运动神经元病的临床及神经电生理分析

目的:探讨本地区运动神经元病(MND)患者的临床表现及神经电生理特点。方法:对入选的21例MND患者进行肌电图(EMG)及神经传导检测(NCS),分析其临床特征及神经电生理特点。结果:在21例患者中,运动神经传导检测异常率为55.2%,主要表现为M波波幅降低;感觉神经传导正常率为98.85%。静息时发现纤颤电位18例(85.71%),正锐波16例(76.19%),束颤电位6例(28.57%),运动单位电位时限延长18例(85.71%),平均波幅增高10例(47.62%),大力收缩时表现为单纯相9例(42.86%)。其中上下肢肌肉的异常率为71.08%,胸锁乳突肌的异常率为92.31%,胸椎旁肌的异常率为33.33%。结论:神经电生理检查对MND的诊断非常重要,其中EMG检测是MND诊断的重要手段。EMG呈广泛性的运动神经元损害是MND的特征性改变,束颤电位在诊断中有重要价值。胸锁乳突肌阳性率高,可作为检查延髓节段下运动神经元受累的首选肌肉。

CLINICAL AND ELECTRONEUROPHYSIOLOGICAL ANALYSIS IN 21 PATIENTS WITH MOTOR NEURON DISEASE

Objective： To investigate the clinical manifestations and electrophysiological characteristics of patients with motor neuron disease （ MND ） in local area. Method： The eleetromyogram （ EMG ） and nerve conduction velocity （ NCV ） were examined in 21 patients with MND, and analyzed the clinical and electrophysiological characteristics. Results： In 21 patients, the abnormal rate of motor nerve conduction velocity was 55.2%, mainly M wave amplitude decreased; the rate of normal sensory nerve conduction is 98.85%. Resting fibrillation potentials was 18 cases （ 85.71% ） , positive sharp wave was 16 cases （ 76.19% ） , fasciculation potentials was 6 cases （ 28.57% ） , prolonged duration of motor unit potentials was 18 cases （ 85.71% ） , average amplitude increased in 10 eases （47.62%） , in strong contraction, 9 cases （ 42.86% ） were simple phase. The abnormal rate of extremity muscles , sternocleidomastoid muscle and paravertehral muscles were separately 71.08%, 92.31% and 33.33%. Conclusion： Electrophysiological examination in the diagnosis of MND is very important, the EMG detection is an important means of the diagnosis of MND. EMG in a motor neuron damage universally is the characteristic of MND, the fasciculation potential is of great value in the diagnosis. The sternocleidomastoid muscle with high positive rate can be used as the preferred muscle examining lower motor neuron involved of medulla segment.