肌电图在糖尿病周围神经病变诊断中的临床应用

目的分析神经肌电图(EMG)在2型糖尿病(T2DM)合并糖尿病周围神经病变(DPN)诊断中的应用价值。方法选取200例T2DM合并DPN患者为研究对象,根据患者的T2DM病程长短分为A组、B组、C组和D组,应用EMG对四级患者的上肢正中神经、尺神经的运动传导速度(MCV)和感觉传导速度(SCV)、下肢的腓总神经MCV、腓浅神经SCV、胫神经H反射和尺神经f波进行检测和比较。结果 A组的EMG异常检出率显著高于其他3组(χ2=4.604、9.558、17.420,P0.05),B组显著高于D组(χ2=5.034,P0.05);A组患者的腓总神经MCV异常检出率显著高于C组或D组(χ2=5.514、9.007,P0.05);A组患者的腓浅神经SCV异常检出率显著高于其他3组(χ2=6.000、6.484、19.841,P0.05),B组、C组均显著高于D组(χ2=4.602、4.905,P0.05);A组的胫神经H反射异常检出率显著高于其他3组(χ2=7.332、17.160、24.008,P0.05),B组显著高于D组(χ2=5.784,P0.05)。结论随着T2DM病程的进展,DPN患者的EMG异常率会出现显著上升,主要表现为腓总神经MCV、腓浅神经SCV和胫神经H反射异常率的显著升高,临床医生应综合考虑患者的EMG变化情况以针对DPN进行早期诊断和及时治疗。     

甲钴胺联合α硫辛酸治疗糖尿病周围神经病变神经电生理分析

目的探讨甲钴胺联合a硫辛酸治疗糖尿病周围神经病变的神经电生理改变。方法 60例糖尿病周围神经病变患者随机分为治疗组和对照组各30例,治疗组给予甲钴胺联合a硫辛酸治疗;对照组给予甲钴胺治疗。比较2组治疗前后运动神经传导速度(MCV)、感觉神经传导速度(SCV)、交感皮肤反应(SSR)潜伏期和波幅(LAT、AMP)的变化。结果 2组治疗后正中神经和腓总神经的MCV、正中神经和腓肠神经的SCV均高于治疗前,且治疗组高于对照组,差异有统计学意义(P0.05);交感皮肤反应2组上肢波幅均高于治疗前,差异有统计学意义(P0.05)。结论甲钴胺联合a硫辛酸治疗糖尿病周围神经病变疗效显著,值得临床使用。     

神经肌电图在合并周围神经病变的Ⅱ型糖尿病患者中的意义

目的主要探讨的是神经肌电图在Ⅱ型糖尿病患者周围神经病变的早期诊断中的价值。方法分析2011年7月至2014年1月在我院治疗的Ⅱ型糖尿病患者的临床资料。入组的Ⅱ型糖尿病患者根据患者的病程进行分组,包括A组（病程〉10年）、B组（病程1-10年）和C组（病程〈1年）。比较三组患者的临床资料,正中、尺神经、腓总神经的MCV（运动传导速度）,SCV（感觉传导速度）以及胫神经H反射和尺神经f波的情况。结果本研究共纳入研究对象180例,其中A组57例,B组65例,C组58例。三组患者的正中神经（χ2=9.104,P=0.011）、尺神经（χ2=9.335,P=0.009）、腓总神经（χ2=9.898,P=0.007）的MCV异常比例均存在着显著的差异,且病程越长,异常率越高;三组患者的正中神经（χ2=13.44,P=0.001）、尺神经（χ2=13.56,P=0.001）、腓总神经（χ2=24.09,P=0.000）的SCV异常比例均存在着显著的差异,病程越长,异常率越高;三组患者胫神经H反射异常比例存在显著的差异（χ2=19.12,P=0.000）,且病程越长,异常率越高。而尺神经F波异常比例并无统计学差异（χ2=3.152,P=0.207）。结论Ⅱ型糖尿病患者的病程越长,相应的尺神经、正中神经、腓总神经的MCV、SCV中的异常比例,以及胫神经的H反射异常检出率越高。结合尺神经F波可早期客观检测到糖尿病周围神经病神经近端损害,提高早期诊断。     

前列腺素E_Ⅰ治疗糖尿病周围神经病变对神经传导速度的影响观察

目的观察前列腺素E_Ⅰ治疗糖尿病周围神经病变的疗效及对神经传导速度的影响。方法选择我院2013-05—2015-05收治的93例糖尿病周围神经病变患者为研究对象,分为2组。对照组单纯应用甲钴铵,治疗组在对照组基础上应用前列腺素E_Ⅰ。比较2组治疗前后正中神经与腓总神经的运动传导速度(MCV)与感觉传导速度(SCV)、治疗总有效率及不良反应发生率。结果 2组治疗前正中神经与腓总神经MCV与SCV的比较差异均无统计学意义(P0.05);经治疗后,治疗组各项指标均高于对照组,比较差异有统计学意义(P0.05)。治疗组总有效率为89.4%(42/47),明显高于对照组71.7%(33/46),差异有统计学意义(P0.05)。治疗组不良反应发生率为6.4%(3/47),与对照组4.4%(2/46)相比差异无统计学意义(P0.05)。结论前列腺素EⅠ治疗糖尿病周围神经病变疗效显著,可显著提高神经传导速度,安全性高,值得推广应用。     

