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1.
目的探讨下胸段脊旁肌肌电图在肌萎缩侧索硬化症(ALS)诊断中的应用价值。方法总结152例确诊ALS患者的临床及电生理资料,观察下胸段脊旁肌肌电图的特点,并分析其与病程、年龄、首发部位、呼吸困难、胸锁乳突肌肌电图、舌肌肌电图的相关性。结果152例ALS中,下胸段脊旁肌肌电图出现自发电位者125例(82.24%);胸锁乳突肌肌电图呈神经源性损害83例(55.33%),其中出现自发电位者45例。通过Logistic多元回归分析提示脊旁肌肌电图与病程、年龄有关,而与首发部位、呼吸困难无明显相关性。结论脊旁肌肌电图与ALS患者的病程及年龄有关,且下胸段脊旁肌肌电图方便易行,在ALS中诊断价值较大。  相似文献   

2.
腹直肌肌电图在肌萎缩侧索硬化诊断中的价值   总被引:9,自引:0,他引:9  
目的建立腹直肌肌电图运动单位动作电位(MUAP)各参数正常参考值,并探讨其在诊断肌萎缩侧索硬化(ALS)中的价值。方法对ALS组67例患者(其中有呼吸困难症状者19例)进行常规肌电图检测,包括上、下肢远近端肌肉、胸锁乳突肌、下胸段脊旁肌及腹直肌,测定自发电位、募集相、MUAP时限、波幅及多相波,其中脊旁肌只检测自发电位和募集相。对健康对照组109名健康志愿者进行腹直肌肌电图的检测。比较ALS组腹直肌肌电图与健康组的差异、ALS组中腹直肌肌电图与下胸段脊旁肌肌电图的差异以及腹直肌肌电图与呼吸障碍症状的关系。结果健康对照组腹直肌肌电图的MUAP参数分别为:波幅(373·78±56·46)μV,时限(9·95±1·13)ms,多相波(19·40±4·52)%;ALS组腹直肌肌电图的MUAP各参数分别为:波幅(537·19±159·04)μV,时限(13·02±1·30)ms,多相波(31·19±8·84)%,ALS组腹直肌肌电图各参数与健康对照组相比差异有统计学意义;ALS组腹直肌肌电图神经源性改变(63/67,94·0%)与下胸段脊旁肌肌电图(57/67,85·1%)的差异无统计学意义;有呼吸困难症状患者的腹直肌肌电图自发电位(18/19,94·7%)多于无呼吸困难症状患者(32/48,66·7%)。结论腹直肌肌电图各参数均能可靠、稳定地测出,可作为检测ALS患者胸段下运动神经元病变的辅助手段。  相似文献   

3.
肌萎缩侧索硬化症90例胸锁乳突肌肌电图的特点   总被引:24,自引:1,他引:23  
目的 探讨胸锁乳突肌肌电图 (EMG)检测在肌萎缩侧索硬化症 (ALS)诊断中的价值。方法 对ALS患者均进行常规EMG检测 ,包括上肢、下肢及胸锁乳突肌 ,测定自发电位 ,募集相 ,运动单位电位的时限、波幅及多相波。比较有、无球部症状的患者之间胸锁乳突肌EMG改变的差异 ,以及不同部位即球部、颈部及腰骶部之间EMG检测结果的差异。结果 有球部症状的患者胸锁乳突肌EMG病变程度重于无球部症状者 (时限增宽幅度分别为 60 6 %± 2 1 2 %和 50 0 %± 1 9 2 % ,P <0 0 5)。胸锁乳突肌EMG自发电位、募集相、运动单位电位时限和波幅改变的程度均不同于上肢和下肢 ,存在显著性差异。结论 胸锁乳突肌EMG检测的异常与球部症状相关 ,而与肢体无关 ,其神经源性改变可反映球部下运动神经元病变  相似文献   

