% in upper and lower extremities together. The percentages of abnormal electrophysiological parameters in different motor and sensory nerves were 39.5% in the peroneal motor nerve, 20.9% in the median motor and sural sensory nerves, 18.6% in the median sensory nerve, 16.3% in the tibial motor nerve, 14% in the ulnar sensory nerve, and 2.3% in the ulnar motor nerve. While distal motor latency was the most frequent abnormal parameter in the median and tibial motor nerves, the amplitude changes in the peroneal and ulnar motor nerves were also prominent. In sensory evaluation, the onset latency in the median-ulnar sensory nerves and the amplitude in the sural sensory nerve were found to be evident abnormalities.     

磁刺激运动诱发电位在多发性周围神经病中的诊断价值

对１２例多发性周围神经病患者进行磁刺激运动诱发电位（ＭＥＰ）测定，同时测定感觉神经传导速度（ＳＣＶ）、运动神经传导速度（ＭＣＶ）及Ｆ波。结果发现，ＭＥＰ潜伏期异常率为７５％，高于ＳＣＶ（６６．７％）和ＭＣＶ（５８．２％）及Ｆ波（６０％）；至少有１项ＭＥＰ指标异常者１１例，占９１．７％。分析认为，ＭＥＰ异常率较高的原因在于它可以对包括神经根在内的周围神经全长进行测定。将ＭＥＰ各项指标综合分析可提高ＭＥＰ的阳性率。ＭＥＰ对周围神经病是一项有较大价值的辅助检查手段。