三叉神经-颈反射对运动神经元病球部损害的诊断价值

背景:运动神经元病的最早及好发部位为颈膨大,随病情发展,最早累及邻近的上部颈段及延髓区,三叉神经-颈反射受累较早。目的:建立三叉神经-颈反射的肌电检测方法,分析三叉神经-颈反射对运动神经元病球部损害的诊断价值。设计:病例-对照观察。单位:北京大学第三医院神经内科电生理检查室。对象:北京大学第三医院2002/2005就诊的运动神经元病患者主要为肌萎缩性侧索硬化症30例及健康志愿者70例。运动神经元病患者符合西班牙ElEscorial会议诊断标准。方法:受检测者取仰卧位,头部轻度抬高。使胸锁乳突肌轻度收缩。刺激一侧眶下神经,于双侧胸锁乳突肌记录峰潜伏期和波幅。所用检测仪器为Keypoint肌电图仪。所用电极均为Ag/Agcl表面电极。主要观察指标:正/负波潜伏期(P20/N30),波幅比率的平方根,即A值。结果:刺激对照者一侧的眶下神经,可于双侧胸锁乳突肌引出正/负波。运动神经元病组7例正常(23.3%),8例未引出(26.7%),11例潜伏期延长(36.7%),4例双侧反射超常不对称(13.3%)。运动神经元病组三叉神经-颈反射正波/负波的峰潜伏期(P20/N30)明显高于正常对照组,差异有显著性。波幅比的平方根(峰值与刺激前波幅比值的平方根即A值)明显低于正常对照组,差异有显著性。结论:三叉神经-颈反射能够可靠测定,可作为颈-球区病变的一种辅助检查手段,有助于运动神经元病的早期诊断。

Diagnostic value of trigemino-cervical reflex on lesion of bulbar region of motor neuron disease

BACKGROUND: Cervical intumescence is the earliest and easy attacking part of motor neuron disease (MND). With the development of patients'condition, cervical part and medulla oblongata region were involved early,and the trigemino-cervical reflex (TCR) was involved earliest.OBJECTIVE: To establish electromyography of TCR and analyze the value in the diagnosis of MND of the TCR.DESIGN: Case-control study.SETTING: Room of Electrophysiologic Study, Department of Neurology,Third Hospital, Peking University.PARTICIPANTS: Thirty MND patients,mainly amyotrophic lateral sclerosis (ALS) patients and 70 healthy volunteers who were examined at Third Hospital, Peking University from 2002 to 2005. MND patients accorded with the diagnostic standard of Spain El Escorial conference.METHODS: The subjects held the heads slightly raised when lying supine to make the sternocleidomastoid muscles contracted slightly. Electrical stimulation was applied to the infraorbital nerves and latency and amplitude of wave were recorded from the bilateral sternocleidomastoid muscles. The detecting instrument was Keypoint electromyography (EMG).The surface EMG activity was recorded via Ag/AgCl.MAIN OUTCOME MEASURES: Latency of positive wave/ negative wave (P20/N30); square root of the ratio of the amplitudes, that is, value A.RESULTS: Stimulation of the infraorbital nerve on one side of controlled people produced bilateral positive and negative waves. In the MND group,7 patients showed normal (23.3%), 8 patients showed absence of wave (26.7%), 11 patients were delayed in latency (36.7%), and extreme asymmetry of reflection of the two sides was found in 4 patients (13.3%).In the MND group, the latency of positive and negative waves of TCR (P20/N30) was markedly longer than that in the normal control group,and the difference was significant. Square root of the ratio between the amplitudes after and before stimulation (square root of the ratio between peak to peak value and amplitude of wave before stimulation, that was,value A) was lower remarkably than that in the normal control group, and the difference was significant.CONCLUSION: The TCR can be reliably measured. It may help examine the cervical-bulbar lesion and diagnosing motor neuron disease in an early period.