4.
目的 探讨斜方肌肌电图在检测肌萎缩侧索硬化(ALS)延髓部下运动神经元损害中的价值.方法 对100例ALS患者、80例颈椎病患者和100名健康志愿者进行斜方肌肌电图检测,AKS组和颈椎病组同时进行胸锁乳突肌、第一骨间肌、腹直肌、胫前肌肌电图检测,比较3组肌电图的差异.颈椎病组中43例患者进行手术前后斜方肌肌电图比较.结果 ALS组中,病程≤8个月的患者斜方肌肌电图自发电位的出现率高于病程>8个月者[分别为21/30(70%)和28/70(40%),X~2=7.56,P=0.004];斜方肌肌电图与胸锁乳突肌肌电图异常率比较差异无统计学意义.ALS组[波幅(1086.9±152.6)μV,时限(17.2±6.5)ms,多相波23.6%±3.4%]与对照组[波幅(606.7±82.7)μV,时限(11.6±1.8)ms,多相波12.8%±2.2%;q=9.27、4.57、4.12,均P<0.01]、ALS组与颈椎病组[术前,波幅(615.7±90.3)μV,时限(12.1±2.0)ms,多相波13.5%±2.4%]间运动单位动作电位(MUAP)各参数比较,差异有统计学意义(q=8.32、4.25、4.23,均P<0.01).颈椎病患者手术前后斜方肌肌电图MUAP各参数无明显变化,5例术后发现少量自发电位.结论 斜方肌肌电图可作为检测ALS延髓部下运动神经元损害的辅助手段,特别是早期可见自发电位增多. 1.6±1.8)ms,多相波12.8%±2.2%;q=9.27、4.57、4.12,均P<0.01]、ALS组与颈椎病组[术前,波幅(615.7±90.3)μV,时限(12.1±2.0)ms,多相波13.5%±2.4%]间运动单位动作电位(MUAP)各参数比较,差异有统计学意义(q=8.32、4.25、4.23,均P< .01).颈椎病患者手术前后斜方肌肌电图MUAP各参数无明显变化,5例术后发现少量自发电位.结论 斜方肌肌电图可作为检测ALS延髓部下运动神经元损害的辅助手段,特别是早期可见自发电位增多. 1.6±1.8)ms,多相波12.8%±2.2%;q=9.27、4.57、4.12,均P<0.01]、ALS组与颈椎病组[术前,波幅(615.7±90.3)μV,时限(12.1±  相似文献   

5.
对106例肌萎缩侧索硬化(ALS)与颈椎病性脊髓病(CSM),及两病鉴别困难者进行胸锁乳突肌、肢体肌及舌肌EMG检查。结果ALS组胸锁乳突肌神经源性损害的异常率高于三肢体肌、舌肌;CSM组胸锁乳突肌无1例异常。表明该肌神经源性损害能明显提高ALS亚临床的阳性率,有助于ALS的早期诊断及ALS与CSM两病的鉴别。  相似文献   

6.
肌萎缩侧索硬化与脊髓型颈椎病的神经电生理检查   总被引:2,自引:1,他引:1  
目的 探讨神经电生理检查在肌萎缩侧索硬化(amyotrophic laleral sclerosis,ALS)及脊髓型颈椎病(cervical spondylotic myelopathty,CSM)鉴别中的价值。方法 对28例初步诊断为ALS组、34例CSM组及两者鉴别困难者5例,这三组病人进行肌电图检查。结果 ALS组胸锁乳突肌及上、下肢肌肌电图都表现为神经源性损害;而CSM组仅表现为上肢脊神经根所支配的相应区域的神经源性损害,胸锁乳突肌及下肢肌无一例异常;而两者鉴别困难者组通过肌电图检查发现有4例存在颈、腰椎神经根病变,有1例为颈椎病合并ALS。本文同时对下胸段脊旁肌(T9.T10、T11)进行检查发现AIS组中阳性率为75%,而颈椎病组无一例异常。结论 神经电生理检查能帮助ALS及CSM的诊断及鉴别诊断。  相似文献   

7.
139例肌萎缩侧索硬化临床及肌电图表现特点   总被引:1,自引:0,他引:1  
目的 探讨肌萎缩侧索硬化(amyotrophic lateral sclerosis,ALS)的临床及电生理特征,为早期准确诊断ALS提供依据.方法 回顾性研究近5年来收治的门诊及住院139例肌萎缩侧索硬化患者的临床及电生理表现,对其发病特点、症状、体征及实验室检查进行统计分析.结果 ALS在临床上慢性隐袭起病,逐渐进展,50岁前后发病,平均年龄49.1岁,平均病程2.4年.男性明显多于女性.首发症状为单侧上肢肌肉无力和肌肉萎缩最常见,其次为肌束震颤、延髓麻痹、锥体束征等,少数患者可出现肢体麻木、疼痛或发凉等感觉异常.临床主要症状是肢体无力、肢体和舌肌肌肉萎缩、锥体束征、肢体和舌肌肌束震颤.所有ALS侵害的部位均表现神经源性损害,胸锁乳突肌肌电图检查、胸脊旁肌肌电图、头部/颈/腰椎CT及MRI等辅助检查具有重要的确诊及鉴别诊断意义.结论 目前ALS的诊断仍然依靠临床表现.肌电图、CT/MRI是ALS诊断和鉴别诊断的重要辅助手段.  相似文献   