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。     

糖尿病前期周围神经病的神经电生理研究

目的 探讨神经电生理(神经传导、F波及皮肤交感反应)检查对糖尿病前期周围神经病的诊断价值。方法 选取100例糖尿病前期患者、50例糖尿病患者及50例健康志愿者,糖尿病前期患者又分为糖耐量异常及空腹血糖受损组,分别为55例及45例; 对上述对象进行四肢神经传导(Nerve conduction studies, NCS)、F波、皮肤交感反应(Skin sympathetic response,SSR)检查。结果(1)糖耐量异常组正中神经感觉动作电位(Sensory nerve active potential,SNAP)、胫后和腓总神经SNAP及感觉传导速度(Sensory nerve conduction velocity,SCV)均低于正常对照组及空腹血糖受损组,空腹血糖受损组腓总神经SNAP、胫后神经SCV均低于正常对照组(P均<0.05);(2)空腹血糖受损组、糖耐量异常组上肢及下肢SSR波幅均低于正常对照组(P均<0.05),糖耐量异常组下肢SSR波幅低于空腹血糖受损组(P均<0.05);(3)糖耐量异常组F波、感觉神经NCS,SSR异常的比例多于正常对照组,空腹血糖受损组SSR异常比例多于正常对照组,糖耐量异常组感觉神经NCS异常的比例多于空腹血糖受损组(P均<0.05)。结论 糖尿病前期患者存在周围有髓鞘大感觉神经纤维及无髓鞘小神经纤维损害,其中糖耐量异常患者周围神经损害重于空腹血糖受损患者,电生理检查以感觉神经NCS及SSR异常为主,利用神经电生理技术利于其周围神经损害的早期诊断。     

电流感觉阈值在糖尿病周围神经病变诊断中的评价

目的利用电流感觉阈值测定与神经传导速度的比较,探讨电流感觉阈值对糖尿病周围神经病变的诊断价值。方法 60例确诊为2型糖尿病患者,分别进行感觉神经传导速度(sense nerve conduction velocity,SNCV)和电流感觉阈值(current perception threshold,CPT)测定,比较SNCV和CPT的异常率。结果 CPT检查异常率68.33%,SNCV检查异常率36.67%;有症状组中CPT检查异常率88.46%,SNCV检查异常率53.85%;无症状组中CPT检查异常率47.06%,SNCV检查异常率17.65%;病程≤5年组中CPT检查异常率55.17%,SNCV检查异常率24.14%;病程5年组中CPT检查异常率77.42%,SNCV检查异常率48.39%。两种检查方式对比差异具有统计学意义(P0.05)。结论 CPT检查和NCV检查对糖尿病周围神经病变的诊断具有一致性,对于早期无症状患者,CPT检查对亚临床患者更有诊断优势。     

脊髓空洞症10例患者皮肤感觉阈值的测定

目的　研究选择性神经诊断刺激器在 10例脊髓空洞症患者中的特点和临床意义。方法　对 10例 (男 6例 ,女 4例 )经病史、临床表现和脊髓MRI检查证实的脊髓空洞症患者在双侧的拇指 (C6皮节 )和小指 (C8皮节 )进行了不同频率 (5、2 5 0和 2 0 0 0Hz)皮肤感觉阈值 (CPT)的测定 ,并与年龄匹配的健康人对照。结果　患者组C6和C8皮节对 5和 2 5 0Hz刺激感觉阈值与健康对照组比较 ,差异有非常显著意义 (P <0 .0 1) ,而 2 0 0 0Hz刺激两组之间差异无显著意义。其中 2例临床上有明显的触觉和音叉震动觉减低 ,MRI显示空洞影响脊髓前角和后角 ,2 0 0 0Hz刺激CPT阈值也有明显的增高 (C6和C8刺激CPT阈值分别为 5 32和 718)。不同频率刺激CPT的异常率是不同的 ,5Hz刺激CPT的异常率最高 (C6和C8刺激分别为 5 5 .0 %和 70 .0 % ) ,2 0 0 0Hz刺激的阳性率最低 (C6和C8刺激分别为 15 .0 %和 2 3.5 % )。结论　通过对 10例不同程度脊髓空洞症的研究 ,进一步证明了不同刺激频率CPT的测定可评价不同感觉神经的功能 ,较客观地对不同直径的感觉纤维进行定量测定。     

糖尿病性周围神经病患者受累神经的分布特点

目的 探讨糖尿病件周围神经病(DPN)患者受累神经的分布特点.方法 对900例2型糖尿病并发DPN患者进行感觉及运动神经传导速度检测,对受累神经的分布进行分析.结果 本组感觉神经异常率为89.3%;包括65.2%(587例)的正中神经、38.9%(350例)的尺神经、89.3%(804例)的腓浅神经、60.4%(544例)的腓肠神经及29.6%(64例)的胫后神经异常.运动神经异常率为34.5%;包括32.1%(289例)的正中神经、28.7%(258例)的腓总神经、22.7%(49例)的胫神经异常.感觉神经异常率明显高于运动神经异常率(P<0.01);下肢感觉神经异常率明显高于上肢(P<0.01).结论 DPN患者受累的感觉神经以腓浅神经、正中神经、腓肠神经最普遍,受累的运动神经以正中神经、腓总神经为多见.     

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     

Diagnostic Difficulties and Treatment Implications

Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.     

Cognitive Dysfunction Associated with Antiepileptic Drug Therapy

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Carbamazepine Efficacy in Adults With Partial and Generalized Tonic-Clonic Seizures

Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.     

Etiologic and Preventive Aspects of Epilepsy in the Child–Bridging the Gap Between Laboratory and Clinic

Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Predisposing and Causative Factors in Childhood Epilepsy

Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non-febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.