8.
不同起病部位的ALS病人异常肌电区域分布研究   总被引:1,自引:0,他引:1  
目的 :探讨不同起病部位的ALS病人在 4个下运动神经元支配区域异常肌电的分布情况。方法 :对 10 2例临床诊断为ALS的病人分别行 4组下运动神经元区域 (脑干 ,颈 ,胸 ,腰骶髓 )的针极肌电图检查。对 87例同时进行了胸锁乳突肌的检查。结果 :4组肌电检查区域的结果示 :颈段与胸段异常率在各起病组中最高 ,脑干及腰骶段在各组中异常率不同 (差异有显著意义 ,P <0 0 5 ) ;胸锁乳突肌上、下肢起病组的异常率均高于同组的脑干支配肌。结论 :在ALS病人中 ,异常肌电的分布与起病部位有关。不论哪一部位起病 ,4个区域均可受累 ,因此必须全都检查。胸锁乳突肌具有特殊的诊断及鉴别诊断价值  相似文献   

9.
目的研究肌萎缩侧索硬化(ALS)患者肌电图(EMG)相关肌肉小力收缩时运动单位动作电位(MUAP)的波幅(Amp)和时限(Lat)与肌萎缩侧索硬化功能评分(ALS-FRS-R)之间的相关性。方法 25例ALS患者分别进行ALS-FRS-R和EMG检查,分别记录并分析左右胫骨前肌、左右伸指总肌、腹直肌及胸锁乳突肌小力收缩时MUAP的Amp和Lat与ALS-FRS-R的相关性。结果 23例ALS患者右胫骨前肌小力收缩时Amp与ALS-FRS-R存在相关性,R2=0.173,P=0.043。左胫骨前肌、左右伸指总肌、腹直肌及胸锁乳突肌小力收缩时的Amp及左右胫骨前肌、左右伸指总肌、腹直肌及胸锁乳突肌小力收缩时的Lat与ALS-FRS-R不存在相关性(P>0.05)。结论 EMG中仅个别相关肌肉小力收缩时MUAP的Amp与ALS-FRS-R相关,因此EMG相关肌肉小力收缩时的Amp和Lat对ALS仅具有定性意义,不能反映ALS患者病情的严重程度。  相似文献   

10.
正患者男性,41岁,因进行性四肢无力4年,于2013年7月15日入院。患者于4年前(2009年初)无明显诱因出现右上肢无力伴肌肉跳动,近端明显,但不影响日常生活。当地医院诊断为腕管综合征,行神经减压松解术,术后症状无明显缓解。遂至上一级医院就诊,肌电图检查(2009年2月25日)显示,双侧斜方肌、双侧胸锁乳突肌、双侧胫前肌、右侧腹直肌、右侧脊旁肌T12水平神经源性损害;未予特殊处理,建议随访。患者1年余前(2012年初)  相似文献   

11.
OBJECTIVE: We studied the involvement of motor neuron groups innervating paraspinal muscles in amyotrophic lateral sclerosis (ALS) and evaluated the value of paraspinal muscle EMG in the diagnosis of the disease. METHODS: We used quantitative concentric needle EMG to study denervation and reinnervation in a paraspinal muscle and a limb muscle innervated by the C6 and L5 segments in 32 patients with ALS. As control subjects we studied 11 patients with peripheral neuropathy, and 46 non-neurogenic control subjects. RESULTS: We found similar abnormalities in motor-unit potentials (MUPs) in paraspinal and limb muscles in these two segments in ALS. Fasciculation potentials (FPs) were more frequent in limb muscles than in paraspinal muscles and fibrillations and sharp waves (fibs-sw) were most frequent in tibialis anterior. In peripheral neuropathy paraspinal muscles were normal but tibialis anterior showed very abnormal motor unit potentials. CONCLUSIONS: These results are consistent with generalised involvement of motor neurons in motor neuron pools in spinal segments in early stages of ALS progression. However, distally predominant fibrillations indicate susceptibility to ongoing denervation in reinnervated distal axons. Complex FPs of similar morphology to MUP analysis in the same early affected muscle suggests a proximal origin for these FPs at this phase. SIGNIFICANCE: Our observations emphasize the value of paraspinal muscle EMG in the electrophysiological diagnosis of ALS.  相似文献   

12.
Assessment of thoracic paraspinal muscles in the diagnosis of ALS   总被引:7,自引:0,他引:7  
The distribution of muscle involvement, assessed clinically and electromyographically, was analyzed prospectively in 55 consecutive amyotrophic lateral sclerosis (ALS) patients and in 54 patients with other predominantly motor syndromes, some of whom were referred with suspected ALS. In ALS patients, distal limb muscles and thoracic paraspinal muscles were affected most frequently, more so than proximal limb and cranial muscles. The incidence of bulbar symptoms in ALS was greater in women than in men. These patterns suggest selective vulnerability of specific neuronal populations. The vulnerability of truncal muscles, illustrated by thoracic paraspinal wasting or head and shoulder drooping, was a helpful differential sign in diagnosing ALS. Thoracic paraspinal electromyography was especially valuable in distinguishing ALS from other disorders, such as combined cervical and lumbar spondylotic amyotrophy or polymyositis, which may masquerade as ALS. The finding of denervation atrophy on biopsy of thoracic paraspinal muscles was diagnostic in difficult cases. Because the thoracic paraspinal muscles are frequently affected in ALS and spared in spondylotic amyotrophy, their assessment provides a practical strategy in differentiating ALS from other motor syndromes.  相似文献   

13.
Electromyography (EMG) could be useful in defining regional motor neuron vulnerability in ALS. We performed EMG in 36 sporadic ALS patients (9 with bulbar-onset and 27 with limb-onset symptoms). Active denervation was more frequent in limb than in corresponding paraspinal muscles, in the thoracic paraspinal, and in the bulbo-cervical muscles in patients with bulbar-onset symptoms. These results are consistent with a regional motor neuron vulnerability along with a nerve length-dependent liability.  相似文献   

14.
We report a 69-year-old man who developed paralytic poliomyelitis in childhood and then decades later suffered from fatal respiratory failure. Six months before this event, he had progressive weight loss and shortness of breath. He had severe muscular atrophy of the entire right leg as a sequela of the paralytic poliomyelitis. He showed mild weakness of the facial muscle and tongue, dysarthria, and severe muscle atrophy from the neck to proximal upper extremities and trunk, but no obvious pyramidal signs. Electromyogram revealed neurogenic changes in the right leg, and in the paraspinal, sternocleidomastoid, and lingual muscles. There was a slight increase in central motor conduction time from the motor cortex to the lumbar anterior horn. Pulmonary function showed restrictive ventilation dysfunction, which was the eventual cause of death. Some neuropathological features were suggestive of amyotrophic lateral sclerosis (ALS), namely Bunina bodies. In patients with a history of paralytic poliomyelitis who present after a long stable period with advanced fatal respiratory failure, one may consider not only respiratory impairment from post-polio syndrome but also the onset of ALS.  相似文献   

15.
Amyotrophic lateral sclerosis (ALS) is the most common adult motor neuron disorder and leads usually to death within two to five years after diagnosis. Clinically, ALS presents with fasciculations, progressive weakness, muscle atrophy, and spasticity. It is a clinical diagnosis, supported by electrodiagnostic and laboratory tests. Nerve conduction studies (NCS) and needle electromyography (EMG) are essential in the evaluation of suspected ALS. NCS are primarily used to exclude any potentially treatable motor neuropathy that may mimic ALS. Standard nerve conduction studies should include at least four sensory and four motor nerves in an arm and leg. At least three sites in three different nerves should be stimulated when searching for conduction blocks, which may distinguish motor neuropathy from ALS. Needle EMG is very valuable as it can demonstrate widespread involvement of muscles that are not clinically weak. Characteristic findings include widespread non-myotomal denervation (both acute and chronic), with fibrillations and fasciculations. Extensive needle examination should include at least two limbs (arm and leg; at least five muscles each), thoracic paraspinal and bulbar muscles.  相似文献   

16.
M Sakuta  T Nakanishi  Y Toyokura 《Neurology》1978,28(12):1289-1293
Electromyography (EMG) of anal sphincter muscles was different in patients with amyotrophic lateral sclerosis (ALS) and Shy-Drager syndome. In 30 patients with ALS, EMG of the external sphincter muscle was essentially normal, with no signs of denervation. In eight cases of Shy-Drager syndrome, however, motor unit potentials of the anal sphincter had highly polyphasic forms of long duration and high amplitude. In the Shy-Drager syndrome, there seems to be specific damage of lower motor neurons that innervate the external sphincter muscle of the anus.  相似文献   

17.